Infection最新文献

{"title":"In vitro activity of ceftazidime-avibactam/aztreonam combination against MBL-producing Pseudomonas aeruginosa strains.","authors":"Niklas Klein, Jonathan Jantsch, Michaela Simon, Jürgen Rödel, Sören L Becker, Annerose Serr, Joerg Steinmann, Stefan F Ehrentraut, Ernst Mollitor, Gunnar T R Hischebeth","doi":"10.1007/s15010-024-02425-4","DOIUrl":"10.1007/s15010-024-02425-4","url":null,"abstract":"<p><strong>Purpose: </strong>The emergence of multidrug-resistant P. aeruginosa isolates poses a challenge to healthcare systems worldwide. Rising numbers in deaths, duration of hospitalization as well as failing treatments prove the hazards posed by these pathogens. This and the lack of promising therapeutic options highlight the urgency of antibiotic drug development. As interim solution or alternative to the development of new antibiotic drugs, investigation of novel combinations of existing antibiotic drugs can be an economic and swift approach. Therefore, this study addresses the evaluation of in vitro activity of the antibiotic combination of ceftazidime-avibactam/aztreonam against MBL-producing P. aeruginosa strains.</p><p><strong>Methods: </strong>We tested 153 isolates from six university hospitals via microdilution against their susceptibility to meropenem, aztreonam, ceftazime-avibactam and the minimal inhibitory concentration of the combination of ceftazidime-avibactam/aztreonam. 64 isolates produced carbapenemases of which 61 were VIM-, 2 NDM- and 1 OXA-producer.</p><p><strong>Results: </strong>We were able to show that the synergetic effects of this regimen with an avibactam concentration of 4 mg/l and an aztreonam concentration of 16 mg/l could successfully lower the number of MBL-producing isolates that showed a high minimal inhibitory concentration compared to a carbapenemase-negative control group in vitro.</p><p><strong>Conclusion: </strong>The antibiotic combination consisting of ceftazidime-avibactam/aztreonam represents a possible approach to the treatment of patients infected with multidrug-resistant P. aeruginosa isolates.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"1061-1068"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647946","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":"Klebsiella pneumoniae species complex bloodstream infection in adult patients: changing epidemiology and determinants of poor outcomes.","authors":"Adam G Stewart, Patrick N A Harris, Felicity Edwards, Behzad Kiani, David L Paterson, Kevin B Laupland","doi":"10.1007/s15010-024-02457-w","DOIUrl":"10.1007/s15010-024-02457-w","url":null,"abstract":"<p><strong>Purpose: </strong>Klebsiella pneumoniae is a common cause of hospital- and community-acquired infection and can readily acquire multiple antimicrobial resistance determinants leading to poor health outcomes. We define the contemporary burden of disease, risk factors for antimicrobial resistance, and poor health outcomes for patients with K. pneumoniae bloodstream infection (Kp-BSI).</p><p><strong>Methods: </strong>All blood cultures with growth of K. pneumoniae species complex among residents of Queensland, Australia (population ≈ 5 million) who received care through a public hospital were identified over a 20-year period. Clinical, microbiological and outcome information was obtained from state-wide databases.</p><p><strong>Results: </strong>A total of 6, 988 patients (7, 496 episodes) with incident Kp-BSI were identified. Incidence rate more than doubled from 5.8 cases to 12.2 cases per 100,000 population over the study period (4.5% rise per year). 258 (3.4%) episodes involved isolates resistant to third-generation cephalosporins (3GC-R). 3GC-R Kp-BSI crude incidence rate increased almost 10% each year. The proportion of hospital-onset episodes reduced from 49.1 to 35.0%. Of all Kp-BSI episodes, 864 (11.5%) died within 30-days. A lower respiratory tract source was associated with a high risk of death (aHR 1.68, 95% CI 1.30-2.16) while a urinary tract source a lower risk (aHR 0.48, 95% CI 0.35-0.66). 3GC-R Kp-BSI was not related to death (aHR 1.08, 95% CI 0.76-1.50).