Infection最新文献

{"title":"The type VI secretion system as a potential predictor of subsequent bloodstream infection of carbapenem-resistant Klebsiella pneumoniae strains on intestinal colonization.","authors":"Chenfeng Zhao, Pingjuan Liu, Xiaoshu Lin, Chenyu Wan, Kang Liao, Penghao Guo, Jiankai Deng, Zhongwen Wu, Yaqin Peng, Junqi Huang, Yili Chen","doi":"10.1007/s15010-024-02456-x","DOIUrl":"https://doi.org/10.1007/s15010-024-02456-x","url":null,"abstract":"<p><strong>Background: </strong>The type VI secretion system (T6SS) has been recognized as a novel virulence factor in Klebsiella pneumoniae. This study investigated the occurrence of T6SS genes in carbapenem-resistant Klebsiella pneumoniae (CRKP) strains during intestinal colonization and evaluated their effect on the development of bloodstream infections.</p><p><strong>Methods: </strong>The study encompassed 2,385 patients admitted to the intensive care unit (ICU) and subjected to routine screening for intestinal colonization with CRKP. PFGE was employed on CRKP strains isolated from both the patients' intestine and blood cultures, confirming their genetic similarity. PCR was employed to detect the presence of carbapenemase genes, T6SS genes, and virulence genes. Quantitative real-time PCR was conducted to assess the expression levels of the core genes associated with the T6SS. The correlation between T6SS expression and sBSI was further investigated.</p><p><strong>Results: </strong>Approximately 10% (238/2385) of ICU patients tested positive for CRKP colonization. Among patients who tested positive, 10.1% (24/238) developed CRKP-sBSI. Patients carrying T6SS-positive CRKP isolates were more commonly linked to a history of invasive procedures, antibiotic use, and immunosuppression (P < 0.05), and were strongly associated with 28-day mortality (P < 0.001). It indicated that T6SS-positive CRKP strains exhibited a higher prevalence of virulence genes, such as rmpA and iucA, compared to T6SS-negative ones (P < 0.001). Compared to the strains isolated from simple colonization group, there was a significant increase in the mRNA expression of both hcp and vgrG genes (P < 0.05) of strains from the sBSI group, suggesting the key genes of the T6SS may play a significant role in the occurrence and progression of sBSI caused by CRKP.</p><p><strong>Conclusion: </strong>The presence of the T6SS in a CRKP strain from intestinal colonization can serve as a promising predictive marker for sBSI. Conducting screenings for CRKP in patients' intestinal flora and monitoring T6SS carriage can improve the prevention and management of CRKP bloodstream infections.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079733","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":"Successful cure of multiple large, inoperable liver abscesses by antibiotic therapy.","authors":"Sarah Niederreiter, Andreas Voelkerer, Christian Datz, Guenter Weiss","doi":"10.1007/s15010-025-02480-5","DOIUrl":"https://doi.org/10.1007/s15010-025-02480-5","url":null,"abstract":"<p><strong>Purpose: </strong>Pyogenic liver abscesses are challenging due to their diverse etiology and the risk of severe complications. In many cases, surgical interventions are initiated. However, these are only applicable in selected scenarios. We report the case of a 63-year-old woman with multiple large liver abscesses of up to 6.7 cm spread across both liver lobes, which could not be managed surgically.</p><p><strong>Methods & results: </strong>Streptococcus intermedius was isolated in blood culture and PCR positivity for this pathogen was obtained in liver puncture specimen. Following a two-weeks course of intravenous therapy with cefuroxime, metronidazole and fosfomycin, the patients received a consecutive, combined oral antibiotic treatment with clindamycin and cephalexin for four months. This resulted in complete resolution of the abscesses, with no evidence of relapse at follow-up.</p><p><strong>Conclusion: </strong>This case illustrates the complex therapeutic challenges in the management of multiple, large hepatic abscesses, highlighting the potential of antibiotic therapy to cure even inoperable patients.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of carbapenem-resistant gram-negative bacterial bloodstream infection in patients with end-stage renal disease in intensive care units: a multicenter retrospective observational study.","authors":"Yu-Chao Lin, Kuang-Yao Yang, Chung-Kan Peng, Ming-Cheng Chan, Chau-Chyun Sheu, Jia-Yih Feng, Sheng-Huei Wang, Wei-Hsuan Huang, Chia-Min Chen, Ding-Han Chen, Chieh-Lung Chen","doi":"10.1007/s15010-024-02343-5","DOIUrl":"10.1007/s15010-024-02343-5","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant gram-negative bacteria (CRGNB) present a considerable global threat due to their challenging treatment and increased mortality rates, with bloodstream infection (BSI) having the highest mortality rate. Patients with end-stage renal disease (ESRD) undergoing renal replacement therapy (RRT) face an increased risk of BSI. Limited data are available regarding the prognosis and treatment outcomes of CRGNB-BSI in patients with ESRD in intensive care units (ICUs).