Infection最新文献

{"title":"Metagenomic next-generation sequencing in blood culture-negative endocarditis: a structured review with illustrative pooled estimates.","authors":"Pontus Westerström","doi":"10.1007/s15010-026-02901-z","DOIUrl":"https://doi.org/10.1007/s15010-026-02901-z","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis is a life-threatening cardiovascular infection with high morbidity and mortality. Identification of the causative microbial pathogen is essential for targeted antimicrobial treatment. Blood culture-negative endocarditis accounts for up to 30% of the cases and supplementary diagnostics (antigen, serology, histopathology, PCR, 16 S/18S) are unable to detect all pathogens. Recent sequencing-based diagnostics, including metagenomic next-generation sequencing (mNGS), have been incorporated as adjunctive tools in the 2023 Duke-ISCVID criteria.</p><p><strong>Methods: </strong>This is a structured literature review with illustrative pooled estimates retrieved from PubMed and Google Scholar using searches for infective endocarditis including BCNE cases and sequencing methods.</p><p><strong>Results: </strong>The database searches identified 12 clinical studies with 794 patients, 10 prospective and two retrospective studies; no randomised controlled trials. Illustrative pooled estimates were calculated using random-effects meta-analyses of proportions and presented in forest plots; mNGS microbial diagnostic yield 0.87 (0.83-0.89), mNGS valve tissue pooled diagnostic yield 0.92 (0.80-0.97), blood culture diagnostic yield 0.43 (0.28-0.58) and valve tissue diagnostic yield 0.23 (0.12-0.39). Relative diagnostic yield, based on ratios of pooled proportions, showed a 2-fold lower yield for blood culture vs. mNGS and a 4-fold lower yield for valve tissue culture vs. mNGS.</p><p><strong>Conclusion: </strong>mNGS is increasingly being implemented in routine infective endocarditis diagnostics and has consistently demonstrated high diagnostic yield across heterogeneous studies, particularly in valve tissue compared with blood and valve tissue culture. Consensus on diagnostic algorithms, standardised mNGS testing, and randomised controlled trials are needed to further define the role of mNGS in BCNE.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792726","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":"Empirical antipseudomonal antibiotic therapy and in-hospital mortality in biliary tract infections with bacteremia: a multicenter retrospective cohort study in Japan.","authors":"Koji Endo, Hiroyoshi Iwata, Makoto Kaneko, Keisuke Kamada, Yuki Honda, Yoshito Homma, Takao Wakabayashi, Kenji Kanto, Yuki Nagai, Shuhei Hamada, Takashi Saito, Kyoji Hashimoto, Takuya Aoki","doi":"10.1007/s15010-026-02955-z","DOIUrl":"https://doi.org/10.1007/s15010-026-02955-z","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the association between the use of empirical antipseudomonal antibiotics and in-hospital mortality in patients with bacteremia due to biliary tract infections.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective cohort study using data from the JApan Bacteremia Inpatient Cohort Association (JA-BICA), a database of 1105 adult inpatients with bacteremia sourced from eight community general hospitals across Japan. Adult patients with bacteremia due to biliary tract infections were included in this study. Patients who received empirical antipseudomonal antibiotics on the day of hospital admission were categorized into the exposure group and those who did not receive such antibiotics were categorized into the comparison group. The primary outcome measure was the all-cause in-hospital mortality. We evaluated the association between antipseudomonal antibiotic use and in-hospital mortality using cumulative incidence functions and the Fine-Gray subdistribution hazard models with propensity score-based stabilized inverse probability of treatment weighting (IPTW). The missing covariates were addressed using multiple imputations.</p><p><strong>Results: </strong>Among 216 eligible patients, 160 (74.0%) received empirical antipseudomonal antibiotics. IPTW-weighted Fine-Gray analysis showed no detectable association between antipseudomonal antibiotic use and in-hospital mortality (subdistribution hazard ratio, 1.02; 95% CI, 0.4-2.59; P = 0.96).</p><p><strong>Conclusions: </strong>In the present study, no clear association was observed between empirical antipseudomonal antibiotic therapy and in-hospital mortality in patients with bacteremia due to biliary tract infection; however, the estimate was imprecise due to the limited number of events. These findings highlight the need for further studies to guide empirical antibiotics selection in this population.