European Journal of Clinical Microbiology & Infectious Diseases最新文献

{"title":"Safety of high-dose daptomycin in obese patients: a multicentric retrospective study.","authors":"Vasco Dias Meireles, Clémentine Airaud, Elouan Demay, Charles Cazanave, Fabien Xuereb, Pauline Lazaro, Astrid Bacle, Marin Lahouati","doi":"10.1007/s10096-025-05065-0","DOIUrl":"10.1007/s10096-025-05065-0","url":null,"abstract":"<p><strong>Purpose: </strong>Obese patients treated with daptomycin at 4 mg/kg have a 30% increased drug exposure, potentially raising the risk of adverse events (AEs) like rhabdomyolysis. Given limited data on the safety of higher doses (10 mg/kg) in this population, this study aimed to assess the safety of high-dose daptomycin in obese patients and to identify potential AEs risk factors.</p><p><strong>Methods: </strong>This multicenter, retrospective observational study was conducted from June 2021 to May 2022 using medical records. Patients with a BMI > 30 kg/m² were classified as obese. AEs assessed included: CK elevation (> 5x upper limit of normal), severe elevation (> 10x upper limit), eosinophilic pneumonia, and elevated liver enzymes. Both univariate and multivariate analyses were conducted.</p><p><strong>Results: </strong>A total of 1 303 patients were included: 970 non-obese and 333 Ob patients. These patients received an average daptomycin dose of 9.9 mg/kg based on actual body weight for an average treatment duration of 8.27 days. One-third of the patients had CK monitoring. AEs rates were 3.5% for the n-Ob group vs. 8.7% in the Ob group (p < 0.01). Ob patients had significantly higher CK levels (n-Ob, 9.5%; Ob, 20.3%; p = 0.001), and severe elevation (n-Ob, 5.2%; Ob, 10.9%; p = 0.03). Factors increasing AE risk included obesity, concomitant prescriptions of drugs with risk of rhabdomyolysis, eGFR 30-60 mL/min, and daptomycin duration (OR = 2.42; 4.34; 2.03 and 1.05, respectively, p < 0.001). On the opposite, consultation with an infectious disease specialist reduced risk (OR = 0.52, p = 0.024).</p><p><strong>Conclusion: </strong>This study highlights that obese patient has a significantly increased risk of AEs with high dose of daptomycin compared to non-obese patients. Adjusted body weight dosing may be considered to reduce AEs risk.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1139-1146"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional distribution of carbapenemase-producing Acinetobacter baumannii isolates in southern Spain (Andalusia).","authors":"Felipe Fernández-Cuenca, Salud Rodríguez-Pallares, Lorena López-Cerero, José Gutiérrez-Fernández, María Fe Bautista, Juan Antonio Sánchez Gómez, Waldo Sánchez-Yebra Romera, Mercedes Delgado, Esther Recacha, Alvaro Pascual","doi":"10.1007/s10096-025-05047-2","DOIUrl":"10.1007/s10096-025-05047-2","url":null,"abstract":"<p><strong>Objectives: </strong>This is the first study conducted in southern Spain to determine i) the population structure (PS) of carbapenem-resistant (CR) Acinetobacter baumannii isolates by multilocus sequencing typing (MLST) and core genome MLST (cgMLST) and ii) the association between the sequence type ST and the bla_OXA-51 variant, capsule polysaccharide locus (KL) and lipooligosaccharide outer core locus (OCL) types.</p><p><strong>Methods: </strong>Of 336 isolates submitted to the Andalusian reference laboratory (PIRASOA; December 2017-2020), 73 were subjected to WGS (MiSeq). The following analyses were performed: bacterial identification (ribosomal MLST), carbapenemase gene detection (Resfinder 4.0), PS delineation (MLST by MLSTfinder 2.0 and cgMLST by Ridom SeqSphere⁺), and KL types and OCL types (Kaptive tool).</p><p><strong>Results: </strong>The carbapenemases detected were bla_OXA-23 (n = 41), bla_OXA-58 (n = 26), bla_OXA-24 (n = 5), bla_OXA-72 (n = 1) and bla_NDM-1 (n = 2). The PS revealed one major ST2 clone (n = 54) and seven minor ST clones by MLST, and 41 lineages by cgMLST_. Thirty-five lineages were detected only in a single hospital whereas five lineages were observed in several hospitals and provinces. bla_OXA-66 was the most frequent bla_OXA-51 variant and was mainly associated with the ST2 clone. Eleven KL types and 3 OCL types were assigned, with KL2 (n = 27), KL7 (n = 16) and OCL1 being the most frequent.