Infection最新文献

Acute respiratory tract infections (ARTIs) are among the most common reasons for antibiotic prescriptions globally, despite the majority being viral and self-limiting. Because clinical signs alone are often insufficient, there is a clear need for rapid diagnostic methods to support evidence-based prescribing. We assessed the effectiveness of point-of-care C-reactive protein (POCT-CRP) testing devices for distinguishing between bacterial and viral ARTIs. Our search of five databases produced 413 studies, of which 29 met criteria, and six were included in the meta-analysis. The devices with adequate performance data were QuikRead CRP, NycoCard Reader II, and FebriDx®. Overall pooled sensitivity 70% (95% CI 52-83%) and specificity 86% (95% CI 80-91%). The FebriDx showed a pooled sensitivity of 84% (95% CI 76-90%) and specificity of 87% (95% CI 82-91%). The QuikRead showed a pooled sensitivity of 35% (95% CI 30-40%) and specificity of 86% (95% CI 82-89%). The NycoCard Reader II showed a pooled sensitivity of 54% (95% CI 21-83%) and specificity of 86% (95% CI 59-96%). Although POCT-CRP testing is useful in distinguishing between bacterial and viral ARTIs and is critical for antibiotic prescription, further evidence, including cost-effectiveness analysis, is needed to determine whether the implementation of POCT-CRP improves value or merely raises healthcare expenses.

Objectives: Complicated urinary tract infections (cUTIs) are ubiquitous, associated with healthcare resources, and demand effective antibiotic treatment to prevent clinical failure and relapse. Evidence on health economic implications of treatment options remains limited. Recent studies have shown that cefepime/enmetazobactam was superior to piperacillin/tazobactam regarding the combined endpoints clinical cure and microbiological eradication, the latter being closely linked to reduced relapse rates. Therefore, we perform a health economic evaluation of cefepime/enmetazobactam vs. piperacillin/tazobactam for cUTI from a German payer perspective.

Methods: To assess monetary impacts of both therapies, we conducted a semi-structured literature review for costs of (relapsed) cUTI. Subsequently, we adjusted international costs to the German healthcare system using European price levels of the Organisation for Economic Cooperation and Development. These built the basis of a comparative health economic analysis using a decision tree incorporating outcome probabilities and relapse rates for both antibiotics. Lastly, we validated the analysis using publicly available remuneration data from German hospitals.

Results: Literature revealed international costs of €5,394 and €6,675 per patient without and with clinical relapse, converting to €5,137.14 and €6,357.14 in Germany, respectively. Considering the probability of occurrence of clinical cure, microbiological persistence, and relapse rates, average treatment costs per patient for cefepime/enmetazobactam amount to €5,332.12 compared to €5,414.83 for piperacillin/tazobactam.

Conclusion: The analysis shows that a higher probability of relapse after antibiotic therapy might be associated with an increase in treatment costs within the German healthcare system. Although per-patient cost differences between cefepime/enmetazobactam and piperacillin/tazobactam are moderate, their cumulative impact at the population level could be substantial, emphasizing the broader health-economic relevance of treatment choice for cUTI.

Background: Typhoid is a serious infectious disease that is highly prevalent in low and middle income countries (LMICs) and causes severe morbidity and mortality. Typhoid conjugate vaccines (TCVs) have been developed to prevent and control typhoid infection, however, overall and pooled evidence on vaccine efficacy, immunogenicity and safety profiles in the pediatric population is limited.

Methodology: We conducted a systematic review and meta-analysis on August 12, 2025 using randomized controlled trials (RCTs) that assessed the vaccine efficacy of TCVs in the pediatric population. Included studies compared TCVs with a well-defined control groups i.e. either placebo, MenA or SA 14-14-2 JE vaccine. The vaccine efficacy data were pooled and estimates were generated via random effects model. Data on immunogenicity and safety were also extracted.

Results: A total of five RCTs, involving over 120,000 participants from Asia and Africa were included. Pooled vaccine efficacy of TCVs was 83% (95% CI 78-87%) with low heterogeneity (I² = 28%). Age-stratified analysis revealed consistent results across age groups, though estimates in children < 2 years were not statistically significant. Immunogenicity outcomes demonstrated marked rises in Vi-IgG titres within 28 days of vaccination which progressively waned. The safety outcomes were favourable, with most adverse events being mild and self-limiting.

Conclusion: We conclude that TCVs are highly efficacious, immunogenic and safe among children, supporting their implementation in national immunization schedules. Further studies are needed to determine the duration of protection and the need for booster doses.

Purpose: Novel β-lactam/β-lactamase inhibitor combinations (BL/BLICs) such as ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MEM/VAB), imipenem/relebactam (IMP/REL) and aztreonam/avibactam (ATM/AVI) have expanded therapeutic choices against KPC-producing K. pneumoniae. However, emerging resistance threatens their long-term efficacy. We investigated the prevalence, genomic mechanisms, and clinical correlates of resistance to these agents among KPC-producing K. pneumoniae bloodstream isolates.

