Infectious diseases (London, England)最新文献

Background: Pneumonia is a major cause of morbidity and mortality, yet causative organisms are rarely identified. Metagenomic next-generation sequencing (mNGS) may improve this, however the impact on outcomes is uncertain and the relative utility in pneumonia subtypes or different clinical samples is unclear.

Methods: This systematic review compared mNGS with conventional microbiology, assessing pathogen identification, turnaround time and clinical impact. It also reviewed difference related to the pneumonia subtype, or sample used. We searched EMBASE, MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) for studies comparing mNGS with conventional microbiology, in patients with pneumonia. All study types were included (excluding case reports of <10 people). Eligibility assessment and data extraction was performed by two independent reviewers, and risk of bias assessed using the QUADAS-2.

Results: We identified 74 studies including 10,566 people, with all studies having high risk of bias or applicability concerns in at least one domain. Conventional tests identified a pathogen in 43.2% of cases (3559/8229) compared to 78.9% for mNGS (6242/7980). mNGS had faster turnaround times than conventional microbiology (MD -73.6h, CI-111.36 - -35.73 hrs) but meta-analysis was not possible for other outcomes. Most studies did not specify the pneumonia subtype. 92%of studies used exclusively or predominantly bronchoalveolar lavage fluid (BALF), and the utility of other sample types could not be established.

Conclusions: mNGS may identify possible pathogens with greater frequency than standard techniques although bias in study design limits definite conclusions, and the clinical relevance of this remains unresolved. There is a need for studies assessing clinical outcomes, and the differential impact in pneumonia subtypes and in samples other than BALF.

In May 2024 with a subsequent update in June 2025, the Swedish Medical Products Agency's expert group revised guidelines on the management and treatment of respiratory syncytial virus (RSV) infection. This is an abridged version and commentary on the full recommendation including specific recommendations for the RSV-season 2025/2026. Key points are: (i) RSV is a seasonal, highly contagious infection. Almost all children are infected by age two, usually with mild illness; (ii) Some infants, children with underlying conditions, and frail elderly are at risk for developing severe disease requiring hospital care; (iii) Preventive measures-such as hand hygiene and avoiding contact with people with colds-are essential to protect infants and the elderly; (iv) Prophylactic treatment with monoclonal antibodies reduces the risk of infants developing severe RSV disease and requiring hospital care. The long-acting drug nirsevimab is preferred over the shorter-acting palivizumab; (v) Universal prophylaxis in infants reduce disease burden for both families and society; (vi) If supply is limited, children at highest risk should be prioritised for prophylaxis; (vii) Maternal vaccination during pregnancy lowers the risk of severe RSV in newborns, decreasing hospital admissions. The protective effect is considered to be equivalent to that of monoclonal antibodies. Recommendations and funding decision for maternal vaccination is under investigation during the autumn of 2025; (viii) In the elderly, vaccination is the most effective pharmacological prevention; (ix) There is no effective antiviral treatment for established RSV disease; management is symptomatic and supportive. Hospitalised children should not be subjected to measures with no proven effect, preferable minimal interventions, with treatment focused on ensuring adequate nutrition; (x) The Swedish recommendations state that during the RSV season 2025/2026, nirsevimab should be administered to prevent RSV infection in all infants aged 0-3 months during the RSV season and to infants under 12 months with increased risk of severe RSV and certain high risk children under 24 months.

Background: Cutibacterium acnes is a cause of implant-associated infections, often co-occurring with methicillin-susceptible Staphylococcus aureus (MSSA), especially in orthopedic settings. In Scandinavia, cloxacillin may be used as initial empiric intravenous treatment if MSSA implant-associated infection is suspected. Clinical breakpoints for C. acnes susceptibility to cloxacillin or other isoxazolyl-penicillins are lacking to guide therapy if C. acnes is subsequently cultured after empiric cloxacillin therapy has been initiated.

Objective: We aimed to compare MIC distributions of C.acnes to benzylpenicillin and cloxacillin. Furthermore, we investigated if the gradient test is a reliable method for determining cloxacillin susceptibility in clinical C. acnes isolates in order to manage mixed infections in orthopedic settings.

Methods: We evaluated the in vitro susceptibility of 39 clinical C. acnes isolates to benzylpenicillin and cloxacillin using gradient tests and validated cloxacillin MICs by agar dilution.

Results: All isolates were susceptible to benzylpenicillin (MIC ≤0.064 mg/L) and cloxacillin (MIC ≤0.5 mg/L), with MIC₅₀ values of 0.016 mg/L and 0.125 mg/L, respectively. The cloxacillin MIC distribution for C. acnes closely resembled that of S. aureus, suggesting that susceptibility to cloxacillin may be inferred from benzylpenicillin susceptibility. Gradient test results for cloxacillin showed high agreement with agar dilution (essential agreement 0.87), supporting its use as a practical alternative to agar dilution cloxacillin MIC determination if susceptibility testing is necessary.

