Clinical Microbiology and Infection最新文献

{"title":"Decoding COVID-19: phenotypes and the pursuit of precision medicine.","authors":"Sias J Scherger, Carlos A Gomez, Anum Abbas, Andre C Kalil","doi":"10.1016/j.cmi.2025.08.028","DOIUrl":"10.1016/j.cmi.2025.08.028","url":null,"abstract":"<p><strong>Background: </strong>The pursuit of personalized medicine has underscored the critical role of phenotypes and subphenotypes in biology and medicine. A growing body of literature has identified diverse phenotypic manifestations of SARS-CoV-2 influenced by host and viral factors.</p><p><strong>Objectives: </strong>To assess and integrate current knowledge regarding the clinical, immunologic, and molecular phenotypes associated with COVID-19, highlighting their impact on disease management, the personalization of therapeutic strategies, and the advancement of clinical research.</p><p><strong>Sources: </strong>We conducted a comprehensive literature search of PubMed, Medline, and Embase databases from 1 October 2024 to 5 August 2025 to identify relevant literature regarding phenotypes observed in SARS-CoV-2 infection.</p><p><strong>Content: </strong>Clinical phenotypes involve various demographic factors and comorbidities, vital sign trajectories, patterns of acute organ dysfunction, and variations in biomarkers, which may differ among viral variants. Immunologic phenotypes involve dysregulated cytokine responses, altered immune cell functions, disruptions in key signalling pathways, and variations in white blood cell ratios, often reflecting a pattern of immune suppression. Molecular phenotypes reflect variations in host polymorphisms involving interleukin-18 secretion, inflammasome formation, and human leucocyte antigen-DR isotype expression and alterations in leukocyte function which may persist beyond the acute phase of infection. Viral protein expression influences infectivity and transmissibility as well as disease severity and progression.</p><p><strong>Implications: </strong>Understanding the phenotypes associated with SARS-CoV-2 infection can assist in clinical management and prognostication, stratification of patient populations for clinical trials, and development of novel therapies targeting various immunologic and molecular factors to improve morbidity and mortality.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999835","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":"Current Situation of Solid Organ Transplantation from HIV-Positive Donors to HIV-Positive Recipients in Europe. The Spanish Perspective.","authors":"Jose M Miro, Nerea L Amondarain, Lucia Serrano, Jon Salmanton-Garcia, Christian Manzardo, Daniela Malano-Barletta, David Paredes-Zapata, Antonio Guerra-Maio, Jean-Paul Stahl, Marta Subirana, Pablo Ruiz, Constantino Fondevila, Federic Cofán, Angela González, Mireia Musquera, Beatriz Mahillo, Gloria de la Rosa, Rosario Marazuela, Antonio Rimola, Asuncion Moreno","doi":"10.1016/j.cmi.2025.08.025","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.08.025","url":null,"abstract":"<p><strong>Objectives: </strong>There is limited information on the use of organs from HIV-positive donors (HIV D+) for HIV-positive recipients (HIV R+) in Europe. In some countries the use of HIV D+ organs is prohibited by law. This study aimed to assess the attitudes of Spanish kidney and liver transplant (KT/LT) teams towards HIV D+/R+ KT/LT through a nationwide survey, and to evaluate the current situation across Europe regarding legislation and reported cases.</p><p><strong>Methods: </strong>In 2018 and 2019, two surveys were conducted across Spain's 24 LT and 39 KT centres, respectively. Specialists in HIV/infectious diseases, nephrology/hepatology, urology/liver surgery and transplant coordination completed a questionnaire, with responses analysed by speciality. We also consulted European representatives on national legal frameworks regarding HIV D+/R+ and conducted a narrative review of published cases (2000-2025).