Infection最新文献

{"title":"A retrospective study of alternative antibiotics for prophylaxis of the Group B Streptococcus maternal-fetal disease.","authors":"Hongxia Guo, Wanqiu Huang, Cheng Chen, Bo Sun","doi":"10.1007/s15010-026-02933-5","DOIUrl":"https://doi.org/10.1007/s15010-026-02933-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to evaluate the effectiveness and safety of cefazolin prophylactic regimen versus standard penicillin treatment in pregnant women colonized with GBS(Group B Streptococcus), and further analyzed the timing of intrapartum antibiotic prophylaxis.</p><p><strong>Method: </strong>We retrospectively analyzed the singleton pregnant women with GBS colonization at 35-37 weeks of gestation in Shenzhen Baoan Women's and Children's Hospital between September 2018 and January 2024. 2653 pregnant women received standardized penicillin prophylaxis and 2418 pregnant women received alternative cefazolin prophylaxis in labor. Maternal and neonatal outcomes were compared between the two different intrapartum antibiotic prophylaxis (IAP) groups.</p><p><strong>Results: </strong>No significant differences were found in postpartum hemorrhage, amniotic fluid fecal contamination, delivery assistance, neonatal sepsis, neonatal asphyxia and Apgar score between Penicillin group and Cefazolin group (P > 0.05). In terms of chorioamnionitis, neonatal pneumonia, cesarean section, neonatal jaundice and NICU admission, the cefazolin group showed significantly lower rates than that of penicillin group(P < 0.05). The incidence of chorioamnionitis, transfer to cesarean section and NICU admission in both penicillin and cefazolin IAP subgroup of more than 4 h were lower than that of less than or equal 4 h, however with no significantly difference when using cefazolin about chorioamnionitis.</p><p><strong>Conclusion: </strong>Our study shows that cefazolin is effective and safe as penicillin in preventing maternal-fetal GBS infection and may be used as an alternative antibiotics. In addition, it is supposed that IAP should be administered during labor for at least 4h prior to delivery.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887383","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":"Outcomes and associated risk factors among hospitalisations attributed to invasive group A streptococcal disease in Northern Queensland, Australia: a 21-year population-based data linkage study.","authors":"Himali Ratnayake, Damon Eisen, Oyelola Adegboye, Anton Pak, Emma McBryde","doi":"10.1007/s15010-026-02940-6","DOIUrl":"https://doi.org/10.1007/s15010-026-02940-6","url":null,"abstract":"<p><strong>Purpose: </strong>Invasive group A Streptococcus (iGAS) disease is associated with substantial morbidity and mortality. This study aimed to assess the outcomes of iGAS infection and associated risk factors in Northern Queensland, Australia.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using linked hospital data from 2000 to 2020. iGAS cases were identified using ICD-10-AM diagnosis codes in administrative health datasets. Mortality and disease burden were analysed, and risk factors for adverse outcomes were assessed using logistic regression and competing risks regression. Disability-Adjusted Life Years (DALYs) were estimated to quantify disease burden.</p><p><strong>Results: </strong>A total of 933 iGAS related hospitalisations were identified among 870 individuals. The mean age of the cohort was 45 years (SD = 24), with a median age of 61 years (IQR: 48-77 years). Hospitalised case fatality rate was 5.2%. Intensive Care Unit (ICU) admission was required for 219 patients (23.5%). Readmissions occurred in 2.0% of cases, and 3.6% experienced recurrent infection. Most deaths were attributable to sepsis (80%), with necrotising fasciitis (18%) and septic shock (13.3%) also contributing. In multivariable analysis, age ≥ 60 years was associated with lower odds of ICU admission, while female sex, non-Indigenous status, higher Socio-Economic Indexes for Areas (SEIFA) decile, cardiac disease, and renal failure were associated with increased odds of ICU admission (p < 0.01). Older age, non-Indigenous status and renal failure were significantly associated with increased mortality (p < 0.01). The total DALY burden was 1,375 years.</p><p><strong>Conclusion: </strong>iGAS imposes a substantial health burden in Northern Queensland, characterised by significant morbidity and high advanced health resource utilisation. Identification of high-risk groups highlights opportunities for targeted prevention of adverse health outcomes of iGAS.