We present our retrospective case series of eight patients with either bloodstream infection, pneumonia or complicated intra-abdominal infection caused by extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E) treated with cefepime/enmetazobactam. Treatment failure and 30-day all-cause mortality occurred in one patient each. Cefepime/enmetazobactam showed favorable clinical results and may represent a carbapenem-sparing treatment option in selected patients with invasive ESBL-E infections. Real-world data remain limited and further studies are needed to specify the most suitable patient population.
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. 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. 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. 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.
Persistent candidemia remains incompletely understood, with inconsistent definitions and conflicting evidence on outcomes. We aimed to identify factors associated with persistent candidemia and to assess its impact on complications and 30-day mortality in a single-centre cohort. We conducted a retrospective matched cohort study including patients aged ≥ 14 years with at least one positive peripheral blood culture for Candida species (September 2014-September 2024) at a 900-bed tertiary hospital in Valencia, Spain. Persistent candidemia was defined as isolation of the same Candida species from blood cultures obtained ≥ 5 days after initiation of appropriate antifungal therapy. A total of 105 patients with persistent candidemia were compared with 105 with non-persistent candidemia, matched by Charlson comorbidity index. Multivariable logistic regression identified factors independently associated with persistence and 30-day mortality. Persistent candidemia was identified in 105/515 (20.4
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. 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. 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
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. 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. 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
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. 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. 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
To evaluate the association between time to positivity (TTP) and 30-day mortality, and to assess species-specific differences in TTP among Candida isolates. 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. 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
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. 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. Among 2,938 patients with left-sided IE, median symptom duration was 8 days [IQR:4–20], and 17.6
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. 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. Among 62,772 adults, 238 (0.4
Invasive Group A Streptococcus (iGAS) is an important cause of severe bacterial infection with increasing incidence and substantial socioeconomic disparities. This study quantified long-term trends, spatial distribution, and determinants of iGAS incidence in Northern Queensland, Australia. A population-based retrospective cohort study was conducted using linked hospital data linkage from 2000–2020. Incidence rates were calculated per 100,000 person-years and temporal trends were assessed. Spatial clustering was evaluated using Moran’s I statistic for spatial autocorrelation. Determinants of incidence were examined using a negative binomial generalized additive model (GAM). A total of 933 iGAS events were identified among 870 individuals. Incidence increased substantially over time, with the highest rates observed among older adults and a secondary peak among infants. Age-standardised incidence was approximately nine-fold higher among Indigenous compared with non-Indigenous populations for both males and females. Spatial analysis demonstrated significant clustering of incidence (Moran’s I = 0.19, p < 0.001), with the greatest burden occurring in remote and very remote regions. In multivariable analysis, Indigenous status (IRR = 8.97, p < 0.001) and male sex (IRR = 1.28, p < 0.001) were independently associated with higher incidence. Smooth terms showed significant nonlinear effects of age (edf = 7.45, p < 0.001) and calendar year (edf = 8.04, p < 0.001), indicating heterogeneous age patterns and temporal acceleration in incidence. iGAS incidence in Northern Queensland increased markedly over two decades and was characterised by pronounced geographic and Indigenous health inequities, highlighting the need for targeted prevention strategies in high-risk populations and regions.
