GERMS最新文献

Introduction: Antimicrobial resistance (AMR) is among the greatest threats to global healthcare. The World Health Organization (WHO) estimates that by 2050 ten million deaths will be attributed to AMR annually. In response, the WHO has implemented antibiotic stewardship programs which focus on optimizing antibiotic use and raise, amongst others, the issue of the preferred method of intravenous antibiotic administration. Various studies have attempted to answer this question with conflicting results.

Review: This review examined several studies assessing extended/continuous infusion compared to intermittent infusion of three beta-lactams: piperacillin-tazobactam, cefepime, and meropenem. The findings and conclusions of each study were summarized and compared to one another to provide a general overview of the current evidence.

Conclusions: We conclude that continuous/extended infusion showed a greater clinical benefit in highly critical cases, namely sepsis and febrile neutropenia, compared to intermittent infusion. Additionally, in cases where a pathogen was identified, continuous/extended infusion showed superiority. Nonetheless, high-quality studies with larger samples are needed to demonstrate the difference between these two modes of infusion in a way that would better inform guidelines and policies, aiding in the fight against AMR.

Introduction: Non-tuberculous mycobacterial (NTM) disease is an underdiagnosed condition that usually manifests as pulmonary infection. Extrapulmonary manifestations are rare and can be easily overlooked or misdiagnosed as tuberculosis or malignancy.

Case report: Herein, we present four cases of extrapulmonary NTM disease in immunocompetent patients. Patient 1 had bone marrow suppression secondary to NTM infection. Patient 2 was diagnosed with Mycobacterium abscessus meningitis, brain abscess and arachnoiditis. Patient 3 had pleural effusion, and fluid cytology revealed Mycobacterium fortuitum. Patient 4 was a 30-year-old male with cervical lymphadenopathy due to NTM. Two patients (case 2 and case 4) were initially diagnosed with tuberculosis but showed no response to anti-tubercular drugs. One patient (case 3) died within seven days of initiation of treatment. The rest of the patients (cases 1 and 2) showed clinical improvement with antimicrobial therapy for NTM species. Case 4 responded well to surgical excision without the need for antibiotics.

Conclusions: Clinicians should be vigilant about the possibility of NTM disease. Early diagnosis is vital to prevent poor outcomes, particularly in the setting of disseminated infections.

Introduction: To better understand the factors which influence the spread of monkeypox (mpox) infection, the patients that tested positive for mpox virus by real-time PCR in one of the main infectious diseases centers in Bucharest were analyzed in this study, amounting to one third of the confirmed cases in Romania.

Methods: Clinical data and laboratory tests were used to build the patient profiles. In the case of positive mpox results, next-generation sequencing of the viral genome was also performed to better comprehend the epidemiology of the infections and the evolutionary path of this virus.

Results: Among 47 patients with clinical suspicion of infection, 18 cases tested positive for mpox by real-time PCR (RT-PCR). Patients were mainly men who have sex with men (MSM), often coinfected with HIV-1 (half of the cases) and presenting with other sexually transmitted infections (STIs). Phylogenetic analysis was performed on 20 samples (15 patients) and indicated that mpox cases in Romania were the result of multiple importing events followed by local spread. A few sequences from European countries (Germany, Italy, France) and USA were found to be closely related to the Romanian sequences. Intra-host evolution was observed and documented in one patient with HIV-1 infection with uncontrolled viremia, showing slightly different mutation profiles in two body compartments.

Conclusions: This study showed that the mpox cases from Romania presented similar clinical, epidemiological and mutational features with those reported by other European countries.

Although Pseudomonas aeruginosa (PA) hasn't been considered as a recognized agent of diarrhea, this organism is able to cause community-acquired diarrhea accompanied by fever and sepsis, as well as antibiotic-associated diarrhea (AAD). Antibiotic resistance rates in stool isolates of PA are generally lower compared to other infection sites, but in patients with AAD, there are reports of resistance to most of the antibiotic classes in these isolates. PA, along with other opportunistic pathogens like Clostridioides difficile, can cause AAD. Therefore, it is suggested to examine stool samples of patients with predisposing factors such as intensive care unit (ICU) admission and long-time antibiotic treatment, especially with cephalosporins, for both C. difficile and PA.

Introduction: Streptococcus pneumoniae is one of the associated bacteria that can cause the rare but high mortality hematological pathology known as purpura fulminans (PF) in both adults and children. Pediatric patients with PF can progress quickly to sepsis and multiorgan failure, especially immunocompromised individuals and young children. Due to the thrombotic blockage of blood arteries in PF, there is diffuse intravascular thrombosis and hemorrhagic infarction of the skin, which evolves from ecchymosis to skin necrosis, risk of limb sequelae, sepsis and fatality.