</p><p><strong>Results: </strong>The Spanish survey was answered by at least one member of all Spanish LT and KT teams (63/63, 100%). Most specialists who responded to the survey (167/252; 66%) supported using organs from HIV D+ virologically suppressed (VS) on ART, high-risk and serodiscordant couples, but not from non-VS HIV D+, for HIV R+. All respondents endorsed implementing a dedicated consent form, and a majority expressed willingness to participate in an HIV D+/R+ trial. No major differences were observed between LT and KT teams. At the European level, the use of organs from HIV D+ was permitted, prohibited or unregulated in 6 (17%), 11 (31.5%) and 18 (51.5%) countries, respectively. Ten HIV D+/R+ transplants (six kidneys and four livers) have been published, with good one-year outcomes.</p><p><strong>Conclusions: </strong>The surveyed Spanish specialists would agree on using organs from VS HIV D+ for HIV D+/R+ transplants. This procedure is only legally allowed in very few European countries. These results should promote changes in donor laws across Europe.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999846","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 role of rapid and advanced microbiological methods in critical care: 2025 Emanuele Russo Delphi consensus.","authors":"Vittorio Sambri, Vanni Agnoletti, Simone Ambretti, Michele Bartoletti, Paola Bernaschi, Elena Giovanna Bignami, Stefano Busani, Caterina Campoli, Edoardo Carretto, Fausto Catena, Irene Coloretti, Monica Cricca, Gennaro De Pascale, Francesco Giuseppe De Rosa, Carla Fontana, Giovanni Gherardi, Maddalena Giannella, Massimo Girardis, Nicasio Mancini, Alessandra Oliva, Mauro Podda, Ornella Piazza, Federica Portunato, Venerino Poletti, Giulio Viceconte, Andrea Rocchetti, Domenico Pietro Santonastaso, Francesca Serapide, Stefania Stefani, Carlo Tascini, Gianpiero Tebano, Martina Tosi, Mario Tumbarello, Bruno Viaggi, Pierluigi Viale, Francesco Cristini","doi":"10.1016/j.cmi.2025.08.022","DOIUrl":"10.1016/j.cmi.2025.08.022","url":null,"abstract":"<p><strong>Scope: </strong>Interpretation of rapid and advanced microbiological test results remains nonstandardized, with no existing reference guidelines. This study aimed to analyse the existing evidence and provide expert guidance on the use of these techniques in critically ill patients.</p><p><strong>Methods: </strong>A Delphi consensus process was conducted by a multidisciplinary panel of experts, including microbiologists, infectious disease specialists, intensivists, surgeons, and pulmonologists. Sixteen prioritized key questions were addressed via literature reviews and two Delphi rounds. Consensus was reached when 70% of the responses showed strong agreement.</p><p><strong>Questions addressed by consensus and recommendations: </strong>Consensus was reached for all 16 statements. The key findings include the importance of interpreting rapid microbiological test results within a specific clinical context; the need for concurrent standard culture examinations alongside rapid tests to ensure the detection of all pathogens; the clinical usefulness of turnaround times <24 hours for rapid techniques; and the benefits of rapid diagnostics, particularly in severe sepsis and other severe infections. Specific recommendations were made regarding the use of rapid tests in various clinical settings (critically ill patients with suspected infection, pneumonia, and ventilator-associated pneumonia). The panel found insufficient evidence to support the routine use of digital polymerase chain reaction in various infection scenarios and concluded that clinical bioinformatics expertise is essential in microbiology laboratories that use advanced technologies. The panel also highlighted the need for basic clinician training to interpret data generated using advanced microbiological techniques. This consensus provides guidance for the appropriate use of rapid and advanced microbiological techniques for critically ill patients. However, the standardization of testing settings, interpretations, and cost-effectiveness analyses of different approaches requires further investigation. Robust preanalytical workflows and multidisciplinary clinical bioinformatics expertise are crucial for the effective implementation and interpretation of advanced techniques.