Conclusion: Our findings indicate that intravenous cloxacillin is an effective treatment of C. acnes infections, and that cloxacillin gradient testing is a convenient and reliable alternative for MIC determination for clinical laboratories.

Objectives: SKYVaricella^TM, a live attenuated varicella vaccine product, is known to increase the risk of herpes zoster (HZ) in vaccinated children. We investigated the impact of introducing the vaccine on HZ incidence in Korea since 2018.

Methods: This ecological study used medical records from the Health Insurance Review and Assessment Service in Korea. We present data on HZ incidence trend in children (<10 years) from 2010 to 2024. A change in HZ incidence trend was evaluated using linear regression analysis, with vaccine introduction as an interaction term. We then calculated the number of excess HZ cases due to the vaccine introduction in Korea.

Results: HZ incidence in children <10 years presented a downward trend that continuously declined from 2010 to 2018. This downward trend was reversed to an upward trend in children <5 years, whereas the decreasing trend in children aged 5-9 years continued after 2019. The change in trend in children <5 years in 2019 was statistically significant (p < 0.001). There were 6,484 excess HZ cases in children <5 years from January 2019 to June 2024.

Conclusions: The vaccine introduction has resulted in a large-scale ongoing HZ outbreak in children in Korea. More studies are needed to assess the long-term impact of the vaccine on HZ incidence in vaccinated individuals.

Background: Salmonella infections are a major cause of human illness in the United States. Salmonella enterica serotype Infantis has re-emerged as a leading serotype with the emergence of a multidrug-resistant S. Infantis strain, designated as REPJFX01 by the Centers for Disease Control and Prevention (CDC). REPJFX01, which typically contains a megaplasmid of emerging Salmonella Infantis (pESI) harbouring multiple resistance genes and a chromosomal gyrA87 mutation conferring decreased susceptibility to ciprofloxacin, has caused human infections linked to chicken consumption.

Objective: The study aimed to describe the epidemiology and antimicrobial resistance of human S. Infantis infections, including the emergence of REPJFX01, in the United States.

Methods: The study used data from five CDC surveillance systems, with combined years from 1979 through 2022. Negative binomial and logistic regression models were used in the multivariable analyses of surveillance data.

Results: In 10 active surveillance sites, the mean annual incidence of human S. Infantis infections was twice as high during 2013-2022 vs. 2003-2012 (adjusted rate ratio = 1.96, 95% CI 1.75-2.20). REPJFX01 infections accounted for nearly one-third of S. Infantis infections during 2018-2022 (vs. 2013-2017, adjusted odds ratio = 2.09, 95% CI 1.56-2.79). Salmonella Infantis infections were more likely among persons who were ≥45 years old, female, from racial and ethnic minority groups, and had Salmonella isolated from urine, than infections with other common serotypes.

Conclusion: The increase in S. Infantis infections during 2013-2022 was likely driven by an increase in REPJFX01 infections. Public health strategies to reduce Salmonella contamination of chicken could help prevent human infections.

Background: Staphylococcus aureus is the second most common cause of brain abscesses, but only few studies describe the disease characteristics.

Objectives: This study aimed to characterise the clinical features and outcomes of S. aureus brain abscess.

Methods: We identified all adults with a brain abscess caused by S. aureus in Denmark between 2007 and 2024, and at the Amsterdam UMC from 2016 to 2024. Unfavourable outcome was defined as Glasgow Outcome Scale scores of 1-4. Modified Poisson regression was used to assess relative risks (RR) with 95% confidence intervals (CI) for an unfavourable outcome.

Results: A total of 56 patients were identified with a median age of 59 years (interquartile range [IQR] 39-70), and 31/56 (55%) were male. Abscesses were mainly located in the frontal lobes (35/56, [63%]) and were due to head trauma or neurosurgery in 27/56 (48%). Patients with non-traumatic abscesses had predisposing otitis media or sinusitis in 9/29 (31%), whereas another 9/29 (31%) had endocarditis. Polymicrobial brain abscesses (Streptococcal species, anaerobic, and skin-colonising bacteria) were observed in 14/56 (25%) among whom 5/14 (36%) were post-traumatic and 9/14 (64%) were non-traumatic. Mortality at six months after discharge was 5/56 (9%), and 20/47 (43%) had an unfavourable outcome. The adjusted RR of an unfavourable outcome was 2.6 (95% CI 1.3-5.1) for post-traumatic abscess compared with non-traumatic S. aureus brain abscess.

Conclusions: Staphylococcus aureus brain abscess frequently involved the frontal lobes and a quarter were polymicrobial. Poor outcomes were common, especially among patients with post-traumatic abscesses.

