Infection最新文献

{"title":"Human intestinal spirochetosis presenting as colonic ulceration in an immunocompetent 65-year-old man.","authors":"Sara Zotti, Lisa Fusaro, Stefano Di Bella, Stella Babich","doi":"10.1007/s15010-025-02574-0","DOIUrl":"https://doi.org/10.1007/s15010-025-02574-0","url":null,"abstract":"<p><strong>Purpose: </strong>To report an unusual case of symptomatic human intestinal spirochetosis (HIS) in an immunocompetent individual without known risk factors, and a potential zoonotic source (domestic pig).</p><p><strong>Methods: </strong>A 65-year-old heterosexual man with no gastrointestinal or immunological history presented with acute diarrhea, abdominal pain, vomiting, and rectal bleeding. Colonoscopy revealed two ulcers in the distal transverse colon; biopsies were taken from ulcerated and normal mucosa. Histopathology included Warthin-Starry staining.</p><p><strong>Results: </strong>Histology showed dense spirochetal colonization forming a \"false brush border,\" consistent with HIS. The ileum was unremarkable. The patient was treated with oral metronidazole 500 mg q6h for 10 days, resulting in complete resolution of symptoms. Follow-up colonoscopy at 13 months confirmed full mucosal healing, and the patient remained asymptomatic.</p><p><strong>Conclusion: </strong>This case highlights the possible pathogenic role of HIS in gastrointestinal symptoms and colonic ulceration, even in immunocompetent individuals without traditional risk factors. It underscores the diagnostic value of histology in atypical colonic lesions and suggests zoonotic transmission as a plausible route of infection outside classical risk groups.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274748","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":"Evaluation of probiotics efficiency for the prevention of Clostridioides difficile infection in hospitalized patients: a systematic review and meta-analysis.","authors":"Yahya A Almutawif, Mustafa A Najim, Najeeb Ullah Khan","doi":"10.1007/s15010-025-02580-2","DOIUrl":"https://doi.org/10.1007/s15010-025-02580-2","url":null,"abstract":"<p><strong>Background: </strong>Clostridioides difficile infection (CDI) poses a significant healthcare challenge, with the most frequent cause being antibiotic-associated diarrhea, affecting hospitalized individuals with substantial cost and mortality concerns. However, there is no information regarding probiotic efficiency for initial CDI treatment, and the modulation of microbiota by probiotics has been suggested as a potential preventive measure against CDI.</p><p><strong>Objective: </strong>To evaluate the efficacy of probiotics in preventing CDI in hospitalized patients.</p><p><strong>Methods: </strong>An exhaustive literature search was performed using PubMed to identify controlled/clinical trials investigating the use of probiotics for CDI prevention among hospitalized individuals based on PRISMA guidelines and the PICO framework. Relevant data were extracted from selected studies. Statistical meta-analysis (subgroup or sensitivity analyses) was performed using R Studio to calculate the pooled effect size, odds ratio (OR) with a 95% CI, p-value, and heterogeneity. The risk of bias was assessed using the Cochrane risk-of-bias (RoB) tool to determine publication bias and sensitivity of the included studies.</p><p><strong>Results: </strong>Four studies with a significant number of participants were identified and included in the meta-analysis. The incidence of CDI was reduced in the probiotic group compared to the placebo group, with an overall OR of 0.99 (95% CI [0.56; 1.7]), increased heterogeneity, and a non-significant p-value, using a random effects model in R Studio. Subgroup analysis suggested possible beneficial outcomes regarding the selection of probiotic strain and dose regimen, supporting the effective use of probiotics in preventing CDI. Two of the included studies showed a high risk of bias in the randomization process, while others indicated a significantly low risk of bias.</p><p><strong>Conclusion: </strong>Detailed or systematic information on CDI treatment provides evidence that the direction of the odds ratio suggests a possible protective role of probiotics, although the overall effect was not significant. The OR < 1.0 indicates a neutral efficiency of probiotics, on CDI incidence observed in the probiotics group compared to the placebo group.