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945348","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":"Comparison of carbapenemase-producing Enterobacterales colonizing war-affected children from the Gaza Strip and hospitalized children from a national reference center in Qatar: an observational cohort study.","authors":"Andrés Pérez-López, Anju Sharma, Sathyavathi Sundararaju, Mohammed Suleiman, Ruwa Mohamed, Diyna Altrmanini, Ibrahim Hassan, Ogra Marufu, Eman Al Maslamani, Clement K M Tsui, Hiam Chemaitelly, Patrick Tang","doi":"10.1016/j.cmi.2025.08.026","DOIUrl":"10.1016/j.cmi.2025.08.026","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the rates and molecular characteristics of carbapenemase-producing Enterobacterales (CPE) from rectal screening swabs in war-affected Palestinian children in the Gaza Strip with those of the local pediatric population at Sidra Medicine in Doha.</p><p><strong>Methods: </strong>Whole-genome sequencing was performed on CPE isolated in screening specimens of Gazan children transferred to our institution from Egyptian hospitals between December 2023 and May 2024 (Gaza cohort) and other pediatric patients between January 2021 and May 2024 (Sidra Cohort).</p><p><strong>Results: </strong>The Sidra cohort included 84 CPE isolates from 79 carriers, whereas the Gaza cohort included 53 isolates from 41 carriers. The Gaza cohort showed a 41.9-fold (95% CI, 22.7-81.6) higher crude incidence rate ratio of colonization. In Sidra cohort, 71 carriers (89.9%) had pre-existing medical conditions, compared with 29 (70.7%) Gazan carriers who had no preexisting medical conditions before the armed conflict between Hamas and Israel began in October 2023. Thirty-two (78.0%) Gazan carriers sustained war-related injuries, with 31 (96.7%) of these patients undergoing at least one surgery in Gaza or Egypt. In the Gaza collection, 47 (88.7%) isolates displayed difficult-to-treat resistance phenotype (DTR), whereas 32 (38.1%) Sidra isolates exhibited this phenotype. NDM-like carbapenemases predominated in the Gaza collection (49 isolates; 92.5%), whereas OXA-48-like were most prevalent in the Sidra collection (41 isolates; 48.8%). Klebsiella pneumoniae and Escherichia coli populations in the Gaza collection were dominated by the high-risk clones ST147 (15/19; 78.9%) and ST167 (13/30; 43.3%). Pairwise single-nucleotide polymorphism analysis of these genotypes revealed genetic diversity, suggesting different sources and transmission chains among Gazan carriers.</p><p><strong>Discussion: </strong>Our study revealed a high CPE colonization rate among war-affected Palestinian children and highlights the potential risk posed by conflict-related health emergencies in the silent spread of multidrug-resistant organisms, particularly high-risk global lineages exhibiting DTR, within the healthcare systems of host countries.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945368","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":"'Survival and quality-of-life in mucormycosis'-author's reply.","authors":"Rizwan Suliankatchi Abdulkader, Malu Mohan, Divya Saravanakumar, Manickam Ponnaiah, Tarun Bhatnagar, S Devika, K Gayathri, Amanda G A Rozario, Aditya Moorthy, K Devaraja, Prasanna Kumar Saravanam, Sunil Kumar Panigrahi, Abhinav Srivastava, Achyut Chandra Baishya, Ajai Garg, Amit Kumar Mishra, Amit Tyagi, Anjana Jyoti Talukdar, Ankita Kankaria, Aparna Bhatnagar, Arathi Karat, Arul Sundaresh Kumar, Ashi Chug, Ashok Vankudre, Balakrishnan Ramaswamy, Bhagirathsinh Parmar, M B Bharathi, Bhargav R Jadav, Bhaskaran Unnikrishnan, Divya Karuppannasamy, Gaurav Medikeri, Girija Ghate, Hardik Shah, Ipsita Saha, Jutika Ojah, Kailesh Pujary, Kajal Srivastava, Karthikeyan Shanmugam, Karthikeyan Krishnasamy, Kavitha Saravu, Kavya Sivapuram, Krupal Joshi, Mahendra Singh, Mukesh Bairwa, E Muthurajesh, Muthuswamy Dhiwakar, Nandini Das, Navneh Samagh, Nethra Dinakaran, Niharika Borugadda, Nikhil Gupta, Nitin Gupta, Nitin Madhusudan Nagarkar, Nitinkumar Solanki, Parul Sharma, Pradipta Parida, PrasanKumar Panda, Praveen Kulkarni, Prithvi Bacchalli, S Priya, Pushpa Patil, Raghunath Shanbag, Rahul Kumar Bagla, Rajashri Patil, Rajesh Kumar Avuluri, Rakesh Patil, Ramanikanth Vijhayaraghavan, Ramesh Hanumantappa, Ramesh Duraisamy, A Rathinavel, Renuka S Melkundi, Rita Singh Saxena, Salil Kumar Mandal, Sanjay Kishve Pandharinath, Sara Varghese Thomas, Satish Satpute, Saurav Sarkar, Seetharaman Narayanan, Shalini Thakur, Shubhashri Jahagirdar, Siddaram Patil, Simmi Dube, Somu Lakshamanan, Srinivas D Rao, V Sumathi, Surendra Babu Darivemula, Tulasi Nayak, Umesh Dixit, Vaibhav Saini, Varsha Backiavathy, Vijendra