GMS infectious diseases最新文献

[This corrects the article DOI: 10.3205/id000098.].

We report the first human case of a novel Salmonella enterica serovar Weitmar (8:z41:1,5), isolated from a 41-year-old outpatient with acute diarrhea and fever in Bochum, Germany. Identification involved culture, multiplex PCR, MALDI-TOF MS, biochemical testing, and reference lab serotyping. The strain showed a unique antigenic profile and was confirmed by the WHO Collaborating Centre for Reference and Research on Salmonella. This case illustrates a routine but essential aspect of microbiological surveillance, highlighting how combined diagnostics and international collaboration support the reliable identification of novel Salmonella serovars.

Background: The German Society for Arthroplasty (AE) recommends a single dose of 2,000 mg amoxicillin as an antibiotic prophylaxis to prevent periprosthetic joint infections (PJI) in patients with total hip or knee arthroplasty (THA, TKA) who undergo invasive dental procedures (DP). We searched for evidence to support this recommendation.

Materials and methods: We conducted a Medline query and made additional searches based on the literature found in the Medline database. We looked for relevant recommendations on antibiotic prophylaxis (AP) in other countries, as well as for standardized reviews and other studies published after the last reviews on the question of antibiotic prophylaxis for joint implant recipients in connection with dental treatment.

Results: In twelve countries, no current guideline recommends general antibiotic prophylaxis for dental procedures, seven guidelines suggest that antibiotic prophylaxis should be considered in patients with risk factors, and five guidelines recommend that antibiotic prophylaxis be considered in conjunction with specific dental procedures that have an increased risk. Three reviews (2012, 2017 and 2020) mostly comprised of low-quality studies, all agreed that there is no direct evidence to indicate AP prior to dental procedures in patients with total joint arthroplasty (TJA). Six new retrospective studies from four countries on three continents, which included a total of more than 200,000 patients with TJA, confirmed the results of earlier studies: PJIs are rare and not significantly associated with DPs, and AP does not significantly reduce the (already low) risk. This applies not only to primary but also to revision TKA. Furthermore, a recent study comprising 61,124 patients with TJA or cardiac conditions who received AP for DP found that 62 (0.1%) experienced serious adverse drug events.

Discussion: Even though most studies were conducted retrospectively and are based on insurance data and not on the analysis of individual medical records, it should be noted that there is still no robust evidence showing that dental procedures increase the risk of PJI, nor that AP has a risk-reducing effect both for primary THA and TKA as well as for revision TKA. Therefore, it is suggested that the AE should revise its recommendation, announced in 2022, in order to avoid the risks of unnecessary AP.

Antibiotic resistance is a major challenge in modern healthcare, as it severely limits the choice of treatment options. In particular, carbapenemase mediated carbapenem resistance in Pseudomonas aeruginosa poses an emerging health risk worldwide. Here, we discovered a hitherto unknown variant of the class A beta-lactamase type GES in a P. aeruginosa strain by whole genome sequencing. This multidrug-resistant strain was isolated from bronchoalveolar lavage samples of a 61-year-old man, who suffered from respiratory insufficiency resulting from pneumonia. Ultimately, the patient succumbed to his condition, as there were no further treatment strategies. Given the high drug resistance of P. aeruginosa and its increasing role in severe infections, the implementation of methods for the rapid detection of carbapenemases is essential for optimizing therapeutic strategies and preventing nosocomial outbreaks.

Background: The number of COVID-19 deaths is an important measure for the impact of the pandemic. However, estimates differ and fuel the debate on COVID-19 as legitimate cause of death.

Objective: To study the role of COVID-19 as cause of death.

Methods: Double (bridge) coding of all death certificates mentioning COVID-19 in the Dutch cause-of-death registry during the pandemic 2020-2022 (n=51,288). The coding of records by the WHO special instruction for COVID-19 as issued in April 2020 was compared with the coding of the same set of records by the prevailing rules of the ICD-10 and the effect on cause-of-death statistics was studied.

Results: When mentioned on a death certificate, COVID-19 was selected as underlying cause of death in 94% of the cases by the WHO special instruction. According to the prevailing ICD-10 coding rules, COVID-19 was the beginning of a causal sequence leading to death in 76% of the cases (General Principle) and when the role of contributing co-morbidity was taken in to account too (Direct Sequel), COVID-19 was the underlying cause of death in 49% of the cases. These different estimates can be explained by a difference in perspective. The WHO special instruction identifies cases from an epidemiological point of view (surveillance), while the prevailing ICD-10 rules identify cases with COVID-19 as a necessary and sufficient cause of death from a medical (pathophysiological) point of view.

