Infection最新文献

{"title":"Exploring vaccination adherence and its determinants in kidney transplant recipients: insights from a large italian transplant centre.","authors":"Annamaria Cattelan, Francesco Vladimiro Segala, Beatrice Bragato, Lolita Sasset, Francesco Colombo, Lucrezia Calandrino, Francesca Katiana Martino, Silvia Cocchio, Marianna Di Bello, Caterina Di Bella, Federico Nalesso, Lucrezia Furian","doi":"10.1007/s15010-026-02969-7","DOIUrl":"https://doi.org/10.1007/s15010-026-02969-7","url":null,"abstract":"<p><strong>Background: </strong>Vaccine-preventable infections are a major cause of morbidity and mortality among kidney transplant recipients, yet real-world adherence to recommended vaccination schedules remains poorly characterised. We aimed to assess adherence to the full vaccination schedule and identify its independent predictors in a large Italian cohort.</p><p><strong>Methods: </strong>Single-centre retrospective cohort study of consecutive adult kidney transplant recipients at the University Hospital of Padua (Veneto, Italy), 2013-2024. Adherence was assessed on the regional immunisation registry data and quantified using a composite vaccination adherence score encompassing up to ten vaccines according to patient-specific elegibility ranging from 0 (adherent to no vaccination) to 1 (adherent to all vaccinations). Determinants were analysed by fractional logit regression (quasi-binomial GLM, logit link, HC1 robust standard errors); sensitivity analyses excluded influential observations by Cook's distance.</p><p><strong>Results: </strong>Among 784 recipients (mean age 52.9 ± 12.3 years; 63.7% male), median adherence score was 0.25 (IQR 0.13-0.44) and only 11 patients (1.4%) were fully adherent. Per-vaccine adherence was highest for COVID-19 (87.4%) and HBV (61.9%), and lowest for Hib (7.9%), MenB (9.0%), HPV (13.1%), and RZV (13.8%). In the multivariable model, transplant in 2023-2024 (aOR 1.53, 95%CI 1.25-1.89; p < 0.001) and older age (aOR 1.01/year, 95%CI 1.00-1.02; p = 0.030) were independently associated with higher adherence, whereas unknown underlying renal pathology (aOR 0.77, 95% CI 0.62-0.96; p = 0.02) and re-transplantation (aOR 0.73, 95%CI 0.56-0.95; p = 0.02) predicted lower adherence. Findings were robust in sensitivity analyses.</p><p><strong>Conclusions: </strong>Vaccination adherence was suboptimal, with patients with unknown renal pathology representing a particularly vulnerable subgroup. Temporal improvement closely aligned with regional guideline publication suggests that structured guideline implementation can meaningfully improve adherence.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080746","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":"Contemporary diagnostic strategies for blood culture-negative infective endocarditis: from conventional microbiology to emerging molecular and multimodality approaches.","authors":"Nabila El Gueddari, Mary Philip, Laurence Camoin-Jau, Frédérique Gouriet","doi":"10.1007/s15010-026-02975-9","DOIUrl":"https://doi.org/10.1007/s15010-026-02975-9","url":null,"abstract":"<p><strong>Background: </strong>Blood culture-negative infective endocarditis (BCNE) remains one of the most challenging presentations of infective endocarditis (IE) because the absence of microbiological confirmation delays diagnosis and complicates therapeutic management. BCNE may result from prior antibiotic exposure, infection with fastidious or intracellular microorganisms, fungal pathogens, or non-infectious conditions mimicking IE.</p><p><strong>Methods: </strong>This narrative review provides a clinically oriented overview of contemporary diagnostic strategies for BCNE based on current evidence and recent international guidelines. The diagnostic performance, limitations, and clinical applicability of biomarkers, microbiological methods, multimodality imaging, and pathological analysis were critically evaluated and integrated into practical diagnostic algorithms.</p><p><strong>Results: </strong>Targeted serology and polymerase chain reaction (PCR), particularly on excised valve tissue, remain the most clinically validated microbiological tools for routine BCNE diagnosis. Emerging molecular approaches, including droplet digital PCR (ddPCR) and metagenomic next-generation sequencing (mNGS), show promising diagnostic potential but remain insufficiently standardized for routine implementation. Echocardiography remains the first-line imaging modality, while cardiac computed tomography, 18 F-FDG PET/CT, and white blood cell SPECT/CT (WBC SPECT/CT) provide complementary diagnostic information, particularly in prosthetic valve endocarditis (PVE) and other diagnostically challenging cases. Histopathological examination combined with molecular analysis of surgical specimens remains an important complementary diagnostic approach when valve tissue is available.