Hospital-acquired infections (HAIs) continue to pose a significant challenge to patient safety, partly because traditional microbiological methods slow down the identification of pathogens and outbreak detection. Near-real-time whole-genome sequencing (WGS) and point-of-care (POC) sequencing workflows offer the potential for quicker pathogen characterization and tracking of transmission, which could lead to better infection control and improved use of antibiotics. To review rapid and POC WGS technologies and workflows used in hospital settings, and to summarize evidence on typical turnaround times, impacts on outbreak detection, and implications for clinical decision-making. A narrative review was conducted using literature retrieved from major biomedical databases, including PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar. Relevant studies addressing whole-genome sequencing, rapid/near-real-time sequencing, healthcare-associated infections, outbreak investigation, and hospital infection control were identified and reviewed. Streamlined WGS workflows cut turnaround times from several days (typical of traditional methods) to between 13.5 and 48 h in many rapid implementations. Some nanopore-based protocols report initial species identification in minutes and complete genomic data within a few hours. Faster sequencing and real-time analytics lead to earlier identification of resistance markers and quicker detection of transmission chains. Several studies indicate outbreak detection is easier than with traditional epidemiological methods. This allows for more timely targeted therapy and can enhance the responsible use of antibiotics when combined with clinical decision processes. Near-real-time and point-of-care whole-genome sequencing significantly reduces the time needed to identify pathogens and speeds up outbreak detection. However, it requires consistent reporting of turnaround metrics, and careful evaluation of how faster genomic data affects clinical decisions and patient outcomes.
Although China has successfully eliminated neonatal tetanus, non-neonatal tetanus, particularly among older adults, remains a persistent clinical and public health challenge. This narrative review synthesizes the current landscape of tetanus in China—covering epidemiology, pathophysiology, prevention, diagnosis, and treatment—and compares it with World Health Organization (WHO) guidance and practices in other countries to identify gaps and optimization strategies. A comprehensive narrative review was conducted across five core domains: epidemiology, pathogen and pathophysiology, prevention strategies, diagnostic advances, and therapeutic interventions. Data were integrated from the WHO, the Chinese Center for Disease Control and Prevention, national guidelines, and relevant clinical studies, with comparative analysis against global best practices. Epidemiological trends show a clear shift in disease burden from neonates to older adults, predominantly in rural areas, with high case fatality rates (10–40
Cytomegalovirus remains a major challenge in LTx recipients. Despite advances in antiviral therapy, refractory and resistant CMV infections persist, and real-world data on maribavir, a recently approved UL97 kinase inhibitor, are limited. We retrospectively analyzed 49 LTx recipients treated with maribavir for refractory and resistant (R/R) CMV between August 2022 and December 2024. Overall, 34 patients (69.4
We describe a rare case of a 35-year-old female patient suffering from polymicrobial hematogenous vertebral osteomyelitis caused by vaginal microbiota following sexual intercourse. Anaerobic blood cultures yielded Fannyhessea vaginae and Gemelliphila asaccharolytica, and intraoperative tissue cultures from decompression surgery identified Gardnerella vaginalis. Beyond Fannyhessea vaginae and Gemelliphila asaccharolytica, 16S rRNA gene Nanopore sequencing of surgical tissue also detected high amounts of Parvimonas parva, Peptostreptococcus anaerobius, Marseillibacter massiliensis, and Gemelliphila palaticanis. Antibiotic treatment with broad anaerobic coverage resulted in complete clinical resolution. Retrospective metagenomic analysis of a cervical swab obtained 9 months earlier revealed Fannyhessea vaginae and G. vaginalis to be already present in the vaginal microbiota. This case highlights the potential for hematogenous dissemination of vaginal anaerobes after sexual intercourse and underscores the diagnostic challenges posed by fastidious anaerobic bacteria. Molecular techniques are helpful tools in uncovering pathogens that may escape conventional culture methods.