Background: Piperacillin/tazobactam is frequently used empirically in patients subsequently diagnosed with bloodstream infections (BSIs) due to extended-spectrum β-lactamase (ESBL) Enterobacterales, yet its effectiveness remains uncertain.

Objective: This study aimed to compare piperacillin/tazobactam with carbapenems as empirical therapy for BSIs caused by ESBL-Enterobacterales.

Methods: A single-centre retrospective study was conducted at Niguarda Hospital in Milan,Italy, enrolling consecutive patients with BSIs caused by ESBL-Enterobacterales treated empirically with either piperacillin/tazobactam or carbapenems from January 2015 to December 2023. The primary outcome was in-hospital all-cause mortality. Propensity Score Matching(PSM) was employed to mitigate potential confounding factors when assessing the association between empirical therapy and mortality. A sensitivity analysis was performed to determine the role of definitive piperacillin/tazobactam or carbapenems on patient outcomes.

Results: A total of 264 patients were included in the study, median age was 72[64-81], 64% were males, 66% had sepsis and 17% septic shock. Among them, 200(76%) received empirical piperacillin/tazobactam and 64(24%) received carbapenems. After PSM adjustment, baseline characteristics were well balanced between the groups. Patients who received empirical piperacillin/tazobactam had a higher in-hospital mortality compared to those receiving empirical carbapenems (14.3% vs 3.5%, adjusted Risk Difference: 10%;95%CI: 2-19%). No difference in in-hospital mortality was observed when comparing definitive piperacillin/tazobactam to definitive carbapenems (6% vs 9%, Risk Difference: -2.5%; 95%CI: -9.2 - 4.2).

Conclusion: Empirical piperacillin/tazobactam may be associated with higher mortality compared tocarbapenemswhen treating patients with BSI due to ESBL-Enterobacterales. Further larger studies are needed to confirm the results andto identify specific scenarios in which piperacillin/tazobactam may be safely used.

Introduction: Infections, particularly sepsis, require rapid initiation of empirical antibiotic therapy. Delays or inadequacies in therapy can significantly increase patient morbidity, mortality and length of stay (LOS). This systematic review and meta-analysis aimed to evaluate the impact of adequate versus inadequate empirical antibiotic therapy on LOS.

Methods: A comprehensive search was conducted in EMBASE, Cochrane Library, Web of Science and MEDLINE for studies published between 2012 and 2024. Studies involving adult hospitalised patients with infections, assessment of antimicrobial adequacy based on microbiological cultures and LOS data were included. Statistical analysis was performed using Review Manager 5.3, with LOS treated as a continuous variable and outcomes assessed through mean difference and 95% confidence intervals (CIs).

Results: Thirteen studies with a total of 4158 participants met the inclusion criteria. The mean LOS for patients receiving adequate therapy was significantly lower than for those receiving inadequate therapy (mean difference -1.17 days; 95% CI: -1.40, -0.94). When pooling data from all included studies and weighting by sample size, the overall mean LOS for patients receiving adequate empirical antimicrobial therapy was 12.5 days, compared to 28.5 days among those receiving inadequate therapy. Additionally, adequate therapy resulted in a reduced ICU LOS by -0.89 days (95% CI: -1.22, -0.57).

Conclusion: Adequate antimicrobial therapy significantly reduces LOS in hospitalised patients with infections.

Background: Avian influenza A viruses (AIVs) remain a global public health concern. Sporadic human infections continue to be reported, particularly in areas with frequent human-poultry contact. We report four cases of human infection with AIVs in Zhejiang Province that occurred between December 2021 and January 2024.

Method: Epidemiological investigations were carried out to collect detailed demographic information, underlying diseases, symptoms, hospital admission details, recent exposures to domestic poultry or wild birds, recent visit to wet markets. Samples from patients and their related environments as well as contacts were collected and detected. Epidemiological sources were also traced based on patient's exposure history 10 days before symptom onset.

Results: The reported cases included two women aged 51 and 55 diagnosed with H5N6 infection in December 2021, a 33-year-old man identified in June 2022 as the first H10N3 case in Zhejiang Province and the second globally, and a 63-year-old woman from Anhui Province who became the world's first documented case of coinfection with H10N5 and H3N2.All patients had a history of unprotected exposure to infected or contaminated poultry, primarily during cleaning and handling processes. Three of the patients responded well to antiviral treatment and recovered, whereas the patient with H10N5 coinfection died due to disease progression. Genomic analyses confirmed that all infections were AIVs, with no evidence of sustained human-to-human transmission.

Conclusion: These cases highlight the continued risk of AIVs spill-over into humans and emphasise the need for strengthened surveillance, improved poultry-handling protocols, and early detection to prevent future outbreaks.