Pub Date : 2025-08-14DOI: 10.1016/j.jinf.2025.106593
Eun Woo Lee, Seonghui Cho, Hyun Mi Kang, Sheikh Taslim Ali, Sukhyun Ryu
{"title":"Post-pandemic shift in scarlet fever incidence towards older children in South Korea and Taiwan","authors":"Eun Woo Lee, Seonghui Cho, Hyun Mi Kang, Sheikh Taslim Ali, Sukhyun Ryu","doi":"10.1016/j.jinf.2025.106593","DOIUrl":"10.1016/j.jinf.2025.106593","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106593"},"PeriodicalIF":11.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-14DOI: 10.1016/j.jinf.2025.106592
Ting-Wei Kao , Sheng-Yuan Ruan , Yu-Tsung Huang , Wang-Da Liu , Chia-Jung Liu , You-Yi Chen , Po-Ren Hsueh , Chong-Jen Yu , Jung-Yien Chien , TACTICS (TAiwan CollaboraTive Intensive Care Study) Group
Objectives
As Pneumocystis pneumonia (PCP) increasingly develops in non-HIV patients without established immunocompromising factors, the study examined the evolving predisposing factors and at-risk medications.
Methods
This multicenter retrospective study included non-HIV PCP at seven clinical centers from 2016–2023. Patients were categorized by exposed medications and underlying predisposing diseases. Demographic characteristics, disease severity, treatment approaches, and outcomes were reported.
Results
470 non-HIV PCP were identified, and 420 probable cases were included for analysis. The proportion of PCP without established high-risk medications increased from 47% in 2016 to 61% by 2023. 209 (49.8%) received established high-risk medications, 106 (25.2%) with suspected at-risk medications, and 155 (36.9%) with no at-risk medications. Subjects with established high-risk medications were more likely to have hematological malignancies (50.2%, P<0.001). Those with suspected at-risk medications had higher rates of solid cancers (63.2%, P<0.001) and transplantation (24.5%, P<0.001). Overall mortality rates were 43.8% at 60-day, with comparable mortality across medication groups (log-rank P=0.08) but significant differences by disease category (log-rank P<0.001), with solid cancers exhibiting the worst outcome (58.0%).
Conclusions
The epidemiology of non-HIV PCP is evolving beyond traditional risk categories. Both emerging high-risk medications and predisposing comorbidities might require further investigation and addressed in prophylaxis guidelines.
{"title":"Evolving risk factors and predisposing conditions of Pneumocystis pneumonia in non-HIV patients: A seven-year multicenter study","authors":"Ting-Wei Kao , Sheng-Yuan Ruan , Yu-Tsung Huang , Wang-Da Liu , Chia-Jung Liu , You-Yi Chen , Po-Ren Hsueh , Chong-Jen Yu , Jung-Yien Chien , TACTICS (TAiwan CollaboraTive Intensive Care Study) Group","doi":"10.1016/j.jinf.2025.106592","DOIUrl":"10.1016/j.jinf.2025.106592","url":null,"abstract":"<div><h3>Objectives</h3><div>As <em>Pneumocystis</em> pneumonia (PCP) increasingly develops in non-HIV patients without established immunocompromising factors, the study examined the evolving predisposing factors and at-risk medications.</div></div><div><h3>Methods</h3><div>This multicenter retrospective study included non-HIV PCP at seven clinical centers from 2016–2023. Patients were categorized by exposed medications and underlying predisposing diseases. Demographic characteristics, disease severity, treatment approaches, and outcomes were reported.</div></div><div><h3>Results</h3><div>470 non-HIV PCP were identified, and 420 probable cases were included for analysis. The proportion of PCP without established high-risk medications increased from 47% in 2016 to 61% by 2023. 209 (49.8%) received established high-risk medications, 106 (25.2%) with suspected at-risk medications, and 155 (36.9%) with no at-risk medications. Subjects with established high-risk medications were more likely to have hematological malignancies (50.2%, <em>P</em><0.001). Those with suspected at-risk medications had higher rates of solid cancers (63.2%, <em>P</em><0.001) and transplantation (24.5%, <em>P</em><0.001). Overall mortality rates were 43.8% at 60-day, with comparable mortality across medication groups (log-rank <em>P</em>=0.08) but significant differences by disease category (log-rank <em>P</em><0.001), with solid cancers exhibiting the worst outcome (58.0%).</div></div><div><h3>Conclusions</h3><div>The epidemiology of non-HIV PCP is evolving beyond traditional risk categories. Both emerging high-risk medications and predisposing comorbidities might require further investigation and addressed in prophylaxis guidelines.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106592"},"PeriodicalIF":11.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-14DOI: 10.1016/j.jinf.2025.106589
Beatriz Dietl , Desirée Henares , Eva Cuchí , Miguel Blanco-Fuertes , Mireia Rajadell , Pedro Brotons , Aleix Lluansí , Lucía Boix-Palop , Esther Calbo , Carmen Muñoz-Almagro
Introduction
Lower respiratory infections (LRIs) rank among the leading causes of mortality worldwide. Many microorganisms responsible for LRIs, such as Streptococcus pneumoniae and respiratory viruses, exhibit variable behavior: they can exist as asymptomatic colonizers, cause mild disease, or lead to severe invasive infections. Various factors influence the clinical manifestations and severity of LRIs. Emerging evidence suggests that the nasopharyngeal microbiota (NM) plays a crucial role in these processes. This study aims to identify microbiota profiles associated with respiratory health and disease.
