Clinical Microbiology and Infection最新文献

{"title":"Fungal infections in patients with haematological malignancies in the pre-triazole era: the dawn of a new era in medical mycology.","authors":"Umut Akova, Rachel Hicklen, Russell E Lewis, Thomas J Walsh, Dimitrios P Kontoyiannis","doi":"10.1016/j.cmi.2025.06.003","DOIUrl":"10.1016/j.cmi.2025.06.003","url":null,"abstract":"<p><strong>Background: </strong>Opportunistic invasive fungal infections (IFIs) emerged as common causes of death of patients with haematological malignancies (HM) once effective antibacterial therapy reduced bacterial deaths. In the dawn of medical mycology, timely diagnosis was difficult, and treatment was limited by the toxicity of antifungals and associated with poor outcomes.</p><p><strong>Objectives: </strong>This study aims to chronicle key diagnostic and therapeutic milestones before triazoles and show how they forged the foundations of modern mycology practice in HM.</p><p><strong>Sources: </strong>Autopsy series, clinical trials, pharmacological studies, and historical commentaries augmented by seminal reviews on chemotherapy, haematopoietic cell transplantation and antifungal development.</p><p><strong>Content: </strong>Autopsy studies identified the importance of Candida, Aspergillus and Mucorales and linked prolonged neutropenia and corticosteroids to heightened risk of infection. Computed tomography and early galactomannan assays improved early diagnosis, whereas trials of empirical amphotericin B in persistent neutropenic fever halved mortality. Adjunctive strategies, including protected environments, gut decontamination, cytokine therapy and granulocyte transfusions, were often constrained by cost, toxicity, or uncertain benefit. Historically, the azole era began with ketoconazole and progressed to itraconazole and fluconazole, broadening prophylaxis but selecting for rare moulds and resistant yeasts. These pressures drove the development of potent newer triazoles and echinocandins and introduced risk-adapted prophylactic strategies.</p><p><strong>Implications: </strong>Lessons from the pre-triazole era endure: host immunity remains the prime determinant of IFI risk and outcome; timely, sensitive diagnostics are lifesaving; and antifungal stewardship must anticipate the evolution of fungal resistance. As novel chemotherapeutics, cellular therapies, and resistant pathogens reshape IFI epidemiology in HM, continuous innovations in diagnostics, antifungals, and immunomodulatory approaches remain essential.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274321","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":"Species-specific risk of ophthalmic involvement in candidemia: a propensity-matched competing risk analysis.","authors":"Sung-Woon Kang, SolAh Han, Geonui Kim, Hyo-Ju Son, Eun Jeong Won, Heungsup Sung, Mi-Na Kim, Euijin Chang, Seongman Bae, Jiwon Jung, Min Jae Kim, Sung-Han Kim, Sang-Oh Lee, Sang-Ho Choi, Yang Soo Kim, Joo Yong Lee, Yong Pil Chong","doi":"10.1016/j.cmi.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.002","url":null,"abstract":"<p><strong>Objectives: </strong>Given the limited data on species-specific ocular involvement in candidemia, we aimed to assess the differential risk of ocular involvement according to Candida species in patients with candidemia.</p><p><strong>Methods: </strong>A retrospective review was conducted of candidemia patients who underwent funduscopic examination at a tertiary center in Seoul, Korea between January 2014 and December 2023. Ocular involvement, defined as endophthalmitis, was determined by two retinal specialists. Propensity score matching and competing risk analyses were performed to adjust for pre-specified risk factors and mitigate competing-risk bias.</p><p><strong>Results: </strong>A total of 674 candidemia patients were included. Endophthalmitis was identified in 5% (32/674), and probable chorioretinitis in 10% (67/674). The prevalence of endophthalmitis was relatively high in Candida albicans (16/245, 7%) and Candida tropicalis (13/126, 10%), but low in Candida glabrata (0/193), Candida parapsilosis (2/68, 3%), and Candida krusei (0/19). Competing risk analysis identified C. albicans or C. tropicalis infection (subdistribution hazard ratio [sHR] 7.90, 95% confidence interval [CI] 2.42-25.75) as an independent risk factor for endophthalmitis. In propensity score-matched analyses, C. albicans (sHR 5.85, 95% CI 1.71-19.95) and C. tropicalis (sHR 6.97, 95% CI 1.58-29.85) were each significantly more associated with ocular involvement than non-albicans and non-tropicalis species.