Methods: Consecutive KPC-producing K. pneumoniae bloodstream isolates collected between 2021 and 2024 at a tertiary university hospital were tested for susceptibility to novel BL/BLICs and comparators. Whole-genome sequencing (WGS) was performed on isolates resistant to any BL/BLIC to characterise genetic backgrounds. Clinical data from corresponding patients were analysed to explore risk factors and outcomes.

Results: Among 178 K. pneumoniae isolates, ATM/AVI, IMP/REL and MEM/VAB retained excellent in vitro activity (≥ 96% susceptible), while 11% were resistant to CAZ/AVI. One hundred fifty-four (86.5%) were susceptible to all BL/BLICs, whereas 24 (13.5%) displayed resistance to at least one agent, most commonly CAZ/AVI. WGS revealed a genetically diverse population mainly comprising high-risk clones ST512 and ST101. Resistance was driven by KPC variants (KPC-31, KPC-167, KPC-93, KPC-49, KPC-14, KPC-121, KPC-33) and porin disruptions (OmpK36 insertions, OmpK35 loss). Most patients (91%) had prior colonisation and recent β-lactam exposure; median time to resistance emergence was 47 days. The 28-day mortality among patients with BL/BLIC-resistant infections was 21.7%.

Conclusion: Resistance to novel BL/BLICs among KPC-producing K. pneumoniae is emerging in Italian hospitals, largely mediated by bla_KPC variants and porin defects under selective antibiotic pressure. While ATM/AVI, MEM/VAB and IMP/REL remain highly active, resistance to CAZ/AVI is increasingly frequent. Continuous genomic surveillance and optimised antimicrobial stewardship are essential to preserve the efficacy of these last-line agents.

A Siberian woman in her forties presented to a public hospital in northeastern Germany with chronic back pain and a paravertebral mass, initially misdiagnosed as spinal tuberculosis. Repeated biopsies and metagenomic next-generation sequencing (mNGS) ultimately confirmed vertebral alveolar echinococcosis. Haplotype analysis revealed a novel Asian-cluster variant, supporting the presumed origin of infection.

Purpose: To quantify virologic failure (VF), identify predictors, characterize resistance patterns at failure, and evaluate time to resuppression in the RESINA cohort.

Methods: ART-naïve adults initiating ART in 2001-2024 were followed. VF was defined as at least one HIV-1 RNA > 200 copies/mL after suppression or ≥ 0.5-log₁₀ rebound. Participants were grouped by treatment era (2001-2007, 2008-2013, ≥ 2014), reflecting availability of drug classes. Genotypes at baseline and VF were interpreted using the HIV-GRADE algorithm. Predictors of VF were assessed with logistic regression; time to resuppression (< 50 copies/mL) after first VF with Cox models and Kaplan-Meier plots.

Results: Among 5136 participants, 139 (2.7%) had VF; rates declined across eras (4.7%, 2.6%, 1.7%). Independent predictors were injection-drug use (OR 1.74), CD4 < 200/µL (OR 2.32), and ART start in 2001-2007 (OR 1.95); MSM acquisition was protective (OR 0.32). At failure, 36 patients showed resistance, often multiclass (61%); INSTI resistance was rare (n = 5). After first VF, 122/139 cases resuppressed (median 147 days). Male sex predicted faster resuppression (HR 1.81); higher failure VL trended to slower resuppression (HR 0.84 per log₁₀). INSTI-based switches consistently achieved resuppression in descriptive analyses and were not associated with multiclass resistance.

Conclusion: VF was uncommon and declined over time, reflecting improved regimen potency and tolerability. Failures were associated with late presentation and IDU, consistent with adherence barriers. Resistance often involved multiple classes, while INSTI resistance remained infrequent. Early, genotype-guided optimization, preferably to INSTI-based therapy, combined with targeted adherence support may improve outcomes.

Aims: Patients with HBV and HBV/HDV infection were compared in terms of clinical outcomes after liver transplantation in a long-term follow-up.

Methods: In a multicenter retrospective study, the patients, who had received liver transplants for HBV chronic liver disease, were enrolled in a long-term follow-up (1-20 years). The primary outcome was overall survival, the secondary outcome occurrence of clinical events.

Results: A total of 257 patients were enrolled, 95 with HBV (HBV group) and 162 with HBV/HDV (HBV/HDV group) infection. Overall, 31 patients died in the follow-up, most frequently due to extrahepatic events. Overall mortality was similar between the two groups (15.8% in HBV vs 9.9% in HBV/HDV group), while deaths from hepatic events were more frequent in the first group (7.4 vs. 1.2%, p = 0.014). In multivariable logistic regression analysis only a history of chronic kidney disease (CKD) at the time of transplantation emerged as independent factor associated with death (OR 7.027, 95% CI 2.068-23.876; p = 0.002). Overall, 84 patients experienced at least one clinical event, mainly onset of renal failure (57 cases), cancer (32) and hepatic clinical (19). Compared with HBV/HDV group, clinical events occurred more frequently in HBV group (44.2 vs. 25.9%; p = 0.003), both hepatic and extrahepatic (11.6 vs. 4.9%, p = 0.050; 35.8 vs. 23.5%, p = 0.034, respectively). In multivariable logistic regression analysis, HBV group (OR 2.243, 95% CI 1.172-4.293; p = 0.015) and CKD at the time of transplantation were associated to the occurrence of clinical events (OR 8.890, 95% CI 2.373-33.306; p = 0.001).