</p><p><strong>Methods: </strong>This multi-center retrospective observational study included a total of 149 ICU patients with ESRD and CRGNB-BSI in Taiwan from January 2015 to December 2019. Clinical and microbiological outcomes were assessed, and multivariable regression analysis was used to evaluate the independent risk factors for day-28 mortality and the impact of antimicrobial therapy regimen on treatment outcomes.</p><p><strong>Results: </strong>Among the 149 patients, a total of 127 patients (85.2%) acquired BSI in the ICU, with catheter-related infections (47.7%) and pneumonia (32.2%) being the most common etiologies. Acinetobacter baumannii (49.0%) and Klebsiella pneumoniae (31.5%) were the most frequently isolated pathogens. The day-28 mortality rate from BSI onset was 52.3%, and in-hospital mortality was 73.2%, with survivors experiencing prolonged hospital stays. A higher Sequential Organ Failure Assessment (SOFA) score (adjusted hazards ratio [aHR], 1.25; 95% confidence interval [CI] 1.17-1.35) and shock status (aHR, 2.12; 95% CI 1.14-3.94) independently predicted day-28 mortality. Colistin-based therapy reduced day-28 mortality in patients with shock, a SOFA score of ≥ 13, and Acinetobacter baumannii-related BSI.</p><p><strong>Conclusions: </strong>CRGNB-BSI led to high mortality in critically ill patients with ESRD. Day-28 mortality was independently predicted by a higher SOFA score and shock status. In patients with higher disease severity and Acinetobacter baumannii-related BSI, colistin-based therapy improved treatment outcomes.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"197-207"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590218","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":"Household transmission of Omicron variant of SARS-CoV-2 under conditions of hybrid immunity-a prospective study in Germany.","authors":"Bianca Klee, Sophie Diexer, Chao Xu, Cornelia Gottschick, Carla Hartmann, Kristin Maria Meyer-Schlinkmann, Alexander Kuhlmann, Jonas Rosendahl, Mascha Binder, Michael Gekle, Matthias Girndt, Jessica I Höll, Irene Moor, Daniel Sedding, Stefan Moritz, Thomas Frese, Rafael Mikolajczyk","doi":"10.1007/s15010-024-02352-4","DOIUrl":"10.1007/s15010-024-02352-4","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated the protection offered by vaccinations and previous infections for the household transmission of Omicron variant of SARS-CoV-2.</p><p><strong>Methods: </strong>34,666 participants of the German DigiHero cohort study with two or more household members were invited to a prospective household transmission study between June and December 2022. In case of a positive SARS-CoV-2 test in a household, symptom diaries were completed for at least 14 days. Dry blood spots (DBS) were taken from all household members at the beginning and six to eight weeks later. DBS were analyzed for SARS-CoV-2 antibodies.</p><p><strong>Results: </strong>1191 individuals from 457 households participated. The risk of acquiring a SARS-CoV-2 infection decreased with higher S-titer levels at the time of exposure (from 80% at titer of 0 binding antibody units (BAU)/ml to 20% at titer of 3000 BAU/ml) and increased linearly with the time since vaccination/previous infection (20% for less than one month to 80% at one year). Transmission probability was also reduced when the symptoms of the primary case were mild and if preventive measures were implemented.</p><p><strong>Conclusion: </strong>Vaccinations/previous infections offer a high protection against infection with the Omicron variant for a few months only, supporting the notion of seasonal circulation of the virus.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"221-230"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734025","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 relationship between group A streptococcus test positivity and clinical findings in tonsillopharyngitis in children: systematic review and meta-analysis.","authors":"Ayşe Eroğlu, Özge Karakaya Suzan, Tuğçe Kolukısa, Özge Kaya, Mehtap Metin Karaaslan, Yeliz Tanrıverdi Çaycı, Mustafa Altındiş, Murat Bektaş, Nursan Çınar","doi":"10.1007/s15010-024-02395-7","DOIUrl":"10.1007/s15010-024-02395-7","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to present an evidence-based conclusion through a systematic meta-analysis to distinguish clinical signs and symptoms associated with the presence of group A beta-hemolytic streptococcus, as confirmed by throat culture or rapid test, from those in cases without culture confirmation.