Clinical Microbiology and Infection最新文献

{"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}

{"title":"Impact of enhanced infection control and antimicrobial stewardship on infections by Clostridioides difficile, vancomycin-resistant enterococci, and third-generation cephalosporin-resistant Enterobacterales: a stepped-wedge cluster intervention study.","authors":"Annika Y Classen, Thilo Dietz, Luisa Durán Graeff, Simone Eisenbeis, Petra Gastmeier, Siri Göpel, Armin Hoffmann, Florian Hölzl, Nadja Käding, Winfried V Kern, Evelyn Kramme, Cristina Belmar Campos, Florian P Maurer, Harald Seifert, Arne Meißner, Anna M Rohde, Holger Rohde, Jan Rupp, Evelina Tacconelli, Sarah V Walker, Janine Zweigner, Jörg J Vehreschild","doi":"10.1016/j.cmi.2025.08.013","DOIUrl":"10.1016/j.cmi.2025.08.013","url":null,"abstract":"<p><strong>Objectives: </strong>Infection prevention and control (IPC) and antimicrobial stewardship (AMS) measures are critical to reducing transmission and infection by Clostridioides difficile (CDI) and other enteric pathogens. This study evaluated the impact of enhanced IPC and AMS on CDI and bloodstream infections (BSIs) caused by vancomycin-resistant enterococci (VRE) and third-generation cephalosporin-resistant Enterobacterales (3GCREB).</p><p><strong>Methods: </strong>The study was conducted in five German university hospitals from January 2016 to July 2019. IPC and AMS interventions were sequentially enhanced in three departments with high-incidence CDI at baseline using a stepped-wedge cluster intervention approach. Main outcome measures were incidence densities of CDI and BSI caused by VRE and 3GCREB. An interrupted time series analysis was performed to assess the intervention effects during a normalized study period.</p><p><strong>Results: </strong>Across 15 departments, >384,000 patient days were included. Incidence density of target infections was low (CDI, 0.77; VRE BSI, 0.07; and 3GCREB BSI, 0.09 per 1000 patient days). Pooled interrupted time series analysis results showed a significant reduction in CDI incidence density following the enhancement of AMS measures (AMS period regression slopes difference, -0.089; F[p] = 5.400 [0.037]). Regarding the incidence density of VRE/3GCREB BSI, no relevant changes could be observed (regression slopes difference, -0.19; F[p] = 0.667 [0.429]). A subgroup analysis focusing on haematological and oncological departments showed that AMS influenced prescription behaviour according to implemented AMS strategies, but not clinical outcomes.</p><p><strong>Discussion: </strong>Combined with IPC enhanced short-term AMS measures led to a significant reduction in the incidence of CDI, whereas the incidence of BSI by VRE and 3GCREB remained unchanged in sites with well-established baseline IPC and AMS programmes and low incidence of hospital-associated infections.</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":"144945345","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":"Lessons from the European mpox outbreak: strengthening cohort research for future pandemic preparedness.","authors":"Alessandro Visentin, Alessandra Nazeri, José Luis Peñalvo, Anna Gorska, Ruth Joanna Davis, Rosanna Louise Flett, Victoria Charlotte Simensen, Nina Langeland, Quentin Gaday, Massimo Mirandola, Valentina Mazzotta, Liem Binh Luong Nguyen, Beatriz Mothe, Christophe Van Dijck, Andreas Meyerhans, Christoph Boesecke, Carlo Giaquinto, Ali Judd, Evelina Tacconelli","doi":"10.1016/j.cmi.2025.08.019","DOIUrl":"10.1016/j.cmi.2025.08.019","url":null,"abstract":"<p><strong>Background: </strong>Well-designed cohort studies are crucial for pandemic preparedness, informing evidence-based infection prevention and treatment strategies.</p><p><strong>Objectives: </strong>Following the 2022 mpox outbreak in Europe, this scoping review critically evaluates the design, implementation, and characteristics of cohort studies focusing on mpox. The aim is to inform recommendations for the Cohort Coordination Board and the COordination MEchanism for Cohorts and Trials (CoMeCT) to enhance cohort study research and improve preparedness.</p><p><strong>Sources: </strong>A comprehensive literature search was conducted in PubMed, Scopus, ClinicalTrials.gov, the European Union Clinical Trials Register, and the European Clinical Research Infrastructure Network (ECRIN) metadata repository up to December 2024.</p><p><strong>Content: </strong>Forty-nine cohorts were identified, encompassing 10 728 individuals with primary or breakthrough mpox and 34 010 individuals without mpox (vaccinated and unvaccinated). The majority of cohorts collected data prospectively (30, 63%) and were multicentre (25, 52%). The primary aims were the natural history of mpox (31, 65%); effectiveness of vaccination (15, 31%); and treatment (2, 4%). The most frequent target population was individuals at increased risk of sexually transmitted infection (18, 38%). Follow-up of participants varied widely among cohorts. Significant data heterogeneity, stemming from the inconsistent use of standardized data dictionaries, impeded data sharing and meta-analyses. Under-representation of vulnerable populations and limited biobanking further compounded these challenges.