</p><p><strong>Conclusion: </strong>While ophthalmic examinations are already recommended in all candidemia cases, our findings underscore their particular importance in C. albicans and C. tropicalis infections, where ocular involvement is significantly more common than in those involving other Candida species.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257423","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":"Re: 'Safety and immunogenicity of hepatitis E vaccine in compensated liver cirrhosis with chronic hepatitis B' by Liao et al.","authors":"Yuwen Yang, Rui Lai","doi":"10.1016/j.cmi.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.06.004","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257422","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":"First trimester mRNA COVID-19 vaccination and risk of congenital malformation: a prospective observational Embryotox cohort study.","authors":"Angela Kayser, Lukas Lohse, Stephanie Padberg, Brigitte Keller-Stanislawski, Doris Oberle, Evelin Beck, Regina Stegherr, Jan Beyersmann, Katarina Dathe","doi":"10.1016/j.cmi.2025.06.005","DOIUrl":"10.1016/j.cmi.2025.06.005","url":null,"abstract":"<p><strong>Objectives: </strong>This observational cohort study evaluates the risk of major birth defects after maternal mRNA COVID-19 vaccination in the first trimester of pregnancy.</p><p><strong>Methods: </strong>Outcomes of prospectively ascertained pregnancies with at least one mRNA COVID-19 vaccination in the first trimester (gestational week 2 + 0 to 12 + 6) were compared with a cohort of unvaccinated pregnant women of the same period, whose data were collected using the same approach. The enrolment of study cases was conducted over a period of 21 months. For inclusion in the study, a structured pregnancy follow-up had to be completed afterwards. The reported congenital anomalies were classified according to EUROCAT. Relevant maternal characteristics were considered and adjusted ORs were calculated using logistic regression.</p><p><strong>Results: </strong>The exposed study cohort included 1828 pregnant women who were vaccinated with an mRNA vaccine in the first trimester. The unexposed comparison cohort consisted of 1955 pregnant women. Sixty-eight major congenital malformations have been observed in the vaccinated and 53 in the unexposed cohort (3.86% vs. 3.09%). The analysis resulted in an adjusted OR of 1.30 (95% CI: 0.90-1.86). A wide range of performed sensitivity analyses was in line with this finding.</p><p><strong>Conclusions: </strong>We did not detect a statistically significant increase in the overall birth defect rate after maternal mRNA COVID-19 vaccination in the first trimester.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257421","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":"Candida Endocarditis: current perspectives on diagnosis and therapy.","authors":"Ben-Ami Ronen, Bassetti Matteo, Bouza Emilio, Kosman Alex, Vena Antonio","doi":"10.1016/j.cmi.2025.05.035","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.05.035","url":null,"abstract":"<p><strong>Background: </strong>Candida infective endocarditis (CIE) is a rare but potentially devastating condition. Although it accounts for only 1-1.5% of infective endocarditis cases, CIE carries a high mortality rate (36-49%) and a substantial risk of relapse. Despite advances in diagnostic and therapeutic strategies, significant uncertainties persist regarding the role and selection of imaging modalities and the most effective medical and surgical management. Furthermore, the best follow-up strategy to promptly detect recurrences in patients with a confirmed diagnosis remains inadequately defined.</p><p><strong>Objectives: </strong>This review explores the diagnosis and management of CIE with a particular focus on: i) optimal use of cardiac imaging studies; ii) challenges associated with antifungal therapy iii) the limitations and real-world impact of surgical intervention, and (iv) strategies for long-term follow-up.