Case report: We present a case of a previously healthy 1-year and 9-months old female who was admitted to the Intensive Care Unit of the National Institute of Infectious Diseases "Prof. Dr. Matei Balş"- Bucharest, Romania. On physical examination, she was febrile, hypotensive, tachycardic, and had erythematous patches on her left upper limb and trunk. Initial blood work was significant for creatinine 4.45 mg/dL, aspartate aminotransferase 112 U/L, alanine aminotransferase 130 U/L and fibrinogen 596 mg/dL. Hematological workup showed a white blood cells count of 34 × 10⁹/L, hemoglobin 9.7 g/dL, platelets 23000/L, D-dimers 89000 μg/L, and elevated PT and aPTT. Broad-spectrum antibiotics vancomycin and ceftriaxone were administrated. A lumbar puncture was performed for cerebrospinal fluid (CSF) analysis and culture grew Streptococcus pneumoniae serotype 1A. She required peritoneal dialysis due to acute kidney injury (AKI) and surgeries for affected skin areas. After multiple organ system failures, our patient evolved rapidly to irreversible tissue necrosis and death.

Conclusions: We aim to report a rare case of PF associated with pneumococcal meningoencephalitis in an immunocompetent child, to better appreciate the risk of fatal evolution when managing this disease in children.

Introduction: Infective endocarditis (IE) is a disease that may frequently lead to significant morbidity and is associated with high mortality rates. Even though IE is classically caused by Gram-positive bacteria, Gram-negative bacteria may seldom cause IE. Antimicrobial resistance (AMR) may pose significant problems in treating IE, especially for carbapenem-resistant pathogens. This study aimed to review all cases of IE by carbapenem-resistant Gram-negative bacteria in a systematic way and present information on epidemiology, clinical findings, treatment, and outcomes.

Methods: A systematic review of PubMed, Cochrane Library, and Scopus (all published studies up to 6 August 2023) for published studies providing information on epidemiology, clinical findings, treatment, and outcomes of IE by carbapenem-resistant Gram-negative bacteria was performed.

Results: A total of 24 studies containing data from 26 patients were included. Among all patients, 53.9% were male, and the median age was 66 years. Among all patients, 38.5% had a history of a prosthetic valve. The most commonly affected valve was the aortic, followed by the mitral valve. Fever, sepsis, emboli, and shock were the most frequent clinical findings. The most commonly isolated pathogens were Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. Aminoglycosides, colistin, cephalosporins, and carbapenems were the most commonly used antimicrobials. Surgery was performed in 53.8% of patients. Mortality was 38.5%.

Conclusions: The development of infection control measures and antimicrobial stewardship interventions is needed to reduce the spread of AMR and the likelihood of this fatal infection.

Introduction: Neonatal candidemia is a life-threatening event in babies requiring ICU admission. Prompt diagnosis and appropriate treatment reduce mortality and morbidity. Worldwide, there is an emergence of drug-resistant rare Candida species causing neonatal sepsis that necessitates antifungal susceptibility testing in each case.

Methods: We did a prospective study to isolate Candida species causing neonatal sepsis and to determine the predisposing risk factors and time to positivity for flagged positivity. We also determined fluconazole, itraconazole and amphotericin B minimum inhibitory concentration (MIC) against isolated Candida species by broth microdilution method using CLSI M27-A3 guidelines.

Results: A total of 107 neonatal candidemia events were noted. Prematurity was the most common predisposing risk factor. Most isolates were non-albicans Candida. Candida utilis, C. pelliculosa, C. tropicalis and K. ohmeri were the predominant fungi causing neonatal candidemia. A varied antifungal MIC against isolated Candida species was noted. However, 90% of the isolated Candida strains had <8 µg/mL fluconazole MIC. Moreover, ≥8 and ≥2 µg/mL MIC for fluconazole and amphotericin B respectively were also noted.

Conclusions: Rare Candida species having varied fluconazole and amphotericin B MIC cause neonatal candidemia. Therefore, culture isolation and antifungal susceptibility testing should be done in each case of neonatal candidemia.

Introduction: Assessment of the denture plaque can provide a valuable report regarding the oral health of geriatric patients and the oral hygiene habits in this population group. Focusing on the current research gap on this topic in Romania, our research aims to highlight the microbial plaque on the different surfaces and types of removable poly(methyl methacrylate) (PMMA) prostheses to qualitatively evaluate the microbial species, and to assess the combined effect of mechanical and chemical cleaning of dentures on the prosthetic microbiome.

