Clinical Microbiology and Infection最新文献

{"title":"Effectiveness of the live zoster vaccine in patients with type 2 diabetes: a nationwide emulated target trial.","authors":"Tae Hyeon Kim, Kyeongmin Lee, Sooji Lee, Jiyeon Oh, Jaeyu Park, Hyesu Jo, Yejun Son, Soeun Kim, Sang Youl Rhee, Lee Smith, Hanseul Cho, Junyang Jung, Seung Geun Yeo, Hayeon Lee, Dong Keon Yon","doi":"10.1016/j.cmi.2025.05.003","DOIUrl":"10.1016/j.cmi.2025.05.003","url":null,"abstract":"<p><strong>Objectives: </strong>Real-world studies on its effectiveness in patients with type 2 diabetes mellitus (T2DM) remain limited. This study aimed to evaluate the effectiveness of the live zoster vaccine in patients with T2DM more than 10 years.</p><p><strong>Methods: </strong>In this target trial emulation study, we utilized a large-scale, nationwide cohort in South Korea, consisting of individuals aged 50 years and older with T2DM from January 1, 2012 to December 31, 2021 (n = 934 945). This cohort was integrated using health insurance data from the Korea Health Insurance Review and Assessment Service, national health screening results from the Korean National Health Insurance Service, and live zoster vaccination data from the Korea Disease Control and Prevention Agency. Vaccine effectiveness in preventing herpes zoster (HZ), postherpetic neuralgia, and hospital admissions for HZ based on International Classification of Diseases 10th edition codes was evaluated in patients with T2DM. In a propensity score-based overlap weighted cohort, Cox proportional hazard models were used to evaluate the adjusted hazard ratios (aHRs) and 95% CIs for the effectiveness of the live zoster vaccine among patients with T2DM.</p><p><strong>Results: </strong>After propensity score-based overlap weighting, 253 660 patients with T2DM were included (mean age, 62.4 years [standard deviation, 2.3 years]; 138 338 males, 54.5%). Live zoster vaccination was associated with a reduced risk of HZ (aHR 0.59 [95% CI: 0.57-0.61]), postherpetic neuralgia (aHR 0.59 [95% CI: 0.57-0.61]), and hospital admissions for HZ (aHR 0.41 [95% CI: 0.36-0.47]). Vaccine effectiveness was highest within the first-year post-vaccination, with a sustained protective effect lasting up to 6 years. Furthermore, the effectiveness was greater in the non-insulin treatment group compared with the insulin treatment group.</p><p><strong>Discussion: </strong>Our target trial highlighted that live zoster vaccination significantly reduced the risk of HZ, postherpetic neuralgia, and hospital admissions in patients with T2DM. However, its effectiveness was attenuated in those undergoing insulin treatment.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988017","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":"Hybrid and vaccination immunity against severe COVID-19 in the post-pandemic era-a retrospective cohort study.","authors":"Ilan Livne, Arnona Ziv, Yair Goldberg, Amit Huppert","doi":"10.1016/j.cmi.2025.05.002","DOIUrl":"10.1016/j.cmi.2025.05.002","url":null,"abstract":"<p><strong>Objectives: </strong>As COVID-19 has transitioned to an endemic disease, there is a need for evidence-based effective strategies to mitigate its public health impacts. This study aims to evaluate the protection offered by vaccination and hybrid immunity, particularly among the elderly, against severe disease by considering their immunological history and individual characteristics.</p><p><strong>Methods: </strong>In a retrospective cohort study, data from the Israeli Ministry of Health (May 2022-April 2024) were analysed, including 1.2 million individuals aged 60 years and older who received at least three COVID-19 vaccine doses. Participants were categorized into two groups: those with hybrid immunity and those with vaccination and without documented previous infection. Poisson regression models, adjusted for age, sex, wave period, and time since the last immunological event, were used to estimate the risk of severe COVID-19.</p><p><strong>Results: </strong>Individuals without documented previous infection are 14.4 (95% CI, 13.2-15.7) times more at risk compared with those with hybrid immunity. Those aged 70-80 and 80+ are 3.7 (95% CI, 3.0-4.5) and 11.3 (95% CI, 9.3-13.7) times more at risk, respectively, than those aged 60-64. Males are at 1.6 (95% CI, 1.5-1.7) times higher risk than females. There is a substantial decrease over time in severe cases. Waning immunity is observed in the 3-6 months cohort, which is 1.8 (95% CI, 1.5-2.2) times more likely to develop severe disease than the 0-3 months cohort. No further waning immunity was observed after that.</p><p><strong>Discussion: </strong>At this post-pandemic stage, individuals with hybrid immunity had a significantly lower risk of severe disease. These findings support the prioritization of protection strategies for individuals without hybrid immunity and suggest that protection remains durable for at least one year.