Choice of antimicrobial therapy for infective endocarditis caused by viridans streptococci: an international practice surveyTazi, Asmaa; Le Moing, Vincent; Goehringer, François; Lecomte, Raphaël; Beraud, Guillaume; Chirouze, Catherine; Ferry, Tristan; Le Bot, Audrey; Moby, Vanessa; Tribouilloy, Christophe; Giannella, Maddalena; Duval, Xavier; Vandenesch, François; ,
doi: 10.1007/s10096-026-05463-ypmid: 41876917
ObjectivesGuidelines recommend penicillin, amoxicillin or ceftriaxone for the treatment of streptococcal infective endocarditis (IE) but do not specify the criteria for choosing the β-lactam to be used. Our objectives were to identify which antibiotics are preferentially considered for susceptibility testing and treatment.MethodsA practice survey was addressed to infectious disease specialists and clinical microbiologists. The questionnaire was diffused to international learned societies as an online google form between September 2022 and 2023.Results94 responses were collected, mainly from participants residing in Europe (60/94, 69%). Over 80% (72/88) of respondents reported that minimum inhibitory concentrations (MICs) other than that of penicillin G were routinely measured, including those of ceftriaxone (43/88, 49%), and ampicillin/amoxicillin (55/88, 63%). For treatment of penicillin-susceptible increased exposure isolates (MIC > 0.125 mg/L and ≤ 2 mg/L), the ß-lactams with the lowest MIC were the molecules of choice for 61% (51/83) of respondents. For penicillin-resistant isolates (MIC > 2 mg/L), non-ß-lactam antibiotics were the preferred molecules, followed by the lowest MIC ß-lactam (48%, 38/79, and 43%, 34/79, respectively).ConclusionsDespite disparities in antibiotic susceptibility testing, we observed a converging approach toward the treatment of choice for IE due to penicillin-non-susceptible isolates, favoring the lowest MIC β-lactam. Further studies are needed to determine the optimal antibiotic therapy for difficult-to-treat streptococcal IE in order to revise future guidelines.
Use of reverse dot blot hybridization DNA-array and targeted next-generation sequencing for the detection of drug resistance in patients with tuberculosis: a prospective diagnostic accuracy studyDudnyk, Andrii; Tytarenko, Nadiia; Andrada, Iris Romero; Lytvyniuk, Oksana; Tolstova, Olena; Millet, Joan-Pau; Casas, Xavier; Antuori, Adrian; Ciobanu, Nelly; Crudu, Valeriu; Domínguez, José
doi: 10.1007/s10096-026-05451-2pmid: 41790343
PurposePhenotypic drug susceptibility testing (pDST) for Mycobacterium tuberculosis complex (MTC) is slow, and routine molecular assays detect only a subset of resistance-associated mutations. We aimed to assess the diagnostic accuracy of the TB Resistance DNA-Array (GenID GmbH, Germany) for detecting isoniazid (INH) and rifampicin (RIF) resistance, and to evaluate the added value of Deeplex® Myc-TB, a culture free, targeted next-generation sequencing (tNGS) from GenoScreen, France, for identifying drug resistance and resolving discrepancies with pDST.MethodsClinical samples from 234 individuals with bacteriologically confirmed pulmonary tuberculosis (TB) were analyzed: 98 (41.9%) from Ukraine, 25 (10.7%) from Moldova, and 111 (47.4%) from Spain. TB Resistance DNA-Array and tNGS results were compared with pDST and cross-evaluated to identify resistance-conferring mutations.ResultsAmong 196 sputum specimens tested with the TB Resistance DNA-Array, 98 (50.0%) produced conclusive RIF results and 102 (52.0%) conclusive INH results. Among conclusive outputs, the assay showed high sensitivity and specificity for RIF (94.3% and 98.4%) and INH (95.7% and 94.6%). Deeplex® Myc-TB generated conclusive results for 24/30 (80.0%) sputum samples and 21/23 (91.3%) culture isolates from 53 individuals. tNGS demonstrated high sensitivity for INH and RIF (both > 97.0%) but misclassified 2 of 8 INH-susceptible cases and 2 of 9 RIF-susceptible cases as resistant, suggesting a potential risk of overtreatment with second-line drugs. For linezolid, tNGS showed perfect specificity (100%); however, 1 of 3 cases was falsely categorised as resistant. For fluoroquinolones, sensitivity and specificity were 90.0% and 83.3%, respectively.ConclusionThe TB Resistance DNA-Array performed reliably for detecting RIF and INH resistance in sputum samples with conclusive results. Integration of tNGS can improve interpretative algorithms tailored to clinically relevant and region-specific resistance mutations.