Shenoy, Vinay Kumar Hallur, Manoj V Murhekar, Ambesh Singh, Anirudha Vijay Muthalik, Ankita Semwal, Anuradha Raj, Arvind Singh, Arvind Kumar, Basanta Haarika, Bijan Adhikary, Chintan Kaswala, Deepak Madi, Dharmendra Solanki, Deepak Haldipur, Deepu Palal, Dillip Kumar Samal, Gracia Sohkhlet, Harmeet Kaur, Jeevithan Shanmugam, Kalpana Singh, Kannan Muthuraman, Kathiravan Rajendran, Kavita Patil, Kshithi Kudlu, Lakshmi Krishnan, Mainak Dutta, Mathavaswami Vijayageetha, Mehul Rathod, Naveen Kumar Jayakumar, Nirmal Patel, Preetam Arthur, Preeti Kale, Preksha Dwivedi, J Puja, Rakesh Ninama, Ramesh Rathinamoorthy, Ripu Daman Arora, Rushika Patel, Sahjid Mukhida, Sai Sri Krishnaja Kanakaveti, Saranya Rajamanickam, Sarthak Verma, K P Senthilnathan, Seshadri Varadarajan, Shivakumar Swamy Shivalingappa, Shivani Kalhan, Srinithya Kancherla, Srinivasa P V Kumar, Vaishnavi Chinnappan, Varun Goel, Vikasdeep Gupta","doi":"10.1016/j.cmi.2025.08.024","DOIUrl":"10.1016/j.cmi.2025.08.024","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945371","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":"Team-based, hybrid, or standard of care? Organizational models of tuberculosis care on tuberculosis outcomes in eleven Italian hospital.","authors":"Giacomo Guido, Francesco Di Gennaro, Francesco Cavallin, Mariantonietta Pisaturo, Lorenzo Onorato, Federica Zimmerhofer, Giuseppe Bruno, Massimo Fasano, Stefano Di Gregorio, Agostina Pontarelli, Tiziana Iacovazzi, Virginia Di Bari, Marika Ferrante, Giorgia Manco Cesare, Luisa Frallonardo, Gianfranco Panico, Raffaella Libertone, Caterina Monari, Alessia Musto, Francesca Serapide, Mariangela Niglio, Salvatore Rotundo, Federica De Gregorio, Marinella Cibelli, Loredana Alessio, Giuseppina De Iaco, Rossana Lattanzio, Luigi Ronga, Gaetano Brindicci, Vincenzo Giliberti, Carmen Rita Santoro, Gina Gualano, Salvatore Minniti, Giovanni Battista Buccoliero, Sergio Lo Caputo, Sergio Carbonara, Antonio Cascio, Alessandro Russo, Roberto Parrella, Fabrizio Palmieri, Annalisa Saracino, Nicola Coppola","doi":"10.1016/j.cmi.2025.08.020","DOIUrl":"10.1016/j.cmi.2025.08.020","url":null,"abstract":"<p><strong>Objectives: </strong>Tuberculosis (TB) continues to pose challenges in high-income countries, among migrant and socioeconomically vulnerable populations. Treatment discontinuity and loss to follow up (LTFU) remain critical barriers to TB control. This study evaluated the impact of three organizational models of TB care on clinical and programmatic outcomes in Italy.</p><p><strong>Methods: </strong>We conducted a multicentre study including all TB patients diagnosed between 2021 and 2024 in 11 hospitals in five regions. Centres were categorized into three care models: (i) TB team (structured care with trained staff, dedicated outpatient clinics, and proactive follow-up); (ii) hybrid centre (HC); and (iii) standard-of-care (SOC). Primary outcomes included hospital length of stay, incidence and severity of adverse events, treatment completion, and LTFU. Mixed-effect regression models adjusted for confounders.</p><p><strong>Results: </strong>Of 717 pansusceptible and monoresistant TB patients, 375 (52.3%) were treated in TB team centres, 175 (24.4%) in HC, and 167 (23.3%) in SOC centres. Treatment completion was higher in TB team (327/375, 87.2%) vs. HC (116/162, 71.6%) and SOC centres (89/158, 56.3%) (p < 0.0001), whereas LTFU was lowest in TB team (35/375, 9.3%) vs. HC (44/162 27.2%) and SOC (63/158, 39.9%) (p < 0.0001). Hospital stay was shorter in the TB team (median 26 days, interquartile range (IQR), 15-55) and HC (35 days, IQR, 22-62) compared with SOC (50 days, IQR, 22-82) (p < 0.0001). The occurrence of adverse events was similar (p 0.54), with lower severity in the TB team and HC. Adjusted analyses confirmed lower risk of incomplete treatment (OR, 0.10; 95% CI, 0.03-0.30), LTFU (OR, 0.09; 95% CI, 0.04-0.23), and severe adverse events (OR, 0.40; 95% CI, 0.17-0.95) in the TB team vs. SOC.</p><p><strong>Discussion: </strong>The TB-dedicated care model was associated with improved outcomes, fewer severe adverse events, higher treatment completion rates, and lower LTFU. Although hybrid models conferred intermediate benefit, implementation of TB care ensured consistent gains. These findings support scaling up TB team-based models to strengthen TB control and align with elimination targets.