</p><p><strong>Conclusions: </strong>Optimal diagnosis of BCNE requires an integrated multidisciplinary strategy combining clinical assessment, microbiology, multimodality imaging, and pathology. Future progress will depend on evidence-based diagnostic algorithms integrating emerging technologies according to their level of validation, local epidemiology, and available expertise.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982697","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":"Epidemiology, antimicrobial resistance trends, and predictors of mortality among vancomycin-resistant enterococci: a six-year retrospective cohort study from Oman.","authors":"Mohan Bilikallahalli Sannathimmappa, Mohammed Idris Qureshi, Syeda Heyam, Majid Al Lawati, Tasnim Saif Alamri, Qabas Hamood Al-Harmali, Vinod Nambiar, Salima Al-Maqbali","doi":"10.1007/s15010-026-02979-5","DOIUrl":"https://doi.org/10.1007/s15010-026-02979-5","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Vancomycin-resistant enterococci (VRE) are an escalating cause of healthcare-associated infection, yet longitudinal data from the Arabian Peninsula remain scarce. We characterised the epidemiology, resistance patterns and predictors of in-hospital mortality of enterococci over six years at a tertiary hospital in Oman, with explicit attention to the effect of changing surveillance practice and to the distinction between colonisation and infection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analysed 1,626 non-duplicate Enterococcus isolates from 1,018 patients (2020-2025). VRE was defined a priori as a vancomycin-resistant result on susceptibility testing or a laboratory VRE flag; agreement between these two routes was quantified, and all trend analyses were repeated using a phenotype-only definition restricted to clinical (non-screening) specimens and excluding intrinsically resistant vanC species. A chart-reviewed cohort provided comorbidity, biomarker and outcome data. Mortality models were fitted on complete cases and after multiple imputation by chained equations (m = 20, Rubin's rules), and discrimination and calibration were assessed by repeated stratified five-fold cross-validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;VRE by the composite definition accounted for 395 of 1,626 isolates (24.3%). Only 196 (49.6%) were vancomycin-resistant on testing; 199 (50.4%) were flag-only with no vancomycin result, and a further 66 isolates were vancomycin-resistant but unflagged. Active rectal screening began only in 2024 and contributed 186 of 395 VRE isolates (47.1%). The composite VRE proportion therefore rose from 1.8% (2020) to 47.4% (2025) (Cochran-Armitage Z = 16.56, p &lt; 0.001), whereas vancomycin resistance among tested clinical non-vanC isolates rose from 0.5% to 21.8% and plateaued after 2023 (21.8%, 20.7%, 21.8% in 2023, 2024 and 2025; Z = 8.32, p &lt; 0.001). Of 193 VRE-positive patients, 96 (49.7%) were detected by rectal screening alone and 30 (15.5%) carried vanC species, leaving 67 (34.7%) with acquired resistance in a clinical specimen; 29 (15.0%) were bacteraemic. E. faecium accounted for 141 of 193 VRE-positive patients (73.1%). Linezolid (0.9%) and tigecycline (1.9%) retained near-complete activity. In the chart-reviewed cohort, 163 of 213 patients were microbiologically confirmed as VRE-positive; in-hospital mortality was 29.5% (44/149) among confirmed patients. Low albumin was an independent predictor on complete-case analysis (adjusted OR 0.86 per g/L, 95% CI 0.77-0.95, p = 0.004; n = 82, 24 events) but attenuated after multiple imputation (OR 0.94, 0.87-1.00, p = 0.066), whereas intensive-care admission was the most robust predictor (imputed OR 3.14, 1.36-7.24, p = 0.007). Cross-validated discrimination was modest and unstable (logistic AUC 0.775, SD 0.128; fold range 0.345-1.000), calibration slope was 0.81, and accuracy at a 0.5 threshold (73.8%) barely exceeded the 70.7% obtained by predicting survival for ever","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982674","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 enemy in our gut? Infections due to extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) in hospital patients: a cohort study comparing 2971 ESBL-E-carriers and 2971 non-carriers.","authors":"Milad Fahimi, Selin Saydan, Frank Schwab, Friederike Maechler, Axel Kola, Christine Geffers, Petra Gastmeier, Rasmus Leistner, Luisa A Denkel","doi":"10.1007/s15010-026-02966-w","DOIUrl":"https://doi.org/10.1007/s15010-026-02966-w","url":null,"abstract":"<p><strong>Purpose: </strong>To quantify the risk of healthcare-associated infections (HAI) with extended spectrum beta-lactamase-producing Enterobacterales (ESBL-E) and other pathogens in carriers and non-carriers, and to identify risk factors for HAI.