Conclusions: In this long-term follow-up study, HDV infection was not associated to a worsen post-transplant outcomes, while chronic kidney disease at transplantation emerged as the strongest predictor of mortality and clinical events.

Purpose: To evaluate a Blood Born Virus (BBV) infection screening program in an emergency department (ED) located in an urban setting with an intermediate prevalence of undiagnosed BBV infections.

Methods: The program in the ED of the St. Joseph Hospital, Berlin, Germany, was active from June 2021 through April 2024. Patients aged 18-68 undergoing routine blood sampling were eligible for opt-in screening. We analyzed testing uptake, temporal trends, positivity rates, and linkage to care.

Results: A total of 23,118 cases were eligible for testing. Screening was offered to 2670 cases (11.5%). 2440 (91.4%) consented of whom 2406 were tested. Testing volumes remained below 11% of the eligible population. Among 2406 cases, 78 (3.2%) individuals were found to have at least one BBV infection. HIV infection was detected in 36 (1.5%) individuals. 12 individuals (0.5%) had previously undiagnosed HIV infection (median [range] CD4 count: 213/µL [66-794]). Linkage to care was successful in 50.0%. HBV was found in 16 (0.7%) individuals, with 6 (0.2%) previously undiagnosed individuals; linkage to care was achieved in 33.3%. HCV was confirmed in 38 (1.6%) individuals, including 13 (0.5%) previously undiagnosed individuals; linkage to care was achieved in 15.4%. Homelessness, substance use, and lack of health insurance coverage were key barriers to successful linkage.

Conclusions: Universal BBV testing in an urban ED proved effective in identifying previously undiagnosed infections. However, due to its opt-in design, the program operated below its potential capacity. Linkage to care was often unsuccessful, largely due to structural barriers.

Background: Ventilator-associated pneumonia (VAP) affects 30-50% of mechanically ventilated patients with acute brain injury (ABI), exceeding general ICU rates (10-20%) due to aspiration risks and immunosuppression, prolonging ICU stays and morbidity. Although short-course antibiotic prophylaxis (AP; e.g., ceftriaxone) targets early VAP, efficacy in ABI remains debated amid mixed evidence, resistance concerns, and non-endorsement by IDSA/ATS guidelines.

Methods: We searched PubMed, Cochrane Library, and Web of Science (inception to October 2024) for RCTs and non-RCTs on systemic AP (short-course beta-lactams) for VAP prevention in ABI (TBI, SAH, stroke, post-arrest coma) requiring ventilation ≥ 48 h.

Primary outcomes: early-onset VAP (≤ 96 h), late-onset VAP (> 96 h), overall VAP, ICU mortality. Secondaries: mechanical ventilation duration, ICU/hospital length of stay (LOS), time to first VAP. Random-effects meta-analysis; heterogeneity via I²; risk of bias (RoB 2.0/ROBINS-I).

Results: Ten studies (5 RCTs [n = 586], 5 non-RCTs [n = 1,087]; total n = 1,673) were included. AP reduced overall VAP (RR = 0.65, 95% CI: 0.48-0.90, P < 0.001; I² = 75.9%) and early-onset VAP (RR = 0.41, 95% CI: 0.33-0.52, P < 0.001; I² = 0%; events: 88/754 AP vs. 240/832 control). No effect on late-onset VAP (RR = 1.13, 95% CI: 0.72-1.78, P = 0.07; I² = 64.8%) or ICU mortality (RR = 0.91, 95% CI: 0.76-1.08, P = 0.27; I² = 0%). Secondaries: Reduced ICU LOS (MD = - 2.05 days, 95% CI: - 3.73 to - 0.37, P = 0.01; I² = 46%) and hospital LOS (MD = - 5.02 days, 95% CI: - 9.20 to - 0.85, P = 0.02; I² = 70.8%); no difference in ventilation duration (MD = - 1.36 days, 95% CI: - 2.91 to 0.19, P = 0.09) or time to VAP (MD = 1.04 days, 95% CI: - 0.87 to 2.95, P = 0.29). RCTs showed low-moderate bias; non-RCTs moderate-serious (confounding).

Conclusion: Short-course AP reduces early/overall VAP and LOS in ABI without impacting late VAP or mortality, supporting targeted use in high-risk cases (e.g., GCS < 8) per stewardship principles. However, heterogeneity, resistance gaps, and guideline caution warrant larger RCTs with non-ABI comparatives to mitigate selection bias and confirm specificity.