Clinical Microbiology and Infection最新文献

{"title":"In Vitro Activity and Resistance Mechanisms of Sulbactam/Durlobactam Against Acinetobacter baumannii Clinical Isolates in China (2019-2020).","authors":"Qingye Xu, Xiaochen Liu, Haiyang Liu, Siyuan Yang, Tailong Lei, Xiaoting Hua, Yunsong Yu","doi":"10.1016/j.cmi.2025.09.016","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.09.016","url":null,"abstract":"<p><strong>Objectives: </strong>Carbapenem-resistant Acinetobacter baumannii (CRAB) poses a critical threat, with carbapenem-resistance rate exceeding 70% and limited therapeutic options in China. This multicenter study aimed to evaluate in vitro activity and resistance mechanisms of sulbactam/durlobactam (SUL-DUR), a newly approved β-lactam/β-lactamase inhibitor combination in China, against clinical A. baumannii isolates.</p><p><strong>Methods: </strong>A total of 1,303 A. baumannii isolates collected nationwide (2019-2020) were investigated. Antimicrobial susceptibility was determined by broth microdilution following CLSI guidelines. SUL-DUR-non-susceptible isolates underwent whole-genome sequencing through Illumina and/or Nanopore, and were assembled using shovill or unicycler. Genomic analyses included sequence typing, resistance gene annotation, SNP-based phylogenetic reconstruction, and pbp3 mutation mapping. Resistance mechanisms were investigated through qRT-PCR, site-directed mutagenesis, knockout and cloning experiments.</p><p><strong>Results: </strong>SUL-DUR demonstrated potent activity, with MIC_50/90 values of 2/4 and 4/4 mg/L and 95.47% susceptibility. Carbapenem-resistant isolates showed a 32-fold median MIC reduction compared to sulbactam alone, attributed to durlobactam's inhibition of OXA-23 and other β-lactamases. Among 59 non-susceptible isolates, PBP3 substitutions were the dominant resistance mechanism (48/59, 81.36%), confirmed by MIC reversions in mutagenesis experiments. Residual resistance in some strains implicated efflux pumps and unidentified factors. Six NDM-producing isolates exhibited elevated MICs, among which one strain harbored a novel NDM-87 with higher resistance to SUL-DUR. Genomic analyses highlighted the high-risk ST164 strains carrying chromosomal bla_NDM-1 and the regional dissemination ST2 clones with diverse PBP3 mutations.</p><p><strong>Conclusions: </strong>Despite SUL-DUR's strong efficacy against CRAB, the emergence of PBP3 mutations and NDM variants highlights the need for vigilant resistance monitoring. This study underscores the importance of integrated surveillance and mechanistic research to optimize SUL-DUR use in China and preserve its therapeutic effectiveness.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Awareness of anti-HCV immunological status among individuals born between 1969 and 1989 participating in anti-HCV screening.","authors":"Massimo De Paschale, Stefano Rusconi, Sergio Finazzi, Claudia Pavia, Arianna Gatti, Bianca Osnaghi","doi":"10.1016/j.cmi.2025.09.017","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.09.017","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145181877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of remdesivir and nirmatrelvir/ritonavir on mortality in patients hospitalized with COVID-19 during the Omicron era - an emulated target trial.","authors":"John Karlsson Valik, Pontus Hedberg, Piotr Nowak, Ola Blennow, Robert Dyrdak, Jan Vesterbacka, Johan Zetterqvist, Pontus Naucler","doi":"10.1016/j.cmi.2025.09.012","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.09.012","url":null,"abstract":"<p><strong>Objectives: </strong>Despite widespread population immunity, SARS-CoV-2 infection remains a common cause of hospitalization. While antiviral treatments have shown efficacy in clinical trials, often in outpatient settings, emerging real-world evidence in hospitalized patients is conflicting. Additionally, the impact of immunity status or viral load remains insufficiently studied. Our aim was to assesses the effect of remdesivir and/or nirmatrelvir/ritonavir in acute SARS-CoV-2 infection requiring hospital admission, including clinically relevant subgroups.