</p><p><strong>Methods: </strong>In 2014 and 2015, a cohort study was conducted including all eligible ESBL‑E-colonized hospital patients and a randomly 1:1 selected sample of non‑colonized controls. Incidence densities per 1,000 patient‑days were calculated, and Fine-Gray sub-distribution hazard models were applied.</p><p><strong>Results: </strong>In total, 2,971 ESBL-E carriers and 2,971 non-carriers were included. Among carriers, incidence densities were 3.29 (95% CI 2.76-3.93) per 1,000 patient days for HAI with ESBL-E, and 4.41 (95% CI 3.78-5.14) for HAI with other pathogens. In contrast, ESBL-E HAI among non-carriers was rare with an incidence density of 0.05 (95% CI 0.01-0.21) per 1,000 patient days. ESBL-E colonization was identified as most important risk factor specific for ESBL-E HAI followed by peptic ulcer, congestive heart failure and age.</p><p><strong>Conclusion: </strong>Incidence of HAI with ESBL-E was high among ESBL-E carriers, but HAI with other pathogens remained more common. ESBL‑E colonization was the dominant determinant of ESBL‑E HAI, with cases occurring almost exclusively in carriers. In conclusion, a known ESBL-E colonization status is an important predictor, but should not be the only factor to rationalize an empirical strategy targeting ESBL-E without considering additional factors.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968280","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 machine learning approach for differential classification of chikungunya virus: an explainable AI study based on surveillance data.","authors":"Natacha Usanase, Berna Uzun, Dilber Uzun Ozsahin","doi":"10.1007/s15010-026-02963-z","DOIUrl":"https://doi.org/10.1007/s15010-026-02963-z","url":null,"abstract":"<p><strong>Purpose: </strong>Mosquito-borne viral diseases such as chikungunya usually present similar clinical symptoms, which makes them hard to differentiate without laboratory confirmatory tests. Therefore, this work retrospectively developed interpretable machine learning models to improve the classification of chikungunya using routinely collected data.</p><p><strong>Methods: </strong>Brazilian surveillance data, with 18,127 records, were analyzed, and eight different machine learning algorithms were trained and five-fold cross-validated. In addition, SHapley Additive exPlanations (SHAP) and permutation feature importance described model behavior.</p><p><strong>Results: </strong>In univariable analysis, arthralgia (OR = 5.84, 95% CI 5.39-6.33) and fever (OR = 5.85, 95% CI 5.29-6.46) were most positively associated with Chikungunya. The macro-AUC values ranged from 0.89 to 0.90 for all models in the multiclass analysis. The Chikungunya-versus-Non-Chikungunya task demonstrated moderate discrimination. The Chikungunya-versus-Dengue scenario produced the highest performance, with an AUC of 0.97 in most models.</p><p><strong>Conclusion: </strong>The explainability mechanism characterized how fitted models utilized available clinical and demographic predictors, with acute symptom variables contributing prominently to predictions. The results demonstrate the potential of using an interpretable model-assisted approach for arboviral classification. Importantly, prospective, temporal, and external geographic validation, with harmonized data, are required before clinical decision-support or point-of-care implementation can be considered.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968168","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":"Association between Toxocara spp. seropositivity and cognitive outcomes in older adults: a cross-sectional analysis of the amirkola health and ageing project.","authors":"Ali Rostami, Seyed Reza Hosseini, Fatemeh Saeedi, Zahra Geraili, Farzan Kheirkhah, Ali Bijani, Mahmood Shams, Ashkan Garshasbi, Negar Jafari","doi":"10.1007/s15010-026-02964-y","DOIUrl":"https://doi.org/10.1007/s15010-026-02964-y","url":null,"abstract":"<p><strong>Background: </strong>Human evidence regarding the association between Toxocara exposure and cognitive function in older adults remains limited and derives largely from U.S. population-based studies, with heterogeneous findings across cognitive domains. Evidence from non-Western older populations is scarce. We therefore examined the association between Toxocara spp. seropositivity and MMSE-based cognitive outcomes among older adults participating in the Amirkola Health and Ageing Project (AHAP) in northern Iran.