</p><p><strong>Conclusions: </strong>The PS of CR A. baumannii in Andalusia is characterized by a dominant ST2/bla_OXA-23 clone and several lineages, showing local spread of lineages in most hospitals, and intercenter or interregional spread of a few lineages. Single-locus bla_OXA-51-like typing and KL typing may be useful as complementary preliminary typing tool.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1069-1076"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher target attainment for B-lactam antibiotics in patients with Gram-negative bloodstream infections when four times actual minimum inhibitory concentrations and epidemiological cutoff values are applied compared to clinical breakpoints.","authors":"Ilja Areskog Lejbman, Gustav Torisson, Fredrik Resman, Fredrik Sjövall","doi":"10.1007/s10096-025-05068-x","DOIUrl":"10.1007/s10096-025-05068-x","url":null,"abstract":"<p><strong>Introduction: </strong>Beta-lactam antibiotics are essential in the treatment of Gram-negative bloodstream infections. The effect of beta-lactam antibiotics depends on the time of unbound antibiotic concentration above the minimal inhibitory concentration (MIC). An antibiotic concentration above MIC during the whole dosing interval (100% ƒT > MIC) has been suggested as a target for severe infections. The aim of the present study was to compare target attainment using targets derived from known MICs with standard generic targets.</p><p><strong>Methods: </strong>In this prospective, single-center study, adult patients with Gram-negative bloodstream infection treated with cefotaxime, piperacillin/tazobactam or meropenem were eligible for inclusion. Trough antibiotic concentrations were collected during a single dosing interval and actual MIC values for the antimicrobial agent against the infecting isolate were obtained using E-tests. Epidemiological cut off values, ECOFFs, were applied from European Committee on Antimicrobial Susceptibility Testing, EUCAST, tables for isolates within the wild-type distribution. Antibiotic concentrations were measured using Liquid Chromatography tandem Mass Spectrometry. Free concentrations were estimated based on total concentrations. Two targets based on actual MICs were assessed: free trough concentrations above (1) four times the actual MIC (100% ƒT > 4MIC) or above (2) the ECOFF (100% ƒT > ECOFF). Proportions of target attainment for the MIC-based targets were compared with attainment using clinical breakpoints or PK/PD breakpoints. Treatment response was defined as clinical resolution at day 7 (No persisting signs or symptoms of infection).</p><p><strong>Results: </strong>We included 98 patients with a median age of 72 years. The most common microbiological finding was Escherichia coli (63%) followed by Klebsiella pneumoniae (12%). Of all patients, 77/98 patients (79%) attained 100% ƒT > 4MIC and 80/98 (82%) attained 100% ƒT > ECOFF, compared with 57/98 (58%) using 100% ƒT > EUCAST clinical breakpoints. Clinical resolution at day 7 was significantly associated with target attainment applying the target 100% ƒT > 4MIC (p = 0.013), but this was not the case when 100% ƒT > ECOFF was applied (p = 0.50).</p><p><strong>Conclusions: </strong>In our material, higher target attainment rates were seen using targets derived from actual MICs, compared to EUCAST clinical breakpoints. Attaining 100% ƒT > 4MIC was associated with resolution of infection, but the latter finding should be interpreted cautiously.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1129-1137"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High prevalence and incidence of HSV-2 among people who inject drugs in Hai Phong, Vietnam, and risk factors associated with seroconversion.","authors":"Morgana D'Ottavi, Ilenia Scialabba, Duong Thi Huong, Hoang Thi Giang, Pham Minh Khue, Vu Hai Vinh, Roselyne Vallo, Laurent Michel, Delphine Rapoud, Catherine Quillet, Nham Thi Tuyet Thanh, Juliette Bouniol, Khuat Thi Hai Oanh, Jonathan Feelmyer, Philippe Vande Perre, Didier Laureillard, Don Des Jarlais, Nicolas Nagot, Jean-Pierre Molès","doi":"10.1007/s10096-025-05079-8","DOIUrl":"10.1007/s10096-025-05079-8","url":null,"abstract":"<p><strong>Purpose: </strong>Genital Herpes Simplex Virus-2 (HSV-2) epidemic is highly active worldwide and can be associated with severe morbidity and mortality. This study aimed to estimate the prevalence and incidence of HSV-2 infection among a vulnerable population of active heroin injectors in Hai Phong, Vietnam, and identify associated risk factors.