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880009","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":"Novel blood biomarkers distinguish active pulmonary tuberculosis from non-pulmonary tuberculosis: a prospective, large scale, clinical trial in Eastern China.","authors":"Hui Ke, Hong-Xiang Xu, Kun-Long Xiong, Hua Wang, Yi Zeng, Qi-Long Zhang, Jie Zhou, Yan Bai, Bing-Qing Liang, Shao-Jun Zhang, Li-Rong Liu, Jian-Ping Xie, Zhe-Min Zhang, Lin Fan","doi":"10.1007/s15010-026-02951-3","DOIUrl":"https://doi.org/10.1007/s15010-026-02951-3","url":null,"abstract":"<p><strong>Objectives: </strong>Active Tuberculosis (TB) had the challenge in early detection. Our pilot study showed four novel diagnostic biomarkers had high value of TB diagnosis. The aim of the study was to further verify the diagnosis value of these biomarkers for active pulmonary TB (PTB) from non-TB through clinical trial with large scale samples.</p><p><strong>Methods: </strong>The prospective, large scale, multicenter, diagnostic clinical trial was performed from 2022 Jan to 2024 Dec in Eastern China. PTB suspects met inclusion criteria were enrolled the study, taken RNA abstract from the Peripheral venous blood for RNA examination of BATF2, UBE2L6, SERPING1, VAMP5 and tested by QFT-GIT as well, the diagnosis value of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and AUC for active TB by single and fixed groups of biomarkers were calculated and evaluated.</p><p><strong>Results: </strong>890 cases were finally included the study, containing 564 cases of PTB (365 had definite and 199 had probable TB) and 326 cases of non-PTB. Any single biomarker from BATF2, UBE2L6, SERPNG1 or VAMP5 has advantage diagnosis values over QFT-GIT, UBE2L6 had the best value of the diagnosis (AUC 0.84) of active TB. Combination of UBE2L6/SERPING1/VAMP5 had best diagnosis value of active PTB (sensitivity of 70.5% and specificity of 95.4%) from non-PTB.</p><p><strong>Conclusions: </strong>Blood derived transcription level of combination on Three-genes (UBE2L6, SERPING1, VAMP5) had excellent diagnosis value of active PTB from non-TB diseases, which deserved clinical application in the future.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864808","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":"Immunosuppressive medication exposure and risk of invasive fungal and nontuberculous mycobacterial infections following TNF-α inhibitor initiation: a time-varying analysis.","authors":"Alexander J Ruehman, Shaimaa Elshafie, Mohammed Zuber, Lorenzo Villa Zapata, Andrés F Henao-Martínez, Daniel B Chastain","doi":"10.1007/s15010-026-02961-1","DOIUrl":"https://doi.org/10.1007/s15010-026-02961-1","url":null,"abstract":"<p><strong>Purpose: </strong>Invasive fungal and nontuberculous mycobacterial (NTM) infections are important complications following TNF-α inhibitor initiation, but the contribution of additional immunosuppressive medication exposure remains incompletely defined. We evaluated their incidence and spectrum and associations with time-varying immunosuppressive medication exposure.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using Merative MarketScan data (2018-2022) among adults initiating TNF-α inhibitors. Invasive fungal and NTM infections were identified using ICD-10-CM codes. Systemic glucocorticoid and non-glucocorticoid immunosuppressant exposures were modeled as time-varying variables. Cox proportional hazards models evaluated associations between immunosuppressive medication exposure and infection risk.</p><p><strong>Results: </strong>Among 62,772 adults, 238 (0.4%) developed an invasive fungal or NTM infection after a median of 14.6 months, corresponding to 146 per 100,000 person-years. Histoplasmosis (26%), NTM infections (22%), and coccidioidomycosis (16%) were most common. In time-varying analyses, glucocorticoid exposure alone (aHR 1.77, 95% CI 1.24-2.52) and non-glucocorticoid immunosuppressant exposure alone (aHR 2.25, 95% CI 1.43-3.52) were associated with higher infection risk compared with periods without either exposure. Combined exposure was not associated with infection risk (aHR 1.31, 95% CI 0.92-1.85).</p><p><strong>Conclusions: </strong>Invasive fungal and NTM infections were uncommon following TNF-α inhibitor initiation. Time-varying glucocorticoid and non-glucocorticoid immunosuppressant exposures were associated with higher infection risk, illustrating the importance of dynamic immunosuppressive medication exposure when assessing infection risk during longitudinal care.