Point of care antimicrobial susceptibility testingCouwenberg, Jora; van Belkum, Alex; van de Kerkhof, Daan; Scharnhorst, Volkher; Wertheim, Heiman; van der Linden, Ardjan; van Asten, Suzanne
doi: 10.1007/s10096-026-05453-0pmid: 41840273
Given the rising threat of antimicrobial resistance (AMR), there is an urgent clinical need for faster, near-patient antibiotic susceptibility testing (AST) solutions. Standard AST methods usually need pure bacterial isolates, with results available in at minimum 18–24 h, leading to a total turnaround time (TAT) of 1–3 days. Financial pressures from healthcare insurers, technological advancements, and the involvement of private investors have changed the laboratory landscape. This trend, together with the ongoing centralization of microbiological laboratories, has led to longer diagnostic TATs. The development and use of point-of-care testing (POCT) devices capable of delivering diagnostic and AMR results have the potential to improve patient outcomes, decrease hospital stay, lower healthcare costs, and improve antimicrobial stewardship. However, widespread adoption remains challenging due to technical complexities, limitations in pathogen detection, high costs, and regulatory barriers. The aim of this review is to outline the current state of affairs in AST focusing on POCT devices from the pre-clinical stage to commercial launching.
Application of targeted next-generation sequencing in children with community-acquired pneumoniaYe, Qian; Chen, Tong; Xu, Kai; Chen, Gang; Deng, Tuo
doi: 10.1007/s10096-026-05479-4pmid: 41863734
BackgroundPediatric community-acquired pneumonia (CAP) represents one of the leading causes of childhood morbidity and mortality worldwide, making accurate pathogen identification critically important for clinical management. Targeted next-generation sequencing (tNGS) is pivotal in infectious diseases, but still lacks systematic studies on its utility for pediatric CAP.MethodsA retrospective analysis was conducted on 1,245 pediatric CAP treated in the pediatric ward of Wenzhou People’s Hospital from January 2024 to December 2024. The consistency of the results of tNGS and clinical traditional methods (CTs) with the clinical diagnosis was evaluated. In addition, the pathogen results detected by tNGS were compared with those of bacterial culture and viral antigen detection.ResultsIn this study, by combining CTs and tNGS, 89% of the infections in pediatric CAP were clearly diagnosed, while only 11% were of unknown cause. Of all pathogen infections, the Mycoplasma pneumoniae accounted for the highest proportion (44.98%), followed by Rhinovirus (17.35%), Haemophilus influenzae (15.90%). Among Mycoplasma pneumoniae, the A2063G mutation was identified in 34.64%. The clinical diagnostic coincidence rate of tNGS for bacterial, viral and multiple infections in CAP patients was greater than 90%, all significantly higher than those of CTs. Meanwhile, tNGS exhibited > 90% concordance with antigen detection and > 70% agreement with culture.ConclusionsCompared with CTs, tNGS has a higher clinical coincidence rate and a wider range of pathogen detection. Therefore, it has great potential in pathogen diagnosis and provides valuable clinical guidance for pediatric CAP.
