Search Results (782)

(1) Background: We aimed to determine rates of bacteremia and multidrug resistance (MDR) bacteremia and associated risk factors among neonates receiving parenteral nutrition (PN). (2) Methods: This is a multicenter study conducted in three neonatal intensive care units in Saudi Arabia, including 414 neonates who received PN. Associations were assessed using Chi-square or Fisher’s Exact tests when applicable and logistic regression analyses were conducted to determine factors predicting outcomes. Odds ratios with their 95% confidence intervals were computed, and a p value < 0.05 was considered statistically significant. (3) Results: PN was started within the first 10 days of life in 74.4% of cases. Fat emulsion was administered to 38.9% of the newborns. Blood cultures were positive in 24.9% of patients. Among the positive cultures, 4.9% were confirmed to have MDR bacteria. The mortality rate following bacteremia was 7.8%. The use of fat emulsion (p = 0.003), birth weight < 700 g (p < 0.001), and a gestational age within 27 weeks (p < 0.001) predicted bacteremia. (4) Conclusions: There was an association between the PN and bacteremia. Significant predictors of bacteremia were the use of fat emulsion, birth weight < 700 g, and a gestational age within 27 weeks. Full article

A novel facultatively anaerobic, Gram-negative, curved rod-shaped bacterium was isolated from blood cultures obtained from a patient with pyogenic spondylitis in Japan. The organism was additionally detected by 16S rRNA gene sequence analysis in a formalin-fixed, paraffin-embedded lumbar spine biopsy specimen from the same patient. The type strain, designated THUN1379ᵀ, is motile by means of a single polar flagellum and forms circular, white to translucent colonies on R2A agar and 5% sheep blood agar. The strain is oxidase-positive and catalase-negative and grows at temperatures ranging from 25 to 42 °C. Phylogenetic analysis based on the 16S rRNA gene sequence placed strain THUN1379ᵀ within the genus Paludibacterium (family Chromobacteriaceae), showing the highest sequence similarity to Paludibacterium purpuratum KJ031ᵀ (98.6%). Whole-genome sequencing revealed a genome size of approximately 3.6 Mb with a DNA G+C content of 61.3 mol%. Phylogenomic analysis based on whole-genome sequences supported the distinct taxonomic position of strain THUN1379ᵀ within the genus. The average nucleotide identity (ANI) and digital DNA-DNA hybridization (dDDH) values between strain THUN1379ᵀ and Paludibacterium purpuratum KJ031ᵀ were 79.7% and 23.1%, respectively, which are well below the accepted thresholds for species delineation. On the basis of phenotypic, chemotaxonomic, and genomic characteristics, strain THUN1379ᵀ represents a novel species of the genus Paludibacterium, for which the name Paludibacterium flexuosum sp. nov. is proposed. The type strain is THUN1379ᵀ (=JCM 36560ᵀ = KCTC 8465ᵀ). Full article

Blood culture is the diagnostic gold standard for bacteremia in the emergency department (ED), but its turnaround time can delay appropriate antimicrobial therapy, highlighting the need for rapid, accessible biomarkers. We retrospectively analyzed adult ED patients from July 2023 to June 2024 who underwent blood culture testing and had complete data for monocyte distribution width (MDW), white blood cell count (WBC), C-reactive protein (CRP), and neutrophil-to-lymphocyte ratio (NLR). Discrimination was assessed using area under the receiver operating characteristic curve (AUROC) and diagnostic accuracy using sensitivity, specificity, and diagnostic odds ratio (DOR); combined models were compared with net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Among 19,325 patients, 2011 (10.4%) had positive blood cultures. MDW had the highest AUROC (0.760) versus CRP (0.730), NLR (0.695), and WBC (0.642); at a cut-off of 22, MDW showed 0.72 sensitivity, 0.68 specificity, and DOR 5.46. The best combined model was MDW+NLR (AUROC 0.785; DOR 6.39; NRI 0.428; IDI 0.770). MDW is a rapid and effective marker for identifying bacteremia in the ED, and performance improves when combined with NLR. Full article

