European Journal of Clinical Microbiology & Infectious Diseases

Zou, Xuanying; Li, Xiaoyan; He, Kang; Song, Qiang; Yin, Ruofeng

doi: 10.1007/s10096-024-04983-9pmid: 39589654

PurposeAs life expectancy increases worldwide, the elderly population in every country is growing in both the size and proportion. This review aims to provide a comprehensive overview of the microbiology, clinical presentation, diagnostic strategies, and therapeutic approaches to vertebral osteomyelitis, summarizing the latest evidence to guide effective treatment.MethodsA comprehensive literature search was conducted using the Medline and Embase databases to identify relevant studies on vertebral osteomyelitis. The search included the following keywords: "vertebral osteomyelitis," "spinal infection," "discitis," "spondylitis," " spondylodiscitis," and "spinal epidural abscess." Both retrospective and prospective studies, case series, and reviews were considered.ResultsThis condition is commonly caused by bacteria such as Staphylococcus aureus or gram-negative bacilli, but can also be caused by other pathogens like fungi and parasites. The onset of vertebral osteomyelitis is insidious, with low specificity in clinical manifestations, often making early diagnosis difficult. Delayed or inadequate treatment may lead to sepsis, permanent neurological damage, or even death. Treatment strategies emphasize the importance of identifying the causative pathogen to guide effective antimicrobial therapy. Current consensus does not advocate for empirical antibiotic treatment unless patients exhibit signs of neurological impairment or severe sepsis. Severe cases involving neurological paralysis, spinal instability, or sepsis may require surgical intervention.ConclusionVertebral osteomyelitis requires prompt diagnosis and treatment for a good prognosis. Delayed diagnosis and treatment can lead to permanent neurological deficits or death. Identifying the causative organism is crucial for guiding appropriate antimicrobial therapy. In addition to conservative and surgical treatments, local drug delivery systems offer new approaches to managing spinal osteomyelitis.

Marshall, Helen S.; Molina, Jean-Michel; Berlaimont, Valérie; Mulgirigama, Aruni; Sohn, Woo-Yun; Berçot, Béatrice; Bobde, Shravani

doi: 10.1007/s10096-024-04968-8pmid: 39601904

PurposeTo describe the relationships between Neisseria meningitidis (NM) and Neisseria gonorrhoeae (NG) at genetic, population, and individual levels; to review historical trends in antimicrobial resistance (AMR); to review the treatment and preventive landscapes and explore their potential impact on AMR.MethodsA narrative literature search was conducted in PubMed, with searches restricted to 2003–2023 and additional articles included based on expertise.ResultsNM and NG are closely related bacterial pathogens causing invasive meningococcal disease (IMD) and gonorrhea, respectively. NM can currently be treated with most antibiotics and generally has a wild-type susceptibility profile, whereas NG is increasingly resistant even in the first line of treatment. These pathogens share 80–90% genetic identity and can asymptomatically cohabit the pharynx. While AMR has historically been rare for NM, recent reports show this to be an emerging clinical concern. Extensively drug-resistant NG are reported globally, with data available from 73 countries, and can lead to treatment failure. Importantly, Neisseria commensals within the normal microbiota in the pharynx can act as a genetic reservoir of resistance to extended-spectrum cephalosporins. Novel oral antibiotics are urgently needed to treat a growing threat from antibiotic-resistant NG, recognized as a major global concern to public health by the World Health Organization. Numerous vaccines are available to prevent IMD, but none are approved for gonorrhea. Research to identify suitable candidates is ongoing.ConclusionHolistic management of AMR in IMD and gonorrhea should couple judicious use of existing antibiotics, optimization of vaccination programs, and development of novel antibiotics and vaccines.Graphical abstract[graphic not available: see fulltext]

Lee, Jia-Arng; Kuo, Yao-Wen; Du, Shin-Hei; Lee, Tai-fen; Liao, Chun-Hsing; Huang, Yu-Tsung; Hsueh, Po-Ren

