Infection最新文献

{"title":"Five-Year German PrEP cohort reveals high HIV protection and persistent STI burden: implications for individualized and flexible prevention strategies.","authors":"Maher Almahfoud, Lukas Weimann, Guido Schäfer, Till Koch, Hanna Matthews, Hanna-Marie Weichel, Friederike Hunstig, Marc Grenz, Robin L Scheiter, Marylyn M Addo, Julian Schulze Zur Wiesch, Olaf Degen","doi":"10.1007/s15010-025-02667-w","DOIUrl":"https://doi.org/10.1007/s15010-025-02667-w","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate adherence patterns, effectiveness, and sexually transmitted infection (STI) incidence among pre-exposure prophylaxis (PrEP) users in Germany and identify strategies to optimize HIV and STI prevention through individualized care and alternative PrEP modalities.</p><p><strong>Methods: </strong>A single-site, pseudonymized prospective cohort study was conducted in Hamburg, Germany from December 2019 to September 2024. Clinical and laboratory data were linked with structured behavioral surveys from PrEP users at the University Medical Center Hamburg-Eppendorf.</p><p><strong>Results: </strong>Of 980 consented individuals, 589 initiated PrEP (median age 32 years, 97.1% male, and 81.8% were born in Germany). The mean follow-up was 102.3 weeks (IQR: 38.6-151.4), totaling 1189.5 person-years. Daily users averaged 315 days of PrEP coverage per year (IQR: 293.0-361.9 days), whereas on-demand users averaged 219 days (IQR: 138.4-311.6 days), highlighting substantial variability in usage patterns. The overall dropout rate was 46.9%. No cases of HIV occurred during active PrEP use. STI incidence remained high 52.4 /100 PY (95% CI: 47.8-57.4, n = 421) for daily PrEP users, 38.9/100 PY (95% CI: 30.1-49.5, n = 79) for event-driven users, predominantly due to Chlamydia trachomatis (21.1/100 PY) and Neisseria gonorrhoeae (18.8/100 PY). Interest in long-acting PrEP was high (70%), especially among illicit substance users (OR 5.54). Renal function remained stable during follow-up.</p><p><strong>Conclusion: </strong>PrEP demonstrated high effectiveness despite heterogeneous risk burden and generally stable renal function. This supports flexible, person-centered models with simplified, risk-stratified monitoring and long-acting options. To extend impact beyond MSM, services should add multilingual access and women- and migrant-inclusive outreach.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145367895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Zimhony and Yakovenko.","authors":"Thomas Sahlström Månsson, Alice Askemyr, Torgny Sunnerhagen, Johan Tham, Kristian Riesbeck, Lisa Mellhammar","doi":"10.1007/s15010-025-02672-z","DOIUrl":"https://doi.org/10.1007/s15010-025-02672-z","url":null,"abstract":"","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145344969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of enteric pathogens in young children before and during acute gastroenteritis: results from a prospective German birth cohort study (LoewenKIDS).","authors":"Chiara Lincetto, Felipe Romero-Saavedra, Diana Laverde, Riccardo Lincetto, Melanie Meyer-Buehn, Bianca Klee, Cornelia Gottschick, Rafael Mikolajczyk, Johannes Huebner, Tilmann Schober","doi":"10.1007/s15010-025-02670-1","DOIUrl":"https://doi.org/10.1007/s15010-025-02670-1","url":null,"abstract":"<p><strong>Purpose: </strong>To identify enteric pathogens in pediatric acute gastroenteritis (AGE) and assess their etiological relevance by comparison with samples during asymptomatic period.</p><p><strong>Methods: </strong>Children < 2 years of age (n = 89) were prospectively enrolled as part of the population-based birth cohort LoewenKIDS. Asymptomatic stool samples were collected regularly, and symptomatic samples were collected after the occurrence of > 3 loose stools and/or one vomiting in 24 h. Intraindividual pairs of symptomatic and preceding asymptomatic samples for each child were analyzed for 25 enteric pathogens via multiplex real-time RT-PCR.