Background/Objectives: Septic arthritis of native joints is an orthopedic emergency in which rapid discrimination from non-infectious arthritis is crucial. Because cartilage damage can occur within hours, urgent irrigation and debridement are often pursued on an emergency basis (ideally within the first 6–8 h) of presentation, underscoring the need for rapidly available biomarkers. The delta neutrophil index (DNI) quantifies circulating immature granulocytes and may complement conventional inflammatory biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell count (WBC), and procalcitonin (PCT). We evaluated the diagnostic performance of DNI for native-joint septic arthritis against both microbiologic and clinical reference standards. Methods: We retrospectively analyzed 85 adults who underwent surgical irrigation and debridement for suspected native joint septic arthritis at a tertiary center. Serum CRP, ESR, WBC, DNI, and PCT (available in 67 patients) were recorded together with synovial leukocyte counts. Infection status was defined using either positive synovial culture (microbiologic reference) or clinical adjudication according to the Guideline for management of septic arthritis in native joints (SANJO). Diagnostic performance was assessed using receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC); exploratory cut-offs were identified by the Youden index, and pairwise AUCs were compared using DeLong’s test. Results: Synovial leukocyte analysis was highly sensitive but poorly specific (sensitivity 92.9%, specificity 10.3%). Against culture, DNI showed the highest discrimination (AUC = 0.914), exceeding CRP (0.687), ESR (0.643), WBC (0.648), and PCT (0.697); DeLong ΔAUC vs. CRP 0.227 (p < 0.001), ESR 0.270 (p < 0.001), WBC 0.266 (p < 0.001), PCT 0.227 (p = 0.001). At pre-specified cut-offs, DNI showed the most balanced sensitivity/specificity (94.3%/84.0%), corresponding to a negative predictive value (NPV) of 95.5% (42/44) and a positive predictive value (PPV) of 80.5% (33/41) against culture in this cohort. Against clinical infection, DNI outperformed others (AUC:0.921; ΔAUC vs. CRP = 0.204, ESR = 0.343, WBC = 0.244, PCT = 0.295; all p < 0.001). As a rule-in threshold, DNI ≥ 0.6 yielded a specificity of 100% with a sensitivity of 73.2%. In culture-negative patients (infected n = 21, uninfected n = 29), DNI remained discriminatory (AUC 0.80, p < 0.001), whereas other biomarkers were not. Conclusions: DNI demonstrated superior diagnostic accuracy compared with conventional inflammatory biomarkers. As a rapid parameter available with the initial complete blood count, DNI may support early risk stratification and rule-in decisions within the first hours of presentation; however, it should be used as a supplementary indicator alongside synovial fluid analysis and clinical assessment rather than as a stand-alone diagnostic tool. Full article

The consumption of ultra-processed foods (UPFs) in adolescence is high due to their widespread availability and accessibility and has been linked to increased cardiometabolic risk. In the Autonomous City of Melilla, an environment with particular cultural and religious characteristics, it is relevant to analyze the relationship of UPFs with metabolic markers of type 2 diabetes mellitus. This is a cross-sectional pilot study on 31 Muslim adolescents aged 15 to 17 years. The NOVA food classification was used to identify UPFs. The final sample comprised Muslim adolescents because written consent for venous blood sampling was obtained only from Muslim families/legal guardians. Separate multiple linear regression models adjusted for sex were fitted to examine the associations between UPF intake (%E/day) and each cardiometabolic and inflammatory marker. Higher UPF intake was positively associated with BMI, body fat percentage, waist circumference, waist-to-height indicator (ICA), and fasting glucose after controlling for the false discovery rate (q < 0.05). Regarding the inflammatory component, Muslim girls had elevated levels of IL-7, IL-10, and IL-13, and Muslim boys had higher levels of MIP-1β. In addition, IL-8 correlated positively with waist circumference, BMI, and the HDL/LDL ratio, while MCP-1 was negatively associated with Apo A1, total cholesterol, and HDL. In this exploratory pilot study, higher intake of UPF appears to be associated with greater central adiposity and higher fasting glucose; these hypothesis-generating findings warrant confirmation in larger, representative samples and may inform culturally adapted nutritional screening in Melilla. Full article