</p><p><strong>Methods: </strong>This population-based cross-sectional study included adults aged ≥60 years who participated in phase 3 of AHAP during 2023-2024. Anti-Toxocara IgG antibodies were measured by enzyme-linked immunosorbent assay. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), with cognitive impairment defined as an MMSE score <22 based on Iranian validation data. Logistic regression was used to examine MMSE-defined cognitive impairment, and upper-censored Tobit regression was used to evaluate continuous MMSE scores.</p><p><strong>Results: </strong>Among 1,559 participants tested for Toxocara, seroprevalence was 44.7% (95% CI, 42.3-47.2%). The analytic sample included 1,453 participants with serological and MMSE data; 223 (15.3%; 95% CI, 13.5-17.3%) had cognitive impairment. In the fully adjusted model, Toxocara seropositivity was not significantly associated with MMSE-defined cognitive impairment (OR=1.31; 95% CI, 0.84-2.06; P=0.231). Similarly, in the fully adjusted Tobit model, the estimated marginal effect of Toxocara seropositivity on the observed MMSE score was -0.16 points (95% CI, -0.51 to 0.18; P=0.356).</p><p><strong>Conclusions: </strong>We found no statistically significant evidence of an association between Toxocara seropositivity and MMSE-based cognitive outcomes in older adults; however, modest associations cannot be excluded. Longitudinal studies using domain-specific cognitive assessments are needed.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968178","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":"Oropouche virus infection: clinical spectrum, geographic expansion, and emerging maternal-fetal implications.","authors":"Peterson Cruz, Lilith Schuler Faccini, Maikel Rosa Oliveira, Luiza Pretto, Ana Cláudia Franco, Juarez Antônio Simões Quaresma, Fernanda Sales Luiz Vianna, Lavinia Schuler-Faccini, Pedro Fernando da Costa Vasconcelos, Lucas Rosa Fraga","doi":"10.1007/s15010-026-02967-9","DOIUrl":"https://doi.org/10.1007/s15010-026-02967-9","url":null,"abstract":"<p><p>Oropouche virus (OROV), an emerging arbovirus of the genus Orthobunyavirus, has become a growing public health concern following its recent expansion across the Americas and its potential to cause severe clinical outcomes in maternal and child health. Although Oropouche fever has classically been described as an acute self-limited febrile illness, accumulating evidence indicates that OROV is associated with meningitis and fatal infection, as well as evidence of vertical transmission associated with adverse fetal outcomes, including microcephaly and other congenital abnormalities, spontaneous abortion, stillbirth, and neuropathological alterations resembling those observed in congenital Zika syndrome. The OROV presents two transmission cycles, namely sylvatic and urban, with Culicoides paraensis as its main vector. The absence of specific vaccines or treatments, together with the wide distribution of competent vectors and the possibility of sexual transmission, underscores the urgent need to strengthen epidemiological surveillance, elucidate the mechanisms of fetal pathogenesis, and develop effective prevention and control strategies to protect vulnerable populations.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968117","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":"Postmortem analysis of secondary infections in a German cohort of patients following COVID-19 infection.","authors":"Silke Schelenz, Martina Rudelius, Gregor Weirich, Sabine Gleich","doi":"10.1007/s15010-026-02965-x","DOIUrl":"https://doi.org/10.1007/s15010-026-02965-x","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective study analyses secondary infections found in post mortem autopsies in patients with COVID-19 and their contribution to the causes of death.</p><p><strong>Methods: </strong>Death certificates and reports of clinically requested autopsies of hospitalised COVID-19 positive cases were retrospectively analysed for documented evidence of secondary infections. Type of infections, pathogens, patient demographics and comorbidities were recorded and data analysed using descriptive statistics.