Infection最新文献

{"title":"Assessing fluoroquinolone resistance in Mycobacterium tuberculosis using nanopore sequencing: concordance with established diagnostic methods.","authors":"Rashmi Ratnam, Parul Jain, Faisal Abbas, Bhoopendra Pandey, Manu Singh, Urmila Singh, Vijay Kumar, Amita Jain, Ram Awadh Singh Kushwaha","doi":"10.1007/s15010-026-02798-8","DOIUrl":"https://doi.org/10.1007/s15010-026-02798-8","url":null,"abstract":"<p><strong>Introduction: </strong>Fluoroquinolones (FQs) are key components of World Health Organization (WHO)-recommended regimens for multidrug-resistant tuberculosis (MDR-TB). Accurate detection of FQ resistance is essential for optimizing treatment. This study evaluated the concordance between the Second-Line Line Probe Assay (SL-LPA) and Liquid Culture Drug Susceptibility Testing (LC-DST) for detecting FQ resistance in Mycobacterium tuberculosis isolates.</p><p><strong>Methods: </strong>In this retrospective study, 1402 non-duplicate clinical isolates of MDR TB were tested using SL-LPA and LC-DST at a reference laboratory. Genotypic resistance was identified through mutations in the gyrA and gyrB genes identified by SL-LPA, while phenotypic resistance was determined using MGIT-based LC-DST at critical concentrations for fluoroquinolones. Targeted nanopore sequencing was performed on a subset of isolates with discordant molecular and phenotypic results to investigate resistance-associated mutations.</p><p><strong>Results: </strong>SL-LPA detected FQ resistance in 907 (64.7%) isolates, whereas LC-DST identified resistance in 852 (60.8%) isolates. Using LC-DST as the reference standard, SL-LPA showed a sensitivity of 93.2%, specificity of 98.6%, positive predictive value of 99.2%, and negative predictive value of 88.7%. Overall concordance between the two methods was observed in 1292 (92.2%) isolates. Discordant results occurred in 110 (7.8%) isolates, mainly involving low-level resistance mutations or inferred resistance due to missing wild-type bands on SL-LPA. Nanopore sequencing of 15 discordant isolates identified high-confidence mutations (Asp94Tyr, Asp94Gly, Asp94Asn) and interim or low-confidence mutations (Ala90Val, Ser91Pro, Asp94Ala, gyrB Asn499Asp, Asp461Asn).</p><p><strong>Conclusion: </strong>SL-LPA demonstrates excellent specificity and positive predictive value for detecting FQ resistance; however, discordance associated with low-confidence mutations and heteroresistance highlights the importance of integrating molecular assays with phenotypic DST and sequencing to improve MDR-TB resistance detection and guide treatment decisions.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770493","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":"Multidrug-resistant Klebsiella pneumoniae in oncology intensive care units: selected genetic markers and clinical predictors.","authors":"Aya El Nahas, Ahmed O El-Gendy, Mona Wassef, Fatma Molham","doi":"10.1007/s15010-026-02793-z","DOIUrl":"https://doi.org/10.1007/s15010-026-02793-z","url":null,"abstract":"<p><strong>Background: </strong>Multidrug-resistant (MDR) Klebsiella pneumoniae poses a critical threat in oncology intensive care units (ICUs), particularly in low- and middle-income countries like Egypt, where immunocompromised patients are at high risk from invasive procedures. This study aimed to characterize antimicrobial resistance patterns and molecular features of MDR K. pneumoniae isolates and to explore clinical and genetic markers associated with resistance burden.</p><p><strong>Methods: </strong>Fifty K. pneumoniae isolates were recovered from cancer patients at Shefa Al Orman Oncology Hospital (Luxor, Egypt). Susceptibility testing was performed using VITEK® 2. Resistance genes (OmpK35, QnrB, AcrAB, OqxA, and Sul2) were detected via PCR. Resistance burden was quantified as a resistance score (R-score) and analyzed against clinical and genetic variables using non-parametric tests and regression models.