Acta microbiologica et immunologica Hungarica最新文献

The aim of this study was to investigate the prevalence of intestinal colonization by major multidrug-resistant (MDR) bacteria and fungi in patients with hematological malignancies (HM) and its relationship with subsequent bloodstream infections (BSIs). The study was performed between December 2023 and June 2024 at the University Hospital "Saint Marina", Varna, Bulgaria. A total of 180 HM patients were screened for intestinal colonization by 3rd generation cephalosporin-resistant (3rdGCephR) and carbapenem-resistant (CR) Enterobacterales, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Vancomycin-Resistant Enterococci (VRE) and Candida sp. according to our own protocol. Blood cultures were taken according to clinical indications. Multiplex PCR was used to detect beta-lactamase genes in all invasive Enterobacterales isolates. A total of 100 patients (55.6%) were colonized by one or more of the screened agents. Among these, 88 patients were MDR carriers (48.9%, 88/180) and the highest colonization rates were found for CR Klebsiella pneumoniae (CRKP) (42%), Candida sp. (34%), VRE (25%) and 3rdGCephR Escherichia coli (23%). A total of 29 patients (16.1%; 29/180) developed BSIs, with K. pneumoniae responsible for 44.8%. Of these, 76.9% (10/13) were CR and blaNDM positive isolates. Related BSIs were diagnosed in 57.9% of the MDR carriers with BSIs (11/19). The related BSIs percentage according to the colonizing agent was 21.4% for CRKP (9/42), 7.1% for 3rdGCephR K. pneumoniae (1/14) and 25% for P. aeruginosa (1/4). CRKP colonization was significantly higher among patients with CRKP BSIs than those with non-CRKP BSIs (P < 0.001). The MDR intestinal colonization, specifically by CRKP is an important source for subsequent BSIs in this high-risk patient population.

Despite the clinical importance of the human cytomegalovirus (CMV) infections especially in pregnant women and immunocompromised patients, there are only a few CMV seroprevalence studies in certain risk groups from Hungary. In this study, the results of CMV-specific IgG antibody tests were analysed by calendar year, gender, and 5-year age groups (from 0 to 97) among the population of South Transdanubia, Hungary from blood samples (N = 13,777), between January 1, 2010, and December 31, 2024, covering 15-years.The average CMV-specific IgG seropositivity was 69.2% (9,522/13,761 patients), which increased with age between 31 and 50 years (+∼1%/year). Seroprevalence was lowest (37.8%) in the 1-5 age group, reached 50% in the 21-25 age group, and exceeded 80% in those over 50 years. In certain age groups (16-20, 26-30, 46-50, 51-55, and 66-70 years old), CMV seroprevalence was significantly higher among women. Women of child-bearing age between 16 and 45 years showed 61.2% seroprevalence. Between 2020 and 2023, the yearly CMV seroprevalence decreased (from 70.8 to 64.7%) by ∼6%.This summary of CMV IgG seroprevalence fills gaps in terms of both the number of elements, the size of the studied population, and its age diversity in Hungary. The average CMV seropositivity in South Transdanubia follows the level of socio-economic development of the countries. Basic knowledge of CMV seroepidemiological data helps physicians with CMV risk assessment and find the optimal infection prevention strategies in different age and sex groups.

This study evaluates the impact of psychosomatic interventions on the immune system and microbiome composition of pregnant women diagnosed with gestational hypertension. A case-control study on 200 pregnant women diagnosed with gestational hypertension was conducted between June 2021 and December 2024. The control group (n = 100) included pregnant women diagnosed with gestational hypertension and under only pharmacological treatment with antihypertensive drugs such as labetalol. The case group (n = 100) received standard care for hypertensive disorders in pregnancy like control group, but in addition to it, we incorporated evidence based psychosomatic medicine to this group. Psychosomatic medicine included stress management, relaxation techniques, and counseling for the study group. Primary outcomes included blood pressure levels, psychological state (SAS and SDS scores), mode of delivery, incidence of complications, neonatal outcomes, patient satisfaction, reductions in inflammatory cytokines (e.g., IL-6, TNF-alpha), and improvements in microbiome diversity. Psychosomatic intervention led to a significant increase in microbiome diversity (Shannon Index, P < 0.05). Beta-diversity analysis revealed a distinct separation in microbial community composition between the study and control groups (P = 0.02). The case group also showed a reduction in pro-inflammatory cytokines, IL-6 decreased from 40.0 to 28.0 pg mL-1 (P = 0.008) and TNF-alpha from 25.0 to 18.0 pg mL-1 (P = 0.004). The case group demonstrated significant improvements in systolic (P = 0.020) and diastolic (P = 0.003) blood pressures, psychological well-being (SAS, P = 0.006; SDS: P = 0.026), and delivery outcomes (P = 0.032). Complications were significantly lower in the case group (P = 0.013), with better neonatal outcomes, including lower rates of intrauterine distress (P = 0.011), premature birth (P = 0.003), and asphyxia (P = 0.013). Emotional resilience, coping confidence, and patient satisfaction were significantly higher in the case group (P < 0.05). These findings suggest that psychosomatic medicine may offer a novel approach for managing gestational hypertension through microbiome modulation.