</p><p><strong>Method: </strong>Associations between HSV-2 infection and socio-demographic characteristics and sexual behaviors were explored in a univariable analysis of seroprevalence. Risk factors were defined using a multivariable Poisson regression accounting for time of follow-up.</p><p><strong>Results: </strong>HSV-2 seroprevalence at baseline was 20.8% [95%CI: 17.8-22.2] for the 1281 men people who inject drugs (PWID), and 67.4% [95%CI: 60.1-74.1] for the 184 women PWID. For HSV-2 incidence, we accumulated a follow-up time of 1156.0 and 85.9 years for men and women, respectively. Standardised incidence rate was 4 [95%CI: 2.2-7.5] and 17.5 [95%CI: 5.7-53.8] infections per 100 person-years for men and women, respectively. Factors independently associated with HSV-2 seroconversion were HIV and injecting drug use for 5-10 years for men, and declared an uncontrolled HIV viral load and the use of street methadone.</p><p><strong>Conclusion: </strong>High HSV-2 prevalence and incidence among PWID in Hai Phong point out the burden of sexually transmissible infections in this population. Together these results advocate for a reinforcement of HSV-2 care and prevention in this population and identify PWID as future beneficiaries of upcoming therapeutic/prophylactic vaccines.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1119-1127"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal syphilis: clinical and laboratory assessments and postnatal treatments for infants born to infected mothers.","authors":"Nursel Atay Ünal, Zeynep Savaş Şen, Ömer Güneş, Eda Tüfekçioğlu, Pınar Yükkaldıran, Ferit Kulalı, Fatma Nur Öz, Türkan Aydın Teke, Ayşe Kaman","doi":"10.1007/s10096-025-05073-0","DOIUrl":"10.1007/s10096-025-05073-0","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to assess congenital syphilis incidence, main clinical presentations and the relation to maternal treatment during pregnancy, with the goal of raising awareness of this emerging public health issue and offering local epidemiological data.</p><p><strong>Methods: </strong>Infants born to mothers diagnosed with syphilis at Etlik City Hospital between June 1, 2023 and June 1, 2024 were included to the study. Patient records were reviewed retrospectively.</p><p><strong>Results: </strong>During the study period, 12,892 live births were recorded, with congenital syphilis detected in 0.12% of cases, corresponding to a rate of 116 cases per 100,000 live births. Fifteen neonates born to mothers with syphilis were evaluated. Penicillin treatment was administered to 93.3% of the neonates, including 73.3% classified as highly probable or probable cases. Bone abnormalities such as periostitis and osteitis were detected in two patients. Only 46.7% of mothers received adequate prenatal treatment, and 40% lacked prenatal care altogether. Co-infections with hepatitis C virus, human papillomavirus, and herpes simplex virus type 2 were noted in 26% of mothers, though none had HIV. Substance addiction was reported in 26.7% of mothers.</p><p><strong>Conclusion: </strong>This study highlights a significant burden of congenital syphilis, with many cases stemming from untreated or inadequately managed maternal infections. Some neonates were infected despite maternal treatment, underscoring gaps in prevention. The limited data from our center, despite high case rates, likely underestimates the regional burden and risks missed diagnoses. These findings emphasize the urgent need for enhanced prenatal screening, timely treatment, and comprehensive care to mitigate congenital syphilis rates.