</p><p><strong>Conclusion: </strong>A rising burden of both Kp-BSI and 3GC-R blood isolates in a previous low-prevalence setting is concerning. A significant rise in community-onset Kp-BSI over the 20-year period was noteworthy and requires further evaluation. 3GC-R status was not associated with mortality.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"1179-1187"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921608","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 a host-protein signature score for differentiating between bacterial and viral infections: real-life evidence from a German tertiary hospital.","authors":"Laura Wagner, Heike Schneider, Peter B Luppa, Kathrin Schröder, Nina Wantia, Christiane Querbach, Samuel D Jeske, Tobias Lahmer, Kathrin Rothe, Miriam Dibos, Florian Voit, Johanna Erber, Christoph D Spinner, Jochen Schneider, Julian Triebelhorn","doi":"10.1007/s15010-024-02384-w","DOIUrl":"10.1007/s15010-024-02384-w","url":null,"abstract":"<p><strong>Purpose: </strong>A host-protein signature score, consisting of serum-concentrations of C-reactive protein, tumour necrosis factor-related apoptosis-inducing ligand, and interferon gamma-induced protein 10, was validated for distinguishing between bacterial and viral infections as an antimicrobial stewardship measure for routine clinical practice among adult patients in a German tertiary hospital.</p><p><strong>Methods: </strong>This single-centre, explorative study prospectively assessed the host-protein signature score, comparing it with serum procalcitonin (PCT) in patients with blood stream infections (BSI) and evaluating its efficacy in patients with viral infections against the standard of care (SOC) to assess the need for antibiotics due to suspected bacterial super/coinfection. Manufacturer-specified threshold scores were used to differentiate viral (< 35) and bacterial (> 65) infections.</p><p><strong>Results: </strong>Ninety-seven patients (BSI [n = 56]; viral infections [n = 41]) were included. The score (cut-off score > 65) tended to detect BSI with higher sensitivity than did PCT (cut-off > 0.5 ng/mL) (87.5% vs. 76.6%). Three patients (5.4%) with BSI had a score < 35. One patient with BSI did not receive antibiotic treatment following SOC prior to positive blood culture results. Among patients with viral infections, 29 (70.7%) had scores > 65, indicating bacterial superinfections. Additionally, 11 patients (26.8%) had scores < 35, indicating no bacterial superinfections. In total, the antibiotic treatment discrepancy in the viral group between the SOC and a host-protein signature score guided approach was 2/41 patients (4.9%).</p><p><strong>Conclusion: </strong>The score tended towards a higher sensitivity in detecting BSI than that with PCT. However, its impact on reducing antibiotic use in viral infections was minor compared with that of SOC.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"883-891"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153935","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":"Prophylactic vs preemptive strategy for the prevention of CMV disease in solid organ transplant recipients: systematic review and meta-analysis of randomized controlled trials.","authors":"Niv Reiss-Gindi, Tomer Hoffman, Tanya Ruderman, Alaa Atamna, Ili Margalit, Dafna Yahav","doi":"10.1007/s15010-024-02441-4","DOIUrl":"10.1007/s15010-024-02441-4","url":null,"abstract":"<p><strong>Purpose: </strong>Cytomegalovirus (CMV) is associated with significant morbidity and mortality among solid organ transplant (SOT) recipients. Strategies for CMV prevention include universal prophylaxis or preemptive approach. We aimed to evaluate the optimal approach.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis of randomized controlled trials comparing prophylaxis versus preemptive therapy for CMV in SOT. The primary outcome was CMV disease. Subgroup analysis of outcomes in D+ R- patients was performed.