Colorectal cancer (CRC) is a malignant disease associated with substantial morbidity and mortality rates, and the implementation of early screening has been shown to greatly enhance survival outcomes. Currently, early screening methods for CRC rely on stool-based tests and colonoscopy; however, the limited adherence of patients to these screening protocols hinders their widespread adoption. The utilization of innovative microbiological sequencing technique known as 2bRAD-M holds promise for the detection of low biomass samples. In this study, the 2bRAD-M technique was employed to ascertain a diverse microbiota consisting of different microorganisms in the serum of patients diagnosed with CRC, as well as in the serum of healthy control individuals. This study included 3 patients with non-metastatic CRC and 3 healthy individuals. Additionally, the microbiota present in CRC tumor tissues and paraneoplastic tissues were also examined. Furthermore, the metabolic pathways of these microorganisms were predicted. The findings indicated that the microbiota community structures in serum and tissues were distinct, while the microbiota composition in tumor tissues and adjacent tissues was largely similar. Microbiota in serum such as Enterobacteriaceae and tissue-associated RC9、Ralstonia may serve as novel biomarkers for CRC screening. Our results suggest that both serum microbiota and cancer tissue microbiota can serve as a valuable basis for conducting early in vitro screening for CRC.

Escherichia coli is a highly adaptable Gram-negative bacterium, commonly part of the gut microbiota in humans and animals, yet capable of causing severe extraintestinal infections. Among its lineages, Sequence Type 131 (ST131) has emerged as a globally disseminated, multidrug-resistant, high-risk clone with remarkable capacity for systemic infections. This study provides a comprehensive molecular epidemiological characterization of 160 clinical E. coli isolates, collected between 15.09.2021 and 28.02.2022, assessing antimicrobial resistance profiles, virulence gene carriage, phylogenetic group distribution, prevalence of ST131 and H30Rx subclone, and biofilm-forming capacity. Isolates were identified by conventional and automated methods, with molecular analyses performed via in-house PCR assays. Our results reveal a striking 69.38% prevalence of ST131, with 95.5% harboring virulence genes and 81.99% exhibiting biofilm formation. Notably, ST131-positive isolates demonstrated extensive resistance to multiple antimicrobial classes, including ESBL production, and were dominated by the H30Rx subclone. Specifically, 73.87% of ST131 isolates were ESBL-positive, fluoroquinolone resistance was observed in 81.37%, while aminoglycoside resistance rate remained very low. The H30Rx subclone was strongly associated with ESBL positivity and multidrug resistance. Moreover, integron carriage diversity and strong association with fimA virulence gene further highlight the adaptive versatility of this clone. Given that ST131 and its H30Rx subclone are recognized as global pandemic lineages associated with multidrug resistance and severe infections, their detection in our cohort emphasizes both the clinical relevance and the public health risk posed by these clones. Our findings underscore the urgent need for targeted surveillance and control strategies, offering novel epidemiological insights into the molecular diversity and clinical threat posed by E. coli ST131 in Turkey.

