Search Results (194)

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: Hospital-acquired influenza remains a persistent threat that amplifies morbidity, mortality, length of stay, and operational strain, particularly among older and immunocompromised inpatients. The COVID-19 era reshaped control norms—normalizing N95 use during surges, ventilation improvements, and routine multiplex PCR—creating an opportunity to strengthen hospital outbreak management. Methods: We conducted a targeted narrative review of WHO/CDC/Infectious Diseases Society of America (IDSA) guidance and peer-reviewed studies (January 2015–August 2025), emphasizing adult inpatient care. This narrative review synthesizes recent evidence and discusses theoretical implications for practice, rather than establishing formal guidelines. Evidence was synthesized into pragmatic practice statements on detection, diagnostics, isolation/cohorting, antivirals, chemoprophylaxis, vaccination, surveillance, and communication. Results: Early recognition and test-based confirmation are pivotal. For inpatients, nucleic-acid amplification tests are preferred; negative antigen tests warrant PCR confirmation, and lower-respiratory specimens improve yield in severe disease. A practical outbreak threshold is ≥2 epidemiologically linked, laboratory-confirmed cases within 72 h on the same ward. Effective control may require immediate isolation or cohorting with dedicated staff, strict droplet/respiratory protection, and daily active surveillance. Early oseltamivir (≤48 h from onset or on admission) reduces mortality and length of stay; short-course post-exposure prophylaxis for exposed patients or staff lowers secondary attack rates. Integrated vaccination efforts for healthcare personnel and high-risk patients reinforce workforce resilience and reduce transmission. Conclusions: A standardized, clinician-led bundle—early molecular testing, do-not-delay antivirals, decisive cohorting and Personal protective equipment (PPE), targeted chemoprophylaxis, vaccination, and disciplined communication— could help curb transmission, protect vulnerable patients and staff, and preserve capacity. Hospitals should codify COVID-era layered controls for seasonal influenza and rehearse unit-level outbreak playbooks to accelerate response and recovery. These recommendations target clinicians and infection-prevention leaders in acute-care hospitals. Full article

Antimicrobial resistance (AMR) is a global health threat, increasing morbidity, mortality, and healthcare costs. Multi-drug resistant ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter cloacae) cause most hospital-acquired infections. Local data on their resistance profiles remain limited in low-income settings. This study assessed the prevalence and resistance patterns of ESKAPE pathogens isolated from clinical specimens at Rwanda Military Referral and Teaching Hospital. A descriptive cross-sectional study was conducted from June 2022 to January 2023. ESKAPE isolates were identified and tested for antimicrobial susceptibility using the BD Phoenix M50 System. Data on sample type, ward, and demographics were analyzed. Of 744 bacterial findings, 207 (30%) were ESKAPE isolates. After excluding duplicates and non-recovered isolates, 156 were identified as ESKAPE. K. pneumoniae was most common (41%), followed by S. aureus (27%), A. baumannii (13%), P. aeruginosa (11%), and E. cloacae (8%); no E. faecium was detected. Among Gram-negatives, 63% were resistant to third-generation cephalosporins and 32% to carbapenems, with A. baumannii showing highest resistance (85% and 75%). Methicillin-Resistance in Staphylococcus aureus (MRSA) was 7%. This first hospital-based study in Rwanda shows high cephalosporin and carbapenem resistance, highlighting the need to strengthen diagnostics and stewardship. Full article