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257987","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":"Clostridioides difficile evolution in a tertiary German hospital through a retrospective genomic characterization.","authors":"Fabian Lorenzo-Diaz, Tilman E Klassert, Cristina Zubiria-Barrera, Amelya Keles-Slevogt, Mario Gonzalez-Carracedo, Mariano Hernandez, Hortense Slevogt, Thomas Grünewald","doi":"10.1007/s15010-025-02576-y","DOIUrl":"https://doi.org/10.1007/s15010-025-02576-y","url":null,"abstract":"<p><strong>Purpose: </strong>Clostridioides difficile is a major cause of healthcare-associated infections, contributing to significant morbidity and mortality. This study aimed to investigate the genomic characteristics, antimicrobial resistance (AMR) profiles, and temporal dynamics of C. difficile strains isolated from hospitalized patients in a German tertiary hospital over nearly two decades (1997-2015).</p><p><strong>Methods: </strong>Whole-genome sequencing was performed on 46 toxigenic C. difficile isolates to determine sequence types (STs) and phylogenetic relationships and these were compared to national surveillance data on C. dificile. AMR profiling was conducted to identify key resistance determinants at genetic level while epsilometer minimum inhibitory concentration (MIC) analyses were used to correlate genetic resistance markers with phenotypic resistance. Longitudinal antibiotic usage data were analysed to assess potential associations with resistance profiles and strains evolution.</p><p><strong>Results: </strong>Five predominant STs were identified: ST1 (30%), ST54 (24%), ST3 (22%), ST11 (11%), and ST37 (4%). Phylogenetic analysis showed that ST1 (ribotype 027) emerged as the dominant and persistent lineage, replacing ST11 and ST54 over time. AMR profiling detected several resistance genetic markers such as CDD-1/CDD-2 (carbapenem resistance), ErmB (macrolide-lincosamide-streptogramin B resistance/MLS resistance), and mutations in gyrA (fluoroquinolone resistance) and rpoB (rifampicin resistance). MIC analyses confirmed high resistance rates to moxifloxacin (87%) and rifampicin (59%), while susceptibility to fidaxomicin, metronidazole, and vancomycin remained. The tetM gene, associated with doxycycline resistance, declined as ST11 and ST54 frequencies decreased. Longitudinal analysis revealed a reduction in moxifloxacin resistance following its decreased use, whereas increased doxycycline use paradoxically correlated with reduced resistance.</p><p><strong>Conclusion: </strong>This study highlights the dynamic strain evolution of C. difficile, reflecting national trends in strain evolution. The findings emphasize the strong correlation between epsilometer MIC values and molecular resistance markers. This observation reinforces the integration of genetic surveillance with antibiotic stewardship in the clinical routine to effectively mitigate CDI recurrence. Further research is needed to better understand the complex interactions between antibiotic exposure and strain evolution in hospital environments.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247728","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":"Antimicrobial treatment for 7 versus 14 days in patients with bacteremia: a meta-analysis of randomized controlled trials.","authors":"Marlene Prager, Felix Bergmann, Lena Pracher, Dragan Copic, Jasmin Zessner-Spitzenberg, Georg Gelbenegger, Heimo Lagler, Nicole Harrison, Heinz Burgmann, Markus Zeitlinger, Anselm Jorda","doi":"10.1007/s15010-025-02562-4","DOIUrl":"https://doi.org/10.1007/s15010-025-02562-4","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal duration of antibiotic treatment in patients with bacteremia is a matter of ongoing debate.</p><p><strong>Methods: </strong>We conducted a meta-analysis of randomized controlled trials that compared 7 days with 14 days of antimicrobial treatment in adults with bacteremia. The systematic search included trials published until December 2024. Efficacy outcomes included 90-day all-cause mortality, recurrence of bacteremia and mean length of hospital stay. Safety outcomes included the total number of adverse events, Clostridioides difficile infections, diarrhea, acute kidney injury, rash or emergence of antibiotic resistance.</p><p><strong>Results: </strong>The final analysis included four randomized controlled trials with a total of 4790 participants. Death by day 90 occurred in 321 (13.3%) of 2406 patients receiving antibiotic treatment for 7 days and 342 (14.3%) of 2384 patients receiving antibiotic treatment for 14 days (RR 0.93 [95% CI, 0.81 to 1.07)]; p = 0.30; prediction interval 0.74 to 1.17). The mean hospital stay did not differ significantly (mean difference - 0.18 days [95% CI, -1.03 to 0.67]; p = 0.69; prediction interval - 2.57 to 2.22). Recurrence of bacteremia was similar between antibiotic treatment for 7 days (64 [2.7%] of 2406) and antibiotic treatment for 14 days (56 [2.3%] of 2384) (RR 1.14 [95% CI, 0.80 to 1.63)]; p = 0.47; prediction interval 0.64 to 2.03). Safety outcomes, including the total number of adverse events, Clostridioides difficile infections, diarrhea, acute kidney injury, rash, and antibiotic resistance, were similar between groups.