</p><p><strong>Implications: </strong>This review underscores critical gaps in the research response during the mpox outbreak. Based on these findings, we propose the following recommendations: (1) establishing and maintaining \"ever-warm\" cohorts of high-risk individuals during inter-epidemic periods to enable rapid data collection during future outbreaks; (2) promoting data interoperability through the development and adoption of standardized data collection tools and ontologies; (3) improving the quality of study reporting through strict adherence to relevant guidelines; and (4) strengthening European and global coordination through the establishment of collaborative research networks. Sustained investment in research infrastructure is essential for a more effective, equitable, and timely public health response to future outbreaks.</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":"144945326","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":"A randomized trial of simultaneous versus sequential pneumococcal vaccination in elderly.","authors":"Christina Bahrs, Nico Andreas, Thomas Lehmann, Sabine Baumgart, Charlotte Sværke Jørgensen, Oliwia Makarewicz, Daniela Röll, Anne Moeser, Stefan Hagel, Carsten Watzl, Christian Bogdan, Thomas Kamradt, Mathias W Pletz","doi":"10.1016/j.cmi.2025.08.014","DOIUrl":"10.1016/j.cmi.2025.08.014","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate whether simultaneous vaccination of the 13-valent pneumococcal conjugate vaccine (PCV13) and the 23-valent polysaccharide vaccine (PPSV23) elicits higher antigen-specific memory B cell responses compared to sequential (PCV13 followed by PPSV23 after 6 months) or single PPSV23 vaccination in elderly.</p><p><strong>Methods: </strong>In this monocentric, randomized trial, vaccine-naïve adults aged ≥60 years were assigned 1:1:1 to a simultaneous, sequential or single vaccination group. The primary outcome was the change in memory B cells specific for four vaccine-serotypes (ST3, ST14, ST19A, and ST23F) at 27 to 28 weeks after first vaccine dose compared to baseline. Secondary outcomes assessed safety, serotype-specific immunoglobuin G geometric mean fold rise (GMFR) and memory B cells over a 24-month period.</p><p><strong>Results: </strong>Total of 123 persons (41 per group, 65.2 ± 4.4 years, 61.8% females) were randomized. Among 118 evaluable persons, median changes (95% CI) in memory B cells relative to total B cells from baseline to week 27 to 28 were most pronounced for ST19A with 0.022% (0.002%-0.045%) in the simultaneous, 0.022% (-0.006% to 0.068%) in the sequential, and 0.005% (-0.004% to 0.054%) in the single group. There was no evidence of a significant difference in memory B cell responses across all four vaccine-serotypes induced by simultaneous when compared with sequential or single vaccination (e.g. Hodges-Lehmann [HL-] estimator for ST19A, -0.007% [95% CI, -0.038% to 0.021%] for simultaneous vs. sequential; 0.009% [95% CI, -0.017% to 0.036%] for simultaneous versus single), at primary endpoint. Six months after completing the full vaccination schedule, memory B cell response for ST19A was lower in simultaneous than sequential group (HL-estimator, -0.039%; 95% CI, -0.071% to -0.010%). At 24 months, sequential vaccination achieved higher immunoglobulin G against ST3 (GMFR 5.17) than simultaneous (GMFR 2.82) or single vaccination (GMFR 1.94). No serious adverse events occurred.</p><p><strong>Conclusion: </strong>Simultaneous vaccination did not elicit higher memory B cell responses compared to sequential or single vaccination. All approaches were safe.</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":"144945163","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":"How do I manage difficult-to-treat Pseudomonas aeruginosa infections? Key questions for today's clinicians.","authors":"Juan P Horcajada, Ana Gales, Burcu Isler, Keith S Kaye, Andrea L Kwa, Cornelia B Landersdorfer, Maria Milagro Montero, Antonio Oliver, Jason M Pogue, Ryan K Shields, Maria Virginia Villegas, Dafna Yahav, David L Paterson","doi":"10.1016/j.cmi.2025.08.018","DOIUrl":"10.1016/j.cmi.2025.08.018","url":null,"abstract":"<p><strong>Background: </strong>Pseudomonas aeruginosa has a remarkable ability to develop resistance to antimicrobials in vivo, often leaving very limited therapeutic options and making treatment particularly challenging. In fact, P. aeruginosa infections with \"difficult-to-treat resistance\" are one of the most concerning contemporary bacterial infections. Many are hospital-acquired and frequently affect immunocompromised patients with high mortality risk.</p><p><strong>Objectives: </strong>In the absence of head-to-head clinical trials, we have conducted a narrative review of the current therapeutic options for these infections, addressing five key management questions.</p><p><strong>Sources: </strong>Pubmed, Scopus, Web od Sicence and reference lists of key articles.</p><p><strong>Content: </strong>Ceftolozane-tazobactam, ceftazidime-avibactam, imipenem-cilastatin-relebactam, and cefiderocol are newer options, but resistance and lack of relevant data from randomized clinical trials hamper knowledge of the best way to use them.