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864842","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":"Impact of time from symptom onset to diagnosis in infective endocarditis: insights from the nationwide NIDUS registry.","authors":"Mads-Gustav Nebel Hvidt, Amna Alhakak, Peter Laursen Graversen, Katra Hadji-Turdeghal, Jacob Eifer Møller, Niels Eske Bruun, Kasper Karmark Iversen, Jonas Agerlund Povlsen, Claus Moser, Morten Holdgaard Smerup, Daniel Faurholt-Jepsen, Henning Bundgaard, Lauge Østergaard, Lars Køber, Emil Loldrup Fosbøl","doi":"10.1007/s15010-026-02960-2","DOIUrl":"https://doi.org/10.1007/s15010-026-02960-2","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) often presents with non-specific symptoms, which may delay diagnosis and treatment. Previous studies exploring symptom duration have been limited by small cohorts or single-centre studies. We aimed to investigate patient characteristics, microbial aetiology, treatment, and all-cause mortality of patients with IE according to symptom duration prior to diagnosis.</p><p><strong>Methods: </strong>We included all patients with first-time IE from the NatIonal Danish Endocarditis StUdies (NIDUS) registry (2016-2021). Patients with left-sided IE and available symptom duration were stratified as short, intermediate, or prolonged (≤ 7, 8-29, or ≥ 30 days). The primary outcome was six-month mortality.</p><p><strong>Results: </strong>Among 2,938 patients with left-sided IE, median symptom duration was 8 days [IQR:4-20], and 17.6% had symptoms ≥ 30 days. The short-duration group compared with the prolonged-duration group was older (median 74.1 vs. 72.2 years), more often female (35.1% vs. 24.8%), had more comorbidities, embolism (14.5% vs. 8.9%), sepsis (28.2% vs. 12.2%), and Staphylococcus aureus IE (38.3% vs. 11.6%). The short- and intermediate-duration groups underwent surgery less frequently (18.1% and 23.2%) than the prolonged-duration group (31.7%). The six-month cumulative incidence of mortality was lower in the prolonged-duration group (21.8%) than in the short and intermediate groups (28.7% and 28.9%), although non-significant after adjustment (HR 0.92 [95% CI:0.74-1.14]) compared to the short group.</p><p><strong>Conclusion: </strong>In patients with left-sided IE, short symptom duration prior to diagnosis was associated with Staphylococcus aureus IE, sepsis, and lower surgical rates. Prolonged symptom duration was associated with lower cumulative mortality, but this was not significant after multivariable adjustment.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864779","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":"Effect of kidney function on drug concentrations of first-line anti-tubercular treatment.","authors":"Divya Datta, Indu Ramachandra Rao, Raghavendra Shetty, Shankar Prasad Nagaraju, Girish Thunga, Rahul Magazine, Shivashankara Kaniyoor Nagri, Nisha Abdul Khader, Pasumarthi Tejashree, Surulivelrajan Mallayasamy, Praveen Kumar Tirlangi, Dharshan Rangaswamy, Srinivas Vinayak Shenoy, Mohan V Bhojaraja, Attur Ravindra Prabhu","doi":"10.1007/s15010-026-02931-7","DOIUrl":"https://doi.org/10.1007/s15010-026-02931-7","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug monitoring. We measured and compared the concentrations of first-line anti-TB drugs in CKD and those with normal kidney function.</p><p><strong>Methods: </strong>A prospective observational study was conducted from September 2020 to December 2023. Patients with microbiologically confirmed tuberculosis were included, and drug concentrations were determined by using Liquid Chromatography-Tandem Mass Spectrometer (LC-MS/MS) and compared between CKD and those with normal kidney function.</p><p><strong>Results: </strong>Of 151 participants, 51 had CKD. Higher trough concentrations were found in CKD for isoniazid [697.15 ng/mL (IQR 199.07-3321.68) vs. 187.58 ng/mL (IQR 95.56-323.65), P < 0.0001], rifampicin [141.53 ng/mL (IQR 40.86-730.66) vs. 33.24 ng/mL (IQR 22.49-86.20), P < 0.0001], and ethambutol [635.67 ng/mL (IQR 264.38-1594.12) vs. 230.92 ng/mL (IQR 161.95-417.22), P < 0.0001], while pyrazinamide level [1469.79 ng/mL (IQR 0.00-5160.53) vs. 4273.94 ng/mL (IQR 2151.29-8023.81), P = 0.002] was higher in those with normal kidney function. At 2-hours, a greater number of CKD patients had below the reference threshold for rifampicin [33/51 (64.7%) vs. 48/100 (48%), P = 0.059] and pyrazinamide [39/40 (97.5%) vs. 29/91 (31.8%), P < 0.0001].</p><p><strong>Conclusion: </strong>CKD affects anti-tubercular drug concentrations, highlighting the need for therapeutic drug monitoring.