</p><p><strong>Conclusions: </strong>This meta-analysis suggests that 7-day and 14-day antimicrobial treatment is associated with a similar efficacy and safety profile in patients with bacteremia.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247727","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 rise in severe necrotizing fasciitis- another consequence of the COVID-19 pandemic?","authors":"Alexander Eijkenboom, Jan Friederichs, Simon Hackl, Sven Hungerer","doi":"10.1007/s15010-025-02564-2","DOIUrl":"https://doi.org/10.1007/s15010-025-02564-2","url":null,"abstract":"<p><strong>Purpose: </strong>During the COVID-19 pandemic restrictions such as social distancing, lockdowns and mask mandates were imposed by Germany's government. After these interventions were abolished, an increase in group A streptococcal infections, including necrotizing fasciitis, was observed in our Level 1 trauma center. The aim of this study was to evaluate the incidence of type I and type II necrotizing fasciitis (NF) before, during and after the COVID-19 pandemic.</p><p><strong>Methods: </strong>165 patients with severe NF, treated in our Level 1 trauma center, were included between 2010 and 2023. Patients were categorized into a pre-mask, mask and post-mask group, according to their date of admission relative to the COVID-19 pandemic. Clinical parameters and patient characteristics were assessed between groups.</p><p><strong>Results: </strong>In the pre-mask group, type I NF (69%) was more common than type II NF (31%). In the mask group 95% of patients had type I NF. In the post-mask group, Streptococcus pyogenes triggered type II NF dominated with 74% of all cases. There was a significant increase in NF type II cases in the post-mask group compared to the pre-mask and mask-group (p < 0.001). Patients with NF in the post-mask group appeared significantly healthier and tended to be younger than patients before and during the COVID-19 pandemic.</p><p><strong>Conclusion: </strong>This study supports the hypothesis that the general population has acquired an \"immune debt\" following the COVID-19 pandemic, resulting in an increase in necrotizing fasciitis incidence, especially triggered by Streptococcus pyogenes, after restrictions such as mask mandates and social distancing were lifted.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215726","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":"Diagnosis and treatment of invasive pulmonary aspergillosis in critically ill intensive care patients: executive summary of the German national guideline (AWMF 113-005).","authors":"Dominic Wichmann, Martin Hoenigl, Philipp Koehler, Christina Koenig, Frederike Lund, Sebastian Mang, Richard Strauß, Markus A Weigand, Christian Hohmann, Oliver Kurzai, Claus Heußel, Matthias Kochanek","doi":"10.1007/s15010-025-02572-2","DOIUrl":"https://doi.org/10.1007/s15010-025-02572-2","url":null,"abstract":"<p><strong>Purpose: </strong>The executive summary of the guideline aims to provide the most relevant recommendations on the diagnosis and treatment of invasive pulmonary aspergillosis in critically ill patients in the intensive care unit.</p><p><strong>Methods: </strong>The guideline's work included a systematic literature search, selection and assessment of the data relevant to the issues identified. Key questions included the areas of epidemiology, risk factors, diagnostics, and therapy. They were discussed analogous to a PICO scheme within the guideline committee, with subsequent working groups proposing recommendations for specific key questions, which were then again discussed and finalized by the entire guideline committee.</p><p><strong>Results: </strong>In addition to the classic risk factors (persistent neutropenia, allogeneic stem cell transplantation, congenital or acquired immunodeficiency, etc.), decompensated liver cirrhosis, COPD, solid tumours and viral pneumonia (influenza, COVID-19) have been established as risk factors for critically ill patients in need of intensive care. If there is no adequate improvement or even further clinical deterioration of the respiratory status in critically ill patients, the presence of IPA should be considered and appropriate diagnostic tests should be initiated. Diagnostics should include a CT scan of the chest and a broncho-alveolar lavage with culture for moulds, testing for galactomannan and PCR. Isavuconazole and voriconazole are recommended as first-line treatment, liposomal amphotericin B as an alternative, with posaconazole (PCZ) or the echinocandins (as an add-on to azole or polyene treatment) being additional options for salvage treatment.</p><p><strong>Conclusion: </strong>Invasive aspergillosis in critically ill patients represents a diagnostic and therapeutic challenge. If indicated, invasive aspergillosis should be considered and appropriate diagnostic tests initiated. Isavuconazole and voriconazole are recommended as first-line treatment, liposomal amphotericin B as an alternative.