Background: Patients with hematologic malignancies are highly vulnerable to Gram-negative bacterial bloodstream infections (GNB-BSIs) due to underlying disease-related immunosuppression, intensive chemotherapy, and repeated invasive interventions, rendering these infections a significant cause of morbidity and mortality in this population. This study aimed to evaluate the epidemiological, clinical, and microbiological features of GNB-BSIs in hospitalized patients with hematologic malignancies, and to compare clinical and microbiological factors between survivors and non-survivors. Methods: We conducted a retrospective cohort study in a tertiary university hospital hematology ward in Türkiye, including adult patients diagnosed with BSIs due to Gram-negative bacteria between January 2005 and December 2024. Demographic characteristics, microbiological profiles, antimicrobial resistance rates, and clinical outcomes were analyzed. We compared survivors and non-survivors to determine differences in clinical and microbiological characteristics. Results: A total of 321 patients with hematologic malignancies experienced 441 episodes of GNB-BSIs. The median age was 46 years, and 59% of them were male. The most frequently isolated pathogen was Escherichia coli (53.3%), followed by Klebsiella spp. (20.6%) and Pseudomonas spp. (7.5%). Extended-spectrum β-lactamase-producing/third-generation cephalosporin-resistant (ESBL/3GCR) and carbapenem-resistant isolates were observed in 21.1% and 13.3% of isolates, respectively. The overall mortality rate was 26.5%. ICU admission, multidrug resistance, and persistent bacteremia were observed more often among non-survivors. Additionally, prolonged fever duration (median 8 vs. 3 days, p < 0.0001), elevated CRP (p = 0.001), and higher procalcitonin levels (p = 0.046) were detected in non-survivors. Conclusions: In patients with hematologic malignancies, E. coli and Klebsiella spp. remain the predominant pathogens causing bloodstream infections, while persistent bacteremia, ESBL/3GCR, and carbapenem resistance are associated with higher mortality. Notably, carbapenem resistance showed a temporal increase over the study period, underscoring the need for continuous surveillance and timely adaptation of empirical treatment strategies. Full article

Introduction: Antimicrobial resistance constitutes one of the key challenges to public health. It is a particularly serious problem in the context of hospital-acquired infections (HAIs). By causing infections that are difficult to treat, multiple-drug-resistant bacteria in the hospital environment often require the use of toxic and costly drugs and prolonged hospital stays, and they result in long-term health consequences for patients, including a high risk of death. This study aimed to assess the epidemiological situation of antibiotic-resistant microorganisms in patients hospitalised at the University Teaching Hospital in Bialystok, Poland, between 2020 and 2023. Methods: Data from epidemiological reports covering 15 alert pathogens, including MRSA, VRE, KPC (+), and ESBL (+), were analysed. Their prevalence was assessed in three groups of wards: intensive care, surgical, and non-surgical. Infection and microbiological testing rates were referenced to the number of hospitalisations and patient-days. Results: A total of 6066 cases of infections caused by resistant microorganisms were identified. The most frequently isolated pathogen was Enterococcus faecium VRE, peaking in 2022 (11.43 per 1000 patients). A marked increase in Klebsiella spp. KPC (+) and Enterobacter spp. ESBL (+) was observed, particularly in the 2021–2022 period. Intensive care units showed the highest infection rate (30–36 per 1000 patient-days). In the 2022–2023 period, infections detected within <72 h of admission predominated, which may indicate prior patient colonisation or intensified screening. Conclusions: The rise in infections caused by antibiotic-resistant bacteria requires a high level of microbiological surveillance to be maintained, especially in intensive care units, and preventive measures at hospital admission to be strengthened. Full article

Acinetobacter baumannii is a multidrug-resistant opportunistic pathogen that poses critical challenges in hospital settings due to its environmental resilience and high resistance to antibiotics. Genomic surveillance has become essential for identifying transmission patterns, guiding antimicrobial stewardship, and informing infection control policies. We conducted whole-genome sequencing on 44 A. baumannii isolates collected between 2022 and 2023 from diverse wards in an Italian hospital. Illumina-based sequencing was followed by a comprehensive bioinformatics pipeline, including genome assembly, taxonomic validation, MLST, SNP-based phylogeny, pan-genome analysis, antimicrobial resistance (AMR) gene profiling, and virulence factor prediction. Most isolates were classified as ST2; SAMPLE-34 was ST1 and genetically distinct. Phylogenetic analysis revealed four clonal clusters with cluster-specific AMR and accessory gene content. The pan-genome included 5050 genes, with notable variation linked to hospital ward origin. ICU and internal medicine strains carried higher loads of AMR genes, especially against aminoglycosides, β-lactams, and quinolones. Virulence profiling highlighted widespread immune evasion mechanisms; “Acenovactin” was predominant, while some isolates lacked key adhesion or toxin factors. Our findings underscore the clinical relevance of integrating genomic epidemiology into routine hospital surveillance. Identifying clonal clusters and resistance signatures supports real-time outbreak detection, risk stratification, and targeted infection prevention strategies. Full article