</p><p><strong>Results: </strong>All isolates (100%) were resistant to β-lactams. High resistance rates were observed for carbapenems (78-84%), fluoroquinolones (84%), aminoglycosides (76-80%), and trimethoprim-sulfamethoxazole (86%), while tetracycline (40%) and tigecycline (10%) showed lower resistance. Genetic analysis revealed Sul2 (100%), OmpK35 (94%), OqxA (92%), QnrB (90%), and AcrAB (68%). Prior hospitalization and antibiotic use within three months were the only independent risk factors for higher R-scores (p = 0.041). Patient mortality reached 46%.</p><p><strong>Conclusion: </strong>MDR K. pneumoniae in oncology ICUs shows extensive resistance and multiple genetic associations. Prior healthcare exposure significantly increases resistance burden, emphasizing the urgent need for stringent antimicrobial stewardship and targeted infection control measures.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147729055","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":"Efficacy and safety of imipenem-cilastatin-relebactam in resistant infections: a systematic review and meta-analysis of randomized controlled trials.","authors":"Nahed Hawsawi","doi":"10.1007/s15010-026-02796-w","DOIUrl":"https://doi.org/10.1007/s15010-026-02796-w","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance represents a major global health concern, particularly with the rise of carbapenem-resistant pathogens that significantly constrain therapeutic options. Imipenem-cilastatin-relebactam (IMI-REL), a novel combination of a β-lactam and β-lactamase inhibitor, has emerged as a promising treatment for patients with few alternatives. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of IMI-REL in comparison with standard-of-care antibiotics for managing resistant or complicated bacterial infections.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed following PRISMA guidelines. Comprehensive searches of PubMed, Scopus, and Web of Science were conducted up to July 2025. Eligible studies included RCTs comparing IMI-REL with alternative antibiotics in patients with resistant or complicated infections, reporting clinical and/or microbiological outcomes. The primary outcomes were clinical and microbiological responses assessed at the end of intravenous therapy (DCIV), early follow-up (EFU), and late follow-up (LFU). Secondary outcomes comprised adverse events, serious adverse events (SAEs), treatment discontinuation due to adverse events, and all-cause mortality.</p><p><strong>Results: </strong>Six randomized controlled trials were included, encompassing different types of infections caused by imipenem-resistant pathogens. Across these studies, IMI-REL demonstrated comparable clinical responses to standard-of-care regimens at the end of intravenous therapy (DCIV) (RR: 1.04; 95% CI 0.94-1.16), early follow-up (EFU) (RR: 1.02; 95% CI 0.92-1.12), and late follow-up (LFU) (RR: 1.01; 95% CI 0.91-1.12). Microbiological outcomes were similarly equivalent between treatment groups. Safety analyses indicated no increased risk of adverse events (RR: 1.01; 95% CI 0.77-1.32), serious adverse events (SAEs) (RR: 0.93; 95% CI 0.70-1.23), discontinuation due to adverse events (RR: 0.62; 95% CI 0.39-1.01), or mortality (RR: 0.83; 95% CI 0.41-1.67).</p><p><strong>Conclusion: </strong>IMI-REL demonstrates efficacy and safety comparable to standard-of-care treatments for resistant and complicated infections. It may serve as a valuable therapeutic option for patients with limited alternatives and can support antimicrobial stewardship when administered as a short-course empirical therapy followed by appropriate de-escalation.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147770475","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":"QuantiFERON-TB gold test: a valuable diagnostic tool for tubercular uveitis in non-endemic regions.","authors":"Sebastian Albus, Antonia Koch, Uwe Pleyer, Anne Rübsam, Leif E Sander, Martin Witzenrath, Nikolai Menner, Lynn S Zur Bonsen, Dominika Pohlmann","doi":"10.1007/s15010-026-02789-9","DOIUrl":"https://doi.org/10.1007/s15010-026-02789-9","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the diagnostic challenges of tubercular uveitis, given the frequent absence of pulmonary involvement and the limited accuracy of ocular detection methods.