</p><p><strong>Results: </strong>Enteric viruses were detected in 64% (57/89) of symptomatic samples and significantly associated with gastrointestinal symptoms (Odds Ratio [OR] 3.9; 95% Confidence Interval [CI] 2.1-7.3). The most common viruses in AGE were norovirus (Genogroups GI and GII) (36%, 32/89) and adenovirus (27%, 24/89). Bacteria were detected in 46% (41/89) of symptomatic samples and 43% (38/89) of asymptomatic ones, with no association to symptoms (OR 1.1; 95% CI 0.6-2). The most common bacteria in AGE were Enteropathogenic Escherichia coli (28%, 25/89) and Clostridium difficile (16%, 14/89). Dientamoeba fragilis was the only detected parasite in AGE (7%, 6/89), and was not associated with symptoms (OR 1.4; 95% CI 0.4-5.5). Pathogen loads in symptomatic and asymptomatic pairs correlated with symptoms for norovirus GII, astrovirus and sapovirus (each p < 0.01), but not for other pathogens.</p><p><strong>Conclusion: </strong>This study supports the clinical significance of detection of viral pathogens in young children with acute gastroenteritis and without relevant comorbidities in high-income countries, but limits the significance of enteric bacterial and parasitic pathogens detection, partly due to constraints in their specific identification.</p><p><strong>Trial registration: </strong>Clinicaltrials.Gov Identifier: NCT02654210.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in RSV-associated lower respiratory tract infections among hospitalized and outpatient children under 2 years in Northern Bavaria after general recommendation of Nirsevimab immunization in 2024.","authors":"Ying Zhou, Katharina Hecker, Géraldine Engels, Oliver Andres, Kerstin Knies, Christine Krempl, Benedikt Weissbrich, Christoph Härtel, Andrea Streng, Johannes Liese","doi":"10.1007/s15010-025-02654-1","DOIUrl":"https://doi.org/10.1007/s15010-025-02654-1","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated changes in the incidence and age distribution of RSV-associated lower respiratory tract infections (RSV-LRTI) among children in Northern Bavaria after the general recommendation of Nirsevimab immunization in 2024.</p><p><strong>Methods: </strong>Postnatal Nirsevimab immunization coverage was assessed at the University Hospital Würzburg (UKW) in children born between 11/2024 and 03/2025. Age distribution of in- and outpatients < 2 years with PCR-confirmed RSV-LRTI was assessed from UKW (ICD-10 based) and pediatric practices in Würzburg for November-March in 2022/23 (S1), 2023/24 (S2) and 2024/25 (S3). Age distribution of RSV cases from nationwide mandatory laboratory RSV surveillance (Robert Koch-Institute) was analyzed for November-March in 2023/24 and 2024/25.</p><p><strong>Results: </strong>Between 11/2024 and 03/2025, postnatal Nirsevimab immunization coverage for newborns at the UKW was 68% (566/833). In the RSV seasons S1/S2/S3, 98/84/29 children < 2 years with RSV-LRTI were hospitalized. The proportion of children < 1 year decreased from 78%/80% in S1/S2 to 42% in S3 (S1 vs. S3 p < 0.001, S2 vs. S3 p < 0.001). In 36/68/30 outpatients < 2 years with RSV-LRTI, the proportion of children < 1 year decreased from 44%/60% in S1/S2 to 33% in S3 (S1 vs. S3 p = 0.358; S2 vs. S3 p = 0.014). In nationwide laboratory RSV surveillance, 23,171/12,826 children < 2 years were reported in S2/S3, with a decrease in the proportion of children < 1 year from 65% in S2 to 47% in S3 (p < 0.001).</p><p><strong>Conclusions: </strong>We observed a clear decrease of RSV-LRTI in hospitalized and outpatient infants < 1 year of age in the first RSV season, suggesting a relevant impact following Nirsevimab recommendation in Germany.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiviral strategies against H5N1: current options and emerging therapeutics.","authors":"Cleo Anastassopoulou, Antonios-Periklis Panagiotopoulos, Kyriaki Ranellou, Ilias Mariolis, Athanasios Tsakris","doi":"10.1007/s15010-025-02657-y","DOIUrl":"https://doi.org/10.1007/s15010-025-02657-y","url":null,"abstract":"<p><p>Highly pathogenic avian influenza A(H5N1) continues to pose a significant threat to global health due to its increasing geographic spread, high mortality in human cases, and expanding host range, including recent mammalian infections. Antiviral therapy remains a key strategy alongside vaccination, especially for controlling outbreaks and