Infectious diseases (London, England)最新文献

Background: Staphylococcus lugdunensis (SL) can cause infective endocarditis (IE), with unusually high complication and mortality rates. According to the 2023 Duke-ISCVID criteria, blood cultures positive for SL now count as a major microbiological criterion.

Objectives: Our aim was to determine the contemporary characteristics of SLIE, and to identify the factors associated with all-cause in-hospital mortality.

Methods: Patients with definite SLIE between 2010 and 2024 were included in a collaborative study involving 17 centres in France, Spain, Brazil, Italy, and Ireland.

Results: We collected data on 112 patients with definite SLIE. Mean age was 67 ± 18 years, and 76 (67.9%) were males. Nosocomial and healthcare-related non-nosocomial SLIE accounted for 15.2% and 16.1% of cases, respectively. Prosthetic valves and cardiac implantable electronic devices (CIED) were involved in 36.6% and 10.7% of cases, respectively. Emboli occurred in 50%, heart failure in 32%, acute kidney injury in 39.4%, and perivalvular abscesses in 20.5% of cases. All strains were methicillin susceptible. Valve surgery was performed in 47 (42%) and CIED removal in 10 (8.9%) patients. All-cause in-hospital mortality was 29.5%. Variables associated with mortality were age (OR 1.10 per one-year increment, 95%CI [1.08-1.31], p < 0.001), malignancy (OR 26.22, [3.78-181.72], p < 0.001), a new severe mitral regurgitation (OR 17.10, [2.81-104.09], p = 0.002), paravalvular abscess (OR 63.40, [6.24-644.03], p < 0.001), and new high-degree atrioventricular block (OR 27.76, [2.49-309.82], p = 0.007).

Conclusion: This international multicentre study confirms that SLIE mimics Staphylococcus aureus IE, particularly with regard to aggressiveness, healthcare-related acquisition, complications, and mortality. Of note, all SL isolates were methicillin-susceptible.

Background: The management of Acinetobacter baumannii infections has become increasingly challenging due to extensive antimicrobial resistance.

Objectives: This study evaluated the in vitro activity of cefiderocol and sulbactam-durlobactam and characterised OXA-type enzyme diversity in carbapenem-resistant A. baumannii isolates collected between March 2019 and December 2024.

Methods: A total of 159 unique carbapenem-resistant isolates were tested for susceptibility to cefiderocol and sulbactam-durlobactam using two Food and Drug Administration-cleared minimum inhibitory concentration (MIC) determination methods: the ComASP Cefiderocol panel (Liofilchem, Italy) for cefiderocol and Etest strips (bioMérieux, USA) for sulbactam-durlobactam. Carbapenemase genes, including bla_NDM, bla_KPC, bla_IMP, bla_VIM, bla_OXA-23, bla_OXA-24/40, bla_OXA-48, and bla_OXA-58, were detected using real-time PCR.

Results: Cefiderocol susceptibility was observed in 91.8% of isolates, with MIC₅₀ and MIC₉₀ values of 0.5 mg/L and 2 mg/L. Among bla_OXA-23-positive isolates, MIC₅₀ and MIC₉₀ values were also 0.5 mg/L and 2 mg/L, while bla_OXA-24/40-positive isolates showed MIC₅₀ and MIC₉₀ values of 0.25 mg/L and 1 mg/L, respectively. The sulbactam-durlobactam combination demonstrated potent in vitro activity against 97.5% of carbapenem-resistant Acinetobacter baumannii clinical isolates, with MIC₅₀ and MIC₉₀ values of 2 mg/L and 4 mg/L, respectively. Among the 159 carbapenem-resistant Acinetobacter baumannii isolates, 72.9% (n = 116) carried the bla_OXA-23 gene, 10.7% (n = 17) harboured bla_OXA-24/40, and 16.4% (n = 26) did not possess any of the carbapenemase genes included in the testing panel.

Conclusion: Cefiderocol and sulbactam-durlobactam exhibited strong in vitro activity against carbapenem-resistant A. baumannii isolates from a single University Hospital and may represent valuable treatment options for patients with limited therapeutic alternatives.