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792567","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":"Plasma-derived extracellular vesicle microRNA as a potential biomarker associated with disease progression in non-severe dengue infection.","authors":"Gokulakannan Venkatesan, Wan Suriana Wan Ab Rahman, Wan Nazatul Shima Shahidan, Norliana Ghazali, Fatmawati Lambuk, Hisham Atan Edinur, Salfarina Iberahim, Azura Hussin, Saiful Azlan Mohamed, Alwi Muhd Besari Hashim","doi":"10.1007/s15010-026-02923-7","DOIUrl":"https://doi.org/10.1007/s15010-026-02923-7","url":null,"abstract":"<p><strong>Background: </strong>Dengue can manifest as a mild febrile illness to life-threatening haemorrhagic fever. The early identification of patients at risk of disease progression remains challenging, particularly in non-severe cases. Therefore, this study aims to investigate the capability of extracellular vesicle plasma microRNA (miRNA) expression as a biomarker in dengue infection.</p><p><strong>Methodology: </strong>A total of 52 dengue patients (26 dengue with warning signs and 26 dengue without warning signs) were enrolled. Microarray analysis was utilised to profile miRNA derived from plasma extracellular vesicles to identify potential biomarkers associated with disease progression. Target genes were predicted bioinformatically to construct a miRNA-mRNA interaction network and identify key hub genes. The expression levels of miRNAs were validated through quantitative reverse-transcription polymerase chain reaction (RT-qPCR), and their diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curve analysis. Additional functional enrichment analysis, gene ontology, and co-expression studies were conducted. An in vitro experiment using THP-1 cells investigated how hsa-miR-107 regulates P2RY12 expression, with further validation of P2RY12 levels through RT-qPCR using GAPDH as a reference.</p><p><strong>Results: </strong>Microarray profiling identified 24 upregulated miRNAs in dengue patients with warning signs, notably hsa-miR-107 and hsa-miR-6879-5p, which were selected as potential biomarkers. Correlation analysis revealed that platelet count exhibited a statistically significant, moderate positive correlation with the hsa-miR-107 expression value. ROC analysis demonstrated strong diagnostic performance, linking these miRNAs to the platelet dysfunction and altered vascular permeability associated with disease severity. Furthermore, functional analysis supported the involvement of these pathways in dengue pathogenesis, and in vitro transfection confirmed that hsa-miR-107 actively decreases P2RY12 expression.</p><p><strong>Conclusion: </strong>This study highlights the expression of hsa-miR-107 and hsa-miR-6879-5p as candidate biomarkers associated with clinical warning signs in dengue infection. These findings could pave the way for improved diagnostic and monitoring strategies.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792634","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":"Incidence and microbiological etiology of vascular graft and endograft infections: a systematic review and meta-analysis.","authors":"Nicholas Geremia, Alberto Enrico Maraolo, Andrea De Vito, Federico Giovagnorio, Agnese Colpani, Andreina Monfreda, Gianfranco Sanson, Stefano Di Bella, Sandro Lepidi, Mario D'Oria","doi":"10.1007/s15010-026-02908-6","DOIUrl":"https://doi.org/10.1007/s15010-026-02908-6","url":null,"abstract":"<p><strong>Purpose: </strong>Vascular graft and endograft infections (VGEIs) represent rare but severe complications following abdominal aortic aneurysm (AAA) repair. Reported incidence rates vary widely, and comparative estimates between surgical procedures remain limited.</p><p><strong>Methods: </strong>A systematic search was performed in PubMed and Scopus. The search covered human studies published up to 3rd May 2025. The protocol was conceived in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline. it was registered in PROSPERO (registration number CRD42024525824) on 18th March 2024.</p><p><strong>Results: </strong>Nineteen studies were included. The pooled incidence of infective events was 0.36 per 100 person-years (95% CI 0.21-0.64; I² = 93.3%) after endovascular aneurysm repair (EVAR) and 0.60 per 100 person-years (95% CI 0.22-1.60; I² = 96.3%) after open surgery (OS). In EVAR-related VGEI, Staphylococcus spp. were the most frequently reported pathogens (5 cases, 12.5%). Polymicrobial etiology was not infrequent (5 cases, 12.5%), and a high proportion of infections were culture-negative (18 cases, 45.0%). In OS, data did not permit an etiological analysis. In mixed-procedure studies, fungal infections (16 cases, 17.8%), Gram-negative bacteria (15 cases, 16.7%), and polymicrobial infections (14 patients, 15.6%) were frequently reported. Considerable heterogeneity across the included studies, particularly regarding the diagnostic criteria used to define VGEI, was identified. Univariable meta-regression analyses did not identify significant associations between incidence rates and study-level covariates, including mean age, sex distribution, or year of publication.