Infectious diseases (London, England)最新文献

Background: India relies primarily on direct smear microscopy for tuberculosis (TB) diagnosis. However, the low sensitivity of smear microscopy emphasizes the need to improve its performance. We recently described the development of 'TBDetect' kit which showed improved performance over direct smear microscopy at National Reference Laboratories (NRLs) in India.

Methods: The present study was aimed to assess the operational feasibility of 'TBDetect' microscopy in field settings. This was evaluated by (i) assessing the performance of 'TBDetect' microscopy vs. LED-fluorescence microscopy (LED-FM) on consecutive presumptive pulmonary TB patients (n = 5300) who attended Designated Microscopy Centres (DMCs, n = 13) under 4 NRLs at Bhubaneswar, Bhopal, Chennai, and New Delhi, and (ii) obtaining feedback from Scientists (n = 10) and laboratory technicians (n = 42) using semi-structured questionnaires under the following parameters: feasibility of initiation of 'TBDetect' microscopy in DMCs, sample preparation and testing, training, time-to-result, logistics, and troubleshooting. A scoring questionnaire was also used to assess 'TBDetect' microscopy vs. LED-FM and statistical significance of the scores was calculated using paired t-test.

Results: The overall positivity of 'TBDetect' microscopy was 10.32% (547/5300) vs. 8.96% (475/5300) of LED-FM at all sites and the increment in positivity was significant (p = 0.019). In addition, 'TBDetect' microscopy yielded an increment in smear grade status over LED-FM (p = 0.043). The feedback from the study-in-charge and kit users indicated that 'TBDetect' microscopy was easily adapted in point-of-care settings. An analysis of scoring feedback suggested that it was easy to perform and observe in comparison to LED-FM (p < 0.005).

Conclusions: This study established the feasibility of 'TBDetect' microscopy in field settings.

Background: Klebsiella pneumoniae (KP) accounts for high antimicrobial resistance and mortality rates of bloodstream infections (BSIs).

Objectives: To investigate incidence, antimicrobial resistance and risk factors for mortality of KP BSIs in East China.

Methods: A retrospective study of patients with KP BSIs was conducted in a tertiary care hospital from 2018 to 2022. Medical records of all hospitalised patients with KP BSIs were reviewed and analysed. The incidence, antimicrobial resistance and mortality of KP BSIs were evaluated. The Kaplan-Meier method was used to plot survival curves and logistic regression was used to analyse risk factors for crude 30-day mortality.

Results: A total of 379 inpatients with KP BSIs were enrolled. The incidence of patients with KP BSIs was fluctuating between 4.77 and 9.40 per 100,000 patient-days. The crude 30-day mortality rate of these patients was 26.39%. Of the 379 KPisolates, 197 (51.98%) were carbapenem-resistant (CR) and 252 (66.49%) were multidrug-resistant (MDR). All isolates showed the lowest resistance to tigecycline (13.77%) and polymyxin B (14.61%). Cases with MDR/CR isolates had significantly longer length of hospital stay, higher crude 30-day mortality and medical costs than non-MDR/non-CR isolates. Age, CR phenotype, paracentesis, indwelling central venous catheter (CVC), use of carbapenems, tetracyclines, polymyxins B, and irrational empiric treatment were independently associated with crude 30-day mortality.

Conclusion: MDR/CR KP BSIs are associated with increased mortality, healthcare costs and prolonged hospitalisation. Patients with advanced age, CR phenotype, paracentesis, CVC, exposure to some antibiotics, and irrational empirical antibiotic treatment are at higher mortality risk.

Background: The 2023 Duke-ISCVID and 2023 ESC classifications have recently issued independent diagnostic criteria for infective endocarditis (IE), updating the 2015 ESC criteria.

Objectives: The specificity of the 2023 ESC criteria should be evaluated and compared to the two other classifications in IE suspected patients.

