Infectious diseases (London, England)最新文献

{"title":"Impact of adequacy of empirical antimicrobial therapy on hospital length of stay: a systematic review and meta-analysis.","authors":"Fernando Merlos, Felipe Francisco Tuon","doi":"10.1080/23744235.2025.2599503","DOIUrl":"10.1080/23744235.2025.2599503","url":null,"abstract":"<p><strong>Introduction: </strong>Infections, particularly sepsis, require rapid initiation of empirical antibiotic therapy. Delays or inadequacies in therapy can significantly increase patient morbidity, mortality and length of stay (LOS). This systematic review and meta-analysis aimed to evaluate the impact of adequate versus inadequate empirical antibiotic therapy on LOS.</p><p><strong>Methods: </strong>A comprehensive search was conducted in EMBASE, Cochrane Library, Web of Science and MEDLINE for studies published between 2012 and 2024. Studies involving adult hospitalised patients with infections, assessment of antimicrobial adequacy based on microbiological cultures and LOS data were included. Statistical analysis was performed using Review Manager 5.3, with LOS treated as a continuous variable and outcomes assessed through mean difference and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Thirteen studies with a total of 4158 participants met the inclusion criteria. The mean LOS for patients receiving adequate therapy was significantly lower than for those receiving inadequate therapy (mean difference -1.17 days; 95% CI: -1.40, -0.94). When pooling data from all included studies and weighting by sample size, the overall mean LOS for patients receiving adequate empirical antimicrobial therapy was 12.5 days, compared to 28.5 days among those receiving inadequate therapy. Additionally, adequate therapy resulted in a reduced ICU LOS by -0.89 days (95% CI: -1.22, -0.57).</p><p><strong>Conclusion: </strong>Adequate antimicrobial therapy significantly reduces LOS in hospitalised patients with infections.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"482-494"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydatid disease (cystic echinococcosis) of the liver: the potential role of artificial intelligence in imaging-based disease classification.","authors":"Temi Lampejo, Bennett Choy, Naman Bhatt","doi":"10.1080/23744235.2026.2649530","DOIUrl":"10.1080/23744235.2026.2649530","url":null,"abstract":"","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"557-559"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of acute kidney injury in <i>Staphylococcus aureus</i> bacteraemia treated with cloxacillin: a retrospective cohort study.","authors":"Malin Hagstrand Aldman, Torgny Sunnerhagen, Magnus Rasmussen, Lisa I Påhlman","doi":"10.1080/23744235.2026.2636308","DOIUrl":"10.1080/23744235.2026.2636308","url":null,"abstract":"<p><strong>Background: </strong>Preliminary results from the SNAP trial presented at ESCMID Global 2025 reported a high incidence (19.8%) of acute kidney injury (AKI) in patients treated with (flu)cloxacillin for <i>Staphylococcus aureus</i> bacteraemia (SAB).</p><p><strong>Objective: </strong>In Sweden, cloxacillin is used at lower daily doses, and the risk of nephrotoxicity has not been assessed in this setting.</p><p><strong>Methods: </strong>We retrospectively evaluated renal outcomes in SAB patients with cloxacillin treatment. Patients on chronic dialysis or lacking creatinine measurements during treatment were excluded. AKI was defined as per the SNAP criteria. Long-term renal function was evaluated using follow-up creatinine values up to 12 months post-treatment.</p><p><strong>Results: </strong>Of 275 included patients, 13.8% had pre-existing renal impairment. Cloxacillin doses in median were 8 g/24h (IQR 6-8). AKI occurred in 35 patients (12.8%), of which 26 had AKI stage 1, four had AKI stage 2 and five had AKI stage 3. AKI was associated with higher Pitt Bacteraemia Score, pre-existing renal disease and high-dose cloxacillin. Among survivors (<i>n</i> = 239), only four patients (1.3%) had verified persistent renal impairment at follow-up.</p><p><strong>Conclusion: </strong>Compared to results from the SNAP trial, cloxacillin was associated with a lower incidence of AKI that was mostly mild and transient. Persistent renal impairment was rare. The data suggest that cloxacillin at lower dosing levels is less nephrotoxic and potentially safe to use.