Background: Sepsis remains a leading cause of morbidity and mortality, particularly when caused by multidrug-resistant organisms (MDROs). Early identification of colonising or infecting pathogens may inform initial antimicrobial selection. Surveillance cultures, providing microbiological data prior to infection onset, could guide timely and targeted therapy. This retrospective study analysed routine surveillance culture results from patients with bloodstream infection (BSI) episodes, assessing pathogen prevalence, resistance phenotypes, and concordance with specimen type in haemato-oncology (HO) and acute care (AC) settings. Methods: Data were retrieved from the institutional Laboratory Information System of the Department of Clinical Microbiology and ATB Centre, General University Hospital in Prague, covering 1 January to 31 December 2024. All positive blood cultures containing ESCAPE pathogens (excluding Clostridioides difficile) were reviewed. Corresponding surveillance culture records were analysed to evaluate concordance with subsequent BSI episodes. Results: In 2024, 6046 AC and 7267 HO surveillance cultures were performed; MDRO prevalence was 5% and 6.56%, respectively. ESBL-producing Enterobacterales predominated (AC 86.9%, HO 81.6%). In HO, BSI-causing Gram-negative and Gram-positive pathogens were frequently detected in rectal swabs, whereas in AC, concordance was higher with upper and lower respiratory tract samples. Rectal screening detected 100% of E. coli and K. pneumoniae BSI episodes in HO. Other specimen types showed limited concordance. Conclusions: Surveillance culture utility varies by specimen type and clinical setting. In both HO and AC units, these cultures provided valuable insights into colonisation and resistance patterns, supporting early risk stratification and guiding initial therapy in high-risk patients. Full article

A 74-year-old man with type 2 diabetes presented with fever, urinary retention, and urinary difficulties. Initial abdominal Computed Tomography (CT) suggested acute pyelonephritis, but a low-density area in the prostate was overlooked. Following the confirmation of methicillin-resistant Staphylococcus aureus (MRSA) in blood and urine cultures, comprehensive screening for metastatic abscesses was necessitated. Diffusion-weighted whole-body imaging with background suppression (DWIBS) was utilized and clearly identified a prostatic abscess (PA), nephritis, urethritis, and subcutaneous cysts. These findings also raised suspicion of pyogenic vertebral osteomyelitis. Crucially, the PA, urethritis, subcutaneous cysts, and potentially the vertebral osteomyelitis were either overlooked or not detected by initial CT imaging. DWIBS allows for simultaneous whole-body screening and serves as a useful adjunctive tool for identifying minute abscesses, which may assist in detecting inflammatory foci that are sometimes overlooked by conventional imaging. Unlike CT, DWIBS avoids radiation and contrast agents, and is significantly more cost-effective than positron emission tomography-CT (PET-CT). DWIBS can thus serve as a useful, non-invasive tool for the early detection and exclusion of abscesses in other organs when metastatic abscess formation is suspected or cultures are positive for microorganisms causing metastatic abscesses. Full article

The Emergency Department (ED) represents an ideal location for antimicrobial stewardship (AMS) intervention, given the large volume of antibiotics seen prescribed to a wide variety of patients. This is particularly true in paediatrics, where most infectious presentations are viral in nature. A recent European Society of Clinical Microbiology and Infectious Diseases (ESCMID) position paper addressed four key areas affecting adult ED. This included: (1) the utility of biomarkers or rapid pathogen tests, (2) the impact of blood cultures on antibiotic prescribing, (3) the effect of watchful waiting on clinical outcomes, and (4) the potential for structured follow-up programmes within the ED to impact prescribing. Comparatively, the paediatric ED remains underrepresented in the literature with regard to AMS interventions. In this review article, we review the evidence surrounding the above four key areas as they relate to the paediatric population. Full article