Methods
A prospective case-control study was conducted between February 2021 and September 2022. NM samples were collected from adults with pneumococcal pneumonia (PPn), COVID-19 pneumonia (CPn), and healthy controls (HC). Samples were analyzed using 16S rRNA gene sequencing. Participants were matched for age and gender. Random Forest modeling was applied to microbiota data to distinguish pneumococcal pneumonia from viral community-acquired pneumonia (CAP).
Results
A total of 129 samples were analyzed, including 38 from PPn cases, 54 from CPn cases, and 37 from HC. While age and sex distributions were similar across groups, comorbidities, immunosuppression, and prior infections were more common among cases. Alpha-diversity analysis revealed no significant differences in species richness or evenness across groups. However, beta-diversity analysis showed distinct microbial compositions: Corynebacterium was predominant in CPn patients, whereas Streptococcus was more abundant in PPn patients compared to HC.
Conclusions
The nasopharyngeal microbiota differs significantly in adults with pneumococcal pneumonia compared to those with COVID-19 pneumonia and healthy controls. These associations highlight the potential relevance of specific bacterial genera in disease susceptibility. A deeper understanding of healthy nasopharyngeal microbiota profiles could contribute to future strategies for the prevention and management of respiratory infections.
{"title":"Differential nasopharyngeal microbiota patterns: A comparative study of pneumococcal pneumonia, COVID-19, and healthy adults","authors":"Beatriz Dietl , Desirée Henares , Eva Cuchí , Miguel Blanco-Fuertes , Mireia Rajadell , Pedro Brotons , Aleix Lluansí , Lucía Boix-Palop , Esther Calbo , Carmen Muñoz-Almagro","doi":"10.1016/j.jinf.2025.106589","DOIUrl":"10.1016/j.jinf.2025.106589","url":null,"abstract":"<div><h3>Introduction</h3><div>Lower respiratory infections (LRIs) rank among the leading causes of mortality worldwide. Many microorganisms responsible for LRIs, such as <em>Streptococcus pneumoniae</em> and respiratory viruses, exhibit variable behavior: they can exist as asymptomatic colonizers, cause mild disease, or lead to severe invasive infections. Various factors influence the clinical manifestations and severity of LRIs. Emerging evidence suggests that the nasopharyngeal microbiota (NM) plays a crucial role in these processes. This study aims to identify microbiota profiles associated with respiratory health and disease.</div></div><div><h3>Methods</h3><div>A prospective case-control study was conducted between February 2021 and September 2022. NM samples were collected from adults with pneumococcal pneumonia (PPn), COVID-19 pneumonia (CPn), and healthy controls (HC). Samples were analyzed using 16S rRNA gene sequencing. Participants were matched for age and gender. Random Forest modeling was applied to microbiota data to distinguish pneumococcal pneumonia from viral community-acquired pneumonia (CAP).</div></div><div><h3>Results</h3><div>A total of 129 samples were analyzed, including 38 from PPn cases, 54 from CPn cases, and 37 from HC. While age and sex distributions were similar across groups, comorbidities, immunosuppression, and prior infections were more common among cases. Alpha-diversity analysis revealed no significant differences in species richness or evenness across groups. However, beta-diversity analysis showed distinct microbial compositions: <em>Corynebacterium</em> was predominant in CPn patients, whereas <em>Streptococcus</em> was more abundant in PPn patients compared to HC.</div></div><div><h3>Conclusions</h3><div>The nasopharyngeal microbiota differs significantly in adults with pneumococcal pneumonia compared to those with COVID-19 pneumonia and healthy controls. These associations highlight the potential relevance of specific bacterial genera in disease susceptibility. A deeper understanding of healthy nasopharyngeal microbiota profiles could contribute to future strategies for the prevention and management of respiratory infections.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106589"},"PeriodicalIF":11.9,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-13DOI: 10.1016/j.jinf.2025.106585
Luke J. McGeoch , Sarah Foulkes , Heather Whitaker , Katie Munro , Jameel Khawam , Dominic Sparkes , Andre Charlett , Colin S. Brown , Ana Atti , Jasmin Islam , Susan Hopkins , Nick Andrews , Victoria J. Hall
Objectives
To determine vaccine effectiveness against influenza infection among UK healthcare workers between 1 September 2023 and 31 March 2024.