</p><p><strong>Conclusion: </strong>VGEIs remain uncommon but relevant complications after AAA repair, with a lower incidence after EVAR than after OS. Future studies should prioritize standardized diagnostic criteria and detailed etiological reporting to improve epidemiological and clinical understanding.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792622","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":"Near-real-time whole-genome sequencing in hospital infection control: a narrative review.","authors":"Taru Singh, Aleena Taufiq, Arshad Jawed, Naseem Akhter, Sajad Ahmad Dar","doi":"10.1007/s15010-026-02937-1","DOIUrl":"https://doi.org/10.1007/s15010-026-02937-1","url":null,"abstract":"<p><strong>Background: </strong>Hospital-acquired infections (HAIs) continue to pose a significant challenge to patient safety, partly because traditional microbiological methods slow down the identification of pathogens and outbreak detection. Near-real-time whole-genome sequencing (WGS) and point-of-care (POC) sequencing workflows offer the potential for quicker pathogen characterization and tracking of transmission, which could lead to better infection control and improved use of antibiotics.</p><p><strong>Objective: </strong>To review rapid and POC WGS technologies and workflows used in hospital settings, and to summarize evidence on typical turnaround times, impacts on outbreak detection, and implications for clinical decision-making.</p><p><strong>Method: </strong>A narrative review was conducted using literature retrieved from major biomedical databases, including PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Relevant studies addressing whole-genome sequencing, rapid/near-real-time sequencing, healthcare-associated infections, outbreak investigation, and hospital infection control were identified and reviewed.</p><p><strong>Results: </strong>Streamlined WGS workflows cut turnaround times from several days (typical of traditional methods) to between 13.5 and 48 h in many rapid implementations. Some nanopore-based protocols report initial species identification in minutes and complete genomic data within a few hours. Faster sequencing and real-time analytics lead to earlier identification of resistance markers and quicker detection of transmission chains. Several studies indicate outbreak detection is easier than with traditional epidemiological methods. This allows for more timely targeted therapy and can enhance the responsible use of antibiotics when combined with clinical decision processes.</p><p><strong>Conclusion: </strong>Near-real-time and point-of-care whole-genome sequencing significantly reduces the time needed to identify pathogens and speeds up outbreak detection. However, it requires consistent reporting of turnaround metrics, and careful evaluation of how faster genomic data affects clinical decisions and patient outcomes.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792693","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":"Prevention and treatment of tetanus in China: a comparative review against international standards.","authors":"Bin Zhang, Yiliu Wei, Yanting Lin, Weizhi Chen, Jun Lin, Qiaoyi Wu","doi":"10.1007/s15010-026-02891-y","DOIUrl":"https://doi.org/10.1007/s15010-026-02891-y","url":null,"abstract":"<p><strong>Purpose: </strong>Although China has successfully eliminated neonatal tetanus, non-neonatal tetanus, particularly among older adults, remains a persistent clinical and public health challenge. This narrative review synthesizes the current landscape of tetanus in China-covering epidemiology, pathophysiology, prevention, diagnosis, and treatment-and compares it with World Health Organization (WHO) guidance and practices in other countries to identify gaps and optimization strategies.</p><p><strong>Methods: </strong>A comprehensive narrative review was conducted across five core domains: epidemiology, pathogen and pathophysiology, prevention strategies, diagnostic advances, and therapeutic interventions. Data were integrated from the WHO, the Chinese Center for Disease Control and Prevention, national guidelines, and relevant clinical studies, with comparative analysis against global best practices.</p><p><strong>Results: </strong>Epidemiological trends show a clear shift in disease burden from neonates to older adults, predominantly in rural areas, with high case fatality rates (10-40%) despite low incidence. Advances in antibody detection include sensitive assays (e.g., quantum dot-based lateral flow tests), while treatment guidelines prioritize metronidazole over penicillin, with specific protocols for human tetanus immunoglobulin dosing and autonomic management.