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"538-543"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features and outcomes of <i>Staphylococcus aureus</i> brain abscess in Denmark and the Netherlands: a multicentre cohort study.","authors":"Emilie Marie Eriksen, Merijn Bijlsma, Sabine Olie, Lykke Larsen, Merete Storgaard, Helene Mens, Henrik Nielsen, Matthijs Brouwer, Jacob Bodilsen","doi":"10.1080/23744235.2025.2607395","DOIUrl":"10.1080/23744235.2025.2607395","url":null,"abstract":"<p><strong>Background: </strong><i>Staphylococcus aureus</i> is the second most common cause of brain abscesses, but only few studies describe the disease characteristics.</p><p><strong>Objectives: </strong>This study aimed to characterise the clinical features and outcomes of <i>S. aureus</i> brain abscess.</p><p><strong>Methods: </strong>We identified all adults with a brain abscess caused by <i>S. aureus</i> in Denmark between 2007 and 2024, and at the Amsterdam UMC from 2016 to 2024. Unfavourable outcome was defined as Glasgow Outcome Scale scores of 1-4. Modified Poisson regression was used to assess relative risks (RR) with 95% confidence intervals (CI) for an unfavourable outcome.</p><p><strong>Results: </strong>A total of 56 patients were identified with a median age of 59 years (interquartile range [IQR] 39-70), and 31/56 (55%) were male. Abscesses were mainly located in the frontal lobes (35/56, [63%]) and were due to head trauma or neurosurgery in 27/56 (48%). Patients with non-traumatic abscesses had predisposing otitis media or sinusitis in 9/29 (31%), whereas another 9/29 (31%) had endocarditis. Polymicrobial brain abscesses (<i>Streptococcal</i> species, anaerobic, and skin-colonising bacteria) were observed in 14/56 (25%) among whom 5/14 (36%) were post-traumatic and 9/14 (64%) were non-traumatic. Mortality at six months after discharge was 5/56 (9%), and 20/47 (43%) had an unfavourable outcome. The adjusted RR of an unfavourable outcome was 2.6 (95% CI 1.3-5.1) for post-traumatic abscess compared with non-traumatic <i>S. aureus</i> brain abscess.</p><p><strong>Conclusions: </strong><i>Staphylococcus aureus</i> brain abscess frequently involved the frontal lobes and a quarter were polymicrobial. Poor outcomes were common, especially among patients with post-traumatic abscesses.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"507-517"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary care at the vanguard of pre-exposure prophylaxis (PrEP) delivery.","authors":"Zacharias Raptopoulos, Georgios Siakallis, Aristos Aristodimou","doi":"10.1080/23744235.2026.2651420","DOIUrl":"10.1080/23744235.2026.2651420","url":null,"abstract":"","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"565-570"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spill-over rabies transmission - a neglected aspect in african rabies control efforts.","authors":"Lawrence Sena Tuglo, Francesco Branda, Ranjan K Mohapatra, Priyabrata Pattnaik, Alok Ranjan Sahu, Snehasish Mishra","doi":"10.1080/23744235.2026.2651416","DOIUrl":"10.1080/23744235.2026.2651416","url":null,"abstract":"","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"560-564"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiological spectrum, clinical outcomes, and risk factors for bloodstream infections during immune checkpoint inhibitor therapy: a nested case-control study.","authors":"Deng Pan, Huan Wang, Yu Fang, Jun Lu, Wendi Zhang, Pin Peng, Minghao Fang","doi":"10.1080/23744235.2025.2612050","DOIUrl":"10.1080/23744235.2025.2612050","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors (ICIs) modulate host immunity and may increase infection risk. The pathogen profile, outcomes, and predictors of bloodstream infections (BSIs) in ICI recipients are not well defined; we aimed to characterise these features and identify independent risk factors.