Methods
We conducted a prospective cohort study, including hospital-based healthcare workers (HCWs) enrolled in the SARS-CoV-2 Immunity & Reinfection Evaluation (SIREN) study. Participants completed fortnightly influenza PCR testing and questionnaires. Influenza vaccination status was identified from national vaccination records and questionnaires. Vaccine effectiveness against PCR-positive influenza was estimated using Cox regression adjusted for age group, sex, chronic disease status, patient-facing role, and region. Case-control and test-negative case-control (TNCC) analyses, using multivariable logistic regression, were also performed.
Results
Among 4934 participants, median age was 55 years (IQR 47–60 years) and most were female (78.7%) and white (85.6%). Overall, 3857 (78.2%) received influenza vaccination and 266 (5.4%) tested positive for influenza, of which 227 (85.3%) reported acute respiratory infection symptoms. Adjusted vaccine effectiveness was 39.9% (95% confidence interval 21.8 – 53.8), and similar using case-control (41.2%, 22.5 – 55.2) and TNCC (45.9%, 21.8 – 62.2) approaches.
Conclusions
Influenza vaccine effectiveness was 40%, consistent with estimates for symptomatic patients. Applied to the combined UK healthcare workforce, this potentially translates to prevention of over 50,000 infections. These findings emphasise the importance of seasonal influenza vaccination to reduce healthcare workers infections and thereby protect patients and reduce workforce pressures.
{"title":"Effectiveness of influenza vaccination against infection in UK healthcare workers during winter 2023-24: The SIREN cohort study","authors":"Luke J. McGeoch , Sarah Foulkes , Heather Whitaker , Katie Munro , Jameel Khawam , Dominic Sparkes , Andre Charlett , Colin S. Brown , Ana Atti , Jasmin Islam , Susan Hopkins , Nick Andrews , Victoria J. Hall","doi":"10.1016/j.jinf.2025.106585","DOIUrl":"10.1016/j.jinf.2025.106585","url":null,"abstract":"<div><h3>Objectives</h3><div>To determine vaccine effectiveness against influenza infection among UK healthcare workers between 1 September 2023 and 31 March 2024.</div></div><div><h3>Methods</h3><div>We conducted a prospective cohort study, including hospital-based healthcare workers (HCWs) enrolled in the SARS-CoV-2 Immunity & Reinfection Evaluation (SIREN) study. Participants completed fortnightly influenza PCR testing and questionnaires. Influenza vaccination status was identified from national vaccination records and questionnaires. Vaccine effectiveness against PCR-positive influenza was estimated using Cox regression adjusted for age group, sex, chronic disease status, patient-facing role, and region. Case-control and test-negative case-control (TNCC) analyses, using multivariable logistic regression, were also performed.</div></div><div><h3>Results</h3><div>Among 4934 participants, median age was 55 years (IQR 47–60 years) and most were female (78.7%) and white (85.6%). Overall, 3857 (78.2%) received influenza vaccination and 266 (5.4%) tested positive for influenza, of which 227 (85.3%) reported acute respiratory infection symptoms. Adjusted vaccine effectiveness was 39.9% (95% confidence interval 21.8 – 53.8), and similar using case-control (41.2%, 22.5 – 55.2) and TNCC (45.9%, 21.8 – 62.2) approaches.</div></div><div><h3>Conclusions</h3><div>Influenza vaccine effectiveness was 40%, consistent with estimates for symptomatic patients. Applied to the combined UK healthcare workforce, this potentially translates to prevention of over 50,000 infections. These findings emphasise the importance of seasonal influenza vaccination to reduce healthcare workers infections and thereby protect patients and reduce workforce pressures.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106585"},"PeriodicalIF":11.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-13DOI: 10.1016/j.jinf.2025.106586
Giusy Tiseo , Antonio Vena , Matteo Bassetti , Claudia Bartalucci , Matteo Cerchiaro , Mario Cesaretti , Anna Marchese , Vincenzo Di Pilato , Pilar Escribano , Arianna Forniti , Daniele Roberto Giacobbe , Jesus Guinea , Alessandro Limongelli , Antonella Lupetti , Marina Machado , Malgorzata Mikulska , Jon Salmanton-García , Ana Soriano-Martin , Lucia Taramasso , Maricela Valerio , Marco Falcone
Objectives
To explore persistent candidemia by different Candida spp.