Methods: We retrospectively collected the characteristics of patients hospitalised in Bichat University Hospital, in 2021, who had been evaluated for suspicion of IE, and in whom IE diagnosis was finally rejected. All were classified by 2015 ESC, 2023 Duke-ISCVID, and 2023 ESC.

Results: In total 130 patients were analysed. Mean age was 62 years, 64.6% were male, 30.0% had prosthetic cardiac valve or valve repair, 16.2% had cardiac implanted electronic device, and 23.1% other cardiac conditions. Overall, 2, 5 and 5 patients were falsely classified as definite IE with the 2015 ESC, 2023 Duke-ISCVID and 2023 ESC criteria, respectively. The corresponding specificities were 99% (95% CI [94%; 100%], 96% (95% CI [91%; 99%]), and 96% (95% CI [91%; 99%]).

Conclusion: The 2023 ESC and the 2023 Duke-ISCVID criteria are highly specific, although slightly less than the 2015 ESC criteria, for ruling out the diagnosis of definite IE.HIGHLIGHTS2023 Duke-ISCVID and 2023 ESC criteria are recently issued diagnostic classifications2023 ESC criteria have an excellent specificity, equivalent to the 2023 Duke-ISCVID one2023 ESC criteria and the 2023 Duke-ISCVID are less specific than the 2015 ESC criteriaSpecificities were quite similar according to the nature of the cardiac valve (native or prosthetic valve) or the duration of antibiotic therapy.

Background: There is limited recent evidence about infective endocarditis (IE) in HIV-infected patients. Our aim was to compare IE according to HIV infection presence.

Methods: Consecutive inclusion of IE patients at 46 Spanish hospitals between 2008 and 2021.

Results: From 5667 patients, 99 were HIV-infected (1·7%; 50 intravenous drugs users). Compared to patients without HIV, HIV-infected patients were more frequently male (84% vs. 67%), had younger median age (46 vs. 69 years), and less comorbidities, except liver disease (52% vs. 9%) and intravenous drug use (51% vs. 1%). They had more common tricuspid location (36% vs. 5%) and community-acquired IE (82% vs. 63%), vascular (29% vs. 17%) and cutaneous (22% vs. 7%) foci of infection, and Staphylococcus aureus aetiology (46% vs. 22%). Vegetations (84% vs. 72%), vascular phenomena (17% vs. 9%), splenomegaly (30% vs. 11%), and embolisation (41% vs 21%) were also more common. Surgical indication and surgery were less frequent in HIV-infected patients (54% vs 67%, 28% vs 47%, respectively). Median CD4 count in HIV-infected patients was 318 cells/mm³. In-hospital mortality (23% vs. 26%) and one-year mortality (25% vs. 32%) were similar in both groups. HIV infection was not independently associated with in-hospital (odds ratio 1·1, 95% CI 0·6-1·9) nor one-year mortality (hazard ratio 0·8, 95% CI 0·4-1·3).

Conclusions: In the combined antiretroviral therapy era, less than 2% of IE patients have HIV infection. HIV-infected patients have a different clinical profile than those without HIV, but the presence of HIV does not seem to impact on IE prognosis.

Background: It is uncertain whether the Centor criteria can be reliably assessed during telemedicine encounters with patients seeking care for a sore throat. Acquiring this knowledge is important as sore throat is a common reason for telemedicine consultations.

Objectives: primary objective: To compare the inter-rater reliability of Centor score assessments via telemedicine versus in-person examinations. Secondary objectives: To investigate whether the interrater reliability varies when assessing patients who are children versus adults, and whether the telemedicine physician considered conditions for assessment as adequate.

Methods: A cross-sectional study in which each patient initially underwent a telemedicine evaluation, followed by an in-person assessment conducted by an independent physician who was kept unaware of the outcome of the initial evaluation. Agreement between both assessments was measured using Cohen's kappa coefficient.