</p><p><strong>Sources: </strong>A comprehensive literature search was conducted in PubMed using the terms Candida endocarditis, fungal biomarkers, echocardiography, antifungal therapy, and surgical management. Additional studies were identified through reference screening. Only clinically relevant articles, as judged by the authors, were included.</p><p><strong>Content: </strong>Diagnosis remains difficult due to intermittently negative blood cultures and limitations of standard endocarditis criteria. Echocardiography is the mainstay diagnostic modality for patients with candidemia, and risk-stratification to guide its use remains exploratory. Novel diagnostic methods, including fungal biomarkers (1,3-β-D-glucan), molecular assays, and PET/CT, may improve detection, but robust clinical data are lacking. Management requires a multimodal approach, combining prolonged antifungal therapy and, when feasible, surgical intervention. Echinocandins or liposomal amphotericin B plus flucytosine are first-line treatments, with fluconazole as a step-down option. Prosthetic valve infections often require lifelong suppressive therapy due to high relapse rates.</p><p><strong>Implications: </strong>Given the high mortality and recurrence rates, early multidisciplinary involvement is crucial. With emerging antifungal resistance, anti-biofilm strategies and next-generation antifungals are needed to improve outcomes.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257420","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":"Re: 'Scope and aims of ESCMID guidelines' by Scudeller et al.","authors":"Hilary Humphreys","doi":"10.1016/j.cmi.2025.05.034","DOIUrl":"10.1016/j.cmi.2025.05.034","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246690","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":"Commentary: Standing on the shoulders of giants - virtue and vulnerability in science.","authors":"Sibylle C Mellinghoff, Agnese Grossi Alessandra, Yannick Assion, Oliver A Cornely, Marylyn M Addo, Claudia Bloeser","doi":"10.1016/j.cmi.2025.05.030","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.05.030","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246689","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":"Rectal colonization by multidrug-resistant Gram-negative bacteria and subsequent bacteraemia in haematological patients.","authors":"Antonio Gallardo-Pizarro, Carlos Lopera, Olivier Peyrony, Patricia Monzo-Gallo, Tommaso Francesco Aiello, Ana Martinez-Urrea, Sabina Herrera, Ana Del Río, Christian Teijon-Lumbreras, Mariana Chumbita, Carlos Jimenez-Vicente, Albert Cortés, Marta Bodro, Cristina Pitart, Elisa Rubio, Josep Mensa, Alex Soriano, Jose Antonio Martínez, Carolina Garcia-Vidal","doi":"10.1016/j.cmi.2025.05.033","DOIUrl":"10.1016/j.cmi.2025.05.033","url":null,"abstract":"<p><strong>Objectives: </strong>This study assessed the prevalence of multidrug-resistant Gram-negative bacilli (MDR-GNB) colonization in rectal swabs from haematological patients with malignancies undergoing routine surveillance and explored the relationship between MDR-GNB colonization and subsequent development of bloodstream infections (BSIs).</p><p><strong>Methods: </strong>Between January 2020 and September 2022, all patients admitted to our haematology ward underwent weekly MDR-GNB colonization screening via rectal swabs. A retrospective analysis was performed. MDR-GNB were defined per 2022 European Society of Clinical Microbiology and Infectious Diseases criteria: (a) third-generation cephalosporin-resistant Enterobacterales (3GCephRE), (b) carbapenem-resistant Enterobacterales (CRE), (c) Pseudomonas aeruginosa with difficult-to-treat resistance (DTR), and (d) carbapenem-resistant Acinetobacter baumannii.</p><p><strong>Results: </strong>Among 3024 rectal swabs from 699 patients, 503 of 3024 (16.6%) tested positive for MDR-GNB in 192 of 699 patients (27.5%). The most prevalent organisms were Escherichia coli (248/503; 49.3%), Klebsiella pneumoniae complex (125/503; 24.9%), and P. aeruginosa (36/503; 7.2%). A total of 59 of 503 (11.7%) colonizations of CRE were identified. Overall, 27 of 192 (14.1%) patients were colonized at admission, primarily by 3GCephRE (27/29; 93.1%). Colonization with CRE and DTR P. aeruginosa was more frequently documented after several days of hospitalization. BSI occurred in 74 of 192 (38.5%) colonized and 61 of 507 (12.0%) non-colonized patients. MDR-GNB caused 57 of 166 BSIs episodes, 50 of 57 (87.7%) of which were in colonized patients. The unadjusted concordance rate between rectal swab isolates and blood cultures was observed in 43 of 90 BSIs (47.8%) occurring in colonized patients, with a positive predictive value (PPV) of 36.4% and a negative predictive value (NPV) of 99.9% for DTR P. aeruginosa; a PPV of 25.0% and an NPV of 99.9% for CRE; and a PPV of 14.6% and an NPV of 99.0% for 3GCephRE.