</p><p><strong>Methods: </strong>The study protocol has been published in PROSPERO (CRD42023450854). Studies published between January 1, 2013 and August 15, 2023 were scanned in seven databases. The methodological quality of the articles was assessed using The Joanna Briggs Institution (JBI) Cross-Sectional Studies and Cohort Studies checklist. Effect size calculations were made using fixed effects and random effects models.</p><p><strong>Results: </strong>A total of 22 articles were included in the systematic review, with 14 included in the meta-analysis. The prevalence of streptococcal pharyngitis in these studies ranged from 7.3 to 44.1%. According to the meta-analysis results, a significant association was observed between GAS test positivity and the presence of tonsillar exudate, palatal petechiae, tonsillar hypertrophy, dysphagia, fever, and cervical lymphadenopathy (p < 0.05). No significant relationship was found between GAS test positivity and symptoms such as headache, sore throat, cough, absence of cough, hoarseness, scarlatiniform rash, tonsillar erythema, vomiting, rhinorrhea, and abdominal pain (p > 0.05).</p><p><strong>Conclusion: </strong>The findings of the meta-analysis suggest that, in addition to the Centor criteria, palatal petechiae, dysphagia, and tonsillar hypertrophy are noteworthy indicators of GAS infection. Contrary to previous studies, our meta-analysis indicates that symptoms such as headache, sore throat, cough, absence of cough, hoarseness, scarlatiniform rash, tonsillar erythema, vomiting, rhinorrhea, and abdominal pain may not be associated with streptococcal infection. Further research is needed to elucidate these findings.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"427-436"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345978","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 new human opisthorchiasis outbreak in central Italy: a never-ending story.","authors":"Chiara Papalini, Maria Angeles Gómez-Morales, Alessandra Mercuri, Elisa Stolaj, Maria Grazia Brancaleoni, Igino Fusco Moffa, Giovanni Lo Vaglio, Alessandra Ludovisi, Gianluca Marucci, Daniela Francisci","doi":"10.1007/s15010-024-02340-8","DOIUrl":"10.1007/s15010-024-02340-8","url":null,"abstract":"<p><strong>Purpose: </strong>Opisthorchis felineus is a trematode causing a foodborne infection transmitted by raw freshwater fish belonging to Cyprinidae family. Human outbreaks in Italy dated back to 2003-2011 and involved lakes of Central Italy. The aim of this study is to report epidemiological and clinical characteristics of the human opisthorchiasis outbreak occurred in Central Italy in 2022 comparing it with previous events.</p><p><strong>Methods: </strong>We report cases diagnosed from June to December 2022 in Perugia hospital thanks to serological and molecular tests and direct examination of feces.</p><p><strong>Results: </strong>Sixty-seven individuals were traced back by epidemiological investigation. Forty-seven received a diagnosis of opisthorchiasis, of which 45 were confirmed cases and two were considered as probable cases. These 47 individuals attended a Trasimeno lakeshore restaurant in May 2022. All but 20 presented symptoms, mostly fever. Sixteen (15 confirmed and 1 probable) cases required hospitalization. Feces examination revealed Opisthorchis spp. eggs in 35/45 (78%) confirmed cases. Thirty individuals underwent to serology and molecular stool test: 5 (16.7%) results positive to the former, 1 (3.3%) to the latter while 4 (13.3%) to both. Laboratory tests, available in 28 patients, showed eosinophilia in 82.1%, increase of alanine aminotransferase, gamma-glutamyl transferase and alkaline phosphatase in 64.3%, 75% and 67.9%, respectively. Because of pharmacy shortage of praziquantel, 22 patients were treated with albendazole, of which 13 failed clearing the parasite.</p><p><strong>Conclusion: </strong>Opisthorchiasis still represents a challenging diagnosis, in particular for asymptomatic patients. Albendazole may lead to treatment failure. Control measures in known endemic areas should be implemented.</p><p><strong>Trial registration: </strong>number 27,498/23/ON, approved by Ethical Committee of Umbrian Region in 09.13.2023.