doi: 10.1007/s10096-024-04993-7pmid: 39551908

PurposeThis study aimed to investigate the genetic and clinical characteristics of carbapenem-resistant Enterobacterales (CRE) isolates carrying metallo-β-lactamases (MBLs) genes.MethodsA total of 146 non-duplicated isolates of CRE were collected in 2022. Their ceftazidime/avibactam (CZA) susceptibilities were determined using the E test. The phenotypic identification of carbapenemases was conducted using the modified carbapenem inactivation method, followed by sequencing of the five common carbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48). Multilocus sequence typing of selected Klebsiella pneumoniae, Escherichia coli, and Enterobacter cloacae complex isolates were performed.ResultsAmong the 146 CRE isolates, 52 (35.6%) were resistant to CZA. MBL-encoding genes were detected in 46 (31.5%) of all tested CRE isolates, with 82.6% (n = 38) of them exhibiting resistance to CZA. Fourteen isolates were resistant to CZA without any detected MBL genes. The most commonly identified MBL genes were blaIMP (n = 20), followed by blaNDM (n = 19), and blaVIM (n = 5). In CZA-R, the most common definite antibiotic before the CZA E test was CZA (n = 18), followed by tigecycline (n = 13), and fluroquinolone (n = 10). The 14-day and 30-day mortality rates were 9.0% (n = 13) and 22.8% (n = 34), and were associated with intensive care unit admission at onset (P = 0.029 and P = 0.001, respectively). The sequence types of CRE isolates carrying MBLs were diverse without major clones.ConclusionThe continuous emergence of MBL gene-encoding CRE with multiple clones has led to reduced CZA susceptibilities and worse outcomes.

Plum, Pierre-Emmanuel; Ausselet, Nathalie; Kidd, François; Noirhomme, Séverine; Garrino, Maria-Grazia; Dili, Alexandra; Hayette, Marie-Pierre; Detry, Olivier; Leonard, Philippe; Motet, Christian; Hites, Maya; Bourgeois, Marc; Montesinos, Isabel; Delaere, Bénédicte

doi: 10.1007/s10096-024-04996-4

Le Terrier, Christophe; Raro, Otávio Hallal Ferreira; Saad, Alaaeldin Mohamed; Nordmann, Patrice; Poirel, Laurent

doi: 10.1007/s10096-024-04965-xpmid: 39589655

PurposeOverproduction of the intrinsic chromosomally-encoded AmpC β-lactamase is one of the main mechanisms responsible for broad-spectrum β-lactam resistance in Pseudomonas aeruginosa. Our study aimed to evaluate the in-vitro activity of anti-pseudomonal β-lactam molecules associated with the recently-developed and commercially-available β-lactamase inhibitors, namely avibactam, relebactam and vaborbactam, against P. aeruginosa isolates overproducing their AmpC.MethodsMIC values of ceftazidime, cefepime, meropenem, imipenem and ceftolozane with or without β-lactam inhibitor were determined for 50 AmpC-overproducing P. aeruginosa clinical isolates. MIC breakpoints for resistance were retained at 8 mg/L for β-lactams and β-lactam/β-lactamase inhibitor combinations containing ceftazidime, cefepime and meropenem, while 4 mg/L was used for those containing imipenem and ceftolozane. The concentration of all β-lactamases inhibitors was fixed at 4 mg/L, except for vaborbactam (8 mg/L).ResultsThe rates of isolates not being resistant to ceftazidime, cefepime, meropenem, imipenem and ceftolozane were found at 12%, 22%, 34%, 8% and 74%, respectively. When combined with avibactam, those rates increased to 60%, 62%, 60%, 46%, and 80%, respectively. The highest rates were found with relebactam-based combinations, being 76%, 64%, 66%, 76% and 84%, respectively. By contrast, associations with vaborbactam did not lead to significantly increased “non-resistance” rates.ConclusionOur results showed that all combinations including relebactam led to higher “non-resistance” rates against AmpC-overproducing P. aeruginosa clinical isolates. The best activity was achieved by combining ceftolozane and relebactam, that might therefore be considered as an excellent clinical alternative against AmpC overproducers.

Bradfield Strydom, Moira; Nelson, Tiffanie M.; Khan, Sohil; Walpola, Ramesh L.; Ware, Robert S.; Tiralongo, Evelin