</p><p><strong>Discussion: </strong>Routine weekly surveillance for MDR-GNB in haematological patients enables early identification of colonization, often preceding MDR-GNB BSIs. Further studies using adjusted analyses are needed to establish its independent predictive value.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246691","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":"Bridging the evidence gap: expert consensus on management of SARS-CoV-2 acute infection and post–COVID-19 condition in immunocompromised patients","authors":"Lorenzo M. Canziani ,&nbsp;Antonella d'Arminio Monforte ,&nbsp;Maddalena Giannella ,&nbsp;Jesús Rodríguez-Baño ,&nbsp;Evelina Tacconelli","doi":"10.1016/j.cmi.2025.05.008","DOIUrl":"10.1016/j.cmi.2025.05.008","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 8","pages":"Pages S1-S2"},"PeriodicalIF":10.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076533","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":"ORCHESTRA Delphi consensus: diagnostic and therapeutic management of post-COVID-19 condition in vulnerable populations","authors":"Elisa Gentilotti ,&nbsp;Lorenzo Maria Canziani ,&nbsp;Maria Giulia Caponcello ,&nbsp;Anna Maria Azzini ,&nbsp;Alessia Savoldi ,&nbsp;Pasquale De Nardo ,&nbsp;Zaira R. Palacios-Baena ,&nbsp;Beatrice Tazza ,&nbsp;Natascia Caroccia ,&nbsp;Giulia Carla Marchetti ,&nbsp;Andrea Antinori ,&nbsp;Maddalena Giannella ,&nbsp;Jesús Rodríguez-Baño ,&nbsp;Evelina Tacconelli","doi":"10.1016/j.cmi.2025.04.009","DOIUrl":"10.1016/j.cmi.2025.04.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Post-COVID-19 condition (PCC) remains poorly understood, especially in clinically vulnerable groups. We applied the Delphi approach to drive recommendations for the diagnosis, management, and prevention of PCC in people living with HIV (PWH) and patients affected by rheumatological diseases (RD) and haematological malignancies.</div></div><div><h3>Methods</h3><div>On the basis of literature review, three areas of interest in PCC in PWH, haematological malignancies, and RD were identified: (a) features and risk factors; (b) diagnosis and management; and (c) prevention. A three-round Delphi anonymous survey consisting of 15 questions was conducted including 69 experts. Consensus was measured by the six-point Likert scale categorized into four tiers: strong disagreement, moderate disagreement, moderate agreement, and strong agreement. Statements were generated on questions achieving consensus.</div></div><div><h3>Results</h3><div>Eleven statements were generated: six on features and risk factors of PCC in clinically vulnerable populations, two on diagnosis and management, and three on prevention. Chronic fatigue was identified as the most frequent presentation of PCC in PWH and RD populations. A different case definition of PCC is required for RD population, as symptoms of PCC and autoimmune disorders may overlap. Risk factors for PCC include age &gt;65, severity of COVID-19, and female sex; the latter is also associated with increased smell/taste impairment. A clinical assessment or a routine laboratory test performed 3 months after acute infection is not suggested to diagnose PCC in PWH. PWH and RD should be screened to exclude additional autoimmune disorders in case of chronic fatigue/arthralgia of new onset. Full-course vaccination and early treatment for COVID-19 should be promoted to prevent PCC, whereas corticosteroids during acute infection are not recommended.</div></div><div><h3>Discussion</h3><div>Diagnosis, management, and prevention of PCC are still under discussion. This Delphi offers valuable insights on PCC in selected clinically vulnerable populations and suggests a tailored approach in vulnerable populations.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 8","pages":"Pages S44-S54"},"PeriodicalIF":10.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977652","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}