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945359","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 interplay between Epstein-Barr virus and cytomegalovirus reactivation following allogeneic haematopoietic cell transplantation in the era of primary cytomegalovirus prophylaxis.","authors":"Tali Shafat, Fareed Khawaja, Ying Jiang, Marilyne Daher, Anthony Febres-Aldana, Terri Lynn Shigle, Gabriela Rondon, Richard Champlin, Micah Bhatti, Amy Spallone, Amanda Olson, Ella J Ariza-Heredia, George Chen, Katayoun Rezvani, Elizabeth J Shpall, Roy F Chemaly","doi":"10.1016/j.cmi.2025.08.017","DOIUrl":"10.1016/j.cmi.2025.08.017","url":null,"abstract":"<p><strong>Objectives: </strong>Epstein-Barr virus (EBV) reactivation following allogeneic haematopoietic cell transplantation (allo-HCT) is associated with increased mortality and possible posttransplant lymphoproliferative disorder. With the lack of prophylactic agents, identifying modifiable risk factors to prevent EBV-related mortality is desired. Cytomegalovirus (CMV) DNAemia has been previously associated with EBV DNAemia; the impact of letermovir prophylaxis on this association remains unclear. We aimed to identify risk factors for EBV reactivation; assess the correlation between EBV, CMV reactivation, and letermovir use; and assess the impact of EBV reactivation on mortality.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of allo-HCT recipients between March 2016 and December 2019. We excluded patients lacking EBV PCR monitoring or with negative CMV recipient serostatus. A multivariable competing risks analysis was used to identify risk factors for EBV reactivation and mortality at week 48 posttransplantation.</p><p><strong>Results: </strong>EBV reactivation occurred in 183 of 668 (27.4%) allo-HCT recipients; of those, 57 (31.1%) had significant EBV reactivation, and 10 (5.5%) were diagnosed with posttransplant lymphoproliferative disorder. EBV reactivation was associated with CMV DNAemia, clinically significant CMV infection, and CMV end-organ disease (49.7%, 48.1%, and 19.1% compared with 37.3%, 34.8%, and 9.7% with no EBV reactivation, respectively, all p < 0.05) and was not associated with letermovir primary prophylaxis (24.2% on vs. 29.7% off letermovir, p 0.118). In multivariable analysis, risk factors for EBV reactivation included CMV reactivation (adjusted hazard ratio (aHR) 1.46), Asian (aHR 2.00) or Black race (aHR 2.71), underlying acute myeloid leukaemia (aHR 1.98) or chronic myelomonocytic leukaemia (aHR 3.16), graft-vs.-host disease (aHR 2.35), and antithymocyte globulin exposure (aHR 5.90). A propensity score-adjusted multivariable analysis confirmed no significant association between letermovir prophylaxis and EBV reactivation. EBV reactivation was not independently associated with mortality.</p><p><strong>Discussion: </strong>EBV reactivation had no apparent correlation with letermovir prophylaxis, was associated with previous CMV reactivation, and had no significant impact on mortality.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945377","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":"Clinical significance of respiratory torque teno virus in immunocompromised patients with acute respiratory failure.","authors":"Alexis Maillard, Linda Feghoul, Virginie Lemiale, Séverine Mercier-Delarue, Alexandre Demoule, Samir Jaber, Kada Klouche, Achille Kouatchet, Laurent Argaud, Francois Barbier, Naike Bigé, Anne-Sophie Moreau, Emmanuel Canet, Frédéric Pène, Maud Salmona, Djamel Mokart, Elie Azoulay, Jérôme LeGoff","doi":"10.1016/j.cmi.2025.07.035","DOIUrl":"10.1016/j.cmi.2025.07.035","url":null,"abstract":"<p><strong>Objectives: </strong>Among immunocompromised patients with acute respiratory failure, identification of those at higher risk for opportunistic infections is crucial to optimize management. The torque teno virus (TTV) DNA burden in the blood has been identified as a surrogate marker of functional immunity in solid organ transplant recipients. This study investigates the clinical relevance of the presence of TTV DNA in nasopharyngeal swabs of immunocompromised patients with acute respiratory failure (ARF).