Search Results (531)

Background/Objectives: Community-acquired pneumonia (CAP) is a leading cause of ICU admission and death in older adults, yet the severity scores used in this setting were not developed for, or validated in, older intensive care patients. We compared a pneumonia-specific score (SMART-COP) with the general ICU scores SOFA and APACHE II and with CURB-65 for predicting adverse outcomes in this population. Methods: In this single-center prospective observational study, 227 consecutive patients aged ≥65 years admitted to the ICU with CAP were enrolled. SMART-COP and CURB-65 were calculated at hospital admission and SOFA and APACHE II at ICU admission. The discrimination of each score for four outcomes—in-ICU mortality, need for intubation, vasopressor requirement, and hospital-acquired pneumonia (HAP)—was assessed by ROC analysis, and areas under the curve (AUCs) were compared pairwise using the DeLong test. Results: All four scores predicted mortality, intubation, and vasopressor requirement (all p ≤ 0.001), but none discriminated well for HAP (all AUCs < 0.70). SMART-COP had the highest AUCs for mortality (0.846) and intubation (0.870), significantly exceeding CURB-65 (both p < 0.01) while performing comparably to SOFA and APACHE II. SOFA was the strongest predictor of vasopressor requirement (AUC: 0.867). Conclusions: In older ICU patients with CAP, SMART-COP—calculable from routine parameters at admission—matched far more complex ICU scores for mortality and intubation and outperformed CURB-65. The optimal score depends on the outcome of interest. Full article

No previous sub-Saharan studies have compared patients with community-acquired pneumonia (CAP) and COVID-19 pneumonia, the focus of this study. Consecutive adult patients hospitalized with CAP (n = 59) or COVID-19 pneumonia (n = 74) were compared regarding multiple characteristics, including cardiac biomarkers. In multivariable logistic regression analysis, differences were noted among various clinical features. Troponin I concentrations (p = 0.00028) and the Troponin I/NT-pro BNP ratio (p = 0.00048) were significantly higher in COVID-19 compared with CAP. After adjustment for age, these differences remained significant (troponin I p = 0.0019; ratio p = 0.00054), while BNP concentrations were now higher in CAP (p = 0.009). PCA demonstrated that BNP and NT-pro BNP contributed most strongly to the dominant cardiac biomarker signature, suggesting shared cardiopulmonary stress across both diseases. Exploratory subgroup analyses suggested higher troponin I levels among people living with HIV and COVID-19, although interaction modelling did not demonstrate significant effect modification by HIV status. Both CAP and COVID-19 pneumonia were associated with evidence of cardiac stress; however, COVID-19 demonstrated a relatively stronger myocardial injury signature characterized by higher troponin I concentrations and an increased Troponin I/NT-pro BNP ratio while CAP had evidence of greater hemodynamic cardiac strain, as evidenced by the higher levels of BNP. The findings suggest that the mechanisms of cardiac involvement may differ between viral and bacterial respiratory infections. Full article

Mycoplasma pneumoniae pneumonia (MPP) is a leading cause of community-acquired pneumonia in children, yet little is known about the role of nasopharyngeal microbiota dysbiosis in susceptibility to infection and disease subtype. In this study, we performed 16S rRNA sequencing on nasopharyngeal samples from 102 pediatric MPP patients, 104 influenza A patients, and 103 healthy controls and compared the microbial diversity, composition, and functional profiles across groups. The MPP group exhibits an altered nasopharyngeal microbial composition, characterized by reduced microbial diversity and an increased relative abundance of genera including Mycoplasma, Pseudomonas, Acinetobacter, and Tannerella. Distinct microbiota profiles were identified for the MPP subtypes, with Mycoplasma more abundant in bronchopneumonia (BP) than in lobar pneumonia (LP). A microbial classifier based on the relative abundance of the nasopharyngeal microbiota was established to distinguish MPP patients from both influenza patients and healthy controls, with an area under the receiver operating characteristic curves of 0.978. Key microbial features associated with MPP included Mycoplasma, Mycobacterium, Aeromonas, and Acinetobacter. In addition, PICRUSt2-based functional predictions suggested alterations in amino acid metabolism and predicted functional pathways associated with bacterial infection and antimicrobial resistance in MPP patients. In conclusion, this study provides comprehensive insights into alterations in the nasopharyngeal microbiota in pediatric MPP. These findings highlight the potential role of dysbiosis in disease progression and suggest that changes in microbiota composition and functional profiles are associated with MPP infection. Full article