limiting disease severity. This article provides a comprehensive, up-to-date overview of antiviral agents with established or investigational activity against H5N1, including both globally approved drugs and regionally licensed compounds, such as arbidol and triazavirin in Russia and laninamivir and favipiravir in Japan. We detail the mechanisms of action, approval status, resistance patterns, and efficacy data in H5N1-specific models. The recent regulatory approvals of onradivir, suraxavir marboxil, and ZX-7101A in China are highlighted, along with emerging antivirals in advanced development. We summarize findings from relevant clinical trials and discuss key resistance-associated mutations identified in recent H5N1 isolates. Although several agents show promise in preclinical studies, clinical data specifically for H5N1 remain nonexistent. Challenges persist around resistance monitoring, access to novel therapies, and regulatory harmonization. Expanding the antiviral armamentarium through accelerated evaluation and integration of both traditional and innovative compounds will be essential to pandemic preparedness and effective H5N1 outbreak response.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The silent spread of Hepatitis E in India - from epidemiological insight to public health action: a comprehensive review.","authors":"Snigdha Maity, Shivam Chowdhary, Akila Swaminathan, Nidhi Ashtaputre, Piya Paul Mudgal, Chiranjay Mukhopadhyay","doi":"10.1007/s15010-025-02661-2","DOIUrl":"https://doi.org/10.1007/s15010-025-02661-2","url":null,"abstract":"<p><p>Hepatitis E represents an increasingly significant yet often overlooked public health issue in India, contributing substantially to both sporadic hepatitis cases and widespread waterborne outbreaks. Hepatitis E virus (HEV) is the foremost cause of acute viral hepatitis (AVH) in India and spreads primarily through contaminated water. Genotype-specific differences in transmission routes, ranging from enteric routes in developing regions to zoonotic routes in industrialized settings, underscore the complexity of its epidemiology. Vulnerable populations such as pregnant women, animal handlers, and immunocompromised individuals face a markedly increased risk of severe disease outcomes, including fulminant hepatic failure and chronic infection, in cases of coinfection with hepatitis B virus.This comprehensive review delves into Indian epidemiological trends, clinical features, diagnostic approaches, and current management options for HEV. While most infections are self-limiting, ribavirin has shown efficacy in select high-risk populations. However, the absence of an approved vaccine in India remains a critical gap in preventive strategies. Emerging therapeutics and vaccine candidates are currently in various stages of development. However, challenges such as the genetic diversity of HEVs, lack of long-term efficacy data, and limited public awareness hinder progress.This review emphasizes the urgent need for strengthened national surveillance systems, improved water and sanitation infrastructure, and integrated public health policies tailored for high-risk groups. A multipronged approach that combines epidemiological vigilance, clinical preparedness, and policy-driven interventions is imperative to halt the silent transmission of hepatitis E in India.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric parapneumonic effusion - a twenty-year clinical narrative.","authors":"Leonie Bregy, Philipp K A Agyeman, Andrea Duppenthaler, Elisabeth Kieninger, Matthias Horn, Jonathan Juzi, Dietmar Cholewa, Carmen Casaulta, Matthias V Kopp, Christoph Aebi, Nina Schöbi","doi":"10.1007/s15010-025-02662-1","DOIUrl":"https://doi.org/10.1007/s15010-025-02662-1","url":null,"abstract":"<p><strong>Purpose: </strong>Paediatric parapneumonic effusion (PPE) is accompanied by an increased risk of complications, e.g., sepsis or lung sequelae. Treatment strategies span from antibiotics alone to surgical interventions, but an internationally accepted guideline is lacking. With this study, we aim to better understand how management strategies influence short-term outcome parameters, like length of stay, antibiotic treatment duration, and lung damage.