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of real-world data from 2285 uveitis patients who underwent QFT screening between 2013 and 2022 at a tertiary care centre in Germany.</p><p><strong>Results: </strong>Among the 2285 screened patients, 172 (7.5%) uveitis patients tested QFT-positive. 17 patients were diagnosed with clinically active tuberculosis disease (TBD) and 155 patients with clinically inapparent tuberculosis infection (TBI). TBD patients were younger (40 vs. 58 years; p = 0.005), more likely to originate from Southeast Asia region (56.3% vs. 43.7%; p < 0.005), and more frequently presented with clinical symptoms (17.6% vs. 1.3%; p < 0.005). No differences were observed in the prevalence of tuberculosis (TB)-suspicious findings on chest X-ray (35.3% vs. 17%; p = 0.08) or CT (71.4% vs. 31.6%; p = 0.06). None of the 98 sputum samples yielded a positive result. Microbiological confirmation was achieved in 4 cases via bronchoscopy. Among TBI patients (n = 155), idiopathic inflammatory uveitis was diagnosed in 109 cases (70.3%), while an alternative aetiology was identified in 46 (29.7%). Posterior uveitis was the predominant subtype in both groups (TBD 65.6% vs. TBI 40.8%; p = 0.03). In TBD patients, the prevalence of bilateral involvement was significantly higher (93.8% vs. 64.0%; p = 0.001), and active retinal vasculitis was significantly more common (75.5% vs. 14.5%; p < 0.005).</p><p><strong>Conclusion: </strong>This study highlights the importance of TB screening, even in non-endemic regions, as evidenced by the prevalence of QFT positivity and active TB cases in uveitis patients.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147716830","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 of infectious endophthalmitis after keratoplasty surgery: an updated systematic review and meta-analysis.","authors":"Kai-Yang Chen, Hoi-Chun Chan, Chi-Ming Chan","doi":"10.1007/s15010-026-02772-4","DOIUrl":"https://doi.org/10.1007/s15010-026-02772-4","url":null,"abstract":"<p><strong>Introduction: </strong>Infectious endophthalmitis is a rare but vision-threatening complication following keratoplasty. With the evolution of corneal transplantation techniques toward endothelial keratoplasty (EK) and anterior lamellar keratoplasty (ALK), contemporary pooled incidence estimates stratified by surgical technique and geographic region are required to inform perioperative prevention strategies and postoperative surveillance. This study aimed to provide an updated systematic review and single-arm meta-analysis evaluating the incidence and risk factors of infectious endophthalmitis after keratoplasty.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was conducted according to PRISMA guidelines. Five databases (PubMed, Scopus, Web of Science, ScienceDirect, and Cochrane Library) were searched from inception to December 31, 2025. Observational studies reporting incidence of infectious endophthalmitis after keratoplasty were included. A random-effects single-arm meta-analysis of proportions with logit transformation was performed. Subgroup analyses were conducted by keratoplasty type, geographic region, study period, and follow-up duration. Heterogeneity was assessed using the I² statistic and τ², and prediction intervals (PIs) were calculated when appropriate.</p><p><strong>Results: </strong>Twenty-one studies comprising multiple keratoplasty procedures were included. The pooled incidence of infectious endophthalmitis after keratoplasty was 0.40% (95% CI 0.30-0.50), with a prediction interval of 0.08-1.95%, indicating substantial between-study variability. Significant heterogeneity was observed (I² = 95.75%, τ² = 0.59, p < 0.001). Stratified analyses showed higher incidence after penetrating keratoplasty (0.50%; 95% CI 0.30-0.60) compared with ALK (0.20%; 95% CI 0.01-0.30) and EK (0.20%; 95% CI 0.20-0.30) (p < 0.0001). By region, incidence was 0.40% in North America, 0.30% in Asia, and 0.70% in Europe (p = 0.007). Incidence varied by follow-up duration: 0.20% (≤ 1 month), 0.60% (1-12 months), and 0.30% (> 12 months) (p = 0.007). Frequently reported risk factors included penetrating keratoplasty, combined intraocular procedures, anterior vitrectomy, donor-related contamination, delayed suture removal, and higher systemic comorbidity burden. Visual outcomes were generally poor, with frequent graft failure and limited visual recovery.