Background: Creating antibiograms solely for adults may overestimate resistance of antimicrobials for certain pathogens in children. The Canadian Paediatric Society comments that areas with no cephalosporin-resistant Streptococcus pneumoniae cases should consider ceftriaxone or cefotaxime monotherapy for meningitis, despite most experts recommending adding vancomycin. The present study created age-specific antibiograms using LifeLabs data to report incidences of resistant bacterial meningitis pathogens at the regional level to determine the need for duo-coverage. Methods: Data of common bacterial meningitis pathogen susceptibility was collected from 1 January 2023 to 31 December 2024, in the LifeLabs community laboratory on Vancouver Island. Results: Most Streptococcus pneumoniae isolates (78/83) were susceptible to ceftriaxone using the meningitis breakpoint; the remaining five isolates showed intermediate susceptibility to ceftriaxone. There was a significant difference when comparing S. pneumoniae susceptibility using penicillin-meningitis and penicillin-non-meningitis breakpoints (82% vs. 99%, respectively; p < 0.05). There was a significant difference between the three age groups (<18 years, 18–50 years, >50 years) when analyzing ciprofloxacin susceptibility of isolates [82% (n = 462), 77% (n = 2452), 75% (n = 8352), respectively, p < 0.05]. Conclusions: Ceftriaxone should remain the drug of choice for community-acquired bacterial meningitis and might be sufficient as a monotherapy for pneumococcal meningitis on Vancouver Island. The age-specific differences in E. coli susceptibilities to ciprofloxacin showed the importance of age-specific antibiograms. Full article

Background: Infectious diseases remain a leading cause of mortality in South Africa, compounded by a high HIV prevalence. This study aimed to delineate the spectrum and clinicopathological characteristics of fatal infectious diseases through a postmortem audit to inform clinical practice and public health strategy. Methods: A retrospective, cross-sectional descriptive study was conducted on all autopsies with a final cause of death attributed to infectious disease at a National Health Laboratory Service, in Northern Pretoria, Gauteng, South Africa, from 2012 to 2021. Using the Systematised Nomenclature of Medicine Clinical Terms (SNOMED) code and word search engines codes, 55 cases were identified. Data on demographics, clinical presentation, HIV status, antiretroviral therapy (ART), comorbidities, and final autopsy diagnosis were extracted from the laboratory information system. Histological confirmation was performed using standard stains. Descriptive statistical analysis was conducted using STATA-18. Results: The cohort (n = 55) had a median age of 31 years (IQR 19–45) and was predominantly female (67%). HIV prevalence was 35%, with 68% of those on ART. The leading cause of death was multilobar pneumonia (36%), followed by bronchopneumonia (22%). AIDS-defining illnesses were present in 27% of cases, with disseminated tuberculosis being the most common (46%). Septic shock was identified in 18% of decedents. A significant proportion (60%) of the cohort was HIV-negative. Conclusions: This autopsy series reveals a high burden of fatal community-acquired pneumonias and HIV-associated opportunistic infections, with a notable proportion of deaths occurring in HIV-negative individuals. The findings underscore diagnostic gaps and highlight the critical role of autopsy in accurate mortality surveillance, advocating for enhanced antemortem diagnostic protocols and targeted public health interventions. Full article