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) threatens Intensive Care Units (ICU), particularly in settings where serine (KPC) and metallo-β-lactamases (NDM) co-circulate. The aim of this study was to assess CRKP susceptibility especially to novel β-lactam/β-lactamase inhibitor combinations, characterize the genetic determinants of resistance, and contribute to the understanding of local epidemiology in the ICU of our hospital. Methods: We studied 32 non-duplicate CRKP isolates (30 ICU, 2 wards) collected at Hippokration General Hospital, Thessaloniki (May–Oct 2023). Bacterial identification and Antimicrobial susceptibility testing (AST) were performed by VITEK-2; Minimum inhibitory concentrations (MICs) for ceftazidime/avibactam (CAZ/AVI), meropenem/vaborbactam (MER/VAB), and imipenem/relebactam (IMI/REL) were determined by E-tests. Colistin MICs were performed by broth microdilution. Carbapenemases were screened phenotypically and by immunochromatography and confirmed by multiplex PCR. One bronchial isolate co-harboring bla_NDM and bla_KPC genes underwent WGS. Results: All isolates were carbapenem-resistant and showed extensive resistance to β-lactams and fluoroquinolones. By PCR, 8/32 (25%) carried bla_KPC alone, 8/32 (25.0%) bla_NDM alone, and 16/32 (50%) co-harbored bla_KPC and bla_NDM. KPC-only isolates were generally susceptible in vitro to CAZ/AVI, MER/VAB, and IMI/REL, whereas dual KPC-NDM producers were resistant to all three combinations. Tigecycline showed the highest retained activity; colistin remained active in a minority. WGS of one ST512 (CG258) isolate revealed co-harboring bla_NDM-1 and bla_KPC-3 with additional resistance determinants and plasmid replicons, consistent with high-risk spread. Conclusions: Half of CRKP isolates in this ICU-predominant series co-produced KPC and NDM, severely limiting β-lactam/β-lactamase inhibitor options. These data support routine screening for carbapenemases, strict infection prevention, antimicrobial stewardship, and access to agents active against MBLs. Full article

Background/Objectives: Modern healthcare faces a growing burden of antimicrobial resistance, prominently driven by ESKAPE pathogens. These organisms—Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.—are the leading causes of healthcare-associated infections, associated with limited therapeutic options and increased morbidity. Continuous surveillance is crucial for informing empirical therapy and guiding stewardship. Methods: We perform a single-center, seven-year retrospective study (2018–2024) at a 1000-bed tertiary hospital in Warsaw, Poland. Bloodstream isolates of ESKAPE pathogens were identified according to the EUCAST guidelines. Data were analyzed by pathogen, ward, and year of isolation. Results: From 2483 positive blood cultures, 3724 ESKAPE pathogens were recovered. S. aureus and K. pneumoniae predominated, particularly in the Intensive Care Unit and Hematology ward. Resistance analysis revealed persistently high vancomycin resistance in E. faecium, variable but notable methicillin resistance in S. aureus, and frequent ESBL production in K. pneumoniae with an alarming rise in carbapenemase-producing strains, including dual NDM + OXA-48 co-producers. A. baumannii exhibited near-universal multidrug resistance. P. aeruginosa demonstrated lower resistance rates with preserved colistin susceptibility, while Enterobacter spp. remained fully carbapenem-susceptible. Linezolid retained activity against E. faecium, while colistin remained effective against A. baumannii and P. aeruginosa. Modern β-lactam/β-lactamase inhibitor combinations were active against K. pneumoniae. Conclusions: Our findings underscore the critical role of ESKAPE pathogens in bloodstream infections and highlight divergent resistance patterns across species. The emergence of carbapenemase-producing K. pneumoniae and the persistence of multidrug-resistant A. baumannii are of particular concern. Sustained surveillance, robust antimicrobial stewardship, and tailored infection control strategies remained essential to curb the evolving resistance threat in tertiary care settings. Full article

