Infectious diseases (London, England)最新文献

Background: Adequate clinical follow-up after diagnosis and high uptake of antiretroviral therapy (ART) are essential to reach the global target to eliminate HIV as a public health threat. Norway currently lacks a comprehensive national system to monitor these outcomes.

Objectives: To describe linkage to specialist care, receiving ART, retention in care and cause-specific mortality among diagnosed people living with HIV (PLHIV) in Norway up to the end of 2023.

Methods: We used linked data from national health and administrative registries from 2008-2023 to define diagnosed PLHIV and the study outcomes. We described linkage to care, ART dispensation and retention in care by year of diagnosis, age, sex, region of residence and place of birth. We stratified mortality rates by ART status and concurrent HIV/AIDS diagnosis.

Results: Among 5,847 PLHIV diagnosed through 2023, 99.6% had been linked to care and 96.4% had received ART. Among 4,926 diagnosed PLHIV who were still resident in 2023, 96.7% were retained in care and 95.3% had received ART in the prior 24 months. All-cause mortality (4.7 per 1000 person-years, 95% confidence interval: 3.9-5.7) and HIV/AIDS-specific mortality (1.0 per 1000 person-years, 95% confidence interval: 0.6-1.5) were lowest among diagnosed PLHIV without a concurrent HIV/AIDS diagnosis and who had received ART.

Conclusion: Norway has achieved high levels of engagement in specialist care for HIV. In the absence of an HIV clinical registry with national coverage, linked data from health and administrative registries can provide an indication of progress towards global clinical care targets in Norway.

Background: Candidemia is a life-threatening, typically nosocomial infection, which often occurs with critical illness and immunosuppression. Alcoholism has not been associated with candidemia risk or outcomes. However, alcoholism is a common comorbidity in hospitalised patients, excess alcohol consumption has detrimental effects on the immune system, and alcoholism is associated with poor outcomes from bacteraemia, sepsis and bacterial pneumonia. We aimed to investigate the patient and disease characteristics, treatment, outcomes, and Candida species distribution in patients with alcoholism.

Methods: We collected retrospective data on cases of candidemia in adults from Southern Finland between 2007 and 2016. Cases were stratified by alcoholism.

Results: We identified a total of 329 patients with candidemia, of which 69 (21%) had alcoholism. Patients with alcoholism were younger and had fewer serious or life-threatening comorbidities. Classical risk factors for candidemia were equally or less prevalent in patients with alcoholism than in those without, including malignancy (20% vs. 34%), central venous catheter (48% vs. 50%), and gastrointestinal surgery (20% vs. 24%). The majority of candidemia cases were nosocomial (92%) without significant differences between patient cohorts. Candidemia diagnosis in the ICU was more common in patients with alcoholism than in those without (19% vs. 10%). Central venous catheters were removed (61%) and antifungal therapy was initiated promptly in patients with alcoholism. The 30-day mortality of patients with and without alcoholism was equivalent (29% vs. 31%).

Conclusions: A significant proportion of patients with candidemia had comorbid alcoholism. Patients with alcoholism did not have significantly different outcomes from patients without alcoholism.

Introduction: Low value diagnostic testing is an increasingly significant issue in the context of rising healthcare costs. The additional benefit of extended respiratory viral polymerase chain reaction (PCR) testing (influenza A/B, RSV, parainfluenza, human metapneumovirus, adenovirus, rhinovirus) over a standard of care Flu/RSV/SARS-CoV-2 PCR is unclear at our institution.

Objective: To investigate whether the additional information provided by extended respiratory viral PCR testing reduces adult patient length of stay, duration of intravenous (IV) or oral antibiotics at our institution.

Methods: A retrospective audit of extended respiratory viral PCR tests was performed in adult inpatients and emergency department patients at the Northern Hospital (Melbourne, Australia) between April 1^st - August 31^st 2024. In the subgroup of patients discharged with a diagnosis of respiratory tract infection or exacerbation, inpatient length of stay, IV, oral and total antibiotic usage were compared based on respiratory viral PCR result, adjusting for clinically appropriate covariables.

Results/discussion: Only 330 of 941 tested patients met the criteria for inclusion in the respiratory tract infection or exacerbation subgroup. Length of stay, IV, oral and total antibiotic usage were not significantly reduced in patients with a positive extended respiratory viral PCR result. In contrast, patients with a positive Flu/RSV/SARS-CoV-2 PCR were significantly less likely to receive oral antibiotics (OR 0.31, p < 0.01) or any antibiotics (OR 0.30, p < 0.01), with no significant difference in IV antibiotic usage.

Conclusion: No objective benefit of extended respiratory viral PCR testing was detected in adult inpatients with regards to antibiotic usage or inpatient length of stay.

Introduction: Necrotising fasciitis (NF) is a rare but life-threatening soft tissue infection, whose diagnosis remains challenging due to non-specific early clinical signs. This retrospective single-center study aimed to compare the clinical, radiological, and microbiological characteristics, as well as outcomes, of patients undergoing fasciotomy for suspected NF, distinguishing between those with surgically confirmed necrosis and those without.

Methods: Data from 62 adults who underwent fasciotomy for suspected NF between 2013 and 2023 were retrospectively analyzed. Patients were stratified into two groups according to intra-operative confirmation of necrosis (n = 29) or its absence (n = 33). Demographic characteristics, clinical presentation, laboratory parameters, timing of surgery, and 30-, 90-, and 180-day mortality rates were compared.