Background: Non-pharmaceutical interventions during the COVID-19 pandemic altered respiratory pathogen circulation, and a bacterial rebound followed once restrictions were lifted. We describe pediatric pneumococcal respiratory infections and their bacterial co-detections in the immediate post-pandemic period. Methods: We retrospectively analyzed respiratory specimens from children aged 0–18 years tested with a multiplex real-time PCR panel (Allplex Respiratory Panel, Seegene, Seoul, South Korea; seven bacterial pathogens) restricted to this predefined bacterial spectrum at a tertiary pediatric hospital in Galați, Romania, during 2022 and 2023. A total of 2546 panels were performed in 2022 and 3250 in 2023, allowing pneumococcal positivity rates to be calculated. Proportions are reported with Wilson 95% confidence intervals; associations were tested with Pearson chi-square and Fisher exact tests in SPSS v.23. Results: Children with detected Streptococcus pneumoniae rose from 100 to 415, corresponding to a rise in pneumococcal positivity from 3.9% (100/2546) to 12.8% (415/3250). Among the positive children, pneumococcus–Haemophilus influenzae co-detection increased from 33.0% to 45.1% (odds ratio 1.63, 95% CI 1.02–2.61; p = 0.029), while pneumococcus alone fell from 60.0% to 50.1%. Boys, urban residence, and early childhood predominated, and community-acquired pneumonia diagnoses rose from 61 to 214. No profile–demographic association reached significance (panel–residence 2023, p = 0.063). Conclusions: A post-pandemic rise in pediatric pneumococcal detections and increasing H. influenzae co-detection were observed, supporting syndromic multiplex PCR in rapid pediatric diagnostics and antimicrobial stewardship. Full article

Background/Objectives: Acute pulmonary embolism (PE) and hospitalization-requiring community-acquired pneumonia (CAP) may present with overlapping clinical, laboratory, and radiological features. Soluble CD40 ligand (sCD40L) is a platelet-derived thrombo-inflammatory mediator that may be influenced by both thrombotic and inflammatory processes. This study retrospectively compared on-admission serum sCD40L concentrations between selected hospitalized patients with established acute PE and selected patients with hospitalization-requiring CAP. Methods: This single-center retrospective exploratory comparative biomarker study included 82 hospitalized adults: 48 with computed tomography pulmonary angiography (CTPA)-confirmed acute PE and 34 with hospitalization-requiring CAP defined using CURB-65-supported admission criteria. Stored admission serum samples were used for sCD40L measurement. Between-group comparison was the primary analysis; receiver operating characteristic (ROC) analysis was performed as a secondary exploratory description of the apparent within-sample discriminatory signal. Results: sCD40L was higher in acute PE than in hospitalization-requiring CAP (median 821.3 vs. 629.0 pg/mL; p < 0.001). ROC analysis demonstrated a strong exploratory within-sample discriminatory signal (AUC 0.951, 95% CI 0.905–0.997). After excluding five patients with recorded antiplatelet or rivaroxaban exposure, the apparent signal remained similar (AUC 0.945; bootstrap 95% CI 0.891–0.984), and sCD40L remained associated with PE in a Firth-penalized model adjusted for platelet count and COPD (OR 3.39 per 50 pg/mL, 95% CI 2.00–7.71; p < 0.001). Conclusions: In this retrospective selected two-group comparison, on-admission serum sCD40L concentrations were higher in established acute PE than in hospitalization-requiring CAP. ROC-derived estimates should be interpreted only as apparent within-sample discrimination and not as a replacement for D-dimer, clinical probability assessment, or imaging-based PE diagnosis. Prospective validation in unselected suspected-PE cohorts is required before any diagnostic or clinical use can be considered. Full article