Results: During 2020-2023 189 patients with a mean age of 31 years (SD 18) were included. Among them, 114 were female and 148 adults. Agreement was low with kappa between 0.47(95% CI 0.38 - 0.56) to 0.58 (95% CI 0.43-0.72) when comparing assessments of lymph nodes, tonsils and the total Centor score. Kappa was potentially acceptable for history of fever and absence of cough. Subgrouping participants into children and adults did not affect kappa of the total Centor score.

Conclusion: Telemedicine examination in patients with an acute sore throat is not reliable for assessing Centor criteria.

Background: We studied the duration of HPV detection and risk of (re-) detection for 25 HPV genotypes in a cohort of 132 women followed every eight weeks for up to two years between 2016 and 2020. Participants were between 18 and 25 years old at inclusion and half of them were vaccinated against HPV. They were recruited near the University and the STI detection centre in Montpellier, France.

Methods: We used genotype-specific longitudinal data to characterise the dynamics of HPV-detected episodes. We investigated the contribution of viral and host factors to the variations in the duration of HPV detection, and the time before (re-)detection of the same genotype using multivariate Cox regression models with frailty at the patient level.

Findings: We detected at least one HPV episode in 74% of the participants and re-detected the same genotype in 47% of them. Covariates related to socio-economic difficulties were associated with a lower risk of detectability loss (hazard ratio 0.45 with a 95% confidence interval, CI, from 0.21 to 0.97). The number of lifetime sexual partners was strongly associated with an increased risk of new positive detection (hazard ratio 2.40 with a 95%CI from 1.07 to 5.39). In contrast, vaccination was associated with a lower risk of displaying incident infections (hazard ratio of 0.64 with a 95%CI from 0.43 to 0.96).

Conclusion: In the short term, vaccination shows clear signs of protection against new HPV detections, including for some genotypes not targeted by the vaccine, such as HPV31 and HPV51.

Background: Throat carriage of methicillin-resistant Staphylococcus aureus (MRSA) has previously been associated with lower decolonisation treatment success rates.

Objectives: To characterise decolonisation treatment and outcome in Danish MRSA throat carriers.

Methods: This retrospective population-based cohort study included MRSA throat carriers between July, 2018 and June, 2019, in the Capital Region of Denmark. Logistic regression analysis was performed to assess variables associated with becoming MRSA free.

Results: Of 178 patients included, 129 (72%) were MRSA free by the end of the study. Overall, 78 (44%) of patients became MRSA free following a treatment attempt. Twenty-six (15%) patients became MRSA free without treatment and 25 (14%) became MRSA free unrelated to a treatment attempt. The success rate of the first decolonisation treatment, mainly nasal mupirocin and chlorhexidine body wash, was 23%. Systemic clindamycin was given in 52 cases and had a success rate of 52%. Logistic regression showed that residing in a household with three to four additional MRSA carriers was negatively associated with becoming MRSA free, although not significant after adjustment. Having MRSA in a clinical sample prior to decolonisation was associated with a lower chance of becoming MRSA free after adjustment. Topical decolonisation treatment was associated with a lower probability of becoming MRSA free.

Conclusion: In this Danish cohort of MRSA throat carriers, the overall success rate of decolonisation treatment was 44% and for systemic clindamycin 52%. A higher number of household MRSA carriers and a previous clinical MRSA infection were associated with a lower chance of becoming MRSA free.

Background: Bacteroides fragilis group species are the most frequently encountered bacteria involved in anaerobic bacteraemia and associated with high mortality rates. In 2012, we performed the first national study of antimicrobial susceptibility in the B. fragilis group from blood cultures in Denmark.

Objectives: The purpose of the present study was to compare the antimicrobial susceptibility rates of piperacillin-tazobactam, meropenem, clindamycin and metronidazole in the B. fragilis group from blood cultures in Denmark in 2022 with susceptibility rates from 2012. In addition, we wanted to investigate whether changes to susceptibility was related to the overall use of the specified antimicrobial agents from 2012 to 2022.