Pylephlebitis is the suppurative thrombosis of the portal vein system. Mainly reported as a severe complication of diverticulitis or appendicitis, it is an uncommon intra-abdominal infection: approximately 200 cases have been reported in the English literature, mostly from surgical wards. Our study aims to assess the role of an infectious disease setting in managing pylephlebitis. We reviewed medical records from 2001 to 2024 at a tertiary infectious diseases hospital and identified 15 cases. The median age was 58 years [IQR = 28], with a male-to-female ratio of 4:1. Along with portal vein thrombosis (PVT), liver abscess(es) was/were the main radiological finding (n = 12), representing 80% of cases. The liver abscesses appear as secondary events in the case of pylephlebitis. In seven of 15 cases, we found the primary event associated with pylephlebitis. Blood cultures were positive in eight cases, with Gram-negative aerobic bacteria being commonly isolated (n = 5), followed by anaerobes (n = 3); in half of the cases, more than one pathogen was involved. All patients received broad-spectrum antibiotics containing beta-lactams, including eight who received carbapenems. Anticoagulation therapy was used in 14 cases. Two deaths were recorded, and four patients required surgical intervention, highlighting the importance of prompt diagnosis and swift antibiotic and anticoagulant treatment. Full article

Background: The COVID-19 pandemic disrupted pediatric healthcare systems globally, altering infection dynamics, hospital admissions, and antimicrobial practices. This study aimed to evaluate temporal shifts in patient demographics, clinical aspects, and microbial pathogen profiles in a tertiary pediatric hospital in Western Romania, spanning pre-pandemic (2019), pandemic (2021), and post-pandemic (2023) periods. Methods: A retrospective observational study was conducted at the “Louis Țurcanu” Emergency Children’s Hospital, Timișoara. Pediatric patients (<18 years) with laboratory-confirmed bacterial infections were included. Data on demographics, hospital wards, sample types, and pathogen distribution were analyzed using Χ² tests, incidence rate ratios (IRR), and non-parametric statistical methods. Results: A total of 3530 patients and 6885 samples were analyzed. Pediatric admissions declined by nearly 50% during the pandemic. The Outpatient and Emergency department observed a decrease in cases, while the ICU and surgical ward cases increased proportionally. Nasal and pharyngeal samples declined during the pandemic, while catheter, blood, and conjunctival samples rose. The study identified a significant shift in pathogen prevalence, with Escherichia coli and Staphylococcus aureus as the most frequent isolates. ICU patients showed increased rates of Pseudomonas aeruginosa, Candida albicans, and Klebsiella pneumoniae. Group A Streptococcus resurged post-pandemic after a decline in 2021. Conclusions: The pandemic significantly impacted pediatric infection profiles, hospital service utilization, and sample collection patterns. Strengthening infection surveillance, ensuring consistent reporting standards, and adapting pediatric care to future crises are critical for improving child health outcomes. Full article

Healthcare professionals (HCPs) working in paediatric settings are routinely exposed to respiratory pathogens, increasing their risk of asymptomatic colonisation by meningitis-associated bacteria. This study is the first to assess oropharyngeal and nasopharyngeal carriage of major bacterial meningitis pathogens among paediatric HCPs in Benin, and to identify associated risk factors. A cross-sectional analytical study was conducted in nine hospitals between 1 September 2023 and 30 September 2024. Data collection involved a structured questionnaire and paired oropharyngeal and nasopharyngeal swabs. Culture-based identification and antimicrobial susceptibility testing were performed according to CA-SFM guidelines. By culture method, Streptococcus pneumoniae was the most frequently isolated pathogen, mainly from oropharyngeal samples (47.5%). Most of these strains exhibited multidrug resistance. In nasopharyngeal samples analysed by real-time PCR, detection rates for S. pneumoniae were markedly higher (24.4%) compared to culture (5.0%), highlighting the limited sensitivity of conventional methods in detecting asymptomatic carriage. Pneumococcal colonisation was significantly associated with recent respiratory tract infections, and residence in high-risk areas (p < 0.05). These findings underscore the need for enhanced molecular surveillance, along with strengthened infection control measures and targeted vaccination strategies, to mitigate the risk of horizontal transmission in paediatric wards. Full article