</p><p><strong>Results: </strong>Nine trials have met inclusion criteria, five of them included kidney transplant recipients, all compared val/ganciclovir universal prophylaxis versus preemptive approach. Universal prophylaxis resulted in lower probability of CMV infection (relative risk [RR] 0.44, 95% confidence interval [CI] 0.33-0.58), yet the impact on CMV disease was insignificant (RR 0.54, 95% CI 0.24-1.23), in neither SOT recipients in general nor among D+R- subgroup (RR 0.93, 95% CI 0.37-2.32). Late-onset CMV disease rates were lower with preemptive approach. Sensitivity analysis according to allocation concealment and blinding showed similar results for CMV disease. No significant differences were demonstrated for the outcomes of mortality, bacterial or fungal infection or graft related outcomes. Acute kidney injury was significantly more common with prophylaxis (RR 1.79, 95% CI 1.12-2.89).</p><p><strong>Conclusion: </strong>Preemptive approach is a reasonable approach for CMV prevention in SOT recipients, if feasible. Strategies for combining the preemptive with prophylaxis strategies, as well as immune monitoring, should be investigated.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"1091-1099"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142687005","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":"Anidulafungin exposure and population pharmacokinetics in critically ill patients with invasive candidiasis.","authors":"Omar Elkayal, Yannick Hoffert, Beatrijs Mertens, Ruth Van Daele, Katrien Lagrou, Joost Wauters, Isabel Spriet, Erwin Dreesen","doi":"10.1007/s15010-024-02448-x","DOIUrl":"10.1007/s15010-024-02448-x","url":null,"abstract":"<p><strong>Purpose: </strong>Anidulafungin is recommended as a first-line treatment for invasive Candida infections in critically ill patients. Pharmacokinetic (PK) variability is large in critically ill patients, potentially compromising pharmacokinetic-pharmacodynamic (PKPD) target attainment under standard dosing. We aimed to assess anidulafungin exposure, PKPD target attainment, and population (pop)PK in critically ill patients.</p><p><strong>Methods: </strong>Adult ICU patients receiving standard anidulafungin dosing [200 mg on day 1, then 100 mg daily] were included (NCT04045366). We performed rich blood sampling on an early (day 2 ± 1) and/or late (day 5 ± 1) treatment day. Using total anidulafungin plasma concentrations, we developed a popPK model (NONMEM7.5) and conducted Monte Carlo simulations (n = 1,000 per virtual patient) to evaluate the impact of patient factors on PKPD target attainment (AUC_24h target 83.5 mg×h/L).</p><p><strong>Results: </strong>Twenty patients contributed 188 anidulafungin concentrations. PKPD target attainment was 45% and 65% on early and late sampling days, respectively. A two-compartment popPK model with first-order elimination described the data. Anidulafungin clearance increased with bodyweight and central volume of distribution increased as serum albumin decreased. Both bodyweight and serum albumin had a clinically relevant impact on PKPD target attainment at day 1 (area under the ROC curve; AUROC 0.82 and 0.62, respectively), and bodyweight on PKPD target attainment at day 14 (AUROC 0.94). Standard anidulafungin dosing regimen fails to achieve adequate target attainment throughout the treatment period.</p><p><strong>Conclusion: </strong>Standard anidulafungin dosing is insufficient for achieving adequate exposure in critically ill patients. An interactive simulation tool is provided to aid dose-finding research and explore different dosing strategies and targets.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"1155-1165"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142785420","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 added value of metagenomic next-generation sequencing in central nervous system infections: a systematic review of case reports.","authors":"Kira Waagner Birkeland, Laurence Mostert, Eric C J Claas, Hege Vangstein Aamot, Thomas Demuyser","doi":"10.1007/s15010-025-02502-2","DOIUrl":"10.1007/s15010-025-02502-2","url":null,"abstract":"<p><strong>Background: </strong>The diversity of pathogens causing central nervous system (CNS) infections presents a diagnostic challenge. Patient demographics and geographical location affect the likelihood of certain pathogens causing infection. Current diagnostic methods rely on labour-intensive cultivation or targeted detection. Metagenomic next-generation sequencing (mNGS) is a promising tool for detecting pathogens in CNS infections, offering an unbiased approach. To enhance our understanding of patient demographics and the range of pathogens identified through mNGS, we conducted a systematic review of case reports.