Conclusion: Different estimates of COVID-19 deaths represent different views on the role of COVID-19 as cause of death, which should be taken in to account when interpreting cause-of-death statistics.

We report the first human case of a novel Salmonella enterica serovar Scharmann (8:z41:1,5), isolated from a 41-year-old outpatient with acute diarrhea and fever in Bochum, Germany. Identification involved culture, multiplex PCR, MALDI-TOF MS, biochemical testing, and reference lab serotyping. The strain showed a unique antigenic profile and was confirmed by the WHO Collaborating Centre for Reference and Research on Salmonella. This case illustrates a routine but essential aspect of microbiological surveillance, highlighting how combined diagnostics and international collaboration support the reliable identification of novel Salmonella serovars.

Background: Colistin is a last-resort antibiotic used against infections caused by multidrug-resistant gram-negative organisms, particularly carbapenem-resistant strains. Rising resistance to colistin is a significant global concern. To address this, an Antimicrobial Stewardship (AMS) Program was introduced in our hospital, including pre-authorization protocols for colistin use.

Objective: To evaluate the prevalence of colistin-resistant organisms and determine the impact of AMS implementation on their occurrence and associated clinical outcomes.

Methods: We conducted a quasi-experimental study at a tertiary care hospital in Pakistan, comparing data from 18 months before and after AMS implementation. Adult patients (>18 years) with confirmed infections due to colistin-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, or Acinetobacter spp. were included. Clinical and microbiological data were analyzed to assess differences in organism prevalence, mortality, and hospital stay duration.

Results: A total of 121 patients met inclusion criteria, with 45 (37.2%) in the pre-AMS period and 76 (62.8%) in the post-AMS period. Klebsiella pneumoniae was the most frequently isolated organism in both groups. The overall in-hospital mortality rate was 34%, and the average length of stay was approximately 20 days, with no significant differences between periods. Despite AMS implementation, colistin resistance prevalence did not decline.

Conclusion: While the AMS facilitated better identification and documentation of colistin-resistant infections, it did not significantly reduce their prevalence or associated mortality. Strengthened stewardship measures, continuous compliance monitoring, and alternative therapeutic strategies are needed to curb rising colistin resistance in high-burden settings.

Background: Genital tuberculosis (GTB) is a significant etiological factor of infertility in developing countries such as India; however, it is frequently undiagnosed due to its asymptomatic nature and a lack of standardised protocols. This study aimed to compare the diagnostic efficacy of GeneXpert (CBNAAT) with Ziehl-Neelsen (ZN) staining, Mycobacterial Growth Indicator Tube (MGIT) liquid culture and histopathological examination (HPE). Additionally, the occurrence of GTB in infertile women aged between 18 and 45 years was also determined.

Methods: The study comprised 200 infertile women with suspected GTB. Endometrial biopsy samples were collected aseptically and subjected to ZN staining, MGIT liquid culture, GeneXpert testing and HPE and the results were analysed and compared. MGIT was considered the gold standard test in accordance with National TB Elimination Programme (NTEP) recommendations.

Results: There were 164 (82%) cases of primary infertility, and 36 (18%) cases of secondary infertility. Out of the 200 samples of endometrial biopsy (EB) specimens, the GeneXpert test detected two positive findings (1%), ZN staining detected two positive results (1%), and MGIT liquid culture as well as HPE detected one positive result (0.5%). GeneXpert demonstrated a sensitivity of 100% (confidence interval (CI) 2.50-100.00%), a specificity of 99.5% (CI 97.23-99.99%), a positive predictive value (PPV) of 50% (CI 12.40-87.60%), and a negative predictive value (NPV) of 100% (CI 98.15-100.00%), with liquid culture as reference. A significant agreement was found between the diagnostic procedures of MGIT and GeneXpert, with a kappa value of 0.66 and a p-value of 0.047 (significant p-value <0.05).

Conclusion: The present study is among the few that has utilised GeneXpert to aid in the diagnosis of female genital tuberculosis (FGTB). GeneXpert, being much faster and more feasible than conventional methods such as culture, could be incorporated into the standard evaluation of GTB.