In this traveller cohort, pfhrp2/3 deletions occurred in 4 of 115 (3.5%) patients, with no double deletions observed. Notably, 51.3% of patients had visited countries anticipated to surpass the WHO 5% pfhrp2/3 threshold by 2028. Continued monitoring of pfhrp2/3 deletions in non-endemic settings is needed to guide testing strategies.

Septic arthritis (SA) in adults can lead to serious complications if not diagnosed promptly. Conventional synovial fluid culture (CC) remains the gold standard for identifying the causing microorganism but is time-consuming and often insensitive, particularly in patients receiving antimicrobial therapy. This study aimed to evaluate the diagnostic performance of a novel automated multiplex PCR (mPCR) system and compared it to conventional culture (CC) in adults with suspected acute native joint infections. In this retrospective single-centre study, adult patients with suspected SA (February 2023-May 2024) were included. Diagnosis was based on institutional criteria incorporating clinical signs, synovial fluid cytological, microbiology, and histology. Agreement between mpCR and CC was assessed using overall percentage agreement and Cohen's Kappa coefficient. Diagnostic performance metrics were calculated for mPCR, CC, and their combined use. Of 143 included patients, 96 (67%) were diagnosed with SA. When considering mPCR-specific microorganisms, mPCR identified 13 additional microorganisms compared to CC. Nine of these (9/13) were diagnosed with SA and six of these (6/9, 67%) were on antibiotics prior to aspiration. Overall agreement between mPCR and CC was 91%, with a positive agreement of 100%, negative agreement of 88% and a Cohen's Kappa coefficient of 0.780. Considering all microorganisms (including off-panel organisms), the overall agreement was 89%, the positive agreement 92%, the negative agreement 88%, and the Cohen's Kappa 0.735. The mPCR demonstrated a sensitivity of 45% and specificity of 89%, while conventional culture showed a sensitivity of 40% and specificity of 100%. No significant difference in performance was observed between the two methods (p = 0.183). Moreover, the combined use (mPCR + CC) yielded a sensitivity of 48% and specificity of 89% (AUC = 0.686). The novel automated mPCR system demonstrated a diagnostic performance similar to that of conventional synovial fluid culture, offering the added benefit of a quicker turnaround time, which can be crucial for patient care. Its use is especially evident in patients who have received prior antibiotic treatment, where conventional cultures may be less reliable.

Human alveolar echinococcosis is a notifiable parasitic infectious disease in most European countries; however, in practice, it is under-reported by national health systems. To fill this knowledge gap, data on the number, incidence, and trend of cases in Europe were extracted through a systematic review approach from both the scientific and grey literature, covering 1997-2023. This systematic review identified 4207 human alveolar echinococcosis cases from 28 of the 40 European countries investigated. Historically endemic Austria, France, Germany, and Switzerland accounted for 2864 (68·08%) of 4207 cases documented in Europe, and Lithuania, Poland, and Slovakia represented an additional 887 (21·08%) cases. Based on incidence rates and trends detected in this study, two main epicentres were seen in countries in the Alpine and the Baltic areas. The mean annual incidence from 1997 to 2023 throughout Europe was 0·063 cases per 100 000 people and in EU member states was 0·060 cases per 100 000 people. Data collected during this period suggest that alveolar echinococcosis is emerging in almost every country where this neglected parasitic infectious disease has been detected.

Aim: The aim of this study was to investigate the diagnostic performance of a novel rapid multiplex polymerase chain reaction (mPCR) in adults with suspected acute native joint infection. Methods: This retrospective single-centre study included 143 patients with suspected acute native joint infection from February 2023 to May 2024. A septic arthritis was classified based on institutional criteria. The agreement between mPCR and conventional culture of synovial fluid (SF) was assessed by calculating the Cohen's κ coefficient. The diagnostic performance of mPCR was calculated, and the area under the curve (AUC) was compared with conventional culture of synovial fluid by using the z test. Results: When considering only microorganisms targeted by mPCR, this method detected 13 novel microorganisms in 13 cases compared to conventional culture, resulting in an overall agreement of 91 %, a positive agreement of 100 %, a negative agreement of 88 %, and a Cohen's κ coefficient of 0.780. Of these 13 cases, 9 were classified as septic, with 6 (n=6/9, 67 %) on antibiotics prior to aspiration. When considering all microorganisms (including off-panel microorganisms), the overall percentage agreement between mPCR and conventional culture was 89 %, with a Cohen's κ coefficient of 0.735, indicating substantial agreement. Sensitivity, specificity, PPV, NPV, LR+, LR−, accuracy, and AUC of mPCR were 45 %, 89 %, 90 %, 44 %, 4.21, 0.62, 59 %, and 0.671, and those of conventional culture were 40 %, 100 %, 100 %, 45 %, 0.60, 59 %, and 0.698. No difference in performance was observed between both methods (p=0.183). The combination of both techniques showed a sensitivity, specificity, PPV, NPV, LR+, LR−, accuracy, and AUC of 48 %, 89 %, 90 %, 46 %, 4.5, 0.58, 62 %, and 0.686. Conclusion: Given its comparable diagnostic performance and faster turnaround time relative to conventional synovial fluid culture, this novel mPCR can be recommended as a valuable adjunct in the diagnosis of septic arthritis in adults, particularly in patients with prior antimicrobial treatment.