</p><p><strong>Methods: </strong>We performed a retrospective nested case-control study within a cohort of 2,584 adult cancer patients who received ICIs at a tertiary centre from January 2018 to December 2023. We identified 185 BSI cases occurring during or within 90 days after the last ICI dose and matched each case 1:2 to infection-free controls by cancer type, ICI agent, and time at risk. Demographics, comorbidities, cancer and treatment details, laboratory values, concomitant medications, and outcomes were extracted and analysed using conditional logistic regression.</p><p><strong>Results: </strong>Cases (median age 62 years; 65.4% male) had predominance of gram-positive organisms (54.1%), led by Staphylococcus aureus (18.4%) and Enterococcus spp. (12.4%); gram-negatives comprised 37.8% with Escherichia coli being the most frequent (15.1%), and opportunistic pathogens (Listeria, Candida) made up 8.1%. Multivariable analysis identified prior corticosteroid use ≥14 days (prednisone equivalent ≥10 mg/day for ≥14 days; adjusted odds ratio [aOR], 4.12; 95% CI, 2.58-6.59; <i>p</i> < 0.001), proton pump inhibitor use (aOR 2.05; 95% CI 1.31-3.22), and baseline absolute lymphocyte count <1.0 × 10^9/L (aOR 2.33; 95% CI 1.48-3.68) as independent predictors. All-cause 30-day mortality among cases was 24.9%.</p><p><strong>Conclusion: </strong>BSIs in ICI-treated patients involve a broad pathogen spectrum, including opportunists and are associated with substantial mortality; corticosteroid exposure, PPI use, and lymphopenia identify high-risk patients who may benefit from targeted surveillance and preventive strategies.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"518-528"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The promise and paradox of dengue vaccines.","authors":"Aristos Aristodimou, Zacharias Raptopoulos","doi":"10.1080/23744235.2026.2645365","DOIUrl":"10.1080/23744235.2026.2645365","url":null,"abstract":"","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"544-550"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147492202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Empirical piperacillin/tazobactam vs carbapenems to treat bloodstream infections due to ESBL enterobacterales: a propensity score-matched observational study conducted in an emergency department in Northern Italy.","authors":"Nicolò Capsoni, Marco Bettina, Beatrice Bellone, Ilaria Emanuela Bossi, Lisa Cantù, Marta Rossmann, Marida Scarnera, Irene Serrai, Silvia Vergani, Daniele Privitera, Davide Paolo Bernasconi, Massimo Puoti, Marco Merli, Filippo Galbiati, Giorgio Costantino, Michele Bombelli","doi":"10.1080/23744235.2025.2600010","DOIUrl":"10.1080/23744235.2025.2600010","url":null,"abstract":"<p><strong>Background: </strong>Piperacillin/tazobactam is frequently used empirically in patients subsequently diagnosed with bloodstream infections (BSIs) due to extended-spectrum β-lactamase (ESBL) <i>Enterobacterales,</i> yet its effectiveness remains uncertain.</p><p><strong>Objective: </strong>This study aimed to compare piperacillin/tazobactam with carbapenems as empirical therapy for BSIs caused by ESBL-<i>Enterobacterales.</i></p><p><strong>Methods: </strong>A single-centre retrospective study was conducted at Niguarda Hospital in Milan,Italy, enrolling consecutive patients with BSIs caused by ESBL-<i>Enterobacterales</i> treated empirically with either piperacillin/tazobactam or carbapenems from January 2015 to December 2023. The primary outcome was in-hospital all-cause mortality. Propensity Score Matching(PSM) was employed to mitigate potential confounding factors when assessing the association between empirical therapy and mortality. A sensitivity analysis was performed to determine the role of definitive piperacillin/tazobactam or carbapenems on patient outcomes.</p><p><strong>Results: </strong>A total of 264 patients were included in the study, median age was 72[64-81], 64% were males, 66% had sepsis and 17% septic shock. Among them, 200(76%) received empirical piperacillin/tazobactam and 64(24%) received carbapenems. After PSM adjustment, baseline characteristics were well balanced between the groups. Patients who received empirical piperacillin/tazobactam had a higher in-hospital mortality compared to those receiving empirical carbapenems (14.3% vs 3.5%, adjusted Risk Difference: 10%;95%CI: 2-19%). No difference in in-hospital mortality was observed when comparing definitive piperacillin/tazobactam to definitive carbapenems (6% vs 9%, Risk Difference: -2.5%; 95%CI: -9.2 - 4.2).