Methods
Observational, retrospective, multicenter study including patients with candidemia (Jan 2018–Dec 2022) from 3 hospitals in Italy and Spain. The primary outcome was persistent candidemia, defined as positive blood culture (BC) yielding the same Candida spp≥5 days from the start of active antifungals. Patients with no available follow-up BCs were excluded. A competing risk analysis (competing risk of death) was performed using Fine and Gray regression models.
Results
Among 1188 patients, 298 (25.1%) had persistent candidemia. Cancer (sHR 1.335, 95% CI 1.037–1.633, p=0.011), total parenteral nutrition (sHR 1.440, 95%CI 1.062–1.818, p=0.006), Candida parapsilosis (sHR 1.312, 95% CI 1.075–1.633, p=0.03) and Candida auris (sHR 1.549, 95% CI 1.155–2.159, p=0.029) compared to Candida albicans, were associated with increased risk of persistent candidemia, whereas primary candidemia (sHR 0.573, 95% CI 0.321–0.825, p<0.001) and early source control (sHR 0.557, 95% CI 0.401–0.713, p<0.001) were protective. Persistent candidemia was associated with higher 30-day mortality (aHR 1.605, 95% CI 1.176–2.191, p=0.003).
Conclusions
Persistent candidemia affects one in four patients with Candida BSI. Infections caused by Candida parapsilosis or Candida auris require individualized management, with early source control being essential to reduce the risk of persistence.
{"title":"Persistent candidemia caused by different Candida species: Data from a multicenter contemporary cohort","authors":"Giusy Tiseo , Antonio Vena , Matteo Bassetti , Claudia Bartalucci , Matteo Cerchiaro , Mario Cesaretti , Anna Marchese , Vincenzo Di Pilato , Pilar Escribano , Arianna Forniti , Daniele Roberto Giacobbe , Jesus Guinea , Alessandro Limongelli , Antonella Lupetti , Marina Machado , Malgorzata Mikulska , Jon Salmanton-García , Ana Soriano-Martin , Lucia Taramasso , Maricela Valerio , Marco Falcone","doi":"10.1016/j.jinf.2025.106586","DOIUrl":"10.1016/j.jinf.2025.106586","url":null,"abstract":"<div><h3>Objectives</h3><div>To explore persistent candidemia by different <em>Candida</em> spp.</div></div><div><h3>Methods</h3><div>Observational, retrospective, multicenter study including patients with candidemia (Jan 2018–Dec 2022) from 3 hospitals in Italy and Spain. The primary outcome was persistent candidemia, defined as positive blood culture (BC) yielding the same <em>Candida</em> spp≥5 days from the start of active antifungals. Patients with no available follow-up BCs were excluded. A competing risk analysis (competing risk of death) was performed using Fine and Gray regression models.</div></div><div><h3>Results</h3><div>Among 1188 patients, 298 (25.1%) had persistent candidemia. Cancer (sHR 1.335, 95% CI 1.037–1.633, p=0.011), total parenteral nutrition (sHR 1.440, 95%CI 1.062–1.818, p=0.006), <em>Candida parapsilosis</em> (sHR 1.312, 95% CI 1.075–1.633, p=0.03) and <em>Candida auris</em> (sHR 1.549, 95% CI 1.155–2.159, p=0.029) compared to <em>Candida albicans</em>, were associated with increased risk of persistent candidemia, whereas primary candidemia (sHR 0.573, 95% CI 0.321–0.825, p<0.001) and early source control (sHR 0.557, 95% CI 0.401–0.713, p<0.001) were protective. Persistent candidemia was associated with higher 30-day mortality (aHR 1.605, 95% CI 1.176–2.191, p=0.003).</div></div><div><h3>Conclusions</h3><div>Persistent candidemia affects one in four patients with <em>Candida</em> BSI. Infections caused by <em>Candida parapsilosis</em> or <em>Candida auris</em> require individualized management, with early source control being essential to reduce the risk of persistence.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106586"},"PeriodicalIF":11.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with hematological malignancies (HM) or undergoing hematopoietic cell transplantation (HCT) face high risk of bloodstream infections (BSI) during febrile neutropenia. Rising antimicrobial resistance (AMR), especially among Gram-negative (GN) bacteria, challenges effective empirical antibiotic therapy (EAT) selection. This ECIL-10 systematic review updates European resistance epidemiology since the 2011 ECIL-4 guidelines publication to inform clinical recommendations.