Background/Objectives: Edwardsiella tarda is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. Case presentation: We report a term neonate born via spontaneous vaginal delivery who developed systemic signs of infection within 18 h of life. Blood and cerebrospinal fluid (CSF) cultures grew Edwardsiella tarda. CSF analysis revealed severe meningoencephalitis. Maternal stool culture was also positive for E. tarda, suggesting vertical transmission. Despite initial systemic antibiotic therapy with ampicillin, gentamicin, and ceftriaxone, neuroimaging revealed progressive multifocal brain abscesses. The infant underwent a series of neurosurgical procedures, including bilateral drainage of abscesses, Rickham reservoir placement and ventriculoperitoneal shunting. A revised antibiotic regimen, including systemic meropenem and trimethoprim-sulfamethoxazole plus intrathecal gentamicin, was administered. At six months, the infant showed mild motor delay with lower limb hypertonia and was under close neurosurgical and developmental follow-up. Methods: We conducted a literature review of 12 published neonatal E. tarda infections, including our case. Results: Most infected infants presented within 72 h of life and exhibited CNS involvement. Mortality was 25%, and 44% of survivors experienced long-term neurologic sequelae. Conclusions: Edwardsiella tarda infection in neonates is rare but potentially devastating. Early suspicion, culture confirmation, aggressive antibiotic therapy, and multidisciplinary care, including neurosurgical management, are essential for improving outcomes. Full article

Blood culture remains the gold standard for identifying bloodstream infections caused by bacteria and fungi. Isolation of the culprit microorganism onto agar plates also facilitates antimicrobial susceptibility testing. The purpose of this study was to determine the contamination rates, pathogen profile, and antimicrobial resistance in a secondary healthcare setting in a two-year timeframe. In this study, data regarding blood cultures of the years 2023 and 2024 were retrospectively analyzed to address the above questions. Blood cultures were incubated for seven days before being discarded as negative. The percentage of positive blood cultures for both years was 14.3%. Most positive cultures contained Gram-positive cocci, with a prevalence of coagulase-negative Staphylococci. In descending order, 72.72% were coagulase-negative Staphylococci, 15.15% were Staphylococcus aureus, and 12.12% were Streptococci. One strain of S. aureus was methicillin-resistant (MRSA), and one strain of Enterococcus faecium was vancomycin-resistant (VRE). Of the Gram-negative rods, 78.3% were Enterobacterales. Of these, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were the top pathogens. The remainder comprised eight strains of Pseudomonas aeruginosa, four strains of Acinetobacter baumannii (one pandrug-resistant), three strains of Stenotrophomonas maltophilia, one strain of Sphingomonas paucimobilis, and one strain of Campylobacter jejuni. The isolated fungi comprised Candida parapsilosis, Candida glabrata, and Candida tropicalis. Of the isolated Escherichia coli strains, 39.5% were resistant to ciprofloxacin regardless of origin (outpatient or hospitalized patients). Outpatient samples were taken in a Hemodialysis Unit that collaborates with our laboratory, obtained from patients with fever or other signs of infection. Distinguishing true bacteremia from contamination remains challenging. The contamination rate in our study was quite high at 5.3%. Since there is no dedicated phlebotomy team in our healthcare setting, in light of our results, educational courses have been conducted to demonstrate the best practices for sample collection. Full article