</p><p><strong>Clinical trial registration number: </strong>CTRI/2020/09/027951.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864823","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 utility of time to positivity in candidemia: prognostic limitations and species-specific implications.","authors":"Zehra Demirbas Yildiz, Mehmet Yildiz, Mehmet Morkoc, Muge Aslan, Emin Ediz Tutuncu","doi":"10.1007/s15010-026-02959-9","DOIUrl":"https://doi.org/10.1007/s15010-026-02959-9","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association between time to positivity (TTP) and 30-day mortality, and to assess species-specific differences in TTP among Candida isolates.</p><p><strong>Methods: </strong>This single-center, retrospective study included adult patients (≥ 18 years) with candidemia between July 2022 and October 2024. Patients were grouped as survivors and non-survivors, and TTP was compared between the groups. Variables associated with mortality in univariate analysis (p < 0.10) and clinically relevant factors, including Candida species, were included in multivariate logistic regression to assess the independent effect of TTP on 30-day mortality. Species-specific TTP differences were also evaluated.</p><p><strong>Results: </strong>A total of 392 patients with candidemia were included. In multivariate analysis, older age, solid tumor malignancy, chronic cardiac disease, use of total parenteral nutrition, inappropriate antifungal therapy, and higher SOFA scores were independently associated with 30-day mortality (p < 0.05). Time to positivity was not independently associated with mortality (OR 0.989, 95% CI 0.974-1.004; p = 0.142). Significant differences in TTP were observed among Candida species, with the shortest median TTP in Candida tropicalis and the longest in Candida glabrata. TTP demonstrated good discriminatory performance for identifying Candida tropicalis (AUC 0.854), with an optimal cut-off value of 23.5 h.</p><p><strong>Conclusion: </strong>TTP was not an independent predictor of 30-day mortality in patients with candidemia. However, TTP demonstrated significant differences among Candida species and may provide an adjunctive clue for early presumptive differentiation of Candida species.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148864858","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":"Follow-up blood cultures in Gram-negative bloodstream infections: predictors of collection and association with mortality-a two-centre cohort study.","authors":"Fabienne Knöpfel, Christine Gutmann, Michael Osthoff","doi":"10.1007/s15010-026-02953-1","DOIUrl":"https://doi.org/10.1007/s15010-026-02953-1","url":null,"abstract":"<p><strong>Introduction: </strong>Given the high morbidity and mortality of Gram-negative bloodstream infections (GN-BSI), follow-up blood cultures (FUBCs) have received increasing attention in clinical practice. However, evidence on their impact remains conflicting. This study assessed the association of FUBCs with 90-day all-cause mortality, accounting for immortal time bias.</p><p><strong>Methods: </strong>This retrospective cohort study included 637 hospitalized adults with GN-BSI from two Swiss tertiary-care hospitals (April 2022-April 2024). FUBCs were defined as blood cultures obtained after availability of the index culture result up to 168 h after collection. Endpoints included predictors of FUBC collection and association with 90-day mortality. Sensitivity analyses evaluated FUBCs collected 48-120 h after the index culture.</p><p><strong>Results: </strong>Mean age was 71.3 years and 46% were female. Most infections were community-acquired (81%), predominantly of genitourinary origin (53%). Overall, 90-day mortality was 12.6%. In 83.5% of FUBCs, no pathogen was isolated, and persistent GN-BSI was identified in 26/33 positive FUBC (13%). FUBC collection was associated with longer antibiotic therapy (median 14 vs. 10 days; p < 0.001), hospital stay (median 10 vs. 7 days; p < 0.001) and higher 90-day mortality (18 vs. 10%). Predictors of FUBC collection included intensive-care unit admission, cardiac devices or intravascular catheters, advanced chronic kidney disease, leukaemia, paralysis, hospital-acquired infection, COPD, and non-urinary/non-biliary sources. Regarding the primary outcome, FUBC collection was not associated with mortality after adjustment for cofounding variables (HR 1.41 [95% CI 0.89-2.23]. However, positive FUBCs were found to be an independent predictor of increased 90-day mortality.</p><p><strong>Conclusion: </strong>FUBCs were markers of disease severity but were not independently associated with mortality, while being linked to prolonged antibiotic use and hospitalization.