</p><p><strong>Methods: </strong>We enrolled immunocompromised patients with ARF admitted to 32 intensive care units. Nasopharyngeal swabs collected on admission were tested for TTV DNA. Causes of ARF were reviewed by three expert investigators blinded to TTV results, with specific attention to the presence of opportunistic infections. The primary endpoint was the association between TTV DNA burden in nasopharyngeal swabs and the rate of opportunistic infections causing the ARF.</p><p><strong>Results: </strong>Of the 505 patients, respiratory TTV DNA was detected in 304 of 505 (60%), with TTV burden ≥2.9 log₁₀ copies/mL in 184 of 305 (36%). TTV burden ≥2.9 log₁₀ copies/mL was significantly associated with a higher prevalence of opportunistic infections (20% [36/178] vs. 11% [33/307]; adjusted odds ratio, 2.41; 95% CI, 1.35-4.28; p 0.002). High TTV burden ≥2.9 log₁₀ copies/mL was also associated with a higher rate of all cause pulmonary infections (67% [119/178] vs. 56% [108/192] when not detected), microbiologically documented bacterial infections (35% [62/178] vs. 23% [45/192]), and with a higher rate of influenza-like respiratory virus detection in nasopharyngeal swabs (15% [27/184] vs. 6% [12/201] when not detected). Furthermore, TTV detection was associated with a higher rate of mechanical ventilation or death at day 28 (59% [179/304] vs. 48% [97/201] when not detected).</p><p><strong>Discussion: </strong>In immunocompromised patients with ARF, high TTV burden in the respiratory tract is associated with higher rates of pulmonary infections due to opportunistic pathogens and with adverse outcomes.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945379","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":"Aminoglycoside breakpoints-the EUCAST approach and what this means for the clinician.","authors":"Christian G Giske, Marlène Amara, Rafael Cantón, Shampa Das, Barbara Holzknecht, Gunnar Kahlmeter, Paul Christoffer Lindemann, Alasdair MacGowan, Joseph Meletiadis, Anouk E Muller, John Turnidge, Mandy Wootton, Sören Gatermann","doi":"10.1016/j.cmi.2025.08.015","DOIUrl":"10.1016/j.cmi.2025.08.015","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945158","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":"Penicillin V as first-line treatment of pneumonia in primary care: a registry-based study.","authors":"Olof Cronberg, Mia Tyrstrup, Anders Beckman, Sara Carlsson, Kim Ekblom, Anna Moberg, Katarina Hedin","doi":"10.1016/j.cmi.2025.08.016","DOIUrl":"10.1016/j.cmi.2025.08.016","url":null,"abstract":"<p><strong>Objectives: </strong>Penicillin V (PcV) is considered the first-line treatment for community-acquired pneumonia in Scandinavian countries, although data supporting this recommendation are scarce. Thus, this study aimed to compare PcV and amoxicillin regarding the risk of treatment failures in children aged >5 years and adults treated for pneumonia in primary care.</p><p><strong>Methods: </strong>In this retrospective study of healthcare registry data from four regions in Sweden with 2.3 million inhabitants, we included 34 306 primary care cases of pneumonia from February 12, 2018 to December 3, 2021. Adjusted odds ratios (aORs) and 95% CIs for treatment failure days 1 to 28 (primary composite endpoint: hospitalization for lower respiratory tract infections [LRTI] or all-cause mortality; and secondary endpoint: antibiotic switch) were calculated using logistic regression analysis. A propensity score matched analysis was conducted.</p><p><strong>Results: </strong>PcV was prescribed in 19 761 cases, amoxicillin in 2363 cases, doxycycline in 9830 cases, and other antibiotics in 2352 cases. Hospitalization for LRTI or all-cause mortality occurred in 4.9% of cases treated with amoxicillin vs. 3.8% of cases treated with PcV (aOR, 1.07; 95% CI, 0.87-1.32). Antibiotic switch occurred in 8.9% of cases treated with amoxicillin vs. 14% of cases treated with PcV (aOR, 0.58; 95% CI, 0.50-0.67). The corresponding ORs of the propensity score match analysis were 1.13 (95% CI, 0.86-1.49) for hospitalization for LRTI or all-cause mortality and 0.55 (95% CI, 0.45-0.65) for antibiotic switch.</p><p><strong>Conclusions: </strong>This study showed no difference in risks of hospitalization for LRTI or all-cause mortality between PcV and amoxicillin for pneumonia in primary care.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945336","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}