</p><p><strong>Conclusion: </strong>Adult tetanus highlights critical immunity gaps in China's aging population. Refining immunization policies with WHO guidance and standardizing management may help improve outcomes. China's experience offers a valuable reference for other low- and middle-income countries undergoing similar epidemiological transitions.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792715","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":"Prevalence, mortality, risk factors, and treatment of carbapenem-resistant hypervirulent Klebsiella pneumoniae: an evidence map.","authors":"Xiaoyu Chai, Qianyi Zhou, Wei Jiang, Jie Liu, Yue Liu, Yi Sun, Wenjie Yang","doi":"10.1007/s15010-026-02849-0","DOIUrl":"https://doi.org/10.1007/s15010-026-02849-0","url":null,"abstract":"<p><strong>Purpose: </strong>Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) is a critical global health threat due to its hypervirulence and multidrug resistance, causing severe, high-mortality infections. This study systematically reviews its epidemiology, risk factors, treatment strategies, and activity.</p><p><strong>Methods: </strong>We searched databases to identify studies reporting CR-hvKP prevalence, resistance profiles, risk factors, treatment strategies, and activity. Two reviewers independently extracted data; a third resolved discrepancies. Results were summarized descriptively.</p><p><strong>Results: </strong>Forty-three studies involving 9283 carbapenem-resistant K. pneumoniae (CRKP) strains were included. The median prevalence of CR-hvKP among CRKP was 9.40% (IQR 4.40-14.80%) via the string test plus virulence assay. Diabetes (OR = 10.947, P = 0.010) and ICU admission (OR = 16.012, P = 0.003) were independent risk factors for CR-hvKP infection. Among 130 patients, the most commonly used antibiotics included meropenem (34.62%), cefoperazone-sulbactam (31.54%), and tigecycline (28.46%). However, treatment failure remains a significant concern. Antimicrobial resistance analysis indicated that CR-hvKP exhibited high resistance rates to cephalosporins (> 80%) and quinolones (45-100%). One study found high susceptibility (92.50-100.00%) to nitrofurantoin, polymyxins, imipenem-relebactam, tigecycline, and colistin. Mortality analysis revealed a median mortality rate of 30.30% (IQR 13.33-53.06%).</p><p><strong>Conclusion: </strong>CR-hvKP remains a formidable public health threat due to its substantial prevalence, elevated mortality, and multidrug resistance. Current therapeutic strategies lack standardization, and widely applied combination therapy has inconsistent efficacy. Further research is urgently needed to optimize treatment regimens. Early detection, precise antimicrobial stewardship, and stringent infection control measures are crucial to mitigate the spread and impact of CR-hvKP.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792690","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":"Maribavir in lung transplant recipients with cytomegalovirus infection: real-life experience.","authors":"Tobias Veit, Stefan Trost, Teresa Kauke, Nina Engels, Gabriela Leuschner, Michael Gerckens, Carlo Mümmler, Sebastian Michel, Michael Zoller, Valeria Hackemann, Jürgen Behr, Nikolaus Kneidinger","doi":"10.1007/s15010-026-02927-3","DOIUrl":"https://doi.org/10.1007/s15010-026-02927-3","url":null,"abstract":"<p><strong>Introduction: </strong>Cytomegalovirus remains a major challenge in LTx recipients. Despite advances in antiviral therapy, refractory and resistant CMV infections persist, and real-world data on maribavir, a recently approved UL97 kinase inhibitor, are limited.</p><p><strong>Methods: </strong>We retrospectively analyzed 49 LTx recipients treated with maribavir for refractory and resistant (R/R) CMV between August 2022 and December 2024.</p><p><strong>Results: </strong>Overall, 34 patients (69.4%) achieved a sustained virological response, defined as complete CMV DNA clearance, with a > 1 log₁₀ viral load decline after a median of 11.5 days and complete viral clearance after a median of 24.8 [7-54] days. Sixteen patients (32.7%) failed therapy; UL97 resistance mutations were detected during maribavir therapy in 14 patients (28.6%). Non-responders had higher baseline viral loads (> 10,000 IU/ml: 53.3% vs. 20.6%; p = 0.047) and slower viral decline (14 (6-85) vs. 10.5 (2-27) days; p = 0.033). In multivariable analysis, higher baseline CMV viral load was independently associated with maribavir resistance (OR 3.729 per log₁₀ increase, 95% CI 1.360-10.226; p = 0.011).</p><p><strong>Conclusion: </strong>In conclusion, maribavir represents an important therapeutic option for R/R CMV after lung transplantation. However, treatment failure, relapse, and resistance remained common, highlighting the need for careful monitoring and further optimization of treatment strategies.