</p><p><strong>Implications: </strong>Ceftolozane-tazobactam and ceftazidime-avibactam are initially preferred when susceptible because they enter the market first, and there is more published evidence about them. Ceftolozane-tazobactam is preferred in P. aeruginosa pneumonia instead of ceftazidime-avibactam. Both can be equally used in other P. aeruginosa infection types. Imipenem-relebactam and cefiderocol may retain susceptibility when there is resistance to ceftolozane-tazobactam and ceftazidime-avibactam, and when metallo-beta-lactamases are not present. However, there are no head-to-head comparative studies to support a preference for one over the other. In the presence of metallo-beta-lactamases, cefiderocol is the preferred agent. Other options in this situation are aztreonam-avibactam, ceftazidime-avibactam combined with aztreonam, and polymyxins combined with meropenem, but evidence is limited. In difficult-to-treat P. aeruginosa infections, combination therapy could be an option. However, despite demonstrations of in vitro synergy and of enhanced activity in hollow fibre or animal models, there is no clinical evidence to support using combination therapy in these infections, and it is not currently recommended as a general option. The role of older antibiotics such as fosfomycin, polymyxin B, or colistin is also reviewed.</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":"144945334","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: 'Hybrid and vaccination immunity against severe COVID-19 in the postpandemic era' by Goldberg et al.","authors":"Xin Xu","doi":"10.1016/j.cmi.2025.08.023","DOIUrl":"10.1016/j.cmi.2025.08.023","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945310","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: 'Diagnostic accuracy of 16S rDNA PCR, multiplex PCR, and metagenomic next-generation sequencing in periprosthetic joint infections: a systematic review and meta-analysis' by Olearo et al.","authors":"Heime Rieber","doi":"10.1016/j.cmi.2025.08.021","DOIUrl":"10.1016/j.cmi.2025.08.021","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945332","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":"Key predictors of mortality in Crimean-Congo haemorrhagic fever: a retrospective multicentre cohort study.","authors":"Deniz Güllü, Defne Yigci, Nurcan Baykam, Aysel Kocagül Çelikbaş, Derya Yapar, Özlem Akdoğan, Kemalettin Özden, Rukiye İnan Sarıkaya, İmran Hasanoğlu, Rahmet Güner, Ebru Doğan, Faruk Karakeçili, Handan Alay, Zeynep Türe Yüce, Esma Eryılmaz Eren, Ayşe Erbay, Şebnem Eren Gök, Çiğdem Kader, Gamze Ünüvar Kalın, Azize Yetişgen, Müge Özgüler, Arzu Şenol, Ömür Gündağ, Merve Çağlar Özer, Firuze Soyak, Büşra Tanır, Işıl Deniz Alıravcı, Güle Çınar, Barçın Öztürk, Esra Gürbüz, Bahadır Orkun Özbay, Fatihan Pınarlık, Mert Kuşkucu, Önder Ergönül","doi":"10.1016/j.cmi.2025.08.009","DOIUrl":"10.1016/j.cmi.2025.08.009","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to identify key predictors of mortality in patients with Crimean-Congo haemorrhagic fever (CCHF). Our specific goals included characterizing the demographic and clinical features of hospitalized CCHF patients in Türkiye, determining the factors associated with mortality among these patients, and evaluating the impact of early ribavirin administration.</p><p><strong>Methods: </strong>A retrospective study was conducted on 1103 CCHF patients across 18 hospitals in Türkiye from 1 January 2019 to 20 November 2024. All data were obtained via an online data collection system by the designated physician at each centre. Patients with laboratory-confirmed CCHF infection who were hospitalized were included in the study. Univariate analyses and time-dependent Cox regression were conducted.</p><p><strong>Results: </strong>Of the 1103 patients, 65.7% (725/1102) were men; 87.2% (962/1103) resided in rural areas; and the mean age was 53 years. Ticks were identified as the transmission route in 68.4% (755/1103) of the cases. Comorbidities included diabetes mellitus, chronic heart disease, and hypertension; 4.6% (51/1103) of the patients developed healthcare-related infections. Intensive care unit admission was required in 8.0% (88/1103) of the patients, and the overall mortality rate was 5.1% (56/1103). In univariate analyses, age ≥50 years (odds ratio [OR], 3.1; 95% CI, 1.58-6.08; p < 0.001) and diabetes mellitus (OR, 4.49; 95% CI, 2.20-9.18; p < 0.001) were associated with increased mortality. Both variables remained statistically significant predictors in the multivariate analysis. Although early ribavirin administration, ≤96 hours from symptom onset, did not reach statistical significance in univariate analysis (OR, 0.52; 95% CI, 0.26-1.05; p = 0.065), it was significantly associated with reduced mortality in time-dependent Cox regression (adjusted hazard ratios, 0.21; 95% CI, 0.07-0.69; p = 0.010).</p><p><strong>Discussion: </strong>Key factors such as age and comorbidities can predict mortality in CCHF patients. Timely identification of these predictors, along with early administration of ribavirin, may contribute to improved survival and better clinical outcomes.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":8.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945314","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}