</p><p><strong>Methods: </strong>The PubMed database was searched in March 2024. Case reports on CNS infections and mNGS published from January 2014 through February 2024 were included based on predefined criteria.</p><p><strong>Results: </strong>The search yielded 649 articles, of which 76 were included, encompassing 104 patients. Most patients were male (75%), the median age was 31,5 years [0-75] and 28% were immunocompromised. The most common diagnosis was encephalitis (36%), followed by meningitis (23%) and meningoencephalitis (22%). 53 unique pathogens were identified, comprising 27 different viruses, 19 bacteria, 5 parasites, and 2 fungi. Syndromic encephalitis/meningitis panels would only have detected four of the viruses and five of the bacteria. Additionally, 14 of the bacterial species are considered slow-growing or fastidious and could be challenging to detect by culture.</p><p><strong>Conclusion: </strong>The application of mNGS in diagnosing CNS infections reveals the diversity of pathogens responsible for these severe infections, thereby improving diagnostics and facilitating targeted treatment. While case reports may be subjected to bias, they provide valuable insights into the use of mNGS in this clinical context.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"831-849"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624386","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":"Kidney involvement in leptospirosis: a systematic review and meta-analysis.","authors":"Astha Sethi, Tirlangi Praveen Kumar, Kutty Sharada Vinod, Carl Boodman, Rachana Bhat, Prithvishree Ravindra, Souvik Chaudhuri, Seema Shetty, V Shashidhar, Attur Ravindra Prabhu, Nitin Gupta","doi":"10.1007/s15010-025-02492-1","DOIUrl":"10.1007/s15010-025-02492-1","url":null,"abstract":"<p><strong>Introduction: </strong>From a public health perspective, it is essential to understand the burden of kidney involvement in leptospirosis. We aimed to assess the frequency of acute kidney injury (AKI) and chronic kidney disease (CKD) in patients with leptospirosis.</p><p><strong>Methodology: </strong>This systematic review and meta-analysis included all articles up to 14.08.2024 from three databases (PubMed, Scopus, Web of Science) using search terms related to leptospirosis and kidney involvement. After de-duplication, two independent reviewers independently checked the articles in two phases (title-abstract and full-text), and a third reviewer adjudicated any conflicts. Patient demographics, diagnostic procedures, and details of kidney involvement were extracted from the included studies. Risk of bias analysis was done using the Joanna Briggs Institute critical appraisal tool. A random effects model estimated the pooled rates for AKI, oliguria, and the need for dialysis.</p><p><strong>Results: </strong>Of the 5913 retrieved articles, 48 met the eligibility criteria. The pooled incidence of AKI, reduced urine output, and dialysis requirement was 49.2% (95%CI: 38.2-60.2%, I² of 99.4%), 31.5% (95%CI: 24.2-38.7%, I²-96.1%) and 14.4% (95%CI: 10.3-18.4%, I²-97%) respectively. The pooled mean serum creatinine and urea levels at admission were 3.6 mg/dl (95% CI: 2.9-4.2, I²-99.1%) and 131.8 mg/dl (95% CI: 98.7-164.9, I²-98.6%), respectively. In four studies, the incidence of new-onset CKD after leptospirosis infection varied from 13 to 62%.</p><p><strong>Conclusion: </strong>AKI reduced urine output and the requirement for dialysis are frequent complications in patients with leptospirosis. Increased resources for their management in endemic areas are essential to mitigate the burden.