</p><p><strong>Methods: </strong>Retrospective observational single-centre study. Patients admitted from 1 July 2004 to 30 June 2024 with PPE to our tertiary hospital were analysed. We used the exact Jonckheere-Terpstra test to analyse trends over time.</p><p><strong>Results: </strong>A total of 278 patients were included, 23 (8%) had to be excluded for lack of informed consent. A majority (173/255, 68%) were treated with pleural drainage. Over time, drains were increasingly more often inserted without surgery, 20% vs. 65% (p = 0.001) in 2004-2008 vs. 2020-2024. Intravenous antibiotic treatment duration declined from 15 days in 2004-2008 to 11 days in 2020-2024, p = 0.002. The most commonly identified pathogen was S. pneumoniae (39%), followed by S. pyogenes (18%). S. pyogenes compared to S. pneumoniae was more often associated with sepsis or toxic shock (45% vs. 6%, p < 0.0001), but fewer patients showed radiologic evidence for acute lung damage (68% vs. 23%, p < 0.001).</p><p><strong>Conclusion: </strong>We found considerable clinical differences in patients with PPE caused by S. pneumoniae vs. S. pyogenes. The former was associated with substantially greater lung damage.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A fluconazole population pharmacokinetics study to improve target attainment in critically ill patients.","authors":"My-Luong Vuong, Omar Elkayal, Ruth Van Daele, Jan-Willem C Alffenaar, Sophie L Stocker, Jason A Roberts, Yves Debaveye, Joost Wauters, Beatrijs Mertens, Jasper M Boonstra, Indy Sandaradura, Deborah J E Marriott, Roger J Brüggemann, Jeroen A Schouten, Raoul Bergner, Steven Buijk, Isabel Spriet, Erwin Dreesen","doi":"10.1007/s15010-025-02663-0","DOIUrl":"https://doi.org/10.1007/s15010-025-02663-0","url":null,"abstract":"<p><strong>Purpose: </strong>Fluconazole is the recommended step-down therapy from echinocandins for fluconazole-susceptible Candida spp in critically ill patients with invasive candidiasis. However, standard fluconazole dosing does not achieve adequate exposure in these patients. We aimed to identify factors impacting fluconazole pharmacokinetic-pharmacodynamic (PKPD) target attainment and provide a dosing regimen ensuring adequate target attainment in critically ill patients.</p><p><strong>Methods: </strong>A population pharmacokinetics study (popPK) was conducted, combining fluconazole concentration data from eight studies. We used multiple imputation to handle missing covariate data, and Monte Carlo simulations to identify a dosing regimen with at least 90% probability of PKPD target attainment (PTA) in every patient. The PKPD target is the 24-hour area under the unbound concentration-time curve over the minimum inhibitory concentration of 100.</p><p><strong>Results: </strong>Data from 177 critically ill patients were included. A two-compartment popPK model with linear elimination described the data best. Continuous renal replacement therapy (CRRT) status, estimated glomerular filtration rate using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation, and total body weight were statistically significant covariates. However, with standard dosing, only CRRT status and total body weight were clinically relevant, as PTA dropped below 90% for all patients on CRRT, and for patients off-CRRT above 60 kg. A weight-based loading dose and flat maintenance doses of 400 mg (off-CRRT) and 800 mg (CRRT) predicted ≥ 90% PTA across the weight range.</p><p><strong>Conclusion: </strong>We have developed a fluconazole dosing regimen, stratified by weight and CRRT status, that may achieve adequate PTA in critically ill patients. External validation is awaited.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geospatial analysis of open-source intelligence data to early detect laboratory-acquired infections, using the 2019 brucellosis laboratory leak in China as a case study.","authors":"Atalay Goshu Muluneh, Samsung Lim, Aye Moa, Chandini Raina Maclntyre","doi":"10.1007/s15010-025-02666-x","DOIUrl":"https://doi.org/10.1007/s15010-025-02666-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to use geospatial analysis to retrospectively determine whether earlier detection of the 2019 brucellosis laboratory leak in China could have been achieved using open-source intelligence data.