European Journal of Clinical Microbiology & Infectious Diseases最新文献

{"title":"Epidemiology and risk factors of expatriates returning to Switzerland colonized at the intestinal level with multidrug-resistant Enterobacterales.","authors":"Edgar I Campos-Madueno, Claudia Aldeia, Marie C Roumet, Andreas Limacher, Parham Sendi, Andrea Endimiani","doi":"10.1007/s10096-025-05069-w","DOIUrl":"https://doi.org/10.1007/s10096-025-05069-w","url":null,"abstract":"<p><p>Living in high-endemic regions increases the risk of intestinal colonization by multidrug-resistant Enterobacterales (MDR-Ent). This study investigated Swiss expatriates residing abroad (≥ 3 months) to assess their colonization status upon returning to Switzerland. Selective culture-based methods were implemented to detect third-generation cephalosporins- (3GC-R), carbapenems- (CR), and colistin-resistant (COL-R) strains. Whole-genome sequencing was used to characterize antimicrobial resistance genes, sequence type (ST), and phylogroup of MDR-Ent. Epidemiological data were analyzed using uni- and multivariable models to identify risk factors, providing crude and adjusted odds ratios (ORs). Among 196 participants living across Africa, Asia, the Americas, and Europe, the overall MDR-Ent colonization prevalence was 42.9%. Continent of residence emerged as a significant risk factor (p = 0.04) for colonization: Africa (adjusted OR = 3.4, 95% CI 1.0-11.0) and Asia (adjusted OR = 4.7, 95% CI 1.5-15.0). Extended-spectrum β-lactamase-producing Escherichia coli (Ec) was the most frequent isolated species (n = 107 out of 119 Ent). Most 3GC-R-Ec possessed bla_CTX-M genes (n = 89; 83.2%) and pandemic lineages were frequent (e.g., ST69 and ST131, n = 18). No CR-Ent were detected, but some COL-R strains (n = 18; of which 15 Ec) harbored the mcr-1.1 gene. Expatriates represent an understudied population at risk of MDR-Ent colonization. This population may contribute to the importation and potential dissemination of dangerous bacteria into low-prevalence countries, as shown in this Swiss study, warranting further investigation and surveillance.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425197","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":"Infectious Disease Specialists' awareness, perceptions and attitudes toward ecological transition in healthcare: a cross-sectional study in France.","authors":"Mathilde Réveillon-Istin, Véronique Mondain, Emmanuel Piednoir, Sylvain Diamantis, Laure Bonnet, Anne-Lise Beaumont","doi":"10.1007/s10096-025-05064-1","DOIUrl":"https://doi.org/10.1007/s10096-025-05064-1","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change is having a major impact on public health. The healthcare system is responsible for around 8% of greenhouse gas emissions in France. Infectious diseases (ID) lie at the heart of these consequences.</p><p><strong>Objectives: </strong>The primary aim of this study was to assess the expectations of French ID specialists in terms of a sustainable healthcare transition. Secondary objectives included the assessment of awareness regarding this subject, perceptions, adopted attitudes and opportunities for actions.</p><p><strong>Methods: </strong>A survey on sustainable healthcare transition was sent to all the French Society for ID members.</p><p><strong>Results: </strong>Of the 860 physicians approached, 220 responded. More than 78% of respondents responded correctly to questions concerning the impact of climate change on public health. The environmental impact of the healthcare system was less well understood. A higher level of environmental anxiety was associated with a higher rate of declaration of concrete actions. People under 40 years of age declared themselves to be more active. Regarding attitudes towards the roles of different stakeholders in a sustainable healthcare transition, the role of medical societies is prominent. Respondents' main expectations and suggestions are the following: (1) creation of a cross functional group dedicated to a sustainable healthcare transition, (2) creation of a training program, to meet the training needs of 94% of respondents, (3) continuation of the French Society for ID's lobbying for the relocation of antibiotic production in Europe, research on life-cycle analysis of anti-infective drugs, single-dose packaging for antibiotics, (4) reflection on the concept of \"sustainably designed healthcare\" in ID, (5) continued exploration of the \"One Health\" concept and (6) development of recommendations for sustainably designed hygiene practice.