Clinical Microbiology and Infection最新文献

{"title":"ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in patients with rheumatological diseases","authors":"Maria Giulia Caponcello ,&nbsp;Paula Olivares Navarro ,&nbsp;Cecilia Bonazzetti ,&nbsp;Caterina Campoli ,&nbsp;Alessia Savoldi ,&nbsp;Elisa Gentilotti ,&nbsp;Antonella d'Arminio Monforte ,&nbsp;Sergio Lo Caputo ,&nbsp;Lucía Otero-Varela ,&nbsp;Isabel Castrejón ,&nbsp;Evelina Tacconelli ,&nbsp;Jesús Rodríguez-Baño ,&nbsp;Zaira R. Palacios-Baena ,&nbsp;the Rheumatological Expert team","doi":"10.1016/j.cmi.2025.02.030","DOIUrl":"10.1016/j.cmi.2025.02.030","url":null,"abstract":"<div><h3>Objectives</h3><div>The clinical management of COVID-19 in immunocompromised patients remains a challenge. This work aimed to develop a consensus to establish recommendations for the clinical, diagnostic, and therapeutic management of patients with rheumatic diseases and COVID-19.</div></div><div><h3>Methods</h3><div>A panel of 14 international experts was selected, and Delphi methodology was used for the consensus, after a systematic literature review. Twenty-four questions were formulated and presented to the panel. The experts voted using a 6-point Likert scale (1) ‘Strongly disagree’ (SD); (2) ‘Disagree’ (D); (3) ‘Somewhat disagree’ (SWD); (4) ‘Somewhat agree’ (SWA); (5) ‘Agree’ (A); (6) ‘Strongly agree’ (SA). To establish consensus, simple or cumulative agreement ≥80% was required over a maximum of three rounds. Cumulative agreement was defined as the sum of response percentages on items 1–2 (SD + D); 2–3 (D + SWD); 4–5 (SWA + A); or 5–6 (A + SA), distinguishing a strong degree of agreement (A + SA) or disagreement (SD + D) from a moderate degree of agreement (SWA + A) or disagreement (D + SWD).</div></div><div><h3>Results</h3><div>After the three rounds, consensus was reached on 23 of the 24 questions and 10 recommendations were made.</div></div><div><h3>Discussion</h3><div>The Delphi methodology allowed consensus on recommendations in areas with insufficient scientific evidence, which can be considered for decision-making in the management of patients with rheumatological diseases while awaiting better evidence.</div></div>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":"31 8","pages":"Pages S37-S43"},"PeriodicalIF":10.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572331","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":"Features and benefits of a graphical abstract.","authors":"J Friedman","doi":"10.1016/j.cmi.2025.05.029","DOIUrl":"10.1016/j.cmi.2025.05.029","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207852","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":"Towards equitable and structured training in paediatric infectious diseases across Europe.","authors":"Luise Martin, Tobias Tenenbaum","doi":"10.1016/j.cmi.2025.05.031","DOIUrl":"10.1016/j.cmi.2025.05.031","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207853","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":"Disposition of colistin in critically-ill patients on sustained low-efficiency dialysis: A population pharmacokinetic study.","authors":"Adhiratha Boonyasiri, Dominika T Fuhs, Thummaporn Naorungroj, Lu Wang, Jiping Wang, Ranistha Ratanarat, Jian Li, Roger L Nation, Visanu Thamlikitkul, Cornelia B Landersdorfer","doi":"10.1016/j.cmi.2025.05.021","DOIUrl":"10.1016/j.cmi.2025.05.021","url":null,"abstract":"<p><strong>Objectives: </strong>Although colistin (administered as colistin methanesulphonate [CMS]) is used to treat infections in critically-ill patients undergoing sustained low-efficiency dialysis (SLED), there is a paucity of information on appropriate dosing regimens. This study aimed to characterize the population pharmacokinetics (popPK) of colistin during SLED and evaluate the likelihood of antibacterial benefit and colistin nephrotoxicity for different regimens.</p><p><strong>Methods: </strong>A prospective popPK study included 13 critically-ill patients (six females) treated with CMS and receiving SLED (6-8 hours). For each subject, the PK of formed colistin was studied on a non-SLED day and a SLED day (n = 8 studied during SLED day first). A single intravenous daily dose (150 mg colistin base activity) was administered on a non-SLED day. On a SLED day, patients received 150 mg colistin base activity 12-hourly. Serial blood, urine and dialysate samples were collected over 24 hours on both days. Colistin plasma concentrations were measured by high-performance liquid chromatography. PopPK modelling and Monte Carlo simulations were performed.</p><p><strong>Results: </strong>A linear one-compartment disposition model well-described the data. The population mean apparent colistin body clearance, excluding SLED clearance, was 1.69 L/h (20.6% inter-individual variability [IIV], 42.1% inter-occasion variability). The apparent colistin SLED clearance was 3.49 L/h (41.7% IIV), i.e. 67.4% of total colistin clearance on a SLED day. The apparent volume of distribution was 50.2 L (23.0% IIV).