Streptococcus pneumoniae is a leading cause of community-acquired pneumonia, yet the immune mechanisms required for protection against invasive pulmonary infection remain inadequately understood. Using a murine model of homologous protection against invasive pneumococcal pneumonia, we explored the relative contributions of humoral and cellular immunity using adoptive serum transfer, immune cell depletion, and lung transcriptional profiling. Our findings indicated that passive transfer of immune serum provided robust protection, while neutrophil depletion significantly compromised bacterial control, highlighting that both antibodies and neutrophils are key mediators of protection. In contrast, depletion of CD4⁺ T cells or NK cells did not compromise survival. Although IL-17A has been widely implicated in host defense against pneumococcal infection, IL-17A-deficient mice remained protected, albeit with delayed clearance and reduced early antibody responses. We associate this delay with compensatory upregulation of IL-17F and increased expression of Th1-associated genes in the lungs. Together, these findings indicate that IL-17A is not essential for protection and support a model in which coordinated Th1- and Th17-related cytokine responses collectively promote neutrophil recruitment and effective antibody-mediated defense. These results highlight functional redundancy within the IL-17 cytokine axis and suggest that integrated cytokine networks, rather than individual mediators, underpin protective immunity to pneumococcal pneumonia, with implications for next-generation vaccine design. Full article

Background: Pneumonia is a common cause of hospitalization and a significant contributor to worldwide morbidity and mortality. Effective definitive antimicrobial therapy for pneumonia relies on accurate identification of bacterial pathogens and their resistance patterns. Therefore, this study aims to evaluate the distribution bacterial pathogens and their antimicrobial resistance patterns, as well as clinical factors associated with outcomes among hospitalized pneumonia patients. Methods: This retrospective cohort study was conducted at Dr. Hasan Sadikin General Hospital, Indonesia, and included adult patients hospitalized with pneumonia between January and December 2024. Clinical, demographic, microbiological, and outcome data were extracted from electronic medical records and the laboratory system. Bacterial distribution, antimicrobial patterns, and clinical outcomes were analyzed descriptively and compared across pneumonia types. Multivariable regression analyses were performed to identify factors associated with in-hospital mortality and length of hospital stay. Results: A total of 662 hospitalized pneumonia patients were included with Gram-negative bacteria (i.e., Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa) identified as the most common pathogens. Carbapenem-resistant Acinetobacter baumannii (CR-Ab) and Klebsiella pneumoniae (CR-Kp) were the most frequently identified resistant pathogens, particularly in hospital-acquired (HAP) and ventilator-associated pneumonia (VAP). HAP and VAP were independently associated with higher in-hospital mortality and longer hospital stay compared to community-acquired pneumonia (CAP). In addition, CR-Ab and difficult-to-treat Pseudomonas aeruginosa (DTR-Psa) were associated with prolonged hospitalization. Conclusions: Type of pneumonia, bacterial pathogens and resistance patterns were associated with in-hospital mortality and length of hospital stay. These findings highlight the importance of ongoing microbiological surveillance, antimicrobial stewardship, and infection prevention strategies to optimize pneumonia management and clinical outcomes. Full article

Background: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and represent a significant public health concern due to their high prevalence and increasing antimicrobial resistance. This study aimed to systematically review the epidemiology, uropathogens, and resistance patterns of UTIs in Portugal over the last decade. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. A literature search was performed in April 2026. A total of 425 records were identified. After removal of duplicates and preliminary exclusions, 121 records were screened by title and abstract. Following application of eligibility criteria, 41 full-text articles were assessed, of which 13 met the criteria for detailed eligibility assessment. Six studies met the inclusion criteria and were included in the final qualitative synthesis. Results: The included studies consistently reported a higher prevalence of UTIs in females and, in some cases, in older populations. Escherichia coli was identified as the predominant uropathogen across all studies, followed by Klebsiella pneumoniae, Proteus spp., and Enterococcus spp. A consistently high prevalence of antimicrobial resistance was observed, particularly against commonly used antibiotics such as ampicillin and trimethoprim–sulfamethoxazole. The presence of extended-spectrum β-lactamase (ESBL)-producing strains was also reported, especially in healthcare-associated infections, which exhibited higher resistance profiles compared to community-acquired infections. Conclusions: The available evidence suggests that UTIs in Portugal are predominantly caused by enterobacteria, particularly Escherichia coli. However, the limited number and heterogeneity of studies highlight the need for cautious interpretation. Further multicenter and methodologically robust studies are required to better characterize national epidemiological patterns and antimicrobial resistance trends. Full article

Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality globally, with serious implications in Lebanon. Both international and local guidelines advocate for empirical antibiotic treatments by illness severity, yet the extent to which these are followed in Lebanese hospitals is unclear. This research examined the adherence to CAP treatment guidelines and its association with clinical outcomes. Methods: We retrospectively studied adults admitted to two Lebanese referral hospitals (Mount Lebanon University Medical Center and Ain Wazein Medical Village) from April 2011 to March 2025 with CAP. Adherence to empirical antibiotic regimens was determined based on the guidelines from the Lebanese Society of Infectious Diseases and Clinical Microbiology, American Thoracic Society/Infectious Diseases Society of America, and British Thoracic Society/National Institute for Health and Care Excellence. The outcomes assessed were in-hospital mortality, Intensive Care Unit (ICU) admission, and length of hospital stay (LOS). We used logistic and linear regression analyses, adjusting for demographic and clinical variables. Results: A total of 337 patients were included with an average age of 61 years; 53.7% were male, 51.6% were admitted to the ICU, and the in-hospital mortality rate was 27%. In general, 65.6% of the treatment regimens adhered to at least one guideline. The combination of β-lactam and macrolide was the most common, used in 87.8% of cases, while monotherapy was administered in 31.8% of cases and included β-lactam, macrolide, fluoroquinolone, and other antibiotics; most monotherapies were non-adherent to guidelines, except for selected fluoroquinolone monotherapy cases that may be considered guideline-concordant under ATS/IDSA recommendations depending on clinical context. Adherence to guidelines did not significantly affect mortality rates (25.8% vs. 29.3%), ICU admissions (52.5% vs. 50.0%), or length of stay (11.4 vs. 9.3 days). Multivariate analysis revealed that older age (OR 1.025, 95% CI 1.008–1.042) and ICU admission (OR 1.024, 95% CI 1.012–1.039) were independent predictors of adverse outcomes, whereas guideline adherence, comorbidities, and inflammatory markers were not independently linked. Surprisingly, mortality was higher among younger patients (average age 58 vs. 67 years, p < 0.001). Conclusions: Although guideline-concordant empirical therapy was prevalent in this two-center Lebanese retrospective population, it did not independently correlate with length of stay following adjustment, ICU admission, or in-hospital mortality. Patient-related and clinical factors, such as the severity of the illness, may have an impact on observed differences in outcomes, which should be taken as relationships. Full article

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a significant pathogen for both hospital-acquired and community-acquired infections, characterized by its strong epidemic potential and high mortality rate, posing a severe threat to global public health. CRKP spreads widely across the globe through the horizontal transfer of plasmid-mediated resistance genes such as *blaKPC*, *blaNDM*, and *blaOXA-48*. The clinical treatment options for this bacterium are limited, and its resistance has been increasing year by year, urgently necessitating the development of new antimicrobial drugs or alternative strategies. In recent years, the CRISPR-Cas system has shown great potential in the diagnosis and treatment of CRKP, including rapid detection and identification, gene editing, antimicrobial strategies, and resistance inhibition. For instance, CRISPR-Cas12a/13a can be used for the rapid detection and identification of CRKP, while CRISPR-Cas9/Cas3 can target resistance genes to reverse the resistance of strains. With the advancement of delivery and biotechnologies, the CRISPR-Cas system is expected to become an important tool against drug-resistant CRKP. This review focuses on the application of the CRISPR-Cas system in the detection and treatment of CRKP, analyzing its technical advantages, limitations, and future development directions. Full article