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1099-1105"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of rapid identification by MALDI-TOF MS from positive blood cultures in Enterococcus spp. bloodstream infections.","authors":"Diogo Lopes, Bruno Grandbastien, Christina Orasch, Gilbert Greub, Antony Croxatto, Guy Prod'Hom, Benoit Guery","doi":"10.1007/s10096-025-05084-x","DOIUrl":"10.1007/s10096-025-05084-x","url":null,"abstract":"<p><strong>Purpose: </strong>Regarding bloodstream infections (BSI) Enterococcus spp. rank among the top five most common organisms. Due to enterococci intrinsic resistance, empiric antibiotic therapy is often inappropriate and early identification becomes crucial. Our objective was to assess the clinical impact of MALDI-TOF identification directly from positive blood cultures (BC) in Enterococcus spp. BSI (E-BSI).</p><p><strong>Methods: </strong>A retrospective cohort study included all adult patients with E-BSI from 2010 to 2017 in a tertiary hospital. ID consultation within 48 h and MALDI-TOF identification directly from BC within 24 h were inclusion criteria. The primary outcome was antimicrobial treatment change following MALDI-TOF and secondary outcomes included 30-day and 1-year mortality, length of stay (LOS) and antimicrobial de-escalation.</p><p><strong>Results: </strong>Among 267 BSI episodes, E. faecalis was isolated in 130 episodes (48.7%), E. faecium in 122 (45.7%), and 104 (39%) were polymicrobial. Empiric antibiotic therapy was inappropriate in 60.3% of patients. The LOS was 36 (IQR 20-64) days, 30-day and 1-year mortality were 16.1% and 43.4%, respectively. Enterococci identification with MALDI-TOF at the species level was possible in 66.3% cases and in 73% of monomicrobial cases. Antibiotics were changed in 85.3% of the former vs. 63.3% in remaining patients (p < 10^- 4), and de-escalation occurred in 35% of subjects (vs. 12.2%,p = 10^- 4). Changing antibiotics after correct identification was associated with a shorter LOS. In multivariate analysis, appropriate antibiotic therapy before MALDI-TOF was protective against 30-day mortality (aOR 0.40(0.08-1.96)), and appropriate antibiotic therapy afterwards against 1-year mortality (aOR 0.21(0.05-0.84)).</p><p><strong>Conclusion: </strong>In E-BSI, direct MALDI-TOF identification from positive BC has a significant clinical impact due to a more frequent antibiotic spectrum correction and de-escalation. This may improve patient outcomes, reducing LOS and potentially mortality.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1185-1196"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Septic arthritis - symptoms, diagnosis and new therapy.","authors":"Angelika Domagała, Barbara Macura, Karolina Piekarz, Aneta Kiecka","doi":"10.1007/s10096-025-05066-z","DOIUrl":"10.1007/s10096-025-05066-z","url":null,"abstract":"<p><p>Septic arthritis (SA) is an infection of one or more joints caused mainly by Staphylococcus aureus, to a lesser extent by streptococci and Gram-negative bacilli. It poses a huge medical problem due to its high mortality rate of 2-15%. Disease symptoms are often vague, resulting in a risk that SA may be diagnosed too late. This shows the urgency of finding a rapid diagnostic method for SA and an effective therapy. Basic treatment of SA including joint drain or empirical antimicrobial therapy does not always provide the desired results. Hence, new therapies are being sought, including the use of antimicrobial peptide or phage therapy.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1019-1029"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction Note: Variations in respiratory pathogen carriage among a homeless population in a shelter for men in Marseille, France, March-July 2020: cross-sectional 1-day surveys.","authors":"Tran Duc Anh Ly, Van Thuan Hoang, Ndiaw Goumballa, Meriem Louni, Naomie Canard, Thi Loi Dao, Hacene Medkour, Audrey Borg, Kevin Bardy, Véra Esteves-Vieira, Véronique Filosa, Bernard Davoust, Oleg Mediannikov, Pierre-Edouard Fournier, Didier Raoult, Philippe Gautret","doi":"10.1007/s10096-025-05076-x","DOIUrl":"10.1007/s10096-025-05076-x","url":null,"abstract":"","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1285"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing carbapenemase-producing extensively drug-resistant Pseudomonas aeruginosa: the potential of cefiderocol and ceftazidime/avibactam plus aztreonam therapy.","authors":"María Milagro Montero, Sandra Domene-Ochoa, Núria Prim, Eliana Ferola, Carla López-Causapé, Marian Gomis-Font, Mario F Ampuero-Morisaki, Daniel