Benzylpenicillin is regaining attention as a treatment option for susceptible S. aureus, including in severe invasive diseases such as blood stream infections. Timely and reliable susceptibility determination is essential to support its use in clinical practice. In this study, we assessed the EUCAST-recommended methodology of interpreting zone edges in a national multicenter trial. In total, nine microbiology laboratories in Austria participated. Each center received 10 isolates in blinded duplicates, all with inhibition zones of ≥ 26 mm. Three were blaZ-positive with sharp edges and seven were blaZ-negative with fuzzy edges. Benzylpenicillin susceptibility testing according to EUCAST guidelines using 1 unit discs was performed by two independent technicians in duplicate on two separate days. All plates were interpreted by two different assessors generating a total of 1440 data points. Overall, 85.5

Multiresistente Erreger sind eine zunehmende Herausforderung für das Gesundheitswesen und erschweren die medizinische Behandlung betroffener Kinder und Jugendlicher. Ein Verständnis der Resistenzmechanismen, ein fundiertes Wissen über die Häufigkeit einzelner multiresistenter Erreger, Möglichkeiten des Nachweises und der gezielten antimikrobiellen Therapie sowie eine enge interdisziplinäre Zusammenarbeit sind wichtig, um diese Infektionen erfolgreich behandeln zu können. Dieser CME-Beitrag gibt den Leserinnen und Lesern einen aktuellen Überblick über multiresistente Erreger und vermittelt wichtige Grundlagen für den klinischen Alltag. Ziel ist es, Fachkräfte im Gesundheitswesen zu unterstützen, fundierte Entscheidungen zu treffen, um die bestmögliche Versorgung der Patient*innen sicherzustellen.

Invasive candidiasis, including candidaemia, is associated with high morbidity and mortality. Diagnosis is traditionally based on blood culture, which lacks sensitivity. Therefore, additional tools such as PCR-based diagnostic methods are increasingly used. The T2MR technology is based on polymerase chain reaction and detection of the PCR product involving magnetic resonance technology. In this study, we compare the T2Candida in a clinical routine setting to conventional blood culture in order to explore its usefulness, strengths and weaknesses in its daily application. This retrospective analysis was performed at the Vienna University Hospital with clinical routine samples submitted between April 2021 and May 2024. Sensitivity, specificity, positive predictive value, negative predictive value and accordance were calculated with blood culture as reference method. Patients with a positive T2Candida result but a negative result in blood culture were assessed according to a clinical case definition. Based on direct detection in blood by alternative methods (e.g. blood culture, alternative PCR), 1-3-beta-D-Glucan, patient risk factors and detection of the same species in other sample materials, each result was categorised as “proven”, “probable”, “possible”, “improbable” or “not assessable”. 2105 samples from 1447 unique patients were submitted for analysis during the study period. 94 samples were positive (4.5

This study presents a graphene field-effect transistor (gFET) biosensor with dual detection capabilities for SARS-CoV-2: one RNA detection assay to confirm viral positivity and the other for nucleocapsid (N-)protein detection as a proxy for infectiousness of the patient. This technology can be rapidly adapted to emerging infectious diseases, making an essential tool to contain future pandemics. To detect viral RNA, the highly conserved E-gene of the virus was targeted, allowing for the determination of SARS-CoV-2 presence or absence using nasopharyngeal swab samples. For N-protein detection, specific antibodies were used. Tested on 213 clinical nasopharyngeal samples, the gFET biosensor showed good correlation with RT-PCR cycle threshold values, proving its high sensitivity in detecting SARS-CoV-2 RNA. Specificity was confirmed using 21 pre-pandemic samples positive for other respiratory viruses. The gFET biosensor had a limit of detection (LOD) for N-protein of 0.9 pM, establishing a foundation for the development of a sensitive tool for monitoring active viral infection. Results of gFET based N-protein detection corresponded to the results of virus culture in all 16 available clinical samples and thus it also proved its capability to serve as a proxy for infectivity. Overall, these findings support the potential of the gFET biosensor as a point-of-care device for rapid diagnosis of SARS-CoV-2 infection and indirect assessment of infectiousness in patients, providing additional information for clinical and public health decision-making.