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215727","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":"Hemophagocytic lymphohistiocytosis in people living with HIV-a single centre experience.","authors":"Pascal Migaud, Daniela Drauz, Alessia Dalla Pria, Kai Hosmann, Markus Müller, Leyli Ghaeni, Hartmut Stocker","doi":"10.1007/s15010-025-02573-1","DOIUrl":"https://doi.org/10.1007/s15010-025-02573-1","url":null,"abstract":"<p><strong>Background: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome that clinically resembles sepsis thus obscuring the underlying condition and delaying its diagnosis and therapy. Among the most common triggers are lymphomas and infectious diseases. Lymphoma-associated HLH appears to be more common in People living with HIV (PLWH).</p><p><strong>Methods: </strong>Retrospective cohort study comprising all adult HIV-infected patients with HLH treated at St. Joseph Hospital Berlin-Tempelhof, Germany, defined by HLH 2004-criteria and the HScore, between April 2020 and November 2024.</p><p><strong>Results: </strong>22 patients were included with at least 5/8 positive HLH criteria and a median HScore of 222 points. Median age was 44 [29-66] years. The median CD4-count at HLH-diagnosis was 100/µL [14-936]. In 8 (36%) patients the HIV-viral load was undetectable. HLH led to the diagnosis of HIV in 6 (27%) patients. In 20/22 patients an LPD was the HLH trigger. Hodgkin's lymphoma, HHV8-positive multicentric Castleman disease and HHV8-positive primary effusion lymphoma accounted for 8 (36%), 5 (23%) and 3 (14%) cases respectively. Kaposi sarcoma inflammatory cytokine syndrome (KICS) HHV8-positive plasmablastic lymphoma, HHV8-positive diffuse large B-cell lymphoma, DLBCL and invasive Aspergillosis were each found in 1 (4%) patient. All patients with Hodgkin's lymphoma had bone marrow involvement. In 1 patient simultaneous malaria and multiple myeloma were diagnosed. 11/22 (50%) patients had HHV8-associated conditions. 5 (23%) patients died within 30 days of the HLH-diagnosis.</p><p><strong>Conclusion: </strong>Lymphomas and HHV8-associated diseases are common triggers of HLH in PLWH and are linked to a high mortality rate.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208466","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":"Global, regional, and national burden of lower respiratory infections and chronic obstructive pulmonary disease, 1990-2021: a systematic analysis from the global burden of disease study 2021.","authors":"Yi-Yuan Wang, Jing Wang, Zhang-Wei Lu, Qian-Qian Zhou, Yang-Guang Cao, Yu-Jie Du, Xue Jin, Bao-Zhu Li","doi":"10.1007/s15010-025-02566-0","DOIUrl":"https://doi.org/10.1007/s15010-025-02566-0","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the global burden of lower respiratory infections (LRIs) and chronic obstructive pulmonary disease (COPD), focusing on their combined impact across age groups and regions.</p><p><strong>Methods: </strong>Data from 204 countries were analyzed using spatiotemporal Gaussian process regression to estimate LRI and COPD incidence, prevalence, and disability-adjusted life years (DALYs). Age-standardized ratios (ASR) and the Socio-Demographic Index (SDI) were used to compare disease burdens, with trends assessed via linear regression and restricted cubic spline models.</p><p><strong>Results: </strong>In 2021, COPD and LRI caused 360 million cases and 5.9 million deaths, with the highest burden in low-SDI regions. COPD remained the fourth leading cause of death, while LRI dropped to seventh.</p><p><strong>Conclusion: </strong>The bidirectional link between LRI and COPD exacerbates disease progression, disproportionately affecting low-income regions and aging populations. Addressing disparities in healthcare access, improving vaccines, and strengthening public health infrastructure are critical to reducing the global burden of these diseases.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198987","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":"Secondary laryngeal manifestation of cavitary pulmonary tuberculosis.","authors":"Matthias J Neuboeck, Nikolaus Poier-Fabian, Stefan Doppler, Helmut J F Salzer","doi":"10.1007/s15010-025-02570-4","DOIUrl":"https://doi.org/10.1007/s15010-025-02570-4","url":null,"abstract":"","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198988","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":"No antibiotics for asymptomatic bacteriuria.","authors":"Annika P Schnell","doi":"10.1007/s15010-024-02369-9","DOIUrl":"10.1007/s15010-024-02369-9","url":null,"abstract":"","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"1251-1252"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}