Methods: Antimicrobial susceptibility testing was performed in accordance with EUCAST guidelines using the agar dilution method and the disc diffusion method.

Results: The study showed a seemingly considerable increase in resistance in the B. fragilis group (n = 234) to piperacillin-tazobactam from a reported 8.5% in 2012 to 42.7% in 2022. Resistance towards meropenem also increased from a reported 3.4% to 10.7%. Most of the increase in resistance for piperacillin-tazobactam and meropenem is caused by a recent EUCAST breakpoint change. Metronidazole still has the lowest resistance rate for the B. fragilis group (one isolate, 0.4%) in this study. The sales of piperacillin-tazobactam in the same period revealed a corresponding increase (+130%), whereas meropenem sales were stable.

Conclusion: The results underscore the need for timely routine antimicrobial susceptibility testing of B. fragilis group species and questions piperacillin-tazobactam monotherapy as empiric treatment for septic patients with a suspected abdominal source.

Background: Usutu virus (USUV) and West Nile virus (WNV) are zoonotic arthropod-borne orthoflaviviruses. The enzootic transmission cycles of both include Culex mosquitoes as vectors and birds as amplifying hosts. For more than 10 years, these viruses have been monitored in birds in Germany by a multidisciplinary network. While USUV is present nationwide, WNV used to be restricted to the central-east.

Methods: In 2021 and 2022, over 2300 live bird blood samples and organs from over 3000 deceased birds were subjected to molecular and serological analysis regarding the presence of WNV and USUV. The samples were collected at sites all over Germany.

Results: Circulation of both viruses increased in 2022. For USUV, the nationwide presence of lineages Africa 3 and Europe 3 reported in previous years was confirmed. Lineage Europe 2, formerly restricted to the German east, was able to expand westward. Nonetheless, USUV neutralizing antibody (nAb) detection rates remained low (< 9%). Years 2021 and 2022 were characterized by stable enzootic circulation of WNV lineage 2, dominated by one previously identified subcluster (95% of generated sequences). In 2022, >20% of birds in the endemic region in eastern Germany carried nAb against WNV. Serological data also indicate expanding WNV circulation west and south of the known hotspots in Germany.

Conclusions: USUV circulates enzootically nationwide. Emergence of WNV at several new locations in Germany with a potential increase in human infections may be imminent. In this context, wild bird monitoring serves as a capable early warning system in a One Health setting.

Background: Urinary tract infections (UTIs) are prevalent among patients carrying indwelling catheters in the intensive care unit (ICU). This study investigates antibiotic use and bacterial colonisation among ICU patients during the third wave of the COVID-19 pandemic, building on our prior discovery of increased Enterococcus colonisation associated with increased cephalosporin use in early COVID-19.

Methods: Longitudinal urine samples from COVID-19 patients (n = 109) with transurethral catheterisation were analysed for bacterial prevalence, further identified via MALDI-TOF. Microbiological results were combined with clinical data obtained daily, assessed and compared with COVID-19 waves 1 and 2.

Results: Patients in wave 3 exhibited improved outcomes compared to those in waves 1 and 2, alongside a decrease in antibiotic use. Staphylococcus emerged as the primary bacterium and early colonizer of the urinary tract, potentially due to the absence of antibiotic treatment. Our results imply that length of stay (LOS) correlates solely with enteric pathogens and that antibiotic treatment correlates with colonisation by certain uropathogens, whereas the absence of antimicrobial therapy is associated with rapid colonisation of skin flora. Polymicrobial colonisation was common, predominantly involving Gram-positive bacteria.

Conclusion: Our findings underscore the complexity of bacteriuria in ICU patients, advocating for targeted surveillance and tailored antibiotic approaches to mitigate UTI risk. Insights into antibiotic use and bacterial colonisation are vital for optimising stewardship practices, combating antimicrobial resistance, and enhancing ICU patient outcomes.