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961553","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":"Inadequate imipenem dosing in patients with decreased kidney function: a global clinical pharmacokinetic study.","authors":"Anh Quan Truong, Tim J L Smeets, Jean Terrier, Letao Li, Xuan Co Dao, Jan Strojil, Tim Preijers, Birgit C P Koch, Angela Huttner, Sebastiaan D T Sassen","doi":"10.1016/j.cmi.2025.05.005","DOIUrl":"10.1016/j.cmi.2025.05.005","url":null,"abstract":"<p><strong>Objectives: </strong>A number of population pharmacokinetic (popPK) models of imipenem in critically ill patients are available for dosing optimization, but they represent only a narrow range of kidney functions. This study evaluates the target attainment of on-label regimens through popPK modelling and simulation in patients across different kidney functions.</p><p><strong>Methods: </strong>A popPK model was built based on two datasets from Switzerland (model development population, 151 patients, 322 concentrations) and externally validated on two datasets from the Czech Republic (19 patients, 111 concentrations) and Vietnam (43 patients, 85 concentrations). Monte Carlo simulations were performed to evaluate the probability of target attainment from a MIC of 0.125 mg/L to 32 mg/L. We estimated the cumulative fraction of response against Pseudomonas aeruginosa (the epidemiological cut-off value was 4 mg/L) across a broad range of Cockcroft-Gault creatinine clearance values (CL_CRCG 15-130 mL/min). Targets of 40% and 100%ƒT > MIC (percentage of dosing interval estimated free concentrations above MIC) were investigated.</p><p><strong>Results: </strong>Decreased kidney function estimated glomerular filtration rate by the Chronic Kidney Disease Epidemiology Collaboration 2021 (eGFR_CKD-EPI <90 mL/min) was observed in 70 of 151 patients (46.4%) within the model development population, and in 11 of 19 (57.9%) and 24 of 43 (55.8%) patients in the Czech Republic and Vietnam, respectively. CL_CRCG significantly influenced the imipenem clearance described by a two-compartment model. For probability of target attainment, all regimens achieved 40% ƒT > MIC_2mg/L. With a 100%ƒT > MIC target, 500 mg q6h (CL_CRCG 30-60 mL/min) could only cover an MIC of up to 1 mg/L, irrespective of infusion time. For cumulative fraction of response, no dosing regimen could cover susceptible P. aeruginosa for 100%ƒT > MIC.</p><p><strong>Discussion: </strong>The highest on-label imipenem dosing regimens failed to attain 100% ƒT > MIC_4mg/L in patients with decreased kidney function. Higher dosing may be necessary to cover MIC of 4 mg/L. Future trials should explore their efficacy, toxicity, and the utility of model-informed precision dosing in this population.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967923","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: 'Carbapenem-resistant enterobacterales acquisition following piperacillin-tazobactam vs. meropenem treatment: a propensity-matched cohort study' by Dallasheh et al.","authors":"Rongqiang Liao, Yao He","doi":"10.1016/j.cmi.2025.05.007","DOIUrl":"10.1016/j.cmi.2025.05.007","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143984738","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":"Establishing core competencies for antimicrobial stewardship teams: a consensus development using the modified Delphi technique-an European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship position paper.","authors":"Joana Alves, Jeroen Schouten, Karin Thursky, Ran Nir Paz, Jordi Rello, David Chien Lye, Tomislav Kostyanev, Jacob Strahilevitz, Katja de With, Aleksandra Barac, Ezgi Gülten, Diane Ashiru-Oredope, Giorgia Caruana, Nathan Peiffer-Smadja, Rita Murri, Lucy Catteau, Bojana Beović","doi":"10.1016/j.cmi.2025.04.035","DOIUrl":"10.1016/j.cmi.2025.04.035","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to identify and develop a standard set of competencies needed for members of an antimicrobial stewardship (AMS) team.</p><p><strong>Methods: </strong>A panel of experts in AMS utilized a survey based on a modified Delphi technique to establish consensus on AMS competencies.</p><p><strong>Results: </strong>The authors identified 88 competencies covering 15 domains with strong agreement by 58 international experts. The identified domains were: the objectives of AMS; management of infection; microbiology diagnostics; pharmacology of antimicrobial agents; general principles of antibiotic use; the structure and the position of AMS; antimicrobial stewardship interventions; AMS in special settings; surveillance and monitoring; behaviour change and communication; infection prevention and control; quality management and patient safety; information technology (IT) support; communication with patients and general public and governance/policy framework. The consensus-based list of competencies was ratified by the European Study Group for Antimicrobial Stewardship Executive Committee.</p><p><strong>Conclusions: </strong>The identified competencies can be used as a tool in planning of AMS training and to develop and optimize AMS programmes worldwide.