</p><p><strong>Conclusion: </strong>This national survey of French ID specialists is a prerequisite for the implementation of actions within the French Society for ID.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143413785","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":"The first two human infections with Helicobacter zhangjianzhongii, a new Helicobacter closely related to Helicobacter canis.","authors":"Sahel Wandji, Quentin Jehanne, Lucie Bénéjat, Astrid Ducournau, Johanna Aptel, Marion Levast, Marine Jauvain, Philippe Lehours","doi":"10.1007/s10096-025-05045-4","DOIUrl":"https://doi.org/10.1007/s10096-025-05045-4","url":null,"abstract":"<p><strong>Purpose: </strong>In 2023, Helicobacter zhangjianzhongii was proposed as a new species in the Helicobacter genus. We here describe two human cases of H. zhangjianzhongii bacteremia.</p><p><strong>Methods: </strong>Four clinical strains from the Helicobacter genus isolated from blood culture between 2017 and 2023 were studied. They were initially identified as H. canis by MALDI-TOF and 16S rDNA sequencing. The strains were biochemically characterized and tested at different temperatures and atmospheres. Two databases were used to characterize the isolates: the Bruker® MBT compass Version 4.1.1 database and a in-house spectrum-enriched database. After bacterial DNA extraction the genomes were sequenced on NovaSeq 6000 (Illumina) and analyzed using an in-house pipeline.</p><p><strong>Results: </strong>Case 1 involved a 58-year-old woman who was hospitalized in a thoracic oncology unit because her general condition deteriorated in a setting of small-cell carcinoma. She presented with abdominal pain associated with significant hepatomegaly. Case 2 involved a 78-year-old woman on rituximab who was hospitalized to treat chest pain, anemia, and inflammatory syndrome. Both strains exhibited very similar microbiological and genomic characteristics, thus growth in a microaerobic atmosphere at 37°C and 42°C, oxidase-positivity, and urease- and catalase-negativity. Both were formally identified by whole-genome sequencing as H. zhangjianzhongii (ANI > 99% and DDH > 94%).</p><p><strong>Conclusion: </strong>This proposed species is associated with bacteremia in humans. It is thus likely to be a novel human pathogen. Dogs may have been the source of infection.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143398752","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":"Evaluation of the Allplex NG & DR assay for molecular prediction of ciprofloxacin and azithromycin resistance in Neisseria gonorrhoeae.","authors":"Anna Roditscheff, Konrad Egli, Andréj Vianin, Fabian Lörtscher, Jürgen Reidla, Faina Wehrli, Martin Risch, Lorenz Risch, Sven N Hobbie, Nadia Wohlwend, Thomas Bodmer","doi":"10.1007/s10096-025-05053-4","DOIUrl":"https://doi.org/10.1007/s10096-025-05053-4","url":null,"abstract":"<p><strong>Purpose: </strong>Molecular methods to detect antimicrobial resistance in Neisseria gonorrhoeae (Ng) are increasingly needed worldwide to improve diagnostic tests and enable individualized patient treatments. The Allplex™ NG & DR Assay (NG & DR assay) was assessed for its ability to detect Ng and its antimicrobial resistance. The assay predicts ciprofloxacin resistance and susceptibility by targeting the molecular antimicrobial resistance (AMR) determinant gyrA S91F. The AMR determinants 23 S rRNA A2059G and C2611T were investigated to predict azithromycin wild-type and nonwild-type genotypes.</p><p><strong>Methods: </strong>After antimicrobial susceptibility testing, 153 Ng isolates were evaluated with the NG & DR assay. Furthermore, 394 clinal specimens, including 76 with corresponding antimicrobial susceptibility results, were analyzed simultaneously by the NG & DR assay and the in-house SYBR-Green assay.</p><p><strong>Results: </strong>The NG & DR assay predicted ciprofloxacin resistance and susceptibility with a sensitivity and specificity of 98.2% and 100.0%, respectively, and the results were consistent with those of the SYBR-Green assay for the detection of S91F. For the prediction of azithromycin nonwild-type and wild-type genotypes, the NG & DR assay demonstrated a sensitivity and specificity of 50.0% and 100.0%, respectively.