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840272","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 rare case of spotted fever group rickettsiosis in southern Iran: diagnostic challenges and review.","authors":"Elham Barahimi, Abbas Poudat, Mehdi Hassani-Azad, Parivash Davoodian, Fatemeh Khajavi-Mayvan, MohammadHosein Sheybani-Arani","doi":"10.1007/s15010-026-02948-y","DOIUrl":"https://doi.org/10.1007/s15010-026-02948-y","url":null,"abstract":"<p><strong>Background: </strong>Mediterranean spotted fever (MSF), caused by Rickettsia conorii and transmitted by the brown dog tick (Rhipicephalus sanguineus), is endemic in Mediterranean regions. In non-endemic countries such as Iran, spotted fever group (SFG) rickettsioses are rarely reported and present significant diagnostic challenges due to overlap with common illnesses like measles and dengue fever.</p><p><strong>Case presentation: </strong>A 58-year-old man from Hormozgan Province, southern Iran, with diabetes and ischemic heart disease, presented with two weeks of high fever, chills, weakness, maculopapular rash, and severe myalgia. Initially misdiagnosed as measles and tested negative for dengue, further history revealed occupational contact with Tatera indica rodents. Examination revealed fever (39.5 °C), rash on the extremities and trunk, and a calf eschar. Key labs included elevated AST (118 U/L), ALT (106 U/L) and CRP (33.98 mg/L). Empirical doxycycline (100 mg twice daily) was started. IFA IgM was positive at a high titer (1:768), with a subsequent convalescent sample showing IgG seroconversion. Fever resolved within 48 h; he was discharged after five days with improving symptoms and labs.</p><p><strong>Conclusion: </strong>This case illustrates the diagnostic challenges of SFG rickettsioses, most consistent with probable MSF, in a non-endemic region of Iran. It potentially emphasises the value of detailed exposure history and prompt empirical doxycycline in suspected cases. Greater awareness, improved access to diagnostics, and enhanced surveillance are needed to better recognise these infections in Iran, especially in Hormozgan province.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840278","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":"Oral transition therapy versus intravenous therapy for the treatment of uncomplicated Enterococcal bloodstream infections.","authors":"Esrat Jahan, Alex Matika, Lauren Allen, Justin Miller","doi":"10.1007/s15010-026-02898-5","DOIUrl":"https://doi.org/10.1007/s15010-026-02898-5","url":null,"abstract":"<p><strong>Purpose: </strong>Growing evidence supports oral transition therapy for gram-negative and certain Staphylococcus bloodstream infections (BSIs). However, clinical data remains limited for other organisms. The purpose of this study is to assess whether oral transition therapy is non-inferior to intravenous (IV)-only therapy for uncomplicated Enterococcal BSIs.</p><p><strong>Methods: </strong>This single-center, retrospective, non-inferiority, observational study included adult patients with microbiology-confirmed Enterococcus bacteremia who received appropriate definitive antibiotic therapy. The primary composite outcome was treatment failure, defined as recurrence of BSI, development of deep-seated infection, or all-cause mortality within 90 days. Secondary outcomes included the individual components of the composite outcome, readmission within 90 days related to the index infection, hospital length of stay, and treatment-emergent adverse events.</p><p><strong>Results: </strong>Of the 156 included patients, 123 received IV-only therapy, and 33 were transitioned to oral therapy. Treatment failure occurred in 18% (22/123) of patients in the IV-only group and 12% (4/33) in the oral group (RR 0.68, 95% CI 0.25-1.83), with a similar safety profile observed in both groups. Additionally, the hospital length of stay was significantly shorter in the oral group (6 vs. 8 days, p < 0.01).</p><p><strong>Conclusion: </strong>Given this study was underpowered, a statistical non-inferiority could not be established. However, given a numerically lower rate of treatment failure observed in the oral therapy group without any overt safety concern, oral transition therapy may be considered in clinically stable patients with uncomplicated Enterococcal BSIs.</p>","PeriodicalId":13600,"journal":{"name":"Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840324","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}