</p><p><strong>Conclusion: </strong>Empirical piperacillin/tazobactam may be associated with higher mortality compared tocarbapenemswhen treating patients with BSI due to ESBL-<i>Enterobacterales</i>. Further larger studies are needed to confirm the results andto identify specific scenarios in which piperacillin/tazobactam may be safely used.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"495-506"},"PeriodicalIF":2.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validating pancreatic stone protein for early sepsis detection and outcome prediction in community acquired infections: evidence from a tertiary medical centre.","authors":"Christos Michailides, Maria Lagadinou, Themistoklis Paraskevas, Konstantinos Papantoniou, Dimitrios Velissaris, Markos Marangos","doi":"10.1080/23744235.2025.2598808","DOIUrl":"10.1080/23744235.2025.2598808","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;Evaluation of pancreatic stone protein (PSP) plasma levels has been proven effective in predicting unfavourable outcomes in patients with Ventilator-Associated Pneumonia (VAP), infection after cardiothoracic surgery and peritonitis. It is also being studied as a sepsis biomarker with promising results compared to other commonly used biomarkers. We aim to validate PSP in septic patients with community acquired infections. This will help to establish its role in point-of-care settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Adult patients consecutively admitted to the Emergency Department (ED) of a tertiary medical centre, with the diagnosis of intra-abdominal infection (IAI), urinary tract infection (UTI) and lower respiratory tract infection (LRTI) who met the inclusion criteria were enrolled. PSP was measured in whole blood, within one hour since admission, by spectrophotometry using &lt;i&gt;abioSCOPE&lt;/i&gt; device. Statistical analysis was performed, and a cut-off value for PSP to predict the composite outcome of sepsis, readmission, antibiotic treatment escalation and need for invasive treatment was estimated. Patients were followed for 28 days to document their outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of one hundred and one (&lt;i&gt;n&lt;/i&gt; = 101) patients were included. Forty-five were male. The most common comorbidity was hypertension (33%). Fifty-three (52.5%) had LRTI, thirty-seven (36.6%) had UTI and nineteen (18.8%) had IAI. Thirteen of them had more than one type of infection. Our primary outcome met statistical significance, as PSP predicted the composite outcome of sepsis, readmission, antibiotic treatment escalation and need of invasive treatment with an Area Under Curve (AUC) =0.844 (95% CI 0.767-0.920), in the optimal cut-off of 48.5 ng/ml. PSP predicted sepsis with an AUC = 0.892 (95% CI 0.826-0.956) and was also an independent risk factor for sepsis and mortality after age adjustment. PSP was superior to the common used sepsis biomarkers, C-reactive protein (CRP), ferritin, lactate dehydrogonase (LDH)/albumin ratio, White Blood Cell count (WBC), fibrinogen and lactate both for sepsis and for the composite outcome. It was also correlated with Sequential Organ Failure Assessment (SOFA) day 1 (D1), SOFA peak and qSOFA and its prognostic value was independent of renal function, despite being inversely proportional to estimated Glomerular Filtration Rate (eGFR), reflecting the sepsis-related acute kidney injury (SAKI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;PSP is a valuable biomarker that can rule out patients who do not have sepsis and are not in high risk to develop sepsis the following days, giving valuable insights regarding their antimicrobial coverage and management in general. It seems to be superior to other biomarkers in sepsis prediction and adequately compatible with frequently used sepsis assessment scores, such as SOFA. In the Emergency Department setting PSP can distinguish infected patients at high ris","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"442-452"},"PeriodicalIF":2.3,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145703105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}