Background: Vibrio vulnificus is a foodborne and waterborne pathogen causing substantial morbidity and mortality; however, its epidemiology remains poorly understood. To inform prevention and control efforts, we characterized U.S. V. vulnificus epidemiology and identified risk factors for mortality.

Methods: For all culture-confirmed V. vulnificus cases reported to the Cholera and Other Vibrio Illness Surveillance (COVIS) system from 2000 to 2022, patient characteristics and medical outcomes were described by foodborne vs. non-foodborne transmission routes. Risk factors for mortality were identified using multivariate logistic regression.

Results: Two thousand nine hundred and eighty-nine V. vulnificus cases were reported from 2000 to 2022, including 656 (22%) foodborne and 1,619 (54%) non-foodborne cases. Five-year case total increased 70% from 2000-2004 (n = 487) to 2018-2022 (n = 827). Most patients were male, older and White, with reported underlying health conditions; 2,493 (83%) patients were hospitalized and 692 (23%) died. Number of deaths (260 vs. 200) and fatality rate (40% vs. 12%) were higher among foodborne vs. non-foodborne cases. Mortality was associated with history of liver disease/alcoholism (odds ratio (OR) = 6.5, p < 0.001), age 45-59 (OR = 11.3, p = 0.001), foodborne transmission (OR = 1.3, p = 0.006), and Black (OR = 1.8, p = 0.03) or Asian (OR = 2.5, p = 0.009) race. Antibiotic use was protective (OR = 0.33, p = 0.001). Liver disease associated with diabetes had lower mortality than other forms of liver disease (interaction OR = 0.5, p = 0.04).

Conclusions: V. vulnificus infections confer a substantial and increasing public health burden in the United States. Non-foodborne transmission caused 2.5 times more cases, and foodborne transmission caused 30% more deaths and had >3 times higher fatality rate. Identifying risk factors for mortality can inform public health and medical interventions.

Background: Extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are an increasing cause of pneumonia in critically ill patients. Current guidelines recommend 7 days of antibiotic therapy for hospital-acquired and ventilator-associated pneumonia, but evidence specific to ESBL-E pneumonia is limited.

Objective: This study aims to compare the clinical outcomes of short versus long antibiotic treatment duration in critically ill patients with pneumonia caused by ESBL-E.

Methods: This retrospective cohort study included adults admitted to an intensive care unit with pneumonia caused by ESBL-E between January 2019 and August 2024. Patients were categorised into short-duration (≤7 days) or long-duration (>7 days) antibiotic therapy groups. Logistic regression was used to evaluate the primary outcome of clinical cure.

Results: A total of 121 patients were included (64 short-duration, 57 long-duration). Clinical cure was achieved in 56.3% vs. 38.6% (p = 0.052) in unadjusted analysis. In the adjusted multivariable model, treatment duration was not significantly associated with clinical cure (OR 0.403; 95% CI 0.126-1.288; p = 0.125). Treatment failure occurred in 50.0% vs. 68.4% (p = 0.040), and microbiologic cure in 78.1% vs. 59.7% (p = 0.028). Median hospital length of stay was shorter with short-duration therapy (20.5 vs. 38.1 days, p < 0.001). Recurrence, all-cause mortality, ICU length of stay, mechanical ventilation, and antibiotic-free days were not significantly different. Multidrug-resistant organisms developed in 7.8% vs. 14.0% (p = 0.270).

Conclusions: Short-duration antibiotic therapy for pneumonia caused by ESBL-E in critically ill patients showed no difference in clinical cure compared to long-duration therapy. Further studies are needed to determine the effect of antibiotic duration on clinical outcomes.

Background: Although the acute phase of the COVID-19 pandemic has subsided, long COVID remains a significant and ongoing public health concern. Persistent symptoms continue to affect a substantial proportion of COVID-19 survivors, increasing healthcare burden.

Objective: This study aims to identify the determinants of long-term symptom trajectories following COVID-19 infection.

Methods: We conducted a prospective cohort study of 1666 adults discharged after hospitalisation for COVID-19 in Tuscany, Italy. The presence of mental confusion, exertional dyspnoea, fatigue, and insomnia was assessed at 1, 3, 6, 9, and 12 months post-discharge. The mean hospital stay was 13.6 (±12) days and 131 patients required intensive care unit admissions. Latent growth curve models were used to examine the baseline prevalence and longitudinal trajectories of each symptom, and to identify demographic and clinical factors associated with symptom persistence.