Methods: The prosthetic plaque from four denture wearers was identified with a UV activated fluorescent revealer and digitally photographed. Swab samples according to a certain hygiene protocol were cultured on three different growth media such as blood agar (BA), bromothymol blue lactose agar (AABTL) and Sabouraud dextrose agar (SDA).

Results: Denture plaque was variably distributed on the surface of the prostheses. Regardless of the denture type (conventional complete denture, tooth or implant supported overdenture, removable partial denture) the microbial plaque was identified at the retentive areas, especially at interdental spaces. The main plaque deposition areas were the vestibular incline of the labial flange of the maxillary denture and the lingual incline of the posterior lingual flange of the mandibular denture. The prosthetic microbiome consisted of pathogenic Gram-positive aerobes (Streptococcus spp. and coagulase-negative Staphylococcus spp.), Gram-positive anaerobes (Actinomyces spp. and Klebsiella spp.) as well as subspecies of fungi of the genus Candida.

Conclusions: Despite its poor variety, the denture microbiome in the investigated cases hosts colonies with high pathogenic potential. Some areas of the prostheses are more likely to accumulate dental plaque. Dentists should insist through more regular checks of the patients and their caregivers on ensuring the biocontrol of the dentures, especially in frail geriatric patients exposed to greater risks related to general health.

Introduction: Crimean-Congo hemorrhagic fever (CCHF) is the widest emerging severe viral tick-borne disease affecting humans. Crimean-Congo haemorrhagic fever virus (CCHFV) circulates by routine enzootic tick-vertebrate hosts-tick transmission cycles. We aimed to evaluate the molecular prevalence of CCHFV in ticks on a global scale.

Methods: A systematic procedure was used to perform this review and meta-analysis using PubMed, Google Scholar, and Web of Science databases from 1 January 2000 through 12 April 2023. Of the 2310 papers identified, 43 articles met the inclusion criteria for this study.

Results: The overall prevalence of CCHFV was 4.0% (95%CI: 2.7-6.0%) in ticks on the global scale, with heterogeneity (I²=96.387; p=0.0001). The genus Hyalomma was shown as the most frequent tick infected with CCHFV 5.4% (95%CI: 3.3-8.7%). We found that the pooled prevalence of CCHFV was higher in Hyalomma aegyptium 27.6% (95%CI: 22.7-33.2%). The pooled prevalence was higher in Asia 5.1% (95%CI: 3.3-7.7%), and Spain 21.0% (95%CI: 3.4-66.9). The locations with annual rainfall of 401-1000 mm 6.1% (95%CI: 2.6-13.5%) and latitude of 31-40° 6.0% (95%CI: 4.1-8.9%) were associated with the greatest pooled prevalence of CCHFV in ticks.

Conclusions: Surveillance of CCHFV in ticks will give a better comprehension for the future implementation of public health interventions. The question of whether Hyalomma aegyptium is a plausible or certain vector should be the subject of further investigation.

Introduction: We aimed to conduct a systematic review of the epidemiology of Escherichia coli in bloodstream infections (BSI) of hematopoietic stem cell transplantation patients.

Methods: For a comprehensive search of studies that reported the prevalence of E. coli and antibiotic resistance in bloodstream infections from 2000 to January 1, 2024, databases such as PubMed, EMBASE, Google Scholar, Scopus, and Web of Science were searched. The main keywords used were: Escherichia coli, epidemiology, bloodstream infection, microbial resistance, antibiotic resistance, hematopoietic malignancy, hematopoietic stem cell transplantation. After applying eligibility criteria, and quality assessment of studies, data analysis was done by comprehensive meta-analysis (CMA) software.

Results: The prevalence of bacterial bloodstream infections amongst different studies varied between 8-51%. Also, bloodstream infections caused by E. coli varied between 2.5-57%. Prevalence of extended-spectrum β-lactamases (ESBLs) of Escherichia coli in bloodstream infections varied between 15-80%. As well, the mortality rate caused by Escherichia coli strains in bloodstream infection varied between 6.7-27.3%. Resistance to ciprofloxacin, cefepime, third- and fourth-generation cephalosporins, was reported to be the highest (prevalence of 100%), and the lowest was against amikacin, with a prevalence between 13-38%.

Conclusions: The high prevalence of Escherichia coli-related BSI, and subsequent mortality, especially by multidrug resistance and ESBL strains, in patients undergoing hematopoietic stem cell transplantation, requires essential measures to prevent the spread of microbial resistance.