Methods
We conducted a systematic review (ID: CRD42025638003) of bacterial epidemiology and resistance in HM/HCT patients across Europe, from June 2011 to September 2024, using PubMed, Embase, and Web of Science according to PRISMA guidelines. We included studies reporting BSI or colonization rates and resistance patterns, including extended-spectrum beta-lactamase-producing/third-generation cephalosporin-resistant (ESBL/3GCR), fluoroquinolone-resistant (FQ-R) carbapenem-resistant (CR), and multidrug-resistant (MDR) for GN bacteria; methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) for Gram-positive (GP) bacteria. Two reviewers independently extracted data with ECDC/EARS-Net surveillance 2011 and 2022 data providing supporting analysis. We examined fluoroquinolone prophylaxis (FQ-P) impact on BSI rate and resistance.
Results
Analysis included 40 studies (33,387 patients/febrile episodes from observational studies and 21,402 patients from one meta-analysis) across 12 European countries. BSI prevalence averaged 30% (range, 15–59%), with 42% GN and 51% GP distribution. Median resistance rates among GN BSI were: 55% for FQ-R, 30% for ESBL/3GCR, 13% for both CR and MDR. CR reached 26% in P. aeruginosa (PsA) and 38% in K. pneumoniae (KPn). Among GP BSI resistance was 3% for MRSA and 1% for VRE. Colonization studies demonstrated 20% ESBL/3GCR and 5% CR rates. We identified a southeastern European resistance gradient and significant temporal increase in ESBL/3GCR, CR KPn, and MDR PsA, confirmed in ECDC/EAR-Net analysis. FQ-P reduced overall and GN BSI incidence but increased FQ-R and ESBL/3GCR GN infections in adults. In children, FQ-P reduced BSI in leukemia but not in HCT and data on resistance were inconclusive. ECIL-10 proposed resistance reporting aligned with ESCMID/IDSA guidelines.
Conclusions
AMR presents an escalating challenge in febrile neutropenic HM/HCT patients with geographical variability and increasing resistance trends. These findings strongly support the need for updated guidelines, antimicrobial stewardship programs, rapid diagnostics implementation, and prospective studies to optimize effective empirical therapy strategies.
背景：血液学恶性肿瘤（HM）或接受造血细胞移植（HCT）的患者在发热性中性粒细胞减少期间面临血流感染（BSI）的高风险。不断上升的抗菌素耐药性（AMR），特别是在革兰氏阴性（GN）细菌中，挑战了有效的经验性抗生素治疗（EAT）选择。自2011年ECIL-4指南出版以来，ECIL-10系统评价更新了欧洲耐药流行病学，为临床推荐提供信息。方法：我们根据PRISMA指南，使用PubMed、Embase和Web of Science，对2011年6月至2024年9月欧洲HM/HCT患者的细菌流行病学和耐药性进行了系统评价（ID: CRD42025638003）。我们纳入了报告BSI或定植率和耐药模式的研究，包括广谱β -内酰胺酶产生/第三代头孢菌素耐药（ESBL/3GCR）、氟喹诺酮耐药（FQ-R）碳青霉烯耐药（CR）和GN细菌的多重耐药（MDR）；耐甲氧西林金黄色葡萄球菌（MRSA）和耐万古霉素肠球菌（VRE）的革兰氏阳性（GP）细菌。两名审稿人独立提取了ECDC/ ear - net 2011年和2022年监测数据，提供了支持分析。我们研究了氟喹诺酮预防（FQ-P）对BSI率和耐药性的影响。结果：分析包括来自12个欧洲国家的40项研究（来自观察性研究的33,387例患者/发热发作，来自一项荟萃分析的21,402例患者）。BSI患病率平均为30%（范围15-59%），GN分布为42%，GP分布为51%。GN BSI的中位耐药率为：FQ-R为55%，ESBL/3GCR为30%，CR和MDR均为13%。铜绿假单胞菌（PsA）和肺炎克雷伯菌（KPn）的CR分别为26%和38%。在GP BSI中，MRSA耐药率为3%，VRE耐药率为1%。定殖研究显示20%的ESBL/3GCR和5%的CR率。我们在ECDC/EAR-Net分析中确认了欧洲东南部的耐药梯度和ESBL/3GCR、CR KPn和MDR PsA的显著时间增长。FQ-P降低了总体和GN BSI发生率，但增加了成人FQ-R和ESBL/3GCR GN感染。在儿童中，FQ-P降低了白血病患者的BSI，但没有降低HCT患者的BSI，耐药数据尚无定论。ECIL-10建议的耐药性报告与ESCMID/IDSA指南一致。结论：AMR在发热性中性粒细胞减少的HM/HCT患者中呈现出不断升级的挑战，具有地域差异和日益增加的耐药趋势。这些发现有力地支持了更新指南、抗菌药物管理计划、快速诊断实施和前瞻性研究以优化有效的经验治疗策略的必要性。