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"785-796"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669816","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":"Comparison of SARS-CoV-2 related in-hospital mortality, ICU admission and mechanical ventilation of 1.4 million patients in Germany and Switzerland, 2019 to 2022.","authors":"Cathrin Kodde, Sven Hohenstein, Irit Nachtigall, Yvonne Cavalli, Reto Schuepbach, Raphael Graf, Andreas Bollmann, Ralf Kuhlen","doi":"10.1007/s15010-024-02412-9","DOIUrl":"10.1007/s15010-024-02412-9","url":null,"abstract":"<p><strong>Purpose: </strong>In the 2020 emergence of SARS-CoV-2, global response lacked unified treatment and surveillance, resulting in diverse impacts due to varied healthcare resources and national guidelines. Germany and Switzerland curbed the virus initially by promptly tracking and testing, bolstered by strong governmental capacity. This study aimed to assess country-specific healthcare disparities and their impact on ICU admission rates, mechanical ventilation, and in-hospital mortality.</p><p><strong>Methods: </strong>To enhance healthcare quality using real-world data, the \"Initiative of Quality Medicine\" (IQM) was established. Pseudonymised routine data from participating hospitals, during 01/01/2019-31/12/2022, was retrospectively analysed, focusing on patients with SARI ± SARS-CoV-2-infection (U07.1). Cohorts were matched based on various factors and multivariable analyses included logistic regression.</p><p><strong>Results: </strong>1.421.922 cases of SARI ± U07.1 involving 386 German and 41 Swiss hospitals were included. Patients in Germany were older (mean: 69.4 vs. 66.5 years) and had more comorbidities than in Switzerland (p < .001). Patients in Germany were also more likely to be treated on ICU (28% vs. 20%, OR 1.5 95% CI 1.5-1.6, p < .001) and mechanically ventilated (20% vs. 15%, OR 1.4, 95% CI 1.4-1.5, p < .001). The in-hospital mortality was significantly higher in Germany than in Switzerland (21% vs. 12%, OR 2.0, 95% CI 1.9-2.0, p < .001). Matched cohorts showed reduced differences, but Germany still exhibited higher in-hospital mortality. Discrepancies were evident in both pre-pandemic and pandemic analyses, highlighting existing disparities between both countries.</p><p><strong>Conclusion: </strong>IQM data from Swiss and German hospitals reveals country-specific differences in SARI ± U07.1 outcomes, highlighting higher in-hospital mortality in Germany, with uncertain causes suggesting varied treatments and resources.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"981-989"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464322","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":"Bibliometrics analysis and knowledge mapping of pertussis vaccine research: trends from 1994 to 2023.","authors":"Caixia Tan, Yuanyuan Xiao, Siyao Chen, Ting Liu, Juan Zhou, Sisi Zhang, Yiran Hu, Jingxiang Zhou, Zhongyan She, Biyue Tian, Anhua Wu, Chunhui Li","doi":"10.1007/s15010-024-02414-7","DOIUrl":"10.1007/s15010-024-02414-7","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to use bibliometric methods to explore the evolving landscape, hotspots, and emerging frontiers of pertussis vaccine research, providing deeper insights into the current research landscape and guiding future vaccine development efforts.</p><p><strong>Methods: </strong>We conducted a comprehensive search of the Web of Science Core Collection database (WoSCC) from January 1, 1994, to December 31, 2023, employing search terms related to vaccination (vacc* or immun*) and pertussis (pertussis, Whooping Cough, Bordetella pertussis, B. pertussis, Bordetella pertussis infection, or B. pertussis infection) in the Title or Author keywords fields. Bibliometrics analysis of pertussis research was performed utilizing the bibliometrix-biblioshiny package in RStudio, alongside CiteSpace and VOSviewer software.