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"175-181"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345972","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":"Genetic basis of antimicrobial resistance, virulence features and phylogenomics of carbapenem-resistant Acinetobacter baumannii clinical isolates.","authors":"Bojana Lukovic, Jovana Kabic, Milan Dragicevic, Sonja Kuljanin, Ivica Dimkic, Branko Jovcic, Ina Gajic","doi":"10.1007/s15010-024-02316-8","DOIUrl":"10.1007/s15010-024-02316-8","url":null,"abstract":"<p><strong>Purpose: </strong>The worldwide emergence and clonal spread of carbapenem-resistant Acinetobacter baumannii (CRAB) is of great concern. In the present study, we determined the mechanisms of antimicrobial resistance, virulence gene repertoire and genomic relatedness of CRAB isolates circulating in Serbian hospitals.</p><p><strong>Methods: </strong>CRAB isolates were analyzed using whole-genome sequencing (WGS) for the presence of antimicrobial resistance-encoding genes, virulence factors-encoding genes, mobile genetic elements and genomic relatedness. Antimicrobial susceptibility testing was done by disk diffusion and broth microdilution methods.</p><p><strong>Results: </strong>Eleven isolates exhibited an MDR resistance phenotype, while four of them were XDR. MIC₉₀ for meropenem and imipenem were > 64 µg/mL and 32 µg/mL, respectively. While all CRABs harbored bla_OXA-66 variant of bla_OXA-51 gene, those assigned to ST^Pas2, ST^Pas636 and ST^Pas492 had bla_ADC-73,bla_ADC-74 and bla_ADC-30 variants, respectively. The following acquired carbapenemases-encoding genes were found: bla_OXA-72 (n = 12), bla_OXA-23 (n = 3), and bla_NDM-1(n = 5), and were mapped to defined mobile genetic elements. MLST analysis assigned the analyzed CRAB isolates to three Pasteur sequence types (STs): ST^Pas2, ST^Pas492, and ST^Pas636. The Majority of strains belonged to International Clone II (ICII) and carried tested virulence-related genes liable for adherence, biofilm formation, iron uptake, heme biosynthesis, zinc utilization, serum resistance, stress adaptation, intracellular survival and toxin activity.</p><p><strong>Conclusion: </strong>WGS elucidated the resistance and virulence profiles of CRABs isolated from clinical samples in Serbian hospitals and genomic relatedness of CRAB isolates from Serbia and globally distributed CRABs.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"39-50"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141295984","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":"Adenovirus nephritis in adult kidney allograft recipients: a systematic review of literature.","authors":"Pothumarthy Venkata Swathi Kiran, Nitin Gupta, Attur Ravindra Prabhu, Anjely Sebastian, Carl Boodman, Tirlangi Praveen Kumar","doi":"10.1007/s15010-024-02455-y","DOIUrl":"10.1007/s15010-024-02455-y","url":null,"abstract":"<p><strong>Background: </strong>Adenovirus nephritis is an increasingly recognized complication in adult kidney transplant recipients, characterized by its diverse clinical presentations and diagnostic challenges. This systematic review summarises the clinical profiles and outcomes of adenoviral nephritis in kidney allograft recipients.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed, Embase, and Web of Science for studies (case reports or series) with individual patient data on adult kidney transplant recipients with confirmed or presumptive adenoviral nephritis up to October 2, 2024. Clinical profile, treatment and outcome data with adenoviral nephritis were collected and summarised for all patients. We compared features of early and late adenoviral nephritis (diagnosis before and after 90 days post-transplantation).</p><p><strong>Results: </strong>Thirty-nine studies met inclusion criteria, involving 57 patients with a mean age of 45.7 years and a male predominance. The median time to infection post-transplant was 168 days. The most common symptoms were fever (68.5%), dysuria (49%) and diarrhoea (21%). Early adenoviral infection was more common in cadaveric graft recipients. Fever and gross haematuria were more common in late adenoviral infections. Biopsies showed interstitial nephritis (100%), with some having acute tubular necrosis (53%). Granulomas were seen in 61.2%. Glomeruli and peritubular capillaries were not affected in any of the biopsies. Reversible graft dysfunction was observed in 75% of cases, while mortality was noted in three patients.</p><p><strong>Conclusion: </strong>Adenoviral nephritis is associated with diverse clinical manifestations with differing chronology post-transplantation. Graft dysfunction is associated with reversible interstitial nephritis. Further research is necessary to improve outcomes.