Evaluating the sensitivity of the Wako β-D-glucan assay for the diagnosis of candidemia caused by Candida parapsilosisKuhara, Yuta; Kitagawa, Hiroki; Tadera, Kayoko; Omori, Keitaro; Shigemoto, Norifumi; Akita, Tomoyuki; Fukuma, Shingo; Takahashi, Shinya; Ohge, Hiroki
doi: 10.1007/s10096-026-05446-zpmid: 41781580
PurposeCandidemia poses diagnostic challenges because of non-specific symptoms and low sensitivity of blood cultures. The Wako (1,3)-β-D-glucan (BDG) assay was recently introduced in Europe; however, its diagnostic performance for Candida parapsilosis compared to that of the Fungitell assay, which has demonstrated lower sensitivity, remains unclear. We evaluated the diagnostic performance of Wako BDG and BDG levels in candidemia, focusing on C. parapsilosis.MethodsBDG samples obtained within ± 3 days of blood culture collection were retrospectively analyzed. Diagnostic performance was compared using multiple cutoffs, including manufacturer-recommended thresholds (Japan: 11 pg/mL, Europe: 7.0 pg/mL). BDG levels and clinical characteristics were compared between C. parapsilosis and non-parapsilosis Candida candidemia.ResultsWe included 154 candidemia episodes (C. parapsilosis: n = 24, non-parapsilosis Candida: n = 130) and 3,856 control episodes. Using 11 pg/mL, sensitivity for C. parapsilosis was 38% (95% confidence interval [CI]: 21–57) versus 62% (95% CI: 54–70) for non-parapsilosis Candida (p = 0.041), with specificity 93%. Lowering the cutoff from 11 to 7.0 pg/mL increased the overall sensitivity from 58% (95% CI: 51–66) to 71% (95% CI: 63–77) while maintaining high specificity (90%) but did not eliminate the sensitivity gap for C. parapsilosis. The median BDG level was lower in C. parapsilosis (5.0 pg/mL, interquartile range [IQR]: 0–68) than in non-parapsilosis Candida (21 pg/mL, IQR: 7.2–97; p = 0.036). C. parapsilosis candidemia was most commonly catheter-related (67%), with 17% in-hospital mortality.ConclusionsDespite high specificity, Wako BDG assay showed significantly lower sensitivity and BDG levels for C. parapsilosis candidemia compared with non-parapsilosis Candida candidemia.
The clinical characteristics and outcomes of Campylobacter spp. bloodstream infection: A systematic review and meta-analysisPaniagua-García, María; Bernal, José Manuel; Sánchez-Suero, María Pilar; Pachón, Jerónimo; Pachón-Ibáñez, María Eugenia; Vallejo-Vaz, Antonio J.; Cordero, Elisa
doi: 10.1007/s10096-026-05465-wpmid: 41820744
PurposeCampylobacter spp. bloodstream infection (BSI) poses a significant challenge in clinical practice, particularly among certain populations such as immunocompromised individuals, mainly humoral immunodeficiencies. Objectives are to provide a comprehensive assessment and summarise the current evidence of the characteristics, clinical management and outcomes associated with Campylobacter spp. BSI.MethodsWe searched PubMed, EMBASE and Cochrane for original research articles and case series/reports published in English or Spanish between January-1990 and October-2024 including patients with Campylobacter spp. BSI. Outcomes included antimicrobial treatment received, treatment resistance, all-cause mortality and relapses. Case reports/series and primary research articles were summarised separately. Primary research studies were pooled in a random-effect meta-analysis to estimate mortality and relapse, overall and by subgroup species. Heterogeneity was assessed using the I2 statistic. Meta-regression for the relationship of outcomes and variables of interest was performed where data allowed. The quality of the studies was assessed using the NIH Quality Assessment Tool for Case Series Studies.FindingsFrom the 1441 articles retrieved from our search, 32 primary research articles (2138 participants) and 196 small case series or single case reports (212 cases) were included. Within the 32 retrospective studies, 1259 (58.9%) patients had some immunocompromise. The most frequent species was Campylobacter jejuni (n = 928, 43.4%), of which 47.8% were resistant to quinolones. The meta-analysis showed a mortality rate of 7.2% (95%CI 4.6%–10.2%; I2 70.7%); subgroup meta-analysis: C. jejuni: 3.8%, C. fetus: 10.4%, C. coli: 10.1%. Meta-regression suggested a direct association between the proportion of C. fetus BSI episodes included in the studies and mortality. The pooled relapse rate was 2.3%, and meta-regression analysis indicated that C. jejuni infection was associated with a lower risk of relapse compared with C. coli and C. fetus (p = 0.0002).InterpretationOur systematic review and meta-analysis suggest high antimicrobial resistance rates, mortality and risk of relapse, with some differences by Campylobacter species.