Background/Objectives: This study aimed to determine the antimicrobial susceptibility patterns of multidrug resistant (MDR) and extensively resistant (XDR) Salmonella enterica serovar Typhi (S. Typhi) strains among children, along with the associated behavioral and environmental risk factors across different population groups in multiple districts of Punjab, Pakistan. Methods: A cross-sectional study was conducted across 20 districts in Punjab, Pakistan. Structured questionnaires were used to assess sociodemographic and behavioral determinants. Blood cultures from febrile children were obtained for the isolation and identification of S. Typhi, followed by antimicrobial susceptibility testing and screening for the resistance genes. Results: A total of 900 blood samples were collected and 41.5% were positive for S. Typhi. The proportion of culture-positive cases were higher among children aged 6–12 years (34.8%). Sociodemographic and behavioral analysis revealed that children from low-income households (PKR < 20,000 showed significantly higher infection rate (67.1%, p < 0.001). Antimicrobial susceptibility testing revealed high resistance rates against several antibiotics: Ciprofloxacin (88.8%), Trimethoprim/sulfamethoxazole (83.7%), Ampicillin (73.8%) and Chloramphenicol (72.7%). However, all isolates remained susceptible to carbapenems and azithromycin. The prevalence of MDR and XDR S. Typhi in urban areas was 28.1% and 60.8%, respectively, while rural areas showed 22.6% MDR and 20.6% XDR. In contrast, nomadic populations exhibited a higher rate of MDR (49.3%) but a lower XDR prevalence of 18.6% with significant geographic variations in resistance patterns. Molecular analysis revealed a high prevalence of resistance genes, including sul1 (83.7%), sul2 (79.7%), followed by dfrA7 (81.3%), catA1 (64.9%) and bla_TEM (60.5%), bla_CTX-M-1 (12.5%), bla_CTX-M-15 (25.9%) and qnrS (88.8%), respectively. Conclusions: The study underscores a persistent typhoid burden and widespread antimicrobial resistance among children in Punjab. Targeted vaccination, antibiotic stewardship, public health education are urgently needed, especially among the nomadic population, where healthcare access and hygiene awareness are limited. Full article

Background/Objectives: Listeria monocytogenes (Lm) is an extremely rare cause of brain abscesses, accounting for 1–10% of neurolisteriosis cases reported in the literature, associated with high mortality (approximately 23%). Data on diagnosis, management, and treatment is scarce. We report a case of listerial brain abscesses in an elderly patient in Italy who experienced progressively worsening bilateral ptosis. Methods: Diagnostic evaluation included neuroimaging, blood cultures, and microbiological investigations, followed by antimicrobial treatment according to available evidence. The isolated Lm strain underwent whole genome sequencing. Dietary history was also collected. Results: Positive early blood cultures were pivotal in identifying Lm as the aetiological agent. Neuroimaging revealed brain abscesses consistent with neurolisteriosis. The clinical course was complicated by pneumonia and opportunistic co-infecting pathogens, and despite adequate treatment according to the available literature, the outcome was fatal. Genomic characterisation revealed that the patient was infected with an strain belonged to the sequence type 206 and clonal complex 14, described as hypervirulent. The patient reported consuming several foods known to be associated with an increased risk of listeriosis. Conclusions: This case highlights the challenges involved in diagnosing and managing listerial brain abscesses, particularly in elderly patients. Even when the primary central nervous system infection is under control, the prognosis may be significantly impacted by comorbid conditions and hospital-related complications rather than the infection itself. Our findings underscore the need for improved preventive strategies and targeted risk communication regarding high-risk foods, particularly among elderly populations. Full article

Aim: To explore the association between urinary stone cultures and infectious complications following PCNL. Materials and Methods: An observational case–control study was conducted in patients undergoing PCNL. The assessment included demographic parameters, medical history, urinalysis, and urine culture and blood testing. Pre-operatively, urinary stone samples were collected for cultures. Post-operatively, patients were observed for infectious complications such as fever and/or SIRS. Patients were divided into two groups based on the presence or absence of infected renal calculi. Patient characteristics, stone factors, and intra-operative and post-operative findings were studied in relation to stone culture. Descriptive statistics was used to present the data and the SPSS software was used for analysis. Results: From December 2023 to March 2025, a total of 126 patients were included in the study. A total of 16 patients (12.6%) had a positive stone culture. Statistical significance was found upon the comparison of stone culture with gender (p = 0.046), chronic kidney disease (p = 0.002), pre-operative urine culture (p = 0.001), pre-operative haemoglobin (g/dL) (<0.001), pre-operative S. creatinine (mg/dL) (p = 0.038), stone volume (mm³) (p = 0.012), CROES score (p = 0.023), SIRS (p = 0.001), and AKI (p = 0.021). Conclusions: Infected renal calculi identified by positive stone cultures were strongly associated with infective complications such as fever and SIRS following PCNL. E. Coli was the dominant bacteria present in both bladder urine and renal stone culture. The occurrence of infectious complications despite the administration of pre-operative antibiotics highlights the antibiotic resistance patterns noted among the cultured bacteria. The pre-operative factors identified to be associated with a positive stone culture could potentially be used for predicting infected stones, thereby improving outcomes. Full article