Echeverria, Luisa Sorlí, Sonia Luque, Eduardo Padilla, Santiago Grau, Antonio Oliver, Juan P Horcajada","doi":"10.1007/s10096-025-05061-4","DOIUrl":"10.1007/s10096-025-05061-4","url":null,"abstract":"<p><p>This study evaluated the activity of cefiderocol and the combination of ceftazidime/avibactam (CZA) plus aztreonam against carbapenemase-producing extensively drug-resistant (XDR) Pseudomonas aeruginosa isolates. Nine clinical XDR P. aeruginosa isolates with different sequence types and class A (GES) or B (VIM, IMP or NDM) carbapenemases were analysed. Time-kill assays assessed bacterial load reduction for each treatment, while chemostat experiments on four isolates validated these findings. All isolates showed resistance to CZA, with four also resistant to aztreonam. Seven isolates were susceptible to cefiderocol, but two displayed borderline susceptibility (MIC 2-4 mg/L). Time-kill assays demonstrated bactericidal activity by cefiderocol in six isolates at 24 h, while CZA plus aztreonam showed bactericidal effects in three isolates and synergistic/additive effects in four isolates. In the chemostat model, cefiderocol and CZA plus aztreonam were bactericidal in all four tested isolates, with cefiderocol showing greater bacterial reduction in three of these isolates. Both cefiderocol and CZA plus aztreonam achieved significant reductions in bacterial counts compared to controls, but there was no significant difference between cefiderocol monotherapy and the combination. Both cefiderocol and CZA plus aztreonam demonstrated activity against XDR P. aeruginosa carrying metallo-β-lactamase (MBL) and/or serine-β-lactamase (SBL) carbapenemases. Cefiderocol was the only consistently effective monotherapy with a bactericidal effect across all tested isolates in the chemostat model.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1077-1087"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143439550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Voriconazole in the treatment of pediatric patients with hematologic malignancies and invasive fungal infections: a real-world study.","authors":"Namei Wu, Lili Cai, Qingquan Zhang, Yaxin Fan, Zhihang Lin","doi":"10.1007/s10096-025-05067-y","DOIUrl":"10.1007/s10096-025-05067-y","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the factors influencing voriconazole (VRC) administration, clinical efficacy, and safety in children with hematological malignancies (HM) and invasive fungal infection (IFD).</p><p><strong>Methods: </strong>This is a single-center, retrospective real-world study conducted between July 2018 and December 2023. Univariate and multivariate logistic regression analysis were used to analyze the affecting factors.</p><p><strong>Results: </strong>A total of 167 patients were included in this study. Among them, 13.77% (23/167) of children under 2 years old received off-label use of VRC, with an initial maintenance dose higher than that of other groups (P < 0.001). There were 8 cases (4.79%) of cured, 148 cases (88.62%) of improved, and 11 cases (6.59%) of ineffective. Thirty-eight cases experienced adverse drug reactions (ADR), with a highest incidence (10.2%) of hepatotoxicity. The concomitant proton pump inhibitors (PPIs), days of central venous catheterization and coagulopathy were independent influencing factors of ADR. Sixty-six patients underwent therapeutic drug monitoring (TDM), which increased the probability of achieving the target plasma trough concentration (C_min). Among children < 2 years old underwent TDM, 88.89% (8/9) achieved therapeutic concentration, and the probability was higher than that of the older groups. Days of VRC treatment had a positive but not statistically significant effect on achievement of target C_min. Hypoalbuminemia and days of antimicrobials treatment were independent influencing factors of C_min distribution.</p><p><strong>Conclusion: </strong>Attention to the off-label use of VRC in children < 2 years old, hypoalbuminemia and coagulopathy correction, potential drug interactions with VRC, and ADR monitoring is crucial for clinical efficacy and safety.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":"1205-1217"},"PeriodicalIF":3.7,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}