Background/Objectives: Patients in long-term care hospitals (LTCHs) are at increased risk of harboring antimicrobial-resistant organisms due to frequent healthcare exposure and multiple comorbidities. This retrospective observational study aimed to compare the antimicrobial susceptibility of bacterial isolates from LTCH-onset infections (LTCHIs) with those from community-acquired infections (CAIs) in elderly patients. Methods: This study was conducted at a 700-bed urban tertiary university hospital and included patients aged ≥65 years with positive cultures for bacteremia, lower respiratory tract infections (LRTIs), or urinary tract infections (UTIs) within 48 h of admission. Medical records, including antimicrobial susceptibility test results, were reviewed for a total of 1780 patients and their isolates. Antimicrobial susceptibility patterns were compared between LTCHI and CAI patients. Results: Patients with LTCHI exhibited significantly higher antimicrobial non-susceptibility than those with CAIs across multiple pathogens and antimicrobial classes (p < 0.05). In bacteremia, Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae from LTCHI cases showed increased non-susceptibility to β-lactams and fluoroquinolones. In LRTIs, Pseudomonas aeruginosa and Acinetobacter baumannii demonstrated high non-susceptibility to carbapenems (52.9% and 90%, respectively) and aminoglycosides. In UTIs, LTCHI isolates exhibited broader resistance among Enterobacterales and P. aeruginosa. Notably, the proportion of multidrug-resistant organisms, including carbapenem-resistant Enterobacterales (15.4–50.0%) and carbapenem-resistant Acinetobacter baumannii (90.5%), was substantially higher in the LTCHI group across all infection sites. Conclusions: Elderly patients with LTCHI are more likely to harbor antimicrobial-resistant pathogens than those with CAIs. Careful consideration of LTCHI origin is therefore essential for empirical antibiotic selection and for strategies aimed at limiting further resistance. Full article

Pseudomonas fluorescens is a rare, environmental Gram-negative bacterium that has been rarely reported as a cause of respiratory tract infections. This paper presents a case of a 72-year-old male who developed community-acquired pneumonia due to P. fluorescens. The diagnosis was made by sputum culture and he responded to meropenem treatment. A literature search revealed three previously reported cases of P. fluorescens pneumonia. These cases primarily affected elderly male patients. All reported patients demonstrated positive clinical outcomes following appropriate antimicrobial therapy. This case highlights that although P. fluorescens is often considered a colonizer, it may act as a potential pathogen in selected clinical settings. Full article

Complicated community-acquired pneumonia (cCAP) remains a major cause of morbidity in children. Although pneumococcal conjugate vaccines (PCVs) have reduced invasive disease, severe complications such as empyema and lung abscess persist. A retrospective analysis was conducted on 69 children treated at the University Children’s Hospital Belgrade between 2019 and 2024. Data included demographic characteristics, pneumococcal vaccination status, and radiologically confirmed complications. Patients were classified by residence and vaccination status. Statistical analysis included chi-square (χ²) tests, odds ratios (ORs) with 95% confidence intervals, and multivariable logistic regression. Pleuropneumonia and pleural effusion were the most frequent complications, while empyema and lung abscess were the most severe. Both occurred significantly more often in unvaccinated children (p = 0.0054 and p = 0.0027). Multivariable analysis confirmed vaccination as an independent protective factor against empyema (adjusted OR = 0.19, 95% CI 0.06–0.61). No significant regional differences were observed after accounting for vaccination status. Vaccination showed a strong protective effect against empyema and lung abscess (OR = 0.24 and 0.04, respectively). Unvaccinated children had significantly longer hospital stays, indicating a more severe clinical course. Prolonged hospitalization was associated with intensified antibiotic therapy, reflecting underlying disease severity. Lack of pneumococcal vaccination is strongly associated with severe complications in children with cCAP. Maintaining high PCV coverage remains essential, alongside early recognition and timely management of pleural disease. Full article