We investigated the epidemiological and clinical characteristics of pertussis in children from Wuxue, China, focusing on age-specific patterns in clinical presentation, laboratory findings and outcomes. A retrospective case-control study was conducted on 306 pediatric patients hospitalized with pertussis at Wuxue First People's Hospital between May 2023 and June 2024. Patients were stratified into three age groups: infants (2-12 months, n = 82), preschool children (1-6 years, n = 127), and school-aged children (7-13 years, n = 97). Age-matched healthy controls (n = 306) were included for hematological comparisons. Data were analyzed using SPSS 22.0 and GraphPad Prism 9.5.0. Infants exhibited the most severe clinical profiles, with significantly elevated leukocyte and lymphocyte parameters compared to older groups (P < 0.001). The incidence of pneumonia was the highest in infants (82.93% vs. 33.07% in preschool and 22.68% in school-aged children, P < 0.001). ROC analysis highlighted lymphocyte percentage as a reliable diagnostic marker in infants (AUC = 0.7620). Seasonal peaks occurred in spring (61.44%) and winter (20.91%). Notably, 84.32% of infected children were fully vaccinated, indicating waning immunity. Macrolide-resistant Bordetella pertussis strains were identified in 7.19% of cases however, co-trimoxazole was effective against these resistant strains. Severe pertussis occurred in 14.05% of cases, predominantly in infants (81.40%, P < 0.001). Age is a critical factor in pertussis presentation. The high vaccination rate among cases underscores issues of waning immunity, necessitating updated immunization strategies. Emerging macrolide resistance warrants vigilance, with co-trimoxazole serving as an effective alternative for therapy. Infants require prioritized surveillance and prompt management.

Campylobacteriosis is the most frequent zoonosis in Europe and its most important human pathogens are Campylobacter jejuni and Campylobacter coli. Resistance of Campylobacter to fluoroquinolones and tetracyclines, previously recommended for treatment of prolonged or complicated disease, has been emerging. We examined phenotypic resistance to erythromycin, tetracycline, ciprofloxacin, gentamicin, amoxicillin-clavulanic acid and imipenem in 150 Campylobacter isolates from human stool during 2010-2011 and the same number of strains during 2023-2024, using the antimicrobial gradient method in both periods, to determine minimum inhibitory concentration (MIC). Comparing the two periods, resistance rate of C. jejuni increased by 35% and 38.43% to tetracyclin and ciprofloxacin, respectively and decreased by 0.83% to erythromycin. Prevalence of resistance in C. coli increased by 42.59% and 42.01% against tetracyclin and ciprofloxacin, respectively and all isolates were sensitive to erythromycin. Resistance of C. jejuni to amoxicillin-clavulanic acid decreased by 0.96% and increased by 3.70% in C. coli. All isolates showed sensitivity for imipenem in both periods, while only 2% of C. jejuni strains were resistant to gentamicin in 2023-2024. The difference of mean MICs for all antibiotics was statistically significant in two examined periods, with exception of those for erythromycin both in C. jejuni and C. coli. In 2023-2024, 79 isolates of C. jejuni and 22 isolates of C. coli were resistant against two and more antibiotics, most frequently tetracycline and ciprofloxacin. The present study provides evidence that in Campylobacter spp. the antimicrobial resistance to ciprofloxacin and tetracycline is on rise in Serbia. Our findings are in accordance with recent reports from countries geographically close to Serbia.

Stenotrophomonas maltophilia has emerged as an opportunistic pathogen that causes life-threatening hospital-acquired infections. This microorganism possesses a diverse array of chromosome-encoded antimicrobial resistance genes, which render it inherently multidrug-resistant (MDR). Its ability to acquire additional antimicrobial resistance via mutations and the horizontal transfer of resistome elements from neighboring microbial communities has further contributed to the development of extensively drug-resistant (XDR) and even pandrug-resistant (PDR) strains. These strains are resistant to routinely used antibiotics, including the first-line drug trimethoprim/sulfamethoxazole as well as levofloxacin and minocycline. Recently, cefiderocol - a siderophore-conjugated cephalosporin - was developed for clinical use. This antibiotic has shown high in vitro efficacy against clinically relevant MDR gram-negative pathogens. Cefiderocol efficiently transverses the outer membrane of bacteria via iron transport systems and exhibits high stability against β-lactamases. An injectable form of cefiderocol has received Food and Drug Administration approval for the treatment of complicated urinary tract infections, hospital-acquired bacterial pneumonia, and ventilator-associated bacterial pneumonia caused by drug-resistant gram-negative bacteria. Clinical data on the use of cefiderocol for S. maltophilia infections remain limited, however, some in vitro, in vivo, and case studies have demonstrated its efficacy and successful treatment of MDR S. maltophilia infections. Given the narrow range of therapeutic options currently available, cefiderocol presents a promising alternative for the effective management of severe S. maltophilia infections. Nevertheless, the potential for the emergence of resistance remains a significant concern, as emerging evidence suggests that S. maltophilia may acquire resistance following exposure to this antibiotic.

