Infectious diseases (London, England)最新文献

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.

Background: When chest tube drainage does not adequately resolve thoracic empyema, video assisted thoracoscopic surgery (VATS) is often needed. However, the proper duration of antibiotics after VATS is poorly defined. Consequently, the objective of this study was to evaluate if short antibiotic durations post-VATS was equally effective compared to longer durations.

Methods: Patients with thoracic empyema treated with VATS were identified retrospectively by a query of the hospital billing database. The bacterial causes of the empyema were divided into 8 different categories while the antibiotic duration after VATS was divided into two groups which included antibiotics ˂ 14 days and antibiotics >14 days. The primary outcome measured was rates of empyema recurrence. Statistical comparisons were conducted between the antibiotic duration groups overall and when stratified based on the different bacterial causes.

Results: 137 patients were included in this study with the main cause of empyema being culture negative empyema (37.2%) while alpha haemolytic Streptococcus spp. was the most cultured bacteria (26.3%). There was no statistical difference (p = 0.5168), in the rates of empyema recurrence, when short antibiotic durations (median 11.6 days)were compared to longer antibiotic durations (median 29.1 days)post-VATS. Nor was there a statistical difference in recurrence rates when stratifying based on bacterial cause.

Conclusion: This study reinforces that antibiotic durations less than 14 days post-VATS are equally effective as prolonged antibiotic durations. However, to determine the proper duration of antibiotic therapy post-VATS, a prospective clinical trial is needed to reduce complications of prolonged antibiotic therapies for these patients.

Objective: Our objective was to assess trends in three sexually transmitted infections (STIs) - gonorrhoea, chlamydia and syphilis - in Spain, by age group and sex from 2016 to 2022.

Study design: Retrospective observational study.

Methods: Data from epidemiological surveillance system were used to calculate the incidence rate for each STIs by age group and sex. Poisson regression was employed to examine the trends for 2016 to 2022.

Results: For gonorrhoea, higher incidence rates were observed among men than women for all period. The incidence rate ratio (IRR) varied between 1.14 (95% CI 1.12-1.16) for the 15-19 age group to 1.24 (1.23-1.25) for the 35-44 age group among men, and between 1.14 (1.09-1.19) for 55 years or more to 1.27 (1.24-1.29) for the 15-19 age group among women. For chlamydia, women showed higher incidence rate for all age groups than men during the period. Individuals aged 55 years and over showed the highest increase, IRR = 1.30 (1.27-1.34) for men, while it was the lowest for women, IRR = 1.22 (1.16-1.27). The incidence rates for syphilis were lower than for the other STIs. IRR values varied between 1.04 (1.02-1.06) in the 20-24 age group and 1.15 (1.14-1.16) in the 35-44 age group for males; and between 1.13 (1.06-1.16) for the 25-34 age group and 1.18 (1.13-1.25) for the 25-34 age group for females.

Conclusion: STIs are more frequent in people aged 25-34 and are increasing in all age groups. However, the rise is most pronounced among older men and among younger women.

Background: Information related to herpes simplex virus 1 and 2 (HSV-1 and 2), varicella-zoster virus (VZV), Epstein-Barr virus (EBV), and cytomegalovirus (CMV) seroprevalence in France is either lacking, incomplete, or outdated, despite their public health burden.

Method: We used routinely collected serological data between 2018 and 2022 to estimate HSV-1, HSV-2, VZV, EBV, and CMV seroprevalence in France. To account for demographic differences between our analytic samples and the French population and get estimates for sparsely sampled districts and age classes, we used a multilevel regression and poststratification approach combined with Bayesian model averaging via stacking weights.

Results: The observed seroprevalence (number of positive tests/number of tests) were 64.6% (93,294/144,424), 16.9% (24,316/144,159), 93.0% (141,419/152,084), 83.4% (63,199/75, 781), and 49.0% (23,276/47,525), respectively, for HSV-1, HSV-2, VZV, EBV, and CMV. Between 2018 and 2022, France had a model-based average (equal-tailed interval at 95%) expected seroprevalence equal to 61.1% (60.7,61.5), 14.5% (14.2,14.81), 89.5% (89.3,89.8), 85.6% (85.2,86.0), and 50.5% (49.3,51.7), respectively, for HSV-1, HSV-2, VZV, EBV, and CMV infections. We found an almost certain lower expected seroprevalence in Metropolitan France than in overseas territories for all viruses but VZV, for which it was almost certainly greater. The expected seroprevalences were likely greater among females for all viruses.