{"title":"Epidemiology of resistant bacterial infections in patients with hematological malignancies or undergoing hematopoietic cell transplantation in Europe: A systematic review by the European Conference on Infections in Leukemia (ECIL)","authors":"Francesco Baccelli , Manuela Aguilar-Guisado , Carolina Garcia Vidal , Malgorzata Mikulska , Yuri Vanbiervliet , Nicole Blijlevens , Patricia Muñoz , Dionysios Neofytos , Catherine Cordonnier , Thierry Calandra , Dina Averbuch , Murat Akova","doi":"10.1016/j.jinf.2025.106571","DOIUrl":"10.1016/j.jinf.2025.106571","url":null,"abstract":"<div><h3>Background</h3><div>Patients with hematological malignancies (HM) or undergoing hematopoietic cell transplantation (HCT) face high risk of bloodstream infections (BSI) during febrile neutropenia. Rising antimicrobial resistance (AMR), especially among Gram-negative (GN) bacteria, challenges effective empirical antibiotic therapy (EAT) selection. This ECIL-10 systematic review updates European resistance epidemiology since the 2011 ECIL-4 guidelines publication to inform clinical recommendations.</div></div><div><h3>Methods</h3><div>We conducted a systematic review (ID: CRD42025638003) of bacterial epidemiology and resistance in HM/HCT patients across Europe, from June 2011 to September 2024, using PubMed, Embase, and Web of Science according to PRISMA guidelines. We included studies reporting BSI or colonization rates and resistance patterns, including extended-spectrum beta-lactamase-producing/third-generation cephalosporin-resistant (ESBL/3GCR), fluoroquinolone-resistant (FQ-R) carbapenem-resistant (CR), and multidrug-resistant (MDR) for GN bacteria; methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) and vancomycin-resistant enterococci (VRE) for Gram-positive (GP) bacteria. Two reviewers independently extracted data with ECDC/EARS-Net surveillance 2011 and 2022 data providing supporting analysis. We examined fluoroquinolone prophylaxis (FQ-P) impact on BSI rate and resistance.</div></div><div><h3>Results</h3><div>Analysis included 40 studies (33,387 patients/febrile episodes from observational studies and 21,402 patients from one meta-analysis) across 12 European countries. BSI prevalence averaged 30% (range, 15–59%), with 42% GN and 51% GP distribution. Median resistance rates among GN BSI were: 55% for FQ-R, 30% for ESBL/3GCR, 13% for both CR and MDR. CR reached 26% in <em>P. aeruginosa</em> (PsA) and 38% in <em>K. pneumoniae</em> (KPn). Among GP BSI resistance was 3% for MRSA and 1% for VRE. Colonization studies demonstrated 20% ESBL/3GCR and 5% CR rates. We identified a southeastern European resistance gradient and significant temporal increase in ESBL/3GCR, CR KPn, and MDR PsA, confirmed in ECDC/EAR-Net analysis. FQ-P reduced overall and GN BSI incidence but increased FQ-R and ESBL/3GCR GN infections in adults. In children, FQ-P reduced BSI in leukemia but not in HCT and data on resistance were inconclusive. ECIL-10 proposed resistance reporting aligned with ESCMID/IDSA guidelines.</div></div><div><h3>Conclusions</h3><div>AMR presents an escalating challenge in febrile neutropenic HM/HCT patients with geographical variability and increasing resistance trends. These findings strongly support the need for updated guidelines, antimicrobial stewardship programs, rapid diagnostics implementation, and prospective studies to optimize effective empirical therapy strategies.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106571"},"PeriodicalIF":11.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1016/j.jinf.2025.106588
Andrew L. Wishart , Joseph Pechacek , Lindsey B. Rosen , Jigar V. Desai , Marissa A. Zarakas , Taura Webb , Stefania Pittaluga , Amir Seyedmousavi , Tobias M. Hohl , Douglas B. Kuhns , Steven M. Holland , Michail S. Lionakis
Objectives
To present a putatively immunocompetent patient with locally invasive aspergillosis and neutralizing autoantibodies (Aabs) against granulocyte-macrophage colony-stimulating factor (GM-CSF) and to characterize GM-CSF Aab-mediated impairments in neutrophil anti-Aspergillus effector function.