Purpose: Candida bloodstream infections remain a major global health challenge, with mortality rates approaching 40%. Beyond classical immunocompromised status, recent evidence highlights additional risk factors, including iatrogenic immunosuppression, advanced age, prolonged hospitalization, exposure to broad-spectrum antibiotics, and total parenteral nutrition. While Candida albicans (C. albicans) remains the most common species in Europe and the USA, non-albicans species, particularly Nakaseomyces glabratus (N. glabratus), Candida tropicalis (C. tropicalis), and Candida parapsilosis (C. parapsilosis), are emerging worldwide. Methods: This retrospective observational cohort study was conducted at the University Hospital “San Giovanni di Dio e Ruggi d’Aragona” in Salerno, Italy, from January 2015 to December 2024. It included all patients with at least one positive blood culture for Candida species. Demographic data, hospital ward of admission, and antifungal susceptibility profiles were collected and analyzed using SPSS software (IBM SPSS Statistics for Mac, version 30 (IBM Corp., Armonk, NY, USA)). Results: The incidence rate is 48.7 new isolates per one thousand patient-days, with a trend of increasing episodes over time among a total of 364 patients. Most cases occurred in medical wards (59.5%), where patients were older (median age 76 (17). C. albicans accounted for 57.9% of isolates, and a significant association was found between species distribution and hospital unit (p < 0.05). Resistance to fluconazole, voriconazole, and amphotericin B increased among C. albicans, with similar trends in N. glabratus and C. parapsilosis. Conclusions: This large single-center cohort highlights both the persistent dominance of C. albicans and the worrisome rise in resistance among C. parapsilosis. Given the aging patient population and increasing antifungal resistance, local epidemiological data are crucial to guide empirical therapy. Our findings underscore the need for multidisciplinary antifungal stewardship programs to optimize personalized treatment strategies and contain the emergence of resistant strains. Full article

Background/Objectives: Rapid and accurate pathogen identification and antimicrobial susceptibility testing (AST) are critical for the proper management of patients with bloodstream infection (BSI). Real-time whole-genome sequencing (WGS) represents an attractive opportunity for exhaustive pathogen identification and antimicrobial susceptibility prediction (ASP). This feasibility study introduces BacT-Seq, a WGS-based prototype assay for the rapid and accurate identification of pathogens and the prediction of antimicrobial susceptibility from positive blood cultures using Oxford Nanopore Technologies (ONT) sequencing. Methods: A total of 200 positive blood culture samples from patients with a confirmed BSI were included in this study. DNA isolation from blood cultures was optimized prior to GridION (ONT) sequencing. Pathogen identification and several ASP methods were compared to conventional identification and phenotypic AST methods. Results: Most of the mono-microbial (89%) and poly-microbial (88%) samples were identified by BacT-Seq in less than 10 min of sequencing. While identification of poly-microbial samples remains challenging, identification of mono-microbial samples by sequencing was non-inferior to that of the conventional approach, even revealing an added value in terms of exhaustivity and/or taxonomic resolution. Machine-learning-based ASP models yielded 80% predictions in 2.5 h of sequencing. Their ability to predict resistance phenotypes varied with the microbial species evaluated, from 55/57 (96.5%) for Escherichia coli to 24/48 (50.0%) for Pseudomonas aeruginosa. Conclusions: This study demonstrates the feasibility of implementation of the BacT-Seq platform for the fast and accurate identification of pathogens from positive blood cultures. BacT-Seq performance of resistance predictions by bioinformatics tools is promising but requires further optimization and validation before clinical implementation. Full article