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792587","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":"Treating the host, not just the spine: a position paper proposing a clinical algorithm for spondylodiscitis based on a prospective 14-year cohort analysis.","authors":"Stavros Oikonomidis, Peer Eysel, Dorothee Hornik, Norma Jung, Ayla Yagdiran","doi":"10.1007/s15010-026-02942-4","DOIUrl":"https://doi.org/10.1007/s15010-026-02942-4","url":null,"abstract":"<p><strong>Purpose: </strong>This study introduces a novel Clinical Risk Stratification Algorithm for spondylodiscitis, shifting the management focus from purely radiological criteria to clinical risk factors.</p><p><strong>Methods: </strong>The study presents a novel clinical risk stratification algorithm for spondylodiscitis, developed through a systematic synthesis of data from a 14-year prospective monocentric cohort. Developed from a prospective 14-year cohort (2008-2022) at a tertiary center, the algorithm synthesizes data from ten sub-analyses using multivariate regression to identify key drivers of mortality and treatment failure.</p><p><strong>Results: </strong>Significant risk factors for adverse outcomes include Chronic Kidney Disease (CKD), malignancy, age ≥ 65, and bacteremia. For patients with Spinal Epidural Abscess (SEA), diabetes and CRP levels ≥ 150 mg/l are critical predictors of neurologic deficit. The algorithm categorizes patients into three pathways: Path A (High Mortality) prioritizes aggressive surgical source control, challenging the traditional view that multimorbid patients are \"too sick for surgery\". Path B addresses failure risks like S. aureus using a \"2-week CRP Checkpoint\" to guide potential revision surgery. Path C focuses on quality-of-life-driven palliative care for oncology patients.</p><p><strong>Conclusion: </strong>This clinical tool enables personalized management by integrating systemic status into surgical decision-making. It emphasizes that surgery is a vital tool for sepsis control in frail patients and pain management in palliative care. While based on robust individual predictors, the proposed integrated decision tree has not yet undergone internal or external validation to confirm its clinical utility.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792681","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":"Clinical characteristics of bloodstream infections in the patients receiving anti-IL-6 receptor antibody.","authors":"Koh Shinohara, Kentaro Tochitani, Yoshiki Katada, Tatsunori Murata, Mayu Morita, Yusuke Tsuda, Yasuhiro Tsuchido, Masaki Yamamoto, Yasufumi Matsumura, Miki Nagao","doi":"10.1007/s15010-026-02938-0","DOIUrl":"https://doi.org/10.1007/s15010-026-02938-0","url":null,"abstract":"<p><strong>Purpose: </strong>Although indications for anti-interleukin 6 (IL-6) receptor antibody (anti-IL6R) therapy continue to expand, the clinical features of bloodstream infection (BSI) in anti-IL6R recipients remain poorly characterized. We investigated the prevalence, clinical and microbiological features of BSI among the anti-IL6R recipients.</p><p><strong>Methods: </strong>We conducted a multicenter, retrospective study of BSI episodes occurring within 90 days of anti-IL6R administration between 2005 and 2024. Complicated BSI was defined as the presence of either (1) infection-related mortality, (2) remote or localized suppurative complications, (3) embolic stroke, or (4) recurrence within 90 days. Associations between clinical variables and complicated BSI were analyzed.</p><p><strong>Results: </strong>Among 922 anti-IL6R recipients, 47 patients (5%) developed BSI. Demographics varied by indication for anti-IL6R, and 89% received concomitant immunosuppressive therapy. Catheter-related bloodstream (23%) and intra-abdominal (21%) were most common foci, followed by bone and joint (14%). At presentation, fever was absent in 53%, and serum CRP was within normal range in 30%. Septic shock occurred in 26%, and all-cause 30-day mortality was 19%. Complicated BSI occurred in 22 episodes (47%). In univariate analysis, underlying rheumatic disease, community acquisition, onset within 21 days of anti-IL6R administration, and Staphylococcus aureus or Klebsiella pneumoniae etiology were associated with complicated BSI, whereas higher pulse rate at presentation and Pitt bacteremia score ≥ 4 were inversely associated.</p><p><strong>Conclusions: </strong>In anti-IL6R recipients, BSI frequently lacked typical signs such as fever but often resulted in severe outcomes. Clinicians should maintain a high index of suspicion for complicated BSI in this population.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792576","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}