Cefiderocol, a novel siderophore cephalosporin, demonstrates promising in vitro activity against multidrug-resistant Gram-negative bacteria, including carbapenemase-producing strains. Nonetheless, only a few reports are available regarding the acquisition of resistance in clinical settings, primarily due to its recent usage. This study aimed to investigate cefiderocol resistance using an in vitro resistance development model to gain insights into the underlying molecular resistance mechanisms. Cefiderocol susceptible reference strains (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) and a clinical Acinetobacter baumannii complex isolate were exposed to increasing cefiderocol concentrations using a high-throughput resistance development model. Cefiderocol susceptibility testing was performed using broth microdilution. Whole-genome sequencing was employed to identify newly acquired resistance mutations. Our in vitro resistance development model led to several clones of strains exhibiting cefiderocol resistance, with MIC values 8-fold to 512-fold higher than initial levels. In total, we found 42 different mutations in 26 genes, of which 35 could be described for the first time. Putative loss-of-function mutations were detected in the envZ, tonB, and cirA genes in 13 out of 17 isolates, leading to a decrease in cefiderocol influx. Other potential resistance mechanisms included multidrug efflux pumps (baeS, czcS, nalC), antibiotic-inactivating enzymes (ampR, dacB), and target mutations in penicillin-binding-protein genes (mrcB). This study reveals new insights into underlying molecular resistance mechanisms against cefiderocol. While mutations leading to reduced influx via iron transporters was the most frequent resistance mechanism, we also detected several other novel resistance mutations causing cefiderocol resistance.

Here, we present the case of a patient with a metastatic neuroendocrine tumor with cytologically negative ascites treated for spontaneous bacterial peritonitis (SBP). Ascitic cultures remained negative for bacterial growth but were positive for Candida albicans 8 days after SBP diagnosis. ß-D-glucan was only positive in ascites, while being negative in blood. Blood cultures remained negative throughout the whole admission. Fungal peritonitis presumably originated from an impending bowl perforation or an increasing vascular permeability caused by an increase in VEGF secondary to diffuse infiltration by the underlying malignant disease.

The increasing prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains resistant to non-beta-lactam antimicrobials poses a significant challenge in treating severe MRSA bloodstream infections. This study explores resistance development and mechanisms in MRSA isolates, especially after the first dalbavancin-resistant MRSA strain in our hospital in 2016. This study investigated 55 MRSA bloodstream isolates (02/2015–02/2021) from the University Hospital of the Medical University of Vienna, Austria. The MICs of dalbavancin, linezolid, and daptomycin were assessed. Two isolates (16–33 and 19–362) resistant to dalbavancin were analyzed via whole-genome sequencing, with morphology evaluated using transmission electron microscopy (TEM). S.aureus BSI strain 19–362 had two novel missense mutations (p.I515M and p.A606D) in the pbp2 gene. Isolate 16–33 had a 534 bp deletion in the DHH domain of GdpP and a SNV in pbp2 (p.G146R). Both strains had mutations in the rpoB gene, but at different positions. TEM revealed significantly thicker cell walls in 16–33 (p < 0.05) compared to 19–362 and dalbavancin-susceptible strains. None of the MRSA isolates showed resistance to linezolid or daptomycin. In light of increasing vancomycin resistance reports, continuous surveillance is essential to comprehend the molecular mechanisms of resistance in alternative MRSA treatment options. In this work, two novel missense mutations (p.I515M and p.A606D) in the pbp2 gene were newly identified as possible causes of dalbavancin resistance.