</p><p><strong>Results: </strong>In total, 2,623 records were analyzed, comprising 89.63% (n = 2,351) original research articles and 10.37% (n = 272) review articles. The study revealed that academic research on the pertussis vaccine was growing at a rate of 4.64% per year. The United States and Canada lead in the number of publications. GlaxoSmithKline and the Centers for Disease Control & Prevention- United States emerged as leading institutions, with Halperin SA and Locht C as the most active authors. Vaccine was the most influential journal. Most studies focused on vaccine effectiveness duration, vaccination schedules for high-risk groups, and people's attitudes toward vaccination.</p><p><strong>Conclusion: </strong>Our analysis showed increasing interest of researchers in pertussis literature, yet current research mainly emphasized expanding vaccine coverage and optimizing strategies, neglecting new vaccine development. This emphasized the need for prioritizing novel pertussis vaccines to tackle the resurgence challenge.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"1001-1012"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464321","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":"Bacteremic nosocomial pneumonia caused by Gram-negative bacilli: results from the nationwide ALARICO study in Italy.","authors":"Giusy Tiseo, Valentina Galfo, Sergio Carbonara, Andrea Marino, Giovanni Di Caprio, Anna Carretta, Alessandra Mularoni, Michele Fabiano Mariani, Alberto Enrico Maraolo, Riccardo Scotto, Lidia Dalfino, Lorenzo Corbo, Margherita Macera, Alice Annalisa Medaglia, Maria Luca d'Errico, Claudia Gioè, Christian Sgroi, Rosa Fontana Del Vecchio, Giancarlo Ceccarelli, Antonio Albanese, Calogero Buscemi, Simona Talamanca, Giuseppe Foti, Giulio De Stefano, Antonina Franco, Carmelo Iacobello, Salvatore Corrao, Domenico Morana, Filippo Pieralli, Ivan Gentile, Teresa Santantonio, Antonio Cascio, Nicola Coppola, Bruno Cacopardo, Mario Venditti, Francesco Menichetti, Marco Falcone","doi":"10.1007/s15010-024-02423-6","DOIUrl":"10.1007/s15010-024-02423-6","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the clinical characteristics and outcomes of patients with nosocomial pneumonia (NP) caused by carbapenem-resistant Gram-negative bacilli (CR-GNB) and to compare them to patients with NP caused by carbapenem-susceptible (CS)-GNB.</p><p><strong>Methods: </strong>Prospective observational multicenter study including patients with bacteremic NP caused by GNB from the ALARICO Network (June 2018-January 2020). The primary outcome measure was 30-day mortality. A Cox regression analysis was performed to identify factors independently associated with 30-day mortality. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated.</p><p><strong>Results: </strong>Overall, 167 patients with GNB NP were included: 101 with bacteremic NP caused by CR-GNB (n = 39 by KPC-producing Klebsiella pneumoniae, n = 29 by carbapenem-resistant Acinetobacter baumannii, n = 28 by carbapenem-resistant Pseudomonas aeruginosa, n = 5 by MBL-producing Klebsiella pneumoniae) and 66 cases of bacteremic CS-GNB NP. Thirty-day mortality rate was higher in patients with NP caused by CR-GNB compared to those with NPcaused by CS-GNB (46.5% vs 30.3%, p = 0.036). On multivariable analysis, age (HR 1.044, 95% CI 1.021-1.067, p < 0.001), hematological malignancy (HR 4.307, 95% CI 1.924-9.643, p < 0.001) and septic shock (HR 3.668, 95% CI 2.001-6.724, p < 0.001) were factors independently associated with 30-day mortality, while the receipt of adequate antibiotic therapy within 24 h from infection onset (HR 0.495, 95% CI 0.252-0.969, p = 0.04) was a protective factor. Carbapenem resistance was not associated with increased risk of mortality (HR 1.075, 95% CI 0.539-2.142, p = 0.837).</p><p><strong>Conclusions: </strong>Patients with bacteremic NP caused by CR-GNB have high mortality rate. Strategies to reduce the time from infection to the administration of adequate antibiotic therapy should be implemented in patients with NP.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"1041-1050"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142790668","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}