</p><p><strong>Conclusion: </strong>Post-keratoplasty infectious endophthalmitis remains uncommon but clinically consequential. Penetrating keratoplasty showed a higher pooled incidence than lamellar techniques in this synthesis, and meaningful geographic variation persists. These findings indicate lower pooled incidence estimates with lamellar techniques in this synthesis and highlight the importance of rigorous perioperative infection-prevention strategies.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698716","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":"Pneumonia due to Mycobacterium shimoidei: a rare non-tuberculous mycobacterial infection in a young patient with anorexia nervosa.","authors":"Ahmad Wael Sultan, Rolf Schwarzer, Martin Kuhns, Hildrun Haibel, Thomas Schneider, Rasmus Leistner","doi":"10.1007/s15010-026-02795-x","DOIUrl":"https://doi.org/10.1007/s15010-026-02795-x","url":null,"abstract":"<p><strong>Background: </strong>Mycobacterium shimoidei is a rare, nontuberculous mycobacterium that predominantly causes pulmonary disease mimicking pulmonary tuberculosis. Fewer than 50 cases have been reported worldwide, with only two cases previously published from Germany. Known risk factors include structural lung disease and immunosuppression.</p><p><strong>Case presentation: </strong>A 37-year-old female patient with anorexia nervosa (BMI 14.5 kg/m²) and Gitelman syndrome, presented with general deterioration of condition and B symptoms. On admission, she displayed a high fever, hypotension and tachycardia. Chest imaging showed an inflamed large left upper lobe cavitary lesion and the patient was examined for Mycobacterium tuberculosis (tbc) pneumonia. Microscopy showed acid-fast bacilli but PCR was negative for tbc. The subsequent amplification of the gene for 16S RNA and its analysis by next generation sequencing (NGS) revealed M. shimoidei. Primarily based on literature research and later on antimicrobial susceptibility testing (AST), the patient was started on a combination therapy with Clarithromycin, Ethambutol and Rifabutin for a planned total of 12 months. She could be discharged after defeverescence and further clinical improvement but was regularly followed up as an outpatient. After terminating therapy, the patient showed complete radiological regression of pneumonia and clinical remission.</p><p><strong>Conclusion: </strong>This case adds to the limited literature on Mycobacterium shimoidei pulmonary disease and supports its role as a clinically relevant cause of cavitary nontuberculous mycobacterial infection. Severe anorexia nervosa may represent a predisposing condition as it might be associated with structural lung diseases. The case further underscores the importance of next-generation sequencing for the identification of rare NTM species.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147698694","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":"Bartonella henselae infection associated with a multisystemic thrombo-inflammatory syndrome in an immunocompetent adult.","authors":"Giovanni Gobbo, Marco Zacchia, Federico Nalesso, Marny Fedrigo, Stefano Da Pozzo, Luca Frison, Fabrizio Vianello, Annalisa Angelini, Paolo Simioni, Ariela Hoxha","doi":"10.1007/s15010-026-02797-9","DOIUrl":"https://doi.org/10.1007/s15010-026-02797-9","url":null,"abstract":"<p><strong>Background: </strong>Bartonella henselae infection is traditionally associated with self-limited cat-scratch disease but may occasionally present with severe systemic manifestations.