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"25-37"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921605","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":"Clinical analysis of Bornavirus Encephalitis cases demonstrates a small time window for Etiological Diagnostics and treatment attempts, a large case series from Germany 1996-2022.","authors":"Kirsten Pörtner, Hendrik Wilking, Christina Frank, Klaus Stark, Silke Wunderlich, Dennis Tappe","doi":"10.1007/s15010-024-02337-3","DOIUrl":"10.1007/s15010-024-02337-3","url":null,"abstract":"<p><strong>Purpose: </strong>The emerging zoonotic Borna disease virus 1 (BoDV-1) and the variegated squirrel bornavirus 1 (VSBV-1) cause severe and fatal human encephalitis in Germany. We conducted the first systematic clinical analysis of acute, molecularly confirmed fatal bornavirus encephalitis cases comprising 21 BoDV-1 and four VSBV-1 patients to identify options for better diagnosis and timely treatment.</p><p><strong>Methods: </strong>Analyses were based on medical records and, for BoDV-1, on additional medical interviews with patients' relatives.</p><p><strong>Results: </strong>Disease onset was unspecific, often with fever and headache, inconsistently mixed with early fluctuating neurological symptoms, all rapidly leading to severe encephalopathy and progressive vigilance decline. Very shortly after seeking the first medical advice (median time interval 2 and 0 days for BoDV-1 and VSBV-1, respectively), all except one patient were hospitalised upon manifest neurological symptoms (median 10 and 16 days respectively after general symptom onset). Neurological symptoms varied, always progressing to coma and death. BoDV-1 and VSBV-1 patients required ventilation a median of three and five days, and died a median of 32 and 72 days, after hospitalisation. Death occurred mostly after supportive treatment cessation at different points in time based on poor prognosis. Disease duration therefore showed a wide, incomparable range.</p><p><strong>Conclusion: </strong>The extremely rapid progression is the most obvious clinical characteristic of bornavirus encephalitis and the timeframe for diagnosis and targeted therapy is very short. Therefore, our results demand an early clinical suspicion based on symptomatology, epidemiology, imaging, and laboratory findings, followed by prompt virological testing as a prerequisite for any potentially effective treatment.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"155-164"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723606","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":"Non-HACEK gram-negative bacilli infective endocarditis: data from a retrospective German cohort study.","authors":"Juliane Dörfler, Herko Grubitzsch, Matthias Schneider-Reigbert, Miralem Pasic, Frieder Pfäfflin, Miriam Stegemann, Leif E Sander, Florian Kurth, Tilman Lingscheid","doi":"10.1007/s15010-024-02392-w","DOIUrl":"10.1007/s15010-024-02392-w","url":null,"abstract":"<p><strong>Purpose: </strong>Infective endocarditis caused by non-HACEK gram-negative bacilli (GNB-IE) is rare but associated with significant morbidity and case fatality. Evidence on optimal treatment and management is limited. We aimed to describe the characteristics and management of GNB-IE patients, investigating factors associated with disease acquisition and unfavorable outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive single-center study (tertiary care and referral hospital) between 2015 and 2021, including adult patients with definite GNB-IE. We reviewed demographic, clinical and microbiological data, focusing on predisposing factors, clinical outcomes and 1-year mortality.</p><p><strong>Results: </strong>Of 1093 patients with probable or definite IE, 19 patients (median age 69 years) had definite GNB-IE, with an increasing incidence throughout the study period. Median age-adjusted Charlson Comorbidity Index score was 4 points. Prosthetic valve IE (PVIE) was present in 7/19 (37%) patients. Nosocomial acquisition occurred in 8/19 (42%) patients. Escherichia coli and Klebsiella pneumoniae were the most common pathogens. Beta-lactam (BL) based combination therapy was applied in 12/19 (63%) patients (58% BL + fluoroquinolone, 42% BL + aminoglycoside). Cardiac surgery was required in 8/19 (42%) patients (PVIE 71%, native valve IE 25%), primarily for embolism prevention and heart failure. Complications occurred in 14/19 (74%) patients. The in-hospital mortality rate was 21% (4/19); the one-year mortality rate was 44% (7/16). One-year mortality did not significantly differ between patients who underwent cardiac surgery and patients managed with anti-infective treatment alone (p = 0.633).</p><p><strong>Conclusions: </strong>GNB-IE affects elderly patients with high comorbidity levels and recent health-care exposure. GNB-IE was associated with high complication rates and high mortality.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":"405-413"},"PeriodicalIF":5.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11825580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286244","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}