</p><p><strong>Methods: </strong>We performed a retrospective population-based cohort study designed as an emulated target trial. Patients were included from six acute care hospitals in Stockholm, Sweden during the Omicron era. All adult patients admitted via the emergency department with a diagnosis indicating infection and a positive polymerase chain reaction SARS-CoV-2 test were assessed for eligibility. Viral burden was estimated using cycle threshold (Ct)-values. Data was analysed using cloning, censoring, and inverse probability weighting. The primary and secondary outcome was 30-day and 90-day all-cause mortality, respectively. Safety outcomes included new-onset kidney failure, liver failure, and cardiac arrhythmia.</p><p><strong>Results: </strong>Among 4,016 included patients, 771 (19%) received antiviral treatment. Overall mortality was 9.1% (n=365) at 30 days and 13.8% (n=554) at 90 days. The adjusted risk ratio (aRR) of antiviral treatment was 0.80 (95% CI, 0.62-1.01) for 30-day mortality and 0.78 (95% CI, 0.63-0.97) for 90-day mortality. The treatment effect was greater in unvaccinated individuals without previous confirmed infection (aRR 0.38 [95% CI, 0.18-0.67] versus aRR 0.95 (0.64 to 1.39) in recently vaccinated). No clear differences were observed in subgroups based on age or Ct-value, but precision was limited. Safety analyses revealed no substantial risk with antiviral treatment.</p><p><strong>Conclusions: </strong>Treatment with remdesivir and/or nirmatrelvir/ritonavir was associated with reduced mortality in hospitalized SARS-CoV-2 infected patients during the Omicron era, primarily in unvaccinated individuals without previous infection. Our findings support prioritizing non-immune individuals for antiviral treatment.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"European pilot interlaboratory comparison study on mpox virus whole genome sequencing.","authors":"Jonas Fuchs, Claire Bertelli, Trestan Pillonel, Rita Cordeiro, Jacques Izopet, Christophe Pasquier, Kuiama Lewandowski, Anastasija Maks, Janine Michel, Belen Rodriguez-Sanchez, Maria Paz Sanches-Seco, Juan Ledesma, Daniel Sobral, Koen Vercauteren, Tessa de Block, Antonio Mauro Rezende, Annika Brinkmann, Andreas Nitsche, Gilbert Greub, Marcus Panning","doi":"10.1016/j.cmi.2025.09.011","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.09.011","url":null,"abstract":"<p><strong>Objectives: </strong>Since 2022, distinct mpox virus (MPXV) clades are spreading across different geographic regions causing a challenging epidemiological situation. Whole genome sequencing (WGS) proved to be instrumental for patient management and global public health. We report a pilot interlaboratory comparison (ILC) study for MPXV WGS.</p><p><strong>Methods: </strong>We distributed non-infectious DNA samples including the main MPXV clades I and II to eight European laboratories. We included one cowpox (CPXV) sample as specificity control. Participants were free to choose their WGS pipeline of choice to mimic a real-world scenario and were asked to report on the sequencing pipeline used, average genome coverage, and MPXV species, clade, and subclade assignments.</p><p><strong>Results: </strong>Seven of the eight invited laboratories reported results back. All participants largely identified the MPXV clades and reported high quality genomes with minimal variations specifically for MPXV clade IIb 2022 outbreak strains. However, reconstructed genomes showed high variability for non-clade IIb MPXV strains. The CPXV sample was correctly identified by three laboratories.</p><p><strong>Conclusions: </strong>Although results for MPXV clade IIb 2022 outbreak strains are reassuring the inclusion of MPXV clade I and IIa strains highlights pitfalls for targeted sequencing approaches and subsequent bioinformatic analyses. Our findings underscore the need for standardized external quality assessement (EQA) studies.