</p><p><strong>Case presentation: </strong> We report a 43 year-old immunocompetent man who developed a multisystem thrombo-inflammatory syndrome with thrombocytopenia, renal involvement, thrombotic events, ocular ischemia, and transient lupus anticoagulant positivity, initially suggestive of catastrophic antiphospholipid syndrome. Extensive investigations were unrevealing until whole blood PCR detected B. henselae. Retrospective histopathology revealed small-vessel endothelial injury compatible with microangiopathy. Doxycycline therapy was followed by clinical improvement, normalization of platelet counts, and resolution of thrombotic manifestations CONCLUSION: This case highlights the diagnostic complexity of systemic Bartonella infection and the need to consider infectious triggers in unexplained thrombo-inflammatory presentations, even in immunocompetent individuals.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690008","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":"Imaging characteristics, yield of computed tomography, and clinical outcomes of central nervous system nocardiosis.","authors":"Zachary A Yetmar, Ryan B Khodadadi, Supavit Chesdachai, Jack W McHugh, Douglas W Challener, Nancy L Wengenack, Jason T Little, Wendelyn Bosch, Maria Teresa Seville, Elena Beam","doi":"10.1007/s15010-026-02792-0","DOIUrl":"https://doi.org/10.1007/s15010-026-02792-0","url":null,"abstract":"<p><strong>Background: </strong>Nocardia frequently disseminates to the central nervous system (CNS). Few studies have described brain imaging characteristics of these infections or compared findings of computed tomography (CT) and magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adults diagnosed with CNS nocardiosis between November 2011 and April 2022 and underwent brain MRI. We aimed to describe common brain imaging characteristics, compare the diagnostic yield of brain CT and MRI, and describe clinical outcomes.</p><p><strong>Results: </strong>52 patients were diagnosed with CNS nocardiosis, of which 26 also underwent brain CT. Most patients (N = 43; 82.7%) were receiving immunosuppressing medication, had concurrent pulmonary involvement (N = 45; 86.5%), and the most common species was N. farcinica (N = 19; 36.5%). 50% had CNS symptoms. The most common radiographic characteristics were supratentorial involvement (N = 50; 96.2%), multiple lesions (N = 31; 59.6%), and bihemispheric involvement (N = 30; 57.7%). Of 26 with both imaging modalities, 5 (19.2%) did not have signs of CNS nocardiosis on CT. These patients had smaller CNS lesions (median 0.6 versus 1.8 cm; p = 0.005) and more often had multiple brain lesions or bihemispheric involvement (both: 100% versus 47.6%; p = 0.053). Twelve (23.1%) patients died within 12 months of diagnosis, though abnormal CT and CNS lesion ≥ 1 cm were not associated with mortality. Of 33 who completed therapy, 3 (9.1%) and 2 (6.1%) patients had residual neurologic deficits or post-treatment recurrence, respectively.</p><p><strong>Conclusions: </strong>CNS nocardiosis commonly presents with multiple, supratentorial brain lesions. About 20% of patients will have a normal brain CT, usually those with multiple small lesions.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672827","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":"Correlation of brain injury biomarkers with brain dysfunction, brain injury, and outcomes in critically ill patients: a post hoc exploratory analysis.","authors":"M Rühlmann, L Xu, M Bauer, T Lehmann, G Panagiotou, S Neugebauer, M Kiehntopf, F Klawitter, J Ehler","doi":"10.1007/s15010-026-02790-2","DOIUrl":"https://doi.org/10.1007/s15010-026-02790-2","url":null,"abstract":"<p><strong>Purpose: </strong>Clinical assessment of brain dysfunction in critically ill patients is frequently limited by impaired consciousness and poor compliance. Blood-based biomarkers may facilitate detection of neurocognitive impairment, quantify structural brain injury, and improve prognostication. This study evaluated the potential diagnostic role of validated brain injury biomarkers compared with routine diagnostics in critically ill patients.</p><p><strong>Methods: </strong>We performed a single-center post hoc analysis of a prospective observational sepsis study conducted in two perioperative ICUs. Critically ill patients with and without sepsis were included. Delirium was assessed using validated tools and structural brain injury was evaluated from radiology reports. Biomarkers-neurofilament light chain (NfL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), glial fibrillary acidic protein (GFAP) and Tau-were measured at two time points (enrollment and day 7). Neurological outcome was assessed using the modified Rankin Scale (mRS). 