Although indications for anti-interleukin 6 (IL-6) receptor antibody (anti-IL6R) therapy continue to expand, the clinical features of bloodstream infection (BSI) in anti-IL6R recipients remain poorly characterized. We investigated the prevalence, clinical and microbiological features of BSI among the anti-IL6R recipients. We conducted a multicenter, retrospective study of BSI episodes occurring within 90 days of anti-IL6R administration between 2005 and 2024. Complicated BSI was defined as the presence of either (1) infection-related mortality, (2) remote or localized suppurative complications, (3) embolic stroke, or (4) recurrence within 90 days. Associations between clinical variables and complicated BSI were analyzed. Among 922 anti-IL6R recipients, 47 patients (5
This study introduces a novel Clinical Risk Stratification Algorithm for spondylodiscitis, shifting the management focus from purely radiological criteria to clinical risk factors. The study presents a novel clinical risk stratification algorithm for spondylodiscitis, developed through a systematic synthesis of data from a 14-year prospective monocentric cohort. Developed from a prospective 14-year cohort (2008–2022) at a tertiary center, the algorithm synthesizes data from ten sub-analyses using multivariate regression to identify key drivers of mortality and treatment failure. Significant risk factors for adverse outcomes include Chronic Kidney Disease (CKD), malignancy, age ≥ 65, and bacteremia. For patients with Spinal Epidural Abscess (SEA), diabetes and CRP levels ≥ 150 mg/l are critical predictors of neurologic deficit. The algorithm categorizes patients into three pathways: Path A (High Mortality) prioritizes aggressive surgical source control, challenging the traditional view that multimorbid patients are “too sick for surgery”. Path B addresses failure risks like S. aureus using a “2-week CRP Checkpoint” to guide potential revision surgery. Path C focuses on quality-of-life-driven palliative care for oncology patients. This clinical tool enables personalized management by integrating systemic status into surgical decision-making. It emphasizes that surgery is a vital tool for sepsis control in frail patients and pain management in palliative care. While based on robust individual predictors, the proposed integrated decision tree has not yet undergone internal or external validation to confirm its clinical utility.
The 2019 EUCAST redefinition of the “susceptible, increased exposure” (I) category aimed to optimize antimicrobial therapy and reduce unnecessary carbapenem prescribing. However, concerns remain that misinterpretation may promote carbapenem overuse. We evaluated clinical and resistance outcomes associated with I-category agents compared to meropenem in wild-type (WT) Pseudomonas aeruginosa infections. In this retrospective cohort study, adult inpatients with microbiologically confirmed WT P. aeruginosa infections between January 2020 and March 2024 were included. Eligible isolates were susceptible to meropenem and categorized as “I” to at least one antipseudomonal agent (piperacillin–tazobactam, ceftazidime, cefepime, or ciprofloxacin). Patients received either I-category agents or meropenem as definitive therapy. Primary outcomes were clinical failure and all-cause mortality. Secondary outcomes included emergence of carbapenem-resistant microorganisms within one year. A total of 411 patients were included (I group n = 152; meropenem group n = 259). Clinical failure (9.2
BACKGROUND:The 2019 EUCAST redefinition of the "susceptible, increased exposure" (I) category aimed to optimize antimicrobial therapy and reduce unnecessary carbapenem prescribing. However, concerns remain that misinterpretation may promote carbapenem overuse. We evaluated clinical and resistance outcomes associated with I-category agents compared to meropenem in wild-type (WT) Pseudomonas aeruginosa infections. METHODS:In this retrospective cohort study, adult inpatients with microbiologically confirmed WT P. aeruginosa infections between January 2020 and March 2024 were included. Eligible isolates were susceptible to meropenem and categorized as "I" to at least one antipseudomonal agent (piperacillin-tazobactam, ceftazidime, cefepime, or ciprofloxacin). Patients received either I-category agents or meropenem as definitive therapy. Primary outcomes were clinical failure and all-cause mortality. Secondary outcomes included emergence of carbapenem-resistant microorganisms within one year. RESULTS:A total of 411 patients were included (I group n = 152; meropenem group n = 259). Clinical failure (9.2% vs. 6.9%, p = 0.409) and mortality at all time points were comparable between groups. However, meropenem use was independently associated with the development of carbapenem-resistant P. aeruginosa (CRPA) within one year (OR 2.38, 95% CI 1.02-5.57; p = 0.046). In contrast, emergence of any carbapenem-resistant organism was associated with prior antibiotic exposure and disease severity, but not treatment group. CONCLUSION:In WT P. aeruginosa infections, treatment with EUCAST I-category agents achieved clinical outcomes comparable to meropenem. However, meropenem use was independently associated with subsequent CRPA isolation. These findings support carbapenem-sparing strategies and highlight the long-term resistance implications of antimicrobial selection following the EUCAST redefinition.