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of a China-developed live attenuated herpes zoster vaccine in Chinese healthy adults aged 40 years and older: a multicentre, randomized, double-blind, placebo-controlled, phase 3 clinical trial.","authors":"Shenyu Wang, Pengfei Jin, Yaru Quan, Huakun Lv, Hongxing Pan, Xiaosong Hu, Qi Liang, Yingping Chen, Mingwei Wei, Qiang Lu, Yidi Wang, Zhenzhen Liang, Jian Fu, Na Xu, Zhiping Chen","doi":"10.1016/j.cmi.2025.09.009","DOIUrl":"10.1016/j.cmi.2025.09.009","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the efficacy and safety of a live-attenuated gelatin-free herpes zoster (HZ) vaccine in adults ≥40 years.</p><p><strong>Methods: </strong>In a multicentre, randomized, double-blind, placebo-controlled phase 3 trial (2020-2021, Zhejiang and Jiangsu provinces), HZ-naïve adults stratified by age (40-49, 50-59, 60-69, and ≥70 years) were randomized 1:1 to receive a single dose of the HZ vaccine (≥4.3 lg PFU) or placebo and followed for 13 months. The primary endpoint was the incidence of HZ; safety outcomes included adverse events (AEs) and serious AEs.</p><p><strong>Results: </strong>The trial included 25 000 participants. HZ incidence was 5.3 versus 12.6/1000 person-years in the vaccine and placebo groups, respectively, resulting in a vaccine efficacy of 57.6% (95% CI: 43.1-68.7%) overall. Per age stratum, vaccine efficacy was 37.4% (95%CI: -117.0% to 83.9%), 62.7% (39.6-77.7%), 64.4% (42.5-78.7%), and 18.63% (-80.4% to 64.0%) in the 40-49, 50-59, 60-69, and ≥70 age groups, respectively. Few postherpetic neuralgia cases occurred (n = 13), limiting vaccine efficacy assessment. Solicited AEs were mild/moderate (13.8% [1719/12 491] vaccine vs. 5.1% [634/12 499] placebo), with no vaccine-related serious AEs. Grade 3 reactions, such as fever, were rare (0.06%, [7/12 491]), and AE rates declined with age (22.0% [219/995] in 40-49 vs. 9.1% [136/1499] in ≥70).</p><p><strong>Discussion: </strong>China's gelatin-free HZ vaccine is safe and moderately effective, particularly in adults aged 50-69 years, with an age-dependent safety profile.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelets and mortality in bloodstream infection: author's response.","authors":"Max W Adelman, Stefano Casarin, Cesar A Arias, Masayuki Nigo","doi":"10.1016/j.cmi.2025.09.010","DOIUrl":"10.1016/j.cmi.2025.09.010","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma microbial cell-free DNA sequencing in transplant and haematologic patients-promise, pitfalls, and path forward.","authors":"Carlos A Gomez, Sias J Scherger, Anum Abbas, Andre C Kalil","doi":"10.1016/j.cmi.2025.09.008","DOIUrl":"10.1016/j.cmi.2025.09.008","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High rates of acquired resistance to fluoroquinolones, bedaquiline and linezolid in patients failing treatment against drug-resistant tuberculosis in the Republic of Moldova.","authors":"Dumitru Chesov, Maja Reimann, Tishya Mukherjee, Krishan Tewatia, Olha Konstantynovska, Aliona David, Doina Rusu, Nelly Ciobanu, Valeriu Crudu, Christoph Lange","doi":"10.1016/j.cmi.2025.09.003","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.09.003","url":null,"abstract":"<p><strong>Objectives: </strong>Mycobacterium tuberculosis with rifampicin resistance rank among the four critical antimicrobial-resistant pathogens needing priority attention as identified by the World Health Organization (WHO) in 2024. Our objective was to identify causes of treatment failure in patients diagnosed with multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) in a nation-wide cohort in the Republic of Moldova, a WHO high-burden country of MDR/RR-TB.</p><p><strong>Methods: </strong>A retrospective cohort study analyzed national tuberculosis surveillance data (2021-2022) on patients diagnosed with MDR/RR-TB with available baseline and follow-up drug susceptibility testing for WHO Group A drugs. Treatment failure was defined as the absence of sputum culture conversion after six months. Logistic regression was used to identify risk factors associated with treatment failure.