90-day mortality was recorded.</p><p><strong>Results: </strong>90 patients were analyzed (60 with, 30 without sepsis). Delirium occurred in 54.4% and structural brain injury in 42.2%. At ICU discharge, 23.3% had favorable neurological outcomes. NfL levels were higher in septic patients with delirium (p = 0.038). GFAP was significantly elevated in patients with structural brain injury (p < 0.001). All biomarkers showed prognostic potential; GFAP demonstrated the strongest association with unfavorable outcome (aOR 5.11, 95% CI 1.57-22.33). GFAP and UCH-L1 improved AUC in reference model 1 (age + SOFA), while all four biomarkers improved AUC in models 2 (age + GCS) and 3 (APACHE-II) for predicting poor outcome and 90-day mortality.</p><p><strong>Conclusion: </strong>Brain injury biomarkers correlate with delirium and structural injury and may enhance outcome prediction in heterogeneous critically ill patients.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov. NCT06749483. Study Registration Date: 23 December 2024.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672770","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":"From bench to triage: diagnostic utility of delta-like canonical notch ligand-1 (DLL-1) for early sepsis prediction in the emergency department.","authors":"Aurelia Hübner, Katharina Friedrich, Noa Galtung, Vivienne Theobald, Judith Schenz, Britta Hecke, Melanie Kraß, Markus A Weigand, Kai Kappert, Wolfgang Bauer","doi":"10.1007/s15010-026-02794-y","DOIUrl":"https://doi.org/10.1007/s15010-026-02794-y","url":null,"abstract":"<p><strong>Background: </strong>The early identification of patients with sepsis among those presenting with suspected infection in the emergency department (ED) remains challenging. Delta-like canonical Notch ligand-1 (DLL-1), a Notch pathway ligand involved in immune and endothelial signaling, has been shown to reflect disease severity and outcomes in ICU-based sepsis cohorts. Its value for early risk stratification at ED presentation is less well defined.</p><p><strong>Methods: </strong>We analyzed DLL-1 concentrations in serum samples from a prospectively enrolled ED cohort of adults presenting with clinically suspected acute infection. Blood samples were obtained during the initial clinical assessment. Sepsis was defined according to Sepsis-3 criteria and adjudicated by an expert panel, including evaluation of organ dysfunction within 72 h after presentation. DLL-1 concentrations were measured using enzyme-linked immunosorbent assay (ELISA), and diagnostic performance was assessed using AUROC analysis.</p><p><strong>Results: </strong>Among 300 enrolled patients, 74 (24.7%) were classified as having sepsis. DLL-1 concentrations were significantly higher in patients with sepsis than in those without sepsis (median 11,454 vs. 8,085 pg/mL; p < 0.001). DLL-1 demonstrated moderate discriminatory performance for sepsis at ED presentation (AUROC 0.69, 95% CI 0.62-0.76). Performance was lower than that of procalcitonin and NEWS2 but comparable to C-reactive protein and lactate. DLL-1 showed a moderate correlation with SOFA score. Importantly, correlations with CRP and white blood cell count were nonsignificant.</p><p><strong>Conclusions: </strong>When measured at ED presentation, DLL-1 concentrations are elevated in patients with sepsis but showed only moderate diagnostic performance. These findings are consistent with earlier disease stages and lower degrees of organ dysfunction compared with ICU populations. DLL-1 may offer complementary host-response information beyond established biomarkers, but does not support stand-alone use for early sepsis diagnosis and warrants further evaluation within multimodal risk stratification strategies.</p><p><strong>Trial registration: </strong>DRKS00017395.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.6,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672781","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}