</p><p><strong>Results: </strong>A total of 120 COVID-19 deaths underwent a clinically requested autopsy. Most cases (71.6%; 86/120) were hospitalised in the ICU. Within this cohort of deaths 17.5% (21/120) had evidence of a secondary infection of which 57% contributed directly to the cause of death. All secondary infection cases had at least two or more comorbidities and were significantly more immunosuppressed compared to the COVID-19 control group (p = 0.017). A total of 52.4% of the infections were due to bacteria (S. pneumoniae, S. aureus, Staphylococcus sp. Enterococcus spp., K. pneumoniae, K. oxytoca and E. coli) which presented in 47.6% of cases as pneumonia and 14.3% had a documented bacteraemia. Viral pneumonitis was detected in 19% due to viruses such as herpes simplex virus and Cytomegaly virus. Invasive fungal infection made up 47.6% of the infections which were documented as fungal pneumonia (23.8%) including invasive pulmonary aspergillosis, tracheobronchitis (14.3%) and invasive candidiasis (14.3%).</p><p><strong>Conclusion: </strong>Secondary infections contribute to the cause of death in a high percentage of hospitalised COVID-19 patients. Autopsies are essential in understanding the role of such infections and may help to guide policies for early diagnosis and therapeutic interventions particularly within high-risk groups.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955764","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":"Re: Liu et al., \"Stepwise breach of maternal-fetal fortress: an adhesion-degradation-immune evasion cascade underpinning Treponema pallidum placental crossing\" (Infection, 2026; https://doi.org/10.1007/s15010-026-02903-x).","authors":"Samia Nawaz, Shahmeer Nawaz, Manal Nawaz","doi":"10.1007/s15010-026-02970-0","DOIUrl":"https://doi.org/10.1007/s15010-026-02970-0","url":null,"abstract":"","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955888","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":"Aztreonam/avibactam during continuous venovenous haemodiafiltration in a critically ill patient with NDM-producing Klebsiella pneumoniae: a case report and review of the literature.","authors":"Federica Cosentino, Andrea Marino, Vittoria Moscatt, Mariagiovanna Coco, Pamela Prestifilippo, Alessandro Franzò, Bruno Cacopardo, Giuseppe Nunnari","doi":"10.1007/s15010-026-02971-z","DOIUrl":"https://doi.org/10.1007/s15010-026-02971-z","url":null,"abstract":"<p><strong>Purpose: </strong>Aztreonam/avibactam represents a valuable therapeutic option for infections caused by metallo-β-lactamase-producing Enterobacterales, but data on its use during continuous renal replacement therapy (CRRT) are scarce and largely limited to a single pharmacokinetic report. Here, we describe the clinical course of a 76-year-old woman with end-stage renal disease who received aztreonam/avibactam while undergoing continuous venovenous haemodiafiltration (CVVHDF) during a critical illness secondary to a presumed invasive infection by NDM-producing Klebsiella pneumoniae.</p><p><strong>Methods: </strong>Ceftazidime/avibactam plus aztreonam was started empirically for fever, pyuria and a urinary NDM-producing K. pneumoniae isolate, then switched to co-formulated aztreonam/avibactam after surgery and ICU transfer (intermittent-haemodialysis phase: loading 1 g/0.333 g, then 0.675/0.225 g every 12 h as a 3-h infusion). When CVVHDF was started for worsening sepsis, the regimen was changed to a 2 g/0.667 g loading dose followed by 1 g/0.333 g every 8 h given as an uninterrupted continuous infusion, replicating the only previously reported CVVHDF regimen.</p><p><strong>Results: </strong>The course was confounded by vancomycin-resistant Enterococcus faecium bacteraemia, bowel ischaemia with perforation, stercoral peritonitis and polymicrobial intra-abdominal infection. No microbiologically documented recurrence of the NDM-producing organism occurred after treatment, although rectal colonization persisted.</p><p><strong>Conclusions: </strong>The case demonstrates the practical feasibility of continuous-infusion aztreonam/avibactam during CVVHDF. Efficacy and PK/PD target attainment cannot be confirmed, as susceptibility testing for the index strain and therapeutic drug monitoring were unavailable.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955631","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}