</p><p><strong>Methods: </strong>We used open-source intelligence data of brucellosis outbreaks from EPIWATCH^@, from late 2016 to mid-2024. The spatial distribution of brucellosis was mapped using heatmap analysis in China to identify the provinces with the densest outbreak signals. Multiple-ring buffer analysis of outbreak signals within a five and 10-kilometer radius of BSL-3 laboratories in Gansu province was implemented to examine the geospatial analysis techniques' capability to detect the 2019 brucellosis laboratory leak early.</p><p><strong>Results: </strong>The central Gansu province, where the 2019 laboratory leak occurred, has China's densest signal of brucellosis outbreaks. In the multiple ring buffer analysis, outbreak signals were identified within a five-km radius of the Zhongmu Lanzhou Biopharmaceutical Plant Laboratory (ZLBPL) with an event date in July 2019. This compares to the official identification date of 6 December 2019. We identified 10,528 cases among 68,571 tests associated with the 2019 ZLBPL leak. This matches the 10,528 cases recorded in official reports among 79,357 tests, with 1,604 seeking medical treatment. This corresponds to a 13.3% test-positive rate among suspected cases and a 15.2% rate of medical treatment among confirmed cases.</p><p><strong>Conclusion: </strong>A prolonged brucellosis laboratory leak occurred in China, with a delay of nearly six months before formal acknowledgment was received from local authorities. Geospatial analysis of open-source intelligence data identified the outbreak early, the likely source and a nearby laboratory affected by the outbreak.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145286099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community-acquired pneumonia in diabetic patients is characterised by a distinct pathogen spectrum and enhanced inflammation: results from CAPNETZ, a prospective observational cohort study.","authors":"Belén Millet Pascual-Leone, Facundo Fiocca Vernengo, David Hillus, Charlotte Wernicke, Gopinath Krishnamoorthy, Jan Rupp, Gernot Rohde, Mathias W Pletz, Martin Witzenrath, Norbert Suttorp, Leif Erik Sander, Andreas Vestergaard Jensen, Bastian Opitz, Charlotte Thibeault","doi":"10.1007/s15010-025-02659-w","DOIUrl":"https://doi.org/10.1007/s15010-025-02659-w","url":null,"abstract":"<p><strong>Purpose: </strong>Diabetes mellitus (DM) is a relevant risk factor for enhanced susceptibility to and adverse outcomes in infections, including community-acquired pneumonia (CAP). We aimed to characterise clinical outcomes, inflammatory and organ failure markers and microbial etiologies in diabetic (DM+) versus non-diabetic (DM-) patients in a European CAP cohort.</p><p><strong>Methods: </strong>Comparative analyses using data from the CAPNETZ multicenter, prospective, observational study including 13,611 patients with CAP enrolled between 2002-2022, with and without a history of DM, were conducted.</p><p><strong>Results: </strong>Seventeen percent (2310/13,611) had a history of DM (DM+). Compared to DM- patients, DM+ patients had a higher 180 days mortality rate following CAP (13% (292/2310) vs. 7% (766/11,301), p < 0.0001) and higher C-reactive protein and leucocyte counts (median CRP 97 mg/L (IQR: 31-202) vs. 86 mg/L (IQR: 24-190), p < 0.0001; median leucocyte count 12/nl (IQR: 9-16)vs. 11/nl (IQR: 8-15), p < 0.0001). Pathogens were identified in 23.4% (540/2310) of the DM+ and 21.7% (2414/11,301) of the DM- patients (p = 0.03), respectively. Overall, pathogen distribution differed between the two groups, with higher frequencies of Enterobacteriaceae in the DM+ group (13.0% (70/539) vs. 8.0% (194/2414), p_adj < 0.01).</p><p><strong>Conclusions: </strong>CAP in DM+ is characterised by a distinct microbial spectrum and enhanced inflammation. While further studies are needed to elucidate the clinical impact of our findings, we recommend early and comprehensive CAP pathogen testing in DM+ patients.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}