Infection最新文献

{"title":"Viral sepsis - pathophysiology and disease manifestation.","authors":"Lutz G Gürtler, Wolfgang Schramm, Rainer Seitz","doi":"10.1007/s15010-025-02486-z","DOIUrl":"10.1007/s15010-025-02486-z","url":null,"abstract":"<p><p>Viral infection is found in approximately 30% of all sepsis cases and may be followed by bacterial infection in organs such as the lungs. Sepsis manifests as fever, hemorrhagic lesions and cell death. Organ dysfunction caused by sepsis, such as meningitis and encephalitis, can lead to organ damage. Sepsis is induced by various viral components, host cells and cellular mediators, such as cytokines and chemokines. Cytokines are secreted from stimulated macrophages, monocytes, dendritic cells and T lymphocytes.Further contributors to sepsis are the cleavage products after activation of the complement cascade with anaphylatoxin generation and peptides of the activated clotting cascade, thrombocytopenia and thrombocyte function alteration, intravasal clotting and/or endothelial leakage. The cells involved in viral sepsis are neutrophil granulocytes, monocytes and macrophages, dendritic cells and thrombocytes, and finally, endothelial cells and epithelial cells.Prolonged cytokine release leads to cell damage, immune cell dysfunction and exhaustion, and either impairs or hyperactivates immune cells. The course of viral sepsis may be enhanced by some patient conditions including age, underlying diseases such as diabetes, obesity; and immunodeficiency. Viral sepsis, similar to bacterial sepsis, is an extremely complex disorder, and the involvement of the abovementioned cellular and humoral components can present quite divergent biological and clinical patterns.Examples of viral sepsis discussed in the manuscript include three viruses causing Dengue fever - an emerging infection, COVID-19 - a disease with a prolonged course, Ebola disease - a disease with typically complete viral clearance, while rabies virus - induces a disease that causes coma and death before signs of viral sepsis are apparent.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"775-784"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440682","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}

{"title":"Toxigenic Corynebacterium ulcerans in raw milk of a cow with acute mastitis: case report and historical review on milk-transmitted diphtheria.","authors":"Andreas Sing, Laura Macias Luaces, Alexandra Dangel, Stefano Deramo, Katja Bengs, Vyacheslav G Melnikov, Anja Berger","doi":"10.1007/s15010-025-02477-0","DOIUrl":"10.1007/s15010-025-02477-0","url":null,"abstract":"<p><strong>Purpose: </strong>Historically, a considerable number of diphtheria outbreaks, mainly in the UK and the USA, have been epidemiologically or bacteriologically linked to the consumption of milk and dairy products. However, with the introduction of milk pasteurization and hygienic improvements in livestock farming and animal welfare, no cases of milk-linked human diphtheria outbreaks or bovine mastitis due to toxigenic corynebacterial have been reported in the recent decades. Here we report the first isolation of a toxigenic Corynebacterium ulcerans strain from the milk of a cow with acute mastitis within nearly 40 years and outside of UK or Finland.</p><p><strong>Methods: </strong>The isolated strain was analysed by state-of-the-art bacteriological methods including toxigenicity testing by a novel Lateral Flow Immunoassay and Elek test, molecular typing was done by whole genome sequencing and MLST/cgMLST analysis. Due to the rarity of our finding, an extensive historical review of milk-associated diphtheria outbreaks was performed.</p><p><strong>Results: </strong>The obtained sequence type ST-331 is also found in human isolates of cutaneous diphtheria. cgMLST analysis, however, found no close relationship to 43 human ST-331 isolates from our German strain collection or to two animal samples from a zoonic cluster of this ST.</p><p><strong>Conclusion: </strong>The risk of milk-associated diphtheria due to C. ulcerans, although today extremely rare, should be avoided by milk pasteurization and the respective hygienic standards.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"767-774"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457829","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":"Insights into the molecular network characteristics of major HIV-1 subtypes in developed Eastern China: a study based on comprehensive molecular surveillance data.","authors":"Qin Fan, Jiafeng Zhang, Xiaohong Pan, Xiaobei Ding, Hui Xing, Yi Feng, Xingguang Li, Ping Zhong, Hehe Zhao, Wei Cheng, Jun Jiang, Wanjun Chen, Xin Zhou, Zhihong Guo, Yan Xia, Chengliang Chai, Jianmin Jiang","doi":"10.1007/s15010-024-02389-5","DOIUrl":"10.1007/s15010-024-02389-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to conduct a comprehensive molecular epidemiology study of major HIV-1 subtypes in developed Eastern China (Zhejiang Province).</p><p><strong>Methods: </strong>Plasma samples and epidemiological information were collected from 4180 newly diagnosed HIV-1 positive patients in Zhejiang Province in 2021. Pol sequences were obtained to determine the subtypes via multiple analytical tools. HIV-1 molecular networks were constructed on the basis of genetic distances to analyze transmission patterns among major subtypes. Furthermore, the birth-death skyline (BDSKY) model was utilized to estimate the transmission risks associated with large clusters (LCs).</p><p><strong>Results: </strong>In 4180 patients, 3699 (88.49%) pol sequences were successfully obtained and classified into four subtype groups. In the networks under an optimal genetic distance of 0.01 substitutions/site, the majority of links (74.52%, 1383/1856) involved individuals within the same city, highlighting the predominant role of local transmission in driving the HIV-1 epidemic. In the CRF07_BC, CRF01_AE, and others/URFs networks, men who have sex with men (MSM) were the primary sexual transmission population, with the younger MSM group (< 30 years old) exhibiting higher linkage frequencies. Within the CRF08_BC network, 93.98% of individuals were infected primarily through heterosexual contact and had a significantly greater risk of localized clustering than other subtypes did. Moreover, fifteen identified LCs were predominantly transmitted through commercial heterosexual contact (CHC), exhibiting localized clustering and high potential for sustained diffusion.</p><p><strong>Conclusions: </strong>Overall, our findings reveal a diverse and heterogeneous distribution of HIV-1 subtypes in Zhejiang Province, with noticeable variations in hotspots across different geographic areas and populations.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"905-920"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345976","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}