doi: 10.1007/s10096-024-04999-1pmid: 39586933

PurposeRecurrent Vulvovaginal Candidiasis (RVVC) is a problematic clinical condition for which fluconazole treatment is commonly prescribed. This study investigated the interkingdom vaginal and gastrointestinal microbiomes of RVVC patients who use fluconazole intermittently or as longer-term maintenance therapy for symptom management and compared them to healthy controls.MethodsVaginal swabs and fecal samples were collected. A novel interkingdom analysis was performed using 16 S rRNA and ITS1 gene sequencing to compare the diversity and taxonomic composition of vaginal microbiome (VMB) and gastrointestinal microbiome (GIMB).ResultsTwenty-seven women participated: 10 intermittent users and healthy controls and 7 maintenance therapy. The study revealed that microbiomes of fluconazole users do not differ in diversity metrics from healthy controls. RVVC patients using intermittent fluconazole displayed a higher abundance of vaginal C. albicans than healthy controls. Candida species pairings were not commonly observed between sites in individuals and, as such a fecal reservoir is unlikely to be implicated in recurrent symptomatology. In many of the RVVC non-Candida fungal spp. were identified in the vaginal microbiome. Users of fluconazole displayed elevations of the CST-I (Community State Type 1) associated bacterium L. crispatus. All participants displaying vaginal Candida spp. belonged to either bacterial CST-I or CST-III (Community State Type 3- L. iners associated).ConclusionTo our knowledge, this is the first study to compare the interkingdom VMB-GIMB of women with RVVC using oral fluconazole. As fluconazole users in this study represent a typical RVVC population, trends observed in microbial abundance require further analysis to establish fluconazole’s long-term microbiome safety. Examining the microbiome at both sites adds to the current understanding of microbial associated with the condition.

Cheng, Hui-Fang; Kuo, Zhe-Yu; Lin, Ching-Chiang; Chen, Ho-Feng; Lo, Horng-Ren; Shyu, Huey-Wen; Wang, Yi-Fen

doi: 10.1007/s10096-024-05000-9pmid: 39601905

PurposeGroup B streptococci (GBS) are Gram-positive bacteria that are a leading cause of neonatal infections. Most invasive isolates are β-hemolytic, and hemolytic activity is critical for GBS virulence. Although nonhemolytic GBS strains are occasionally isolated, they are often thought to be attenuated in virulence. Recent studies have observed that many nonhemolytic and nonpigmented (NH/NP) strains originated from invasive infections, including bacteremia and meningitis, in neonates or adults. The mutations causing the NH/NP phenotype are predominantly localized in the cyl operon and abx1 gene. Previous studies on group B streptococci in Taiwan have focused on the serotype and genotype distribution. In this study, we investigated the serotype distribution of the NH/NP strains and detected the mutations of abx1.MethodsOne hundred clinical GBS strains from non-invasive (vaginal and rectal swabs, 69) and invasive infections (blood, urine and abscess, 31), including 10 NH/NP isolates, were collected during 2019–2021 at Fooyin University Hospital. To confirm GBS isolates, we have developed a multiplex PCR method that detects GBS isolates, virulent strain ST-17 and virulent factor Srr1 simultaneously. Molecular serotyping was performed by multiplex PCR assay using serotype specific primer sets. The genomic region containing abx1 was amplified from DNA extracts by PCR and the amplicons were directly sequenced and analyzed on an ABI prism 3730 DNA analyzer.ResultsThe capsular serotypes III and VI were the most abundant in both the non-invasive specimens and invasive specimens. The ST-17 isolates were more frequently associated with invasive infections (16.1%, 5/31) than non-invasive diseases or colonization (7.2%, 5/69). The association of NH/NP strains between noninvasive diseases or colonization (10.1, 7/69) and invasive infection (9.7%, 3/31) is nearly compatible. The NH/NP strains were isolated from various serotypes (Ia, III, V and VI) and five NH/NP isolates were serotype III. The virulence factor Srr1was detected in most of the NH/NP isolates (8/10) and one NH/NP isolate was ST-17. Abx1 mutations, including transitions, transversions and deletions, were observed in some NH/NP isolates, but some mutations also observed in hemolytic isolates. Five NH/NP isolates were erythromycin and clindamycin resistant.ConclusionThese results indicate NH/NP GBS strains may have the potential for invasive infections and may show higher tendency to get mutated.

Ergon, Mahmut Cem; Gürbüz, Ebru Demiray; Arslan, Nazlı; Alp, Sema; Dereli, Mine Doluca; Özkütük, Ayşe Aydan