</p><p><strong>Conclusion: </strong>The NG & DR assay demonstrated promising results for the molecular prediction of ciprofloxacin resistance and susceptibility, expanding the potential diagnostic tool kit for individualized patient treatment. Furthermore, it might serve as a surveillance tool for azithromycin nonwild-type strains.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390549","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":"Comparative efficacy of pre-moistened sponges and E-swabs for active surveillance of carbapenem-resistant Acinetobacter baumannii carriage.","authors":"Reut Efrati Epchtien, Elizabeth Temkin, Samira Masarwa, Adi Cohen, Ella Kaplan, David Schwartz, Alona Keren-Paz, Yehuda Carmeli, Vered Schechner","doi":"10.1007/s10096-025-05055-2","DOIUrl":"https://doi.org/10.1007/s10096-025-05055-2","url":null,"abstract":"<p><p>We evaluated whether skin sampling with E-swabs is an effective alternative to pre-moistened sponges for detecting carbapenem-resistant Acinetobacter baumannii (CRAB) carriage. Skin samples were collected by sponges with enrichment and E-swabs with and without enrichment. We collected 899 samples (from 250 patients); 191 samples were CRAB positive. Sensitivity was 90.8% for sponges with enrichment, 40.0% for E-swabs without enrichment, and 50.0% for E-swabs with enrichment. E-swabs failed to detect at least half of CRAB carriers detected by sponges. If E-swabs are used for CRAB screening, a negative result should carry a warning regarding low sensitivity.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381934","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":"Evaluation of a four-day incubation protocol for blood cultures: a quality improvement project.","authors":"Fatimah AlMutawa, Johan Delport","doi":"10.1007/s10096-025-05054-3","DOIUrl":"https://doi.org/10.1007/s10096-025-05054-3","url":null,"abstract":"<p><p>Blood cultures are critical in diagnosing bloodstream infections and guiding the treatment of sepsis, which carries a significant mortality risk. Traditional blood culture protocols often recommend a five-day incubation period to ensure the recovery of clinically significant pathogens. However, recent evidence suggests that a shorter incubation period may be sufficient, potentially reducing laboratory workload and the recovery of contaminants.</p><p><strong>Methods: </strong>This quality improvement project was conducted to evaluate the performance of a four-day incubation protocol using the BD BACTEC automated blood culture system in a large academic center with over 1,000 beds, processing more than 70,000 blood culture requests annually. A retrospective analysis was performed on 71,862 blood cultures processed in 2022.</p><p><strong>Results: </strong>Results indicated that 99.2% of all positive cultures, including those in pediatric cases, were detected within four days, with a mean time to positivity of 23.97 h. Only 0.8% of blood cultures flagged positive after the four-day mark, and these were predominantly cases with previous positive cultures or repeat cultures that did not alter patient management.</p><p><strong>Conclusion: </strong>We conclude that a four-day incubation period is sufficient for the detection of clinically significant pathogens using the BD BACTEC system. This change not only optimizes laboratory operations by increasing capacity and reducing waste but also supports timely clinical decision-making.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381935","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":"Description of an Enterococcus faecium genotype vanB outbreak in a hospitalization ward.","authors":"M Andrés, A Fajardo, M C García, L Grau, Y Angulo, V Marín, V Plasencia, G Santillana, E Jiménez, M Ballestero","doi":"10.1007/s10096-025-05056-1","DOIUrl":"https://doi.org/10.1007/s10096-025-05056-1","url":null,"abstract":"<p><strong>Background and objectives: </strong>Vancomycin-resistant Enterococcus faecium (VRE) infections have increased in the last years. Hospital outbreaks have been described with a challenging microbiological diagnosis and control of the transmission.