</p><p><strong>Results: </strong>Of 1034 patients initiating MDR/RR-TB treatment, 55 (5.3%) experienced treatment, failure, while 693 (67.1%) were successfully treated. Baseline resistance to WHO Group A drugs was significantly higher in patients with treatment failure than in those with successful outcomes: fluoroquinolones ((32/48 (66.7%) vs. 86/471 (18.3%), p<0.0001), bedaquiline (6/42 (12.5%) vs. 3/468 (0.6%), p<0.0001), and linezolid (12/48 (25.0%) vs. 3/468 (0.6%), p<0.0001). Acquired resistance occurred in 19/48 (39.6%) of those failing treatment but none with successful outcomes, particularly to bedaquiline 13/42 (30.9%), linezolid 6/36 (16.7%), and fluoroquinolones 4/16 (25.0%). Baseline fluoroquinolone resistance (OR 4.7, 95% CI 2.0 - 11.2) and acquired resistance to any WHO Group A drug (OR 63.5, 95% CI 7.7 - 8311.7) were associated with treatment failure.</p><p><strong>Conclusions: </strong>While frequencies of treatment failure in MDR/RR-TB are low on bedaquiline-containing treatment regimens, we find alarmingly high rates of baseline and acquired drug resistance to key second-line anti-TB drugs as a driver for treatment failure in MDR/RR-TB. Strengthening resistance monitoring, improving adherence, and optimizing individualized regimens are urgently needed to prevent the emergence of extensively drug-resistant (XDR)-TB in high-burden settings of MDR/RR-TB.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic performance of Xpert MTB/RIF Ultra assay with pulmonary and extrapulmonary specimens: a retrospective evaluation in a low-incidence setting in Finland.","authors":"Bruno Luukinen, Maarit Ahava, Janne Aittoniemi, Terhi Miikkulainen-Lahti, Anu Pätäri-Sampo","doi":"10.1016/j.cmi.2025.09.002","DOIUrl":"10.1016/j.cmi.2025.09.002","url":null,"abstract":"<p><strong>Objective: </strong>The aim was to evaluate the sensitivity and specificity of the Xpert MTB/RIF Ultra (Xpert Ultra) assay in the detection of extrapulmonary tuberculosis (TB) in comparison to pulmonary TB in a low-incidence setting in the Helsinki capital area of Finland.</p><p><strong>Methods: </strong>The retrospective analysis included results from 1112 pulmonary and 705 extrapulmonary samples collected between 2018 and 2023, of which 193 and 136 were culture-positive for Mycobacterium tuberculosis (MTB), respectively. Xpert Ultra results were compared with mycobacterial culture. PCR-positive and culture-negative cases were separately compared with available clinical data (composite reference standard, CRS).</p><p><strong>Results: </strong>Compared with culture, Xpert Ultra demonstrated 95.3% sensitivity (95% CI, 91.3%-97.7%) and 94.5% specificity (95% CI, 92.8%-95.8%) with pulmonary samples, 47.1% (95% CI, 26.2%-69.0%) and 96.7% (95% CI, 93.8%-98.4%) with pleural fluid, 100% (95% CI, 86.9%-100%) and 81.8% (95% CI, 72.4%-88.6%) with tissue, 96.6% (95% CI, 81.4%-100%) and 75.0% (95% CI, 62.2%-84.6%) with pus, and 95.1% (95% CI, 83.0%-99.5%) and 67.5% (95% CI, 51.9%-80.0%) with lymph node samples, respectively. Other, less common sample types were also included. When CRS was also considered, specificity exceeded 93% for all sample types. Sensitivity was 100% with both smear-positive pulmonary and smear-positive extrapulmonary samples. Neither false rifampicin susceptibility testing results nor cross-reactivity with nontuberculous mycobacteria was detected.</p><p><strong>Discussion: </strong>Xpert Ultra detected MTB in lymph node, tissue, and pus samples with high-accuracy comparable with the analysis of pulmonary samples while reducing the time to diagnosis by up to several weeks compared with mycobacterial culture.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disseminated Fusarium solani complex infection with ocular involvement in a leukaemia patient.","authors":"Guangyu Sun, Yongqin Wu, Baolin Tang, Xiaoyu Zhu","doi":"10.1016/j.cmi.2025.09.004","DOIUrl":"10.1016/j.cmi.2025.09.004","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}