Results: Fatigue was the most common persistent symptom at baseline, followed by exertional dyspnoea, insomnia, and mental confusion. Female sex was consistently associated with both baseline presence and persistence of all symptoms. Older age was linked to baseline mental confusion and to persistent dyspnoea and fatigue. Markers of greater acute severity (ICU admission, longer hospital stay, higher WHO score) were associated with symptom improvement over time. Pre-existing coronary heart disease and cancer independently predicted persistent dyspnoea and fatigue, whereas hypertension appeared protective.

Conclusions: Persistent symptoms are common after COVID-19 and vary by sex, age, comorbidities, and acute disease features. Symptoms may persist up to 12 months post-hospitalisation, underscoring the need for long-term follow-up and targeted interventions.

Background: Immune checkpoint inhibitors (ICIs) modulate host immunity and may increase infection risk. The pathogen profile, outcomes, and predictors of bloodstream infections (BSIs) in ICI recipients are not well defined; we aimed to characterise these features and identify independent risk factors.

Methods: We performed a retrospective nested case-control study within a cohort of 2,584 adult cancer patients who received ICIs at a tertiary centre from January 2018 to December 2023. We identified 185 BSI cases occurring during or within 90 days after the last ICI dose and matched each case 1:2 to infection-free controls by cancer type, ICI agent, and time at risk. Demographics, comorbidities, cancer and treatment details, laboratory values, concomitant medications, and outcomes were extracted and analysed using conditional logistic regression.

Results: Cases (median age 62 years; 65.4% male) had predominance of gram-positive organisms (54.1%), led by Staphylococcus aureus (18.4%) and Enterococcus spp. (12.4%); gram-negatives comprised 37.8% with Escherichia coli being the most frequent (15.1%), and opportunistic pathogens (Listeria, Candida) made up 8.1%. Multivariable analysis identified prior corticosteroid use ≥14 days (prednisone equivalent ≥10 mg/day for ≥14 days; adjusted odds ratio [aOR], 4.12; 95% CI, 2.58-6.59; p < 0.001), proton pump inhibitor use (aOR 2.05; 95% CI 1.31-3.22), and baseline absolute lymphocyte count <1.0 × 10^9/L (aOR 2.33; 95% CI 1.48-3.68) as independent predictors. All-cause 30-day mortality among cases was 24.9%.

Conclusion: BSIs in ICI-treated patients involve a broad pathogen spectrum, including opportunists and are associated with substantial mortality; corticosteroid exposure, PPI use, and lymphopenia identify high-risk patients who may benefit from targeted surveillance and preventive strategies.

Background: Spinal epidural abscess (SEA) is a serious complication of Staphylococcus aureus bacteraemia (SAB) that can be difficult to diagnose. We aimed to describe the proportion of SAB cases with SEA and evaluate useful history or physical exam findings to help diagnose SEA.

Methods: This single-centre retrospective cohort study included consecutive SAB patients from 2021 to 2023. The index tests included risk factors, symptoms and signs of SEA as documented in patient charts. The reference standard was diagnosis of SEA based on spinal MRI or intra-operative finding during 90-day follow-up.

Results: Of 357 SAB patients, 29 (8.1%) patients had a SEA. Saddle anaesthesia, radicular pain, numbness or paresthaesia, and spine tenderness were most useful to rule in SEA based on positive likelihood ratio (PLR) of 22.6, 13.8, 9.9 and 7.5 respectively. Absence of acute back pain, no objective limb weakness, no subjective limb weakness and no spine tenderness were most useful to rule out SEA based on negative likelihood ratio (NLR) of 0.19, 0.46, 0.57, and 0.62 respectively. A clinical prediction rule based on these findings had a sensitivity of 97% (95% CI 83%-100%), specificity of 77% (95% CI 73%-82%), PLR of 4.3 (95% CI 3.5-5.3) and NLR of 0.05 (95% CI 0.01-0.31).

Conclusions: All SAB patients should undergo systematic neurologic evaluation for SEA as we found SEA is not an uncommon complication of SAB. A clinical prediction rule may be helpful to identify high-risk patients needing an urgent spinal MRI to assess for SEA.