</p><p><strong>Methods: </strong>This is a prospective study of a nosocomial outbreak of VRE in a conventional hospitalization ward. Three clinical samples of VRE genotype vanB (vanB VRE) were detected in two surgical wards. Epidemiological control measures were implemented, including contact isolation, patients from clean surgery ward transferred to other wards, staff training, weekly screening with rectal swab and environmental study.</p><p><strong>Results: </strong>In a 3-month follow-up period, rectal screening was performed on a total of 314 patients, being positive for vanB VRE 51 patients (16.2%). A study of the surface of the common areas with exclusive use by healthcare personnel detected vanB VRE in 28% of the samples. All the strains of VRE analyzed by MLST were ST117, which belongs to clonal complex 17. Hand hygiene observations show proper adherence in 56% of the events monitored. Notwithstanding the large number of colonized patients, just one patient had a relevant infection requiring treatment, with good evolution.</p><p><strong>Conclusions: </strong>The survival of VRE on surfaces and the poor adherence to hand hygiene might have contributed to repetitively infect surfaces, perpetuating the outbreak. After 10 months without positive clinical samples, it was decided to suspend the screening, even though there were still screening positive results. Despite its spread, the clinical impact was low, possibly because the outbreak took place in a ward without severe immunosuppressed patients. The frequent isolation of VRE on surfaces which were exclusive from healthcare personnel areas, indicates how important is the disinfection of these areas.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373855","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":"Which antimicrobial treatment for patients with bloodstream infection during ECMO support?","authors":"Nicolas Massart, Sofia Ortuno, Charles Vidal, Samuel Henri, Hadrien Rozé, Adrien Bouglé, Francesca Manicone, Frank Bidar, Benjamin Assouline, Paul Masi, Sami Hraiech, Nicolas Nesseler, Etienne de Montmollin, Charles-Edouard Luyt","doi":"10.1007/s10096-025-05059-y","DOIUrl":"https://doi.org/10.1007/s10096-025-05059-y","url":null,"abstract":"<p><strong>Ojective: </strong>We aim to describe a large, multicenter cohort of patients with bloodstream infection (BSI) acquired during extracorporeal membrane oxygenation (ECMO) support.</p><p><strong>Methods: </strong>We conducted a retrospective observational study in 12 Europeans ICUs. Only patients who developed a BSI of unknown source during ECMO support were included in the present analysis. Primary aim was to describe BSI epidemiology in patients with ECMO support. Secondary objectives were to describe antimicrobial susceptibility of incriminated micro-organisms.</p><p><strong>Results: </strong>One hundred and eighty-two patients were included. Main reason for ECMO support was ARDS, followed by cardiogenic shock and post-cardiotomy. Half of the patients (51.9%) received early antimicrobial therapy. Main incriminated microorganisms were Enterococcus sp. (37.4%), Enterobacterales (26.9%), coagulase negative Staphylococci (15.9%) and Gram negative bacilli (11.5%). Multi drug resistant organisms (MDRO) were incriminated in 26 (14.3%) BSI and were mainly extended spectrum producing-Enterobacterales (17/26). Antimicrobial therapy was considered as appropriate in 130 patients (71.4%). Patients who received inappropriate antimicrobial therapy were more frequently infected with MDRO. Only 59 (32.4%) of cases were susceptible to 3rd generation cephalosporin while association of piperacillin/tazobactam with vancomycin was considered appropriate in 155 cases (85.2%) as compared with 168 cases (92.3%) for carbapenems combined with vancomycin.</p><p><strong>Conclusion: </strong>Enterococcus sp. was incriminated in about a third of BSI among patients with ECMO support. High appropriateness would only be obtained with piperacilline/tazobactam or carbapenems in association with vancomycin while 3rd generation cephalosporin would have failed in the majority of BSI cases.