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986886","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":"Insidious infections of Nocardia farcinica in immunocompetent individuals with fever of unknown origin and disseminated lymphadenopathy.","authors":"Le Lu, Zhiming Zhao, Yi Sun, Kailun Zhou, Dongyi Wang, Wei Shang","doi":"10.1016/j.cmi.2025.05.004","DOIUrl":"10.1016/j.cmi.2025.05.004","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995607","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":"Comparing large language models for antibiotic prescribing in different clinical scenarios: author's response.","authors":"Andrea De Vito, Nicholas Geremia, Davide Fiore Bavaro, Susan K Seo, Justin Laracy, Maria Mazzitelli, Andrea Marino, Alberto Enrico Maraolo, Antonio Russo, Agnese Colpani, Michele Bartoletti, Anna Maria Cattelan, Cristina Mussini, Saverio Giuseppe Parisi, Luigi Angelo Vaira, Giuseppe Nunnari, Giordano Madeddu","doi":"10.1016/j.cmi.2025.04.041","DOIUrl":"10.1016/j.cmi.2025.04.041","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977501","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":"'Oral switch vs continued intravenous antibiotic therapy in patients with bacteraemia and sepsis': author's response.","authors":"Qinyuan Li, Qi Zhou, Ling Zeng, Zhengxiu Luo","doi":"10.1016/j.cmi.2025.04.042","DOIUrl":"10.1016/j.cmi.2025.04.042","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957233","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":"Debridement, antibiotics and implant retention: are all approaches to periprosthetic joint infection equal? Same procedures, different outcomes.","authors":"Parham Sendi, Rihard Trebse, Werner Zimmerli","doi":"10.1016/j.cmi.2025.04.037","DOIUrl":"10.1016/j.cmi.2025.04.037","url":null,"abstract":"<p><strong>Background: </strong>The reported success rate of debridement, antibiotics, and implant retention (DAIR) for periprosthetic joint infection varies considerably between studies, despite institutions reporting use of the same procedure. In this narrative review, we aim to delineate the differences between the various DAIR approaches and highlight why they influence the outcome.</p><p><strong>Objectives: </strong>We performed a PubMed and internet search investigating the different approaches for DAIR and their associated outcomes.</p><p><strong>Sources: </strong>Twenty-two studies with defined infection criteria, consisting of 50 or more periprosthetic joint infection cases and a follow-up of 1 year or longer, were included.</p><p><strong>Content: </strong>Most studies did not report whether the presence of a sinus tract was a criterion for not performing DAIR, and the use of biofilm-active agents for curative DAIR was only reported in a few studies. The duration of infection as criterion for early postoperative and acute haematogenous infection varied between studies. The epidemiology of host factors and microorganisms, healthcare systems, patient-doctor interactions, and decision-making processes for surgical interventions vary worldwide, and so do the indications for DAIR.</p><p><strong>Implications: </strong>Studies should precisely declare the indication for DAIR, the variables that influence decision-making for treatment options, the surgical technique applied, and the type and duration of antimicrobial therapy. Such an approach will increase the quality of research data and allow the development of recognized subcategories of DAIR.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974732","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 a patient with Stenotrophomonas maltophilia infection?","authors":"Roberta Monardo, Maria F Mojica, Marco Ripa, Samuel L Aitken, Robert A Bonomo, David van Duin","doi":"10.1016/j.cmi.2025.04.031","DOIUrl":"10.1016/j.cmi.2025.04.031","url":null,"abstract":"<p><strong>Background: </strong>Stenotrophomonas maltophilia is a Gram-negative bacillus that may cause a range of infections, most frequently bloodstream and respiratory infections. S. maltophilia exhibits intrinsic resistance to several antibiotics including carbapenems. Clinical assessment and treatment of a patient with positive S. maltophilia cultures are challenging.</p><p><strong>Objectives: </strong>We aimed to provide a resource for clinicians to help diagnose and treat S. maltophilia infections.</p><p><strong>Sources: </strong>A comprehensive literature search on S. maltophilia infections was conducted using PubMed, with no restrictions on publication date.</p><p><strong>Content: </strong>The review uses a hypothetical clinical vignette as a context to explore the epidemiology, risk factors, clinical presentation, mortality, diagnostic management, antibiotic resistance mechanisms, and antibiotic management of S. maltophilia infections.</p><p><strong>Implications: </strong>The assessment and treatment of S. maltophilia infections remain challenging. Standardized indications to distinguish colonization from infection and to guide the start of targeted therapy are lacking. The optimal treatment approach has similarly not been established in randomized controlled trials.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":""},"PeriodicalIF":10.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975268","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}