Methods
Imaging studies and histological analyses of infected tissue were employed to diagnose sino-orbital aspergillosis and monitor antifungal treatment responses. Whole genome sequencing (WGS), dihydrorhodamine testing, and particle-based Aab detection were employed to assess for the underlying etiology of fungal disease. Neutrophils from the patient and healthy donors were harvested from peripheral blood and underwent evaluations for cell viability, fungal conidial uptake and intracellular killing, conidial germination inhibition, hyphal damage, reactive oxygen species (ROS) production, and GM-CSF-induced STAT5 phosphorylation.
Results
We describe a 61-year-old woman who developed isavuconazole-refractory sino-orbital aspergillosis with a lymphoplasmacytic infiltrate in the infected tissue without neutrophil infiltration. WGS revealed no known inborn error of immunity to account for infection susceptibility. The patient carried high titers of neutralizing Aabs against GM-CSF without associated pulmonary alveolar proteinosis (PAP) or other opportunistic infections. Although the patient’s neutrophils exhibited no intrinsic antifungal effector function defects, the patient’s GM-CSF Aab-containing serum inhibited GM-CSF-mediated neutrophil activation and Aspergillus-induced ROS production. The infection remitted with long-term posaconazole administration.
Conclusions
Invasive aspergillosis may occur in patients with neutralizing GM-CSF Aabs, even in the absence of PAP or other opportunistic infections. GM-CSF Aabs impair GM-CSF-mediated neutrophil activation and Aspergillus-induced ROS production, which may contribute to the invasive fungal infection susceptibility. GM-CSF Aabs should be tested in putatively immunocompetent individuals who develop invasive mold disease.
{"title":"Neutralizing GM-CSF autoantibodies impair neutrophil antifungal effector function in a patient with aspergillosis","authors":"Andrew L. Wishart , Joseph Pechacek , Lindsey B. Rosen , Jigar V. Desai , Marissa A. Zarakas , Taura Webb , Stefania Pittaluga , Amir Seyedmousavi , Tobias M. Hohl , Douglas B. Kuhns , Steven M. Holland , Michail S. Lionakis","doi":"10.1016/j.jinf.2025.106588","DOIUrl":"10.1016/j.jinf.2025.106588","url":null,"abstract":"<div><h3>Objectives</h3><div>To present a putatively immunocompetent patient with locally invasive aspergillosis and neutralizing autoantibodies (Aabs) against granulocyte-macrophage colony-stimulating factor (GM-CSF) and to characterize GM-CSF Aab-mediated impairments in neutrophil anti-<em>Aspergillus</em> effector function.</div></div><div><h3>Methods</h3><div>Imaging studies and histological analyses of infected tissue were employed to diagnose sino-orbital aspergillosis and monitor antifungal treatment responses. Whole genome sequencing (WGS), dihydrorhodamine testing, and particle-based Aab detection were employed to assess for the underlying etiology of fungal disease. Neutrophils from the patient and healthy donors were harvested from peripheral blood and underwent evaluations for cell viability, fungal conidial uptake and intracellular killing, conidial germination inhibition, hyphal damage, reactive oxygen species (ROS) production, and GM-CSF-induced STAT5 phosphorylation.</div></div><div><h3>Results</h3><div>We describe a 61-year-old woman who developed isavuconazole-refractory sino-orbital aspergillosis with a lymphoplasmacytic infiltrate in the infected tissue without neutrophil infiltration. WGS revealed no known inborn error of immunity to account for infection susceptibility. The patient carried high titers of neutralizing Aabs against GM-CSF without associated pulmonary alveolar proteinosis (PAP) or other opportunistic infections. Although the patient’s neutrophils exhibited no intrinsic antifungal effector function defects, the patient’s GM-CSF Aab-containing serum inhibited GM-CSF-mediated neutrophil activation and <em>Aspergillus-</em>induced ROS production. The infection remitted with long-term posaconazole administration.</div></div><div><h3>Conclusions</h3><div>Invasive aspergillosis may occur in patients with neutralizing GM-CSF Aabs, even in the absence of PAP or other opportunistic infections. GM-CSF Aabs impair GM-CSF-mediated neutrophil activation and <em>Aspergillus-</em>induced ROS production, which may contribute to the invasive fungal infection susceptibility. GM-CSF Aabs should be tested in putatively immunocompetent individuals who develop invasive mold disease.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106588"},"PeriodicalIF":11.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1016/j.jinf.2025.106578
Zhiyao Li , Xin Wang , Senke Chen , Wenxue Xiong , Qiong Wang , Meng Zheng , Kunpeng Wu , Qun He , Wen Chen , Li Ling
Objective
To examine whether more stringent border controls (BCs), including quarantine, ban on regions, and total border closure, are associated with slower initial-stage epidemic progression compared to screening.