</p><p><strong>Discussion: </strong>Colistin clearance was substantially higher during SLED; therefore, SLED should be accounted for in CMS dosing regimens. This project generated clinically applicable regimens, such as loading doses, to achieve required probabilities of target attainment in patients undergoing SLED.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191570","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":"Mortality due to carbapenem-resistant Acinetobacter baumannii bacteraemia: author's response.","authors":"Stamatis Karakonstantis, Evangelos I Kritsotakis, Renatos-Nikolaos Tziolos, Kyriaki Tryfinopoulou, Diamantis P Kofteridis","doi":"10.1016/j.cmi.2025.05.023","DOIUrl":"10.1016/j.cmi.2025.05.023","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186728","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":"Association of time to positivity with disease severity in bloodstream infections-a population-based cohort study.","authors":"Oskar Ljungquist, Jonas Tverring, Karl Oldberg, Torgny Sunnerhagen, Gustav Torisson","doi":"10.1016/j.cmi.2025.05.027","DOIUrl":"10.1016/j.cmi.2025.05.027","url":null,"abstract":"<p><strong>Objectives: </strong>Short time to positivity (TTP) has been proposed as a prognostic indicator in bloodstream infection (BSI) but results have been conflicting. The aim of this study was to explore the association between TTP and disease severity, using non-linear models.</p><p><strong>Methods: </strong>This population-based retrospective study included all blood cultures in southern Sweden from 2021 to 2023. Using healthcare databases, BSI episodes were linked to information regarding prespecified disease severity markers at the time of culture (laboratory values and vital signs) as well as patient outcomes (intensive care admission and all-cause mortality at 30 days). The associations between TTP vs. disease severity were explored using non-linear regression models.</p><p><strong>Results: </strong>The study included 12 585 unique BSI episodes, with a median (interquartile range) TTP of 12.1 (9.7-17.7) hours, and an overall 30-day mortality rate of 14.4%. Non-linear regression models indicated a higher mortality rate with shorter TTP, with a mortality rate of 20% at a TTP of 6 hours, and 30% at a TTP of 3 hours. In Enterobacterales, beta-haemolytic streptococci, Streptococcus pneumoniae, Staphylococcus aureus, as well as in polymicrobial findings, regression models indicated that shorter TTP was associated with a risk of >30% of intensive care admission or mortality, as compared with an overall rate of 18.2%. Shorter TTP was also associated with laboratory values and vital signs. For lactate, with an overall median value of 1.9 mmol/L, the model indicated a value of 3 mmol/L at a TTP of 8 hours, and at 4 mmol/L at a TTP of 4 hours. All associations with disease severity markers and outcomes were non-linear.</p><p><strong>Discussion: </strong>TTP is an indicator of disease severity and prognosis in BSIs. The exponential association provides a biologically plausible explanation for previously conflicting results. Future studies should focus on determining the clinical utility of TTP.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186727","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":"Evaluation of a multiplex PCR assay using barcoded magnetic bead technology for detection of fungal pathogens in bronchoalveolar lavage fluid.","authors":"Nitipong Permpalung, Kate Uhteg, Moreno Rodrigues, Warda Memon, Marissa Totten, Sean X Zhang","doi":"10.1016/j.cmi.2025.05.022","DOIUrl":"https://doi.org/10.1016/j.cmi.2025.05.022","url":null,"abstract":"<p><strong>Objectives: </strong>Invasive fungal infections (IFIs) are increasingly prevalent, particularly in immunocompromised patients. Traditional culture-based diagnostic methods have limitations, including low sensitivity and long turnaround times. The Applied BioCode (ABC) assay, utilizing barcoded magnetic bead technology, enables simultaneous detection of 22 fungal pathogens directly in bronchoalveolar lavage (BAL) fluids in 5 hours. This study aimed to assess the ABC's diagnostic performance in combination with other methods for diagnosis of IFIs.</p><p><strong>Methods: </strong>A prospective study was conducted from August 2023 to March 2024 in patients with suspected pulmonary IFIs. BAL samples were tested simultaneously using the ABC assay, fungal microscopy, culture, BAL galactomannan (GM), and an in-house Pneumocystis jirovecii PCR. The diagnostic performance of the ABC assay was evaluated individually and in combination with other methods.