Personal protective equipment and adherence to disinfection protocols are essential to prevent nosocomial severe acute respiratory syndrome coronavirus (SARS-CoV-2) transmission. Here, we evaluated infection control measures in a prospective longitudinal single-center study at the Vienna General Hospital, the biggest tertiary care center in Austria, with a structurally planned low SARS-CoV-2 exposure. SARS-CoV-2-specific antibodies were assessed by Abbott ARCHITECT chemiluminescent assay (CLIA) in 599 health care workers (HCWs) at the start of the SARS-CoV-2 epidemic in early April and two months later. Neutralization assay confirmed CLIA-positive samples. A structured questionnaire was completed at both visits assessing demographic parameters, family situation, travel history, occupational coronavirus disease 2019 (COVID-19) exposure, and personal protective equipment handling. At the first visit, 6 of 599 participants (1%) tested positive for SARS-CoV-2-specific antibodies. The seroprevalence increased to 1.5% (8/553) at the second visit and did not differ depending on the working environment. Unprotected SARS-CoV-2 exposure (p = 0.003), positively tested family members (p = 0.04), and travel history (p = 0.09) were more frequently reported by positively tested HCWs. Odds for COVID-19 related symptoms were highest for congestion or runny nose (p = 0.002) and altered taste or smell (p < 0.001). In conclusion, prevention strategies proved feasible in reducing the risk of transmission of SARS-CoV-2 from patients and among HCWs in a low incidence hospital, not exceeding the one described in the general population.

Respiratory syncytial virus (RSV) testing is generally available in most care centres, but it is rarely performed because clinicians’ seldom suspect RSV to be the underlying pathogen in adults with respiratory disease. Here, we evaluate the impact of broad combined influenza/RSV testing on the clinical practice. Overall, 103 patients were tested positively for RSV. Our study indicates that positively tested patients were mostly of advanced age and suffered from chronic diseases. Mortality was significant in our cohort and higher in patients with advanced age. Further, we report a significant increase in detected RSV cases but also in detection rate. Together, these findings suggest that implementation of a combined influenza/RSV testing led to a significant increase in detection rate, supported clinicians establishing the correct diagnosis and allowed a safe and controlled handling of RSV patients.

Respiratory syncytial virus (RSV) testing is generally available in most care centres, but it is rarely performed because clinicians’ seldom suspect RSV to be the underlying pathogen in adults with respiratory disease. Here, we evaluate the impact of broad combined influenza/RSV testing on the clinical practice. Overall, 103 patients were tested positively for RSV. Our study indicates that positively tested patients were mostly of advanced age and suffered from chronic diseases. Mortality was significant in our cohort and higher in patients with advanced age. Further, we report a significant increase in detected RSV cases but also in detection rate. Together, these findings suggest that implementation of a combined influenza/RSV testing led to a significant increase in detection rate, supported clinicians establishing the correct diagnosis and allowed a safe and controlled handling of RSV patients.

Between January 2018 and May 2019, 349 cases of Candida auris were reported in the European Union/European Economic Area*, 257 (73.6%) colonisations, 84 (24.1%) bloodstream infections, seven (2.0%) other infections and one case of unknown infection/colonisation status (0.3%). Most cases (97.1%, n = 339) were reported from Spain or the United Kingdom, but also for the first time in Greece, the Netherlands and Poland. Laboratory capacity and preparedness has improved since January 2018.

BACKGROUND:Human toxocariasis occurs worldwide and is caused by nematodes of the species of the genus Toxocara. Infection occurs by the ingestion of eggs and is usually asymptomatic or oligosymptomatic. However, severe manifestations occur. The burden of disease and its public health impact remain ill-defined. The aim of this review was to summarize all available data on the seroprevalence of toxocariasis on the African continent and factors associated with seropositivity. METHODS:Twenty-seven original papers published between 1991 and 2017 were identified that provided data suitable for this review. Case-control studies were included and the seroprevalence in the (healthy) control group was used as a surrogate parameter. RESULTS:Antibodies against Toxocara spp. were found to be frequent in most populations and regions in Africa with the exception of two publications, one from the Democratic Republic of the Congo and one from Djibouti, where all participants were seronegative. The highest proportion of participants with antibodies was found on the island of La Réunion with 359 out 387 study participants being positive (92.8%). Factors associated with seropositivity were reported across studies, including-among others-older age, contact with soil via geophagia, agricultural activity or playing with soil, contact with animals, especially dogs, and low socio-economic status, defined as absence of water supply or poor housing. Three Egyptian studies found male gender to be associated with toxocariasis, whereas in La Réunion females were at increased risk. CONCLUSIONS:Exposure to toxocariasis seems to be very frequent and common in large parts of the African continent. However, no data are available for most countries. The public health impact of human toxocariasis and the frequency of severe manifestations remain unclear.

Analysis of sequencing data for 143 blaNDM-1- and blaOXA-48-positive Klebsiella pneumoniae isolates from 13 European national collections and the public domain resulted in the identification of 15 previously undetected multi-country transmission clusters. For 10 clusters, cases had prior travel/hospitalisation history in countries outside of the European Union including Egypt, Iran, Morocco, Russia, Serbia, Tunisia and Turkey. These findings highlight the benefit of European whole genome sequencing-based surveillance and data sharing for control of antimicrobial resistance.