Results: Patients with confirmed necrosis showed significantly higher LRINEC scores (7.5 vs 5.6; p = 0.004), blood glucose (223.6 vs 154.9 mg/dL; p = 0.031), and urea levels (75.4 vs 50.4 mg/dL; p = 0.019) at admission. Advanced clinical signs, including bullae or crepitus, were strongly associated with necrosis (OR = 4.82; p = 0.007). These patients were more frequently admitted to the ICU (82.8% vs 42.4%; p = 0.002) and underwent earlier surgery (<24 h; OR = 0.19; p = 0.002). No significant differences were observed in infection site, microbiology, hospital stay, or mortality (6.9% vs 12.2%; p = 0.676).

Conclusion: Elevated LRINEC scores and advanced clinical signs predict confirmed necrosis but not mortality. The timely decision to perform fasciotomy, regardless of confirmed necrosis, appears to be critical for improving outcomes. This suggests that relying on clinical judgement and early surgical exploration is critical for a timely and effective response to highly suspected cases of NF.

Background: Preliminary results from the SNAP trial presented at ESCMID Global 2025 reported a high incidence (19.8%) of acute kidney injury (AKI) in patients treated with (flu)cloxacillin for Staphylococcus aureus bacteraemia (SAB).

Objective: In Sweden, cloxacillin is used at lower daily doses, and the risk of nephrotoxicity has not been assessed in this setting.

Methods: We retrospectively evaluated renal outcomes in SAB patients with cloxacillin treatment. Patients on chronic dialysis or lacking creatinine measurements during treatment were excluded. AKI was defined as per the SNAP criteria. Long-term renal function was evaluated using follow-up creatinine values up to 12 months post-treatment.

Results: Of 275 included patients, 13.8% had pre-existing renal impairment. Cloxacillin doses in median were 8 g/24h (IQR 6-8). AKI occurred in 35 patients (12.8%), of which 26 had AKI stage 1, four had AKI stage 2 and five had AKI stage 3. AKI was associated with higher Pitt Bacteraemia Score, pre-existing renal disease and high-dose cloxacillin. Among survivors (n = 239), only four patients (1.3%) had verified persistent renal impairment at follow-up.

Conclusion: Compared to results from the SNAP trial, cloxacillin was associated with a lower incidence of AKI that was mostly mild and transient. Persistent renal impairment was rare. The data suggest that cloxacillin at lower dosing levels is less nephrotoxic and potentially safe to use.

Background: Superspreading persons (SSPs) drive marked heterogeneity in SARS-CoV-2 transmission, yet quantitative evidence on their determinants in community settings remains limited.

Objectives: To quantify the impact of SSPs and identify demographic, virologic, and contextual correlates of superspreading in Gangwon Province, Korea.

Methods: We analysed province-wide epidemiological investigation records for laboratory-confirmed COVID-19 from 21 February 2020 to 31 January 2022. Transmission networks linking index and secondary cases were reconstructed. Superspreaders were prespecified as individuals generating ≥7 secondary infections. Offspring counts were modelled with a negative binomial distribution; multivariable logistic regression estimated adjusted odds ratios for age, vaccination, symptoms at diagnosis, PCR cycle-threshold (Ct), occupation, exposure setting, and viral variant based on specimen date.

Results: Among 15,300 community-acquired cases, offspring counts followed a negative binomial distribution(κ = 0.36). Most cases generated ≤6 secondaries, whereas 164 cases (1.1%) met the superspreader criterion and accounted for 1,571 downstream infections (11.3%). Higher odds of superspreading were observed among ages 0-19 (aOR 1.86) and 40-59 (1.84), the unvaccinated (1.64), those symptomatic at diagnosis (2.13), individuals with Ct <16.0 (2.54) or 16.0-23.9 (2.15), white-collar workers (1.68), same-facility exposures (2.39), and cases with an unknown source of infection (3.91). Superspreading odds also varied across variant-dominant periods inferred from specimen dates, although confidence intervals included unity.

Conclusion: SARS-CoV-2 transmission in Gangwon was highly overdispersed, with a small minority of cases responsible for a disproportionate share of spread. Targeted vaccination, rapid isolation of symptomatic or low-Ct index cases, and strengthened controls in high-risk workplaces and shared facilities may help blunt future superspreading.

Background: Patients admitted with viral respiratory tract infections are at risk of bacterial co-infections, often requiring antibiotics. Standard bacterial cultures may take days to yield results, making early indicators of bacterial co-infection a potential asset.

Methods: In a retrospective regionwide cohort study, we included all patients admitted to a hospital in the Central Denmark Region with COVID-19, influenza, or respiratory syncytial virus (RSV) in the period February 2019 to February 2024. Further inclusion criteria were having a blood sample taken for procalcitonin measurement and blood cultures within 72 h of admission. We evaluated the diagnostic value of procalcitonin compared to other inflammatory markers.

Results: There were 1,670 patients fulfilling the inclusion criteria. The majority 1,556 (92.2%) were infected with SARS-CoV-2, 51 (3.7%) with influenza A, 1 (0.1%) with influenza B, 45 (2.7%) with RSV, and 17 (1.0%) with multiple viruses. Blood cultures were positive in 43 (2.6%) of the patients after a median of 67.4 h from time of admission. Median procalcitonin levels were higher in patients with bacteraemia (1.7 µg/L) than in patients without bacteraemia (0.2 µg/L. Overall, procalcitonin cut-off at >0.25 µg/L and >0.50 µg/L tended to have higher sensitivity, specificity, positive and negative predictive values than C-reactive protein (CRP) > 100 mg/L and total leukocyte count >10 × 10⁹ cells/L, although the numerical differences were small. Overall diagnostic performance for bacterial pneumonia was lower.

Conclusions: All biomarkers had relatively low sensitivity for bacteraemia and bacterial pneumonia in patients with viral respiratory tract infection.