Limitations: Our results relied on the assumption that individuals were sampled at random conditionally to variables used to build the poststratification table.

Implications: The analysis highlights spatial and demographic patterns in seroprevalence that should be considered for designing tailored public health policies.

Mixta calida, previously known as Pantoea calida, was initially isolated from powdered infant milk in 2010. It falls within the Erwiniaceae family (class: Enterobacterales). While Mixta calida was traditionally regarded as non-pathogenic, we now present a case of Mixta calida bacteraemia and meningitis in a 5-week-old child, successfully treated with cefotaxime. This case, in contrast to prior reports with potential contamination issues, is the first to offer compelling evidence of Mixta calida's pathogenicity in humans.

Aim of study: The study aims to assess the growing public health threat posed by Oropouche virus (OROV), focusing on its epidemiology, transmission patterns, and the challenges in diagnosis and control. By analyzing the recent spread of OROV to new regions, including Cuba and Colombia, the study seeks to highlight the need for improved surveillance, enhanced diagnostic capabilities, and research into potential treatments and vaccines. Additionally, the study investigates the clinical similarities between Oropouche fever and other arboviruses, which often lead to diagnostic difficulties and mismanagement in affected regions.

Results: The virus has caused over 500,000 cases in Brazil alone, with recent outbreaks reporting fatalities, suspected vertical transmission, and potential associations with microcephaly in newborns. Underreporting and limited surveillance have likely led to the underestimation of the true burden of Oropouche fever. Current diagnostic methods, such as serology and RT-PCR, are often inaccessible in low-resource settings, further complicating efforts to control the spread of the virus. The study highlights the importance of improving diagnostic capacity, enhancing surveillance, and conducting further research into vector control, antiviral treatments, and vaccine development.

Conclusion: This study emphasizes the urgent need for coordinated international efforts to address the rising threat of Oropouche virus. Considering its rapid spread and potential for global transmission, comprehensive public health measures are necessary to protect vulnerable populations and mitigate the impact of this emerging disease. Enhanced surveillance and the development of accessible diagnostics, vaccines, and treatment options are critical to containing OROV and preventing further outbreaks.

Background: Hospital-acquired pneumonia (HAP) is the most common hospital-acquired infection (HAI). HAP is associated with a high burden of morbidity and mortality, but the diagnosis is difficult to establish and the incidence uncertain.

Methods: Patients aged ≥ 18 years hospitalised with radiologically verified non-ventilator hospital acquired pneumonia (NV-HAP) during 2018 were retrospectively identified at Drammen Hospital, a Norwegian general hospital. Infectious Diseases Society of America and the American Thoracic Society's definition of HAP was used.

Results: In total 119 cases of NV-HAP were identified among 27,701 admissions. The incidence was 4.3 per 1000 admissions and 1.2 per 1000 patient-days. The median age was 74 years, 63% were male and median Charlson comorbidity index was 5. Coronary heart disease (42%) was the most common comorbidity. Median length of stay was 17.2 days. A blood culture was obtained in 53.8% of patients, while samples from lower airways were seldom obtained (10.9%). In-hospital mortality was 21%, accumulated 30-day mortality was 27.7% and accumulated 1-year mortality was 39.5%. Thirty-day readmission rate among survivors was 39.4%.

Conclusion: NV-HAP was present in approximately 1 in 250 hospitalisations, most had multiple comorbidities, and 1 in 5 died in hospital. Although thorough microbiological sampling is recommended when NV-HAP is suspected, our data indicate that airway sampling is infrequent in clinical practice. Our findings underscore the need to develop microbiological diagnostic strategies to achieve targeted antimicrobial treatment that may improve patient outcomes and reduce broad-spectrum antibiotic usage.