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370627","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":"Clinical revenues of selective use of [18F]-FDG-PET/CT scanning in the management of Staphylococcus aureus bacteremia.","authors":"Dewi Verkaik, Annette C Westgeest, Jian Ling Wu, Kim C E Sigaloff, Merel M C Lambregts, Mark G J de Boer","doi":"10.1007/s10096-025-05052-5","DOIUrl":"https://doi.org/10.1007/s10096-025-05052-5","url":null,"abstract":"<p><strong>Purpose: </strong>Although [18F]-FDG-PET/CT scanning (PET/CT) is recommended for managing Staphylococcus aureus bacteremia (SAB), its added value remains debated. This study investigated the clinical revenues of selective PET/CT use in SAB by considering three consequence-categories: detection of new infection foci, performance of new interventions, and alterations in antimicrobial therapy.</p><p><strong>Methods: </strong>All adult patients with ≥ 1 blood culture (BC) positive with Staphylococcus aureus admitted in a Dutch academic center between 2017¹¹ and 2023¹¹ were identified. Standard practice was to order PET/CT for patients with community acquired SAB and/or positive BCs after ≥ 48 h of treatment, or if multiple foci, or persistent fever, or endocarditis were present. Clinical- and laboratory data were obtained from electronic health records. Numbers-needed-to-scan (NNT-scan) were calculated for each consequence-category. Regression analyses were performed to identify variables correlated with consequence-bearing PET/CT.</p><p><strong>Results: </strong>Of 397 SAB patients, 143 (36%) underwent PET/CT. This led to detection of new foci in 73/143 patients (NNT-scan ≈ 2), new interventions in 33/143 patients (NNT-scan ≈ 4), and a change in antimicrobial therapy in 44/143 patients (NNT-scan ≈ 3). A CRP > 200 mg/L at presentation and positive follow-up BCs at 48 h were independently associated with interventions following PET/CT (adjusted OR and 95%CI 3.2 (1.2-8.3) and 2.6 (1.0-6.7) respectively). PET/CT results instigated changes in antimicrobial therapy predominantly in patients < 65 years and those with a CRP < 100 at presentation.</p><p><strong>Conclusions: </strong>Selective PET/CT ordering in real-life practice resulted in a relatively low NNT-scan across all consequence-categories. Further research is warranted to optimize patient selection for PET/CT using clinical parameters or profiles.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373854","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":"Eschar is not the sole clue for scrub typhus: a retrospective analysis of pediatric scrub typhus without eschars.","authors":"Yonghan Luo, Xiaotao Yang, Houxi Bai, Litao Xiao, Yan Guo, Feng Jiao, Yanchun Wang","doi":"10.1007/s10096-025-05050-7","DOIUrl":"https://doi.org/10.1007/s10096-025-05050-7","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the clinical characteristics and analyze the diagnostic approaches employed for pediatric cases of scrub typhus (ST) that present without eschars.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 256 ST cases hospitalized at Kunming Children's Hospital in Yunnan Province, China, from January 2015 to November 2022. Patients were categorized into an eschar group (n = 213) and a non-eschar group (n = 43). Clinical data were collected and analyzed for significant differences between the groups. This study particularly highlights the diagnostic methods for confirming ST in cases without eschars.</p><p><strong>Results: </strong>The non-eschar group exhibited a higher incidence of pneumonia, a lower history of outdoor activities prior to onset, and a longer hospital stay; however, the remaining clinical and laboratory characteristics did not show statistically significant differences. The most common site for eschar formation was the axilla (12.7%, n = 27), followed by the groin (9.4%, n = 20) and auricle (8.9%, n = 19). Other notable sites included the scalp (7.5%, n = 16) and shoulder (6.6%, n = 14). The Weil-Felix test (OXK) demonstrated a positivity rate of 69.7% (23 out of 33 cases), cerebrospinal fluid (CSF) PCR had a positivity rate of 50.0% (3 out of 6 cases), and blood PCR exhibited a positivity rate of 92.3% (24 out of 26 cases).</p><p><strong>Conclusion: </strong>These findings underscore the importance for clinicians to consider ST in pediatric patients, even in the absence of eschars. A comprehensive evaluation based on epidemiology, symptoms, signs, and laboratory characteristics is essential. Blood PCR testing methods are recommended.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":11782,"journal":{"name":"European Journal of Clinical Microbiology & Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188667","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}