</p><p><strong>Results: </strong>Among 323 patients (44 proven/probable IFIs, 279 non-IFIs), the ABC assay demonstrated a sensitivity of 43.2% (95% CI: 28%-59%) and a specificity of 98.5% (95% CI: 96%-99%). When combined with BAL GM (≥0.5), the ABC assay was able to detect 70.4% (95% CI: 54%-83%) of cases with proven/probable IFIs in 5 hours. When the ABC assay, fungal culture, and BAL GM (≥0.5) were combined and IFIs were considered to be detected if either of the combined tests was positive, sensitivity increased to 88.6% (95% CI: 75%-96%), with a specificity of 93.5% (95% CI: 90%-96%). The ABC assay' sensitivity was not affected by antifungal therapy (46.1% [95% CI: 19%-74%] with antifungal therapy vs 42.0% [95% CI:24%-60%] without antifungal therapy, p=0.77), unlike fungal culture (23.0% [95% CI:0%-53%] with antifungal therapy vs 64.0% [95% CI: 45%-80%] without antifungal therapy, p=0.01).</p><p><strong>Conclusions: </strong>The ABC assay, when combined with BAL GM and fungal culture, significantly improved diagnostic accuracy for IFIs. Further validation of the ABC assay is warranted to optimize its clinical use.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180697","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 gaps from mathematical model to clinical application: precision management of severe fever with thrombocytopenia syndrome.","authors":"Haifeng Hu, Hong Du, Chunfu Wang, Jianqi Lian","doi":"10.1016/j.cmi.2025.05.017","DOIUrl":"10.1016/j.cmi.2025.05.017","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180643","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":"Which trial do we need? A randomized controlled trial comparing 7 vs. 14 days of antibiotic therapy for the treatment of urinary tract infection with systemic signs and symptoms in male patients.","authors":"Johan Van Laethem, Marco Moretti, Ineke Aerts, Pieter-Jan Cortoos","doi":"10.1016/j.cmi.2025.05.025","DOIUrl":"10.1016/j.cmi.2025.05.025","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181070","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":"Diagnosis and management of Candida endophthalmitis and chorioretinitis.","authors":"Nitipong Permpalung, Sarah Sedik, Peter G Pappas, Martin Hoenigl, Luis Ostrosky-Zeichner","doi":"10.1016/j.cmi.2025.05.028","DOIUrl":"10.1016/j.cmi.2025.05.028","url":null,"abstract":"<p><strong>Background: </strong>Candida endophthalmitis (CE) and chorioretinitis are uncommon but potentially devastating complications of candidemia, associated with significant risks of vision loss and long-term morbidity. Effective management relies on timely diagnosis and targeted antifungal therapy. However, diagnostic and therapeutic approaches are hindered by inconsistent guidelines, limited evidence, and variations in clinical practice.</p><p><strong>Objectives: </strong>This review synthesizes current knowledge on CE and chorioretinitis to provide a comprehensive framework for clinicians. It addresses diagnostic challenges, including ophthalmoscopy, imaging, and microbiological diagnostics, and therapeutic strategies such as systemic and intravitreal antifungal therapies, surgical interventions, and serial ophthalmic evaluations.</p><p><strong>Sources: </strong>An extensive literature search was conducted using PubMed, Embase, and Scopus, with a focus on epidemiology, pathogenesis, diagnostics, treatment, and outcomes. Guidelines from the Infectious Diseases Society of America, European Confederation for Medical Mycology, and American Academy of Ophthalmology were reviewed.</p><p><strong>Content: </strong>The prevalence of CE among patients with candidemia has increased from 1.8% in the pre-echinocandin era to 2.1% after the introduction of echinocandins. Diagnosis relies primarily on indirect ophthalmoscopy, the reference standard for retinal visualization. In selected cases, optical coherence tomography or fundus photography may support lesion assessment. Microbiological confirmation via vitreous sampling remains definitive but is often limited by low organism burden. Emerging diagnostics-such as clustered regularly interspaced short palindromic repeats-based fungal DNA assays-have shown promise. Although artificial intelligence-assisted imaging tools are established in other retinal diseases, they have not yet been validated for Candida ocular infections. Fluconazole and voriconazole remain first-line systemic therapies, with intravitreal injections and vitrectomy reserved for severe cases.</p><p><strong>Implications: </strong>Improving outcomes in CE requires harmonized screening protocols, timely access to ophthalmologic care, and multidisciplinary collaboration. Future research should aim to refine diagnostic algorithms, define optimal treatment durations, clarify the role of emerging diagnostics, and leverage telemedicine and imaging technologies to improve early detection and longitudinal monitoring.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180696","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}