{"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":"Bacterial-like inflammatory response in children with adenovirus leads to inappropriate antibiotic use: a multicenter cohort study.","authors":"Cristina Moracas, Marco Poeta, Francesca Grieco, Agnese Tamborino, Maria Moriondo, Marta Stracuzzi, Alfredo Diana, Laura Petrarca, Simona Marra, Amelia Licari, Stefano Linsalata, Chiara Albano, Anna Condemi, Ester Del Tufo, Teresa Di Fraia, Liana Punzi, Eleonora Ardia, Andrea Lo Vecchio, Eugenia Bruzzese, Claudia Colomba, Vania Giacomet, Fabio Midulla, Gian Luigi Marseglia, Luisa Galli, Alfredo Guarino","doi":"10.1007/s15010-024-02405-8","DOIUrl":"10.1007/s15010-024-02405-8","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical severity of Human Adenovirus (HAdV) infection with other viral diseases in a cohort of children, evaluating presentation, therapy, and outcome.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study in Italian children hospitalized from January to December 2023 for respiratory symptoms. The study included children with HAdV infection presenting primarily with respiratory symptoms. Patients with isolated gastrointestinal involvement or coinfection with bacteria were excluded.</p><p><strong>Results: </strong>A total of 171 children were enrolled: 98 with HAdV infection (age 44.3 ± 37.9 months) and 73 with other viruses (age 20.4 ± 27.2 months). In the first group, 57.1% had a coinfection with one or more additional viruses. The most common symptoms were fever (89.8%), cough (73.5%) and sore throat (52%). Respiratory distress and hypoxemia were more frequent in the non-HAdV group. Children with HAdV infection demonstrated significantly higher C-reactive protein levels (50.8 ± 54.2 vs. 16.5 ± 33.8 mg/L, p < 0.001), experienced a longer duration of fever (4.9 ± 3.6 vs. 3.4 ± 2.3 days, p = 0.009) and were more likely to receive antibiotic treatment (77.6% vs. 27.4%, p < 0.001). No differences were observed in hospitalization stay, rate of complications, and ICU admission.</p><p><strong>Conclusions: </strong>Interestingly, our data suggests that HAdV-infected children exhibit a more pronounced inflammatory response despite experiencing less severe respiratory symptoms compared to other viruses. The presence of prolonged fever and a strong inflammatory response often leads to antibiotic overuse during the initial phase, when the viral etiology is yet to be confirmed. Early and accurate identification of HAdV infection is crucial to optimize treatment strategies and minimize unnecessary antibiotic use.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"935-946"},"PeriodicalIF":5.4,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390268","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}

{"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":"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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137434/pdf/","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":"OA","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137511/pdf/","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":"OA","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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137393/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}