The aim of this study is to detect the carbapenemase type and to determine the in vitro effects of ceftazidime/avibactam-colistin, ceftazidime/avibactam-meropenem and ceftazidime/avibactam-tigecycline combinations against Carbapenem-Resistant Klebsiella pneumoniae (CRKP) isolates. A total of 35 CRKP isolates were included to the study. The minimum inhibitory concentrations of ceftazidime/avibactam, meropenem, colistin and tigecycline were determined by broth dilution method. Synergistic effects of ceftazidime/avibactam-colistin, ceftazidime/avibactam-meropenem and ceftazidime/avibactam-tigecycline were investigated by microdilution checkerboard method. Carbapenemase genes (blaOXA-48, blaNDM, blaKPC, blaIMP, blaVIM) were detected by multiplex PCR. All of the isolates were resistant to meropenem, whereas 77.1% of the isolates were resistant to ceftazidime/avibactam and 14.3% of the isolates were resistant to colistin.The carbapenemase genes of the CRKP isolates were determined as 17 OXA-48+NDM, 9 KPC, 6 OXA-48, 1 NDM, 1 KPC+NDM and 1 KPC+OXA-48. Ceftazidime/avibactam-colistin, ceftazidime/avibactam-meropenem and ceftazidime/avibactam-tigecycline combinations were synergistic against 5.7% (2/35), 17.1% (6/35), and 5.7% (2/35) of the isolates, respectively. Ceftazidime/avibactam-meropenem was the most effective synergistic combination in our study, showing synergism in 17.1% of isolates, however, the synergistic effect varied depending on the CRKP isolate tested.

Vancomycin-intermediate Staphylococcus aureus (VISA) strains represent a serious public health concern. It is crucial to investigate the genetic diversity, biofilm formation, and virulence analysis of VISA isolated from hospitalized patients. During the two-year study period, 42 VISA were obtained from 520 S. aureus isolates collected from various clinical samples, corresponding to a prevalence of 8.1%, as determined by the broth microdilution method. These VISA isolates were further characterized using biofilm formation, antimicrobial susceptibility tests, SCCmec typing, spa typing, multilocus sequence typing (MLST), and PCR analysis for detecting resistance (erm(B), tet(M), mecC, msr(B), mecA, mupA, vanA, aac(6')-Ie/aph(2˝), mupB, msr(A), erm(C), erm(A), vanB, ant(4')-Ia, and aph(3')-IIIa), biofilm (clfA, clfB, fnbA, fnbB, ebp, cna and bap) and virulence (eta, etb, pvl, and tst) genes. Our results indicated that the 42 VISA isolates belonged to three clonal complexes, including CC8 (78.6%), CC22 (11.9%), and CC5 (9.5%). The vast majority of S. aureus isolates belonged to CC8/ST239-SCCmec III/t037 (42.9%). Our result revealed that PVL-positive strains belonged to CC/ST5-SCCmec IV/t002 (9.5%), CC/ST8-SCCmec IV/t008 (19%), and CC/ST22-SCCmec IV/t790 (7.1%) while TST-positive isolates belonged to CC8/ST239-SCCmec III/t030 (9.5%) and CC8/ST239-SCCmec III/t037 (35.7%). The majority of HLMUPR isolates belonged to CC8/ST239-SCCmec III/t037 (14.3%), followed by CC/ST8-SCCmec IV/t008 (7.1%), CC8/ST239-SCCmec III/t030 (4.8%), and CC/ST5-SCCmec IV/t002 (2.4%) lineages carrying mupA. The highest frequency of VISA strain with iMLSB phenotype belonged to the CC8/ST239-SCCmec III/t037 (11.9%) clonal lineage. The study highlights that genetic diversity and characteristics of the VISA strains should be closely and continuously monitored. Besides that, importance of measures to prevent the transmission of VISA to treat such infection were urgently needed.