Methods
Using real-world BCs and COVID-19 epidemic data from 174 countries and regions from 1 January to 31 July 2020, we compared the effectiveness of different stringency BCs in slowing countries from reaching the first infection peak. To account for the immortal time bias due to staggered BC adoptions across countries, the target-trial-emulation and cloning-censoring-weighting approaches were applied. Kaplan-Meier model with inverse probability censoring weights (IPCW) was used to obtain effectiveness estimates for each BC. Country-specific timing and methods of implementing diagnostic testing were not included in the IPCW calculation model due to data unavailability. BC adoption timing was investigated as a potential mechanism for BCs’ effectiveness.
Results
Compared with countries adopting basic border screening, those adopting more stringent BCs were not associated with a reduced risk of reaching the first infection peak, including the most stringent total border closure (Hazard Ratio [HR]: 1.07, 95% CI: 0.88–1.30). Countries adopting those stringent BCs experienced significant delays than those adopting screening potentially elucidating the mechanism. Further analysis revealed that BC adoption timing, regardless of stringency, was independently associated with the risk of the first infection peak attainment.
Conclusions
More stringent BCs in response to pandemics did not necessarily lead to slower initial-stage epidemic progression if adoptions were delayed. These findings highlight the importance of considering both timing and stringency—rather than focusing on stringency alone—when adopting BCs against future emerging infectious disease surges.
{"title":"Assessing global border controls in response to COVID-19 pandemic using real-world data and target trial emulation","authors":"Zhiyao Li , Xin Wang , Senke Chen , Wenxue Xiong , Qiong Wang , Meng Zheng , Kunpeng Wu , Qun He , Wen Chen , Li Ling","doi":"10.1016/j.jinf.2025.106578","DOIUrl":"10.1016/j.jinf.2025.106578","url":null,"abstract":"<div><h3>Objective</h3><div>To examine whether more stringent border controls (BCs), including quarantine, ban on regions, and total border closure, are associated with slower initial-stage epidemic progression compared to screening.</div></div><div><h3>Methods</h3><div>Using real-world BCs and COVID-19 epidemic data from 174 countries and regions from 1 January to 31 July 2020, we compared the effectiveness of different stringency BCs in slowing countries from reaching the first infection peak. To account for the immortal time bias due to staggered BC adoptions across countries, the target-trial-emulation and cloning-censoring-weighting approaches were applied. Kaplan-Meier model with inverse probability censoring weights (IPCW) was used to obtain effectiveness estimates for each BC. Country-specific timing and methods of implementing diagnostic testing were not included in the IPCW calculation model due to data unavailability. BC adoption timing was investigated as a potential mechanism for BCs’ effectiveness.</div></div><div><h3>Results</h3><div>Compared with countries adopting basic border screening, those adopting more stringent BCs were not associated with a reduced risk of reaching the first infection peak, including the most stringent total border closure (Hazard Ratio [HR]: 1.07, 95% CI: 0.88–1.30). Countries adopting those stringent BCs experienced significant delays than those adopting screening potentially elucidating the mechanism. Further analysis revealed that BC adoption timing, regardless of stringency, was independently associated with the risk of the first infection peak attainment.</div></div><div><h3>Conclusions</h3><div>More stringent BCs in response to pandemics did not necessarily lead to slower initial-stage epidemic progression if adoptions were delayed. These findings highlight the importance of considering both timing and stringency—rather than focusing on stringency alone—when adopting BCs against future emerging infectious disease surges.</div></div>","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106578"},"PeriodicalIF":11.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-12DOI: 10.1016/j.jinf.2025.106587
Shuo Yu , Hongbo Wang , Dongshu Wang , Shaomi Dai, Sheng Sun, Jinxia Zhang, Foday Sahr, Doris Harding, James Squire, Mohamed Alex Vandi, Alusine Fofana, Zhixin Yang, Hengliang Wang, Yufei Lyu, Xiankai Liu
{"title":"Whole-genome sequencing and phylogenetic analysis of the first and second confirmed cases of human infection with Monkeypox virus from Sierra Leone","authors":"Shuo Yu , Hongbo Wang , Dongshu Wang , Shaomi Dai, Sheng Sun, Jinxia Zhang, Foday Sahr, Doris Harding, James Squire, Mohamed Alex Vandi, Alusine Fofana, Zhixin Yang, Hengliang Wang, Yufei Lyu, Xiankai Liu","doi":"10.1016/j.jinf.2025.106587","DOIUrl":"10.1016/j.jinf.2025.106587","url":null,"abstract":"","PeriodicalId":50180,"journal":{"name":"Journal of Infection","volume":"91 3","pages":"Article 106587"},"PeriodicalIF":11.9,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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