doi: 10.1007/s10096-024-04998-2pmid: 39612138

PurposeWe aimed to investigate the clonal relationship and antifungal susceptibility of C. parapsilosis isolated from hospitalized patients and to determine whether it is due to transmission or not and the spread status of resistant isolates.MethodsBetween January 2017 and June 2019, totally 277 C parapsilosis isolated from blood, urine and catheter samples of adult or pediatric in-patient (intensive care and service) who applied to Mycology laboratory in our hospital were included in the study. All isolates were identified using conventional methods, API 20 C AUX (Biomerieux, France) semi-automated system and confirmed by MALDI-TOF MS Biotyper Smart (Bruker Daltonik GmbH, Germany). Randomly amplified polymorphic DNA (RAPD) PCR method was used for molecular genotyping of isolates. MIC values for fluconazole, anidulafungin and amphotericin B were determined according to the M27-A3 CLSI broth microdilution reference method guideline.ResultsSeven different band patterns (A-G) were detected in 277 isolates by RAPD PCR method. According to the rank order of the isolates, 170 (61.37%) C, 65 (23.47%) A, 18 (6.50%) G, 11 (3.97%) B, six (2.17%) E, two (0.72%) F and one (0.36%) D patterns were determined. When the band patterns of the isolates were evaluated according to the years, it was detected that C pattern continued between 2017 and 2019 and that all isolates continued to spread only as C pattern in 2019. While 211 (76.17%) of the isolates were resistant to fluconazole (≥ 8 µg/ml), two (0.72%) were resistant to amphotericin B (≥ 2 µg/ml) and two (0.72%) were intermediate to anidulafungin.ConclusionsIt is noteworthy that the spread of the C pattern in C. parapsilosis strains has increased over the years and is the main pattern isolated from the whole hospital. The detection of high fluconazole resistance in C. parapsilosis isolates in our hospital may also be related to the dominant pattern.

Vélez-Tobarias, M.; Torres-Vega, AM.; Carmelo, E.; Morais-Martín, J.; Pérez, JA.; Gonzalo-Hernández, C.; Clot, G.; Ascaso-Terrén, C.

doi: 10.1007/s10096-024-04976-8pmid: 39612139

Purpose and methodsThis prospective study aims to diagnose the etiology of non-focalized fever lasting between 5 and 28 days in the islands of La Palma and El Hierro (Canary Islands, Spain) during 2021, using serology and PCR.ResultsThe etiological profile described in this study aligns with that of fever of intermediate duration (FID), with zoonoses being the primary cause. Murine typhus (MT) is identified as the leading cause, followed by Q fever (QF). The incidence of MT is the highest reported nationally and comparable to the highest in Europe, with 39.6 cases per 100,000 inhabitants in La Palma and 79.7 cases per 100,000 inhabitants in El Hierro. Q fever, known to be endemic to the Canary Islands, presents incidences of 26.5 cases per 100,000 inhabitants in La Palma and 15.6 cases per 100,000 inhabitants in El Hierro. MT shows no gender differences and has a homogeneous geographical distribution. In contrast, QF is more prevalent in men and has a heterogeneous geographical distribution.ConclusionsThe high incidence of MT found in both urban and peri-urban areas is particularly noteworthy. Its potential connection with climate change and/or the growth of the reservoir population in the Canary Islands remains unknown. MT's similarity to QF in terms of clinical signs and treatment, coupled with the absence of a specific protocol for early diagnosis, may have contributed to its underdiagnosis. MT can lead to significant health concerns, including risk of hospitalization, complications, and even death. Therefore, the registration of cases for epidemiological control is deemed essential.

Yilmaz, Dilek; Tasar, Selin; Tuz, Aysegul Elvan; Eroz, Nesli Agralı; Oncel, Eda Karadag; Aksay, Ahu Kara; Yilmaz, Nisel

doi: 10.1007/s10096-024-05003-6pmid: 39612140

ObjectiveRespiratory syncytial virus (RSV) is the primary etiology of lower respiratory tract infection in children. The fluctuating incidence of RSV, particularly in light of the COVID-19 pandemic, has shifted the spotlight onto preventive strategies. Our study aims to investigate both the risk factors and clinical symptoms of RSV.Materials and methodsFrom February 2015 to February 2023, samples were analyzed during all seasons to identify viral respiratory infections. RSV was identified in a total of 835 individuals.ResultsIn 2021, following the easing of limitations after the COVID-19 pandemic, the largest number of identified cases was recorded. January was the most commonly used month. The median age were 5 months (min-max: 1-204 months) and 128 (17.7%) cases had a history of prematurity. Around 24.7% of the patients had a preexisting medical condition. Neurological disease patients were followed up in the intensive care unit more often than others (53.3 vs. 35.8% p = 0.036). While the hospital stay of pediatric patients born under the 29th week of gestation is almost twice as long compared to other groups, the hospital stay is almost twice as long as that of patients between 29 and 32 weeks. (p = 0.046, p = 0.012 respectively).ConclusionRSV was a powerful companion during the pandemic and a persistent reminder of its severity. Our initial data suggest that RSV prevention is difficult for children with pre-existing diseases, notably neurological abnormalities, who are not advised for preventive treatments. Given this outcome, late-premature newborns and children with medical issues should receive RSV prophylaxis first.