The recent increase in the number of rare yeasts isolated from clinical specimens is a cause for concern, requiring accurate identification of these yeasts and assessment of their antifungal susceptibility to guide treatment. In this regard, we identified 196 rare yeasts isolated from various clinical specimens, mostly urine and respiratory tract specimens of patients hospitalized in intensive care unit and wards, using MALDI-TOF MS, and assessed their susceptibility to amphotericin B, fluconazole, voriconazole, posaconazole, itraconazole, isavuconazole and anidulafungin using the EUCAST broth microdilution method. Among the rare yeast species we isolated, Candida lusitaniae (13.8%) was the most common, followed by Magnusiomyces capitatus (13.3%), Candida fabianii (12.2%), and Trichosporon asahii (11.7%). Antifungal susceptibility testing revealed high echinocandin MIC values against Magnusiomyces spp., Trichosporon spp., and Rhodotorula mucilaginosa isolates. Similarly, we found high MIC values for fluconazole against the isolates of Magnusiomyces spp., T. asahii, R. mucilaginosa, and several Candida spp., including Candida guilliermondii, Candida pararugosa, Candida rugosa, Candida pelliculosa, Candida norvegensis, and Candida fabianii. We found similar MIC values across phylogenetically closely related species. In conclusion, prompt identification of rare yeasts and assessment of their antifungal susceptibilities are essential for effective treatment of the infections they cause. Full article

Background/Objectives: Infections after stroke are a serious medical problem and have a significant impact on the outcome of stroke, but data regarding the Asian population are limited. This study aims to determine the bacterial and fungal profile of pathogenic organisms of infections after acute ischemic stroke (AIS). Methods: This is a retrospective study using the medical records of patients at least 18 years old who were hospitalized with AIS in a tertiary stroke hospital from 1 January 2018 to 31 December 2022. Demographic, patient-related, and other examination data were extracted from hospital medical records. Infections after AIS were defined as any infection that developed during the acute phase of ischemic stroke and was confirmed by microbiologic culture as the gold standard. Factors associated with infection were analyzed using multiple logistic regression. Results: Among 599 AIS patients with infection who underwent microbiologic culture, the prevalence of infection with an isolated pathogen was 21.4%, and most organisms were from sputum. Positive microbiologic culture revealed that bacteria such as K. pneumoniae, E. coli, A. baumannii, and S. aureus were the most common causes of infection, while fungi were rare. During the COVID-19 period, bacteria developed resistance to antimicrobials, including β-lactamase antibiotics for Gram-negative bacteria and methicillin for Gram-positive bacteria. Care in the intensive ward, including the stroke unit, reduced the risk of a positive microbiological culture in the COVID-19 and non-COVID-19 period. Urinary catheters promoted infections in the non-COVID-19 period, whereas steroids, total parenteral nutrition, and tracheostomy were negatively associated with infections after AIS in the COVID-19 period. Conclusions: The prevalence and factors associated with infection after stroke changed during the COVID-19 period. The risk of infection after stroke requires preventive measures such as early dysphagia screening. Full article

Background/Objectives: Enterococci, particularly Enterococcus faecalis and Enterococcus faecium, are Gram-positive cocci that can cause severe infections in hospitalized patients. The rise of vancomycin-resistant enterococci (VRE) and vancomycin-variable enterococci (VVE) poses significant challenges in healthcare settings due to their resistance to multiple antibiotics. Methods: We conducted a point prevalence survey (PPS) to assess the prevalence of VRE and VVE colonization in hospitalized patients. Rectal swabs were collected from 160 patients and analyzed using molecular assays (MAs) and culture. Whole-genome sequencing (WGS) and core-genome multilocus sequence typing (cgMLST) were performed to identify the genetic diversity. Results: Of the 160 rectal swabs collected, 54 (33.7%) tested positive for the vanA and/or vanB genes. Culture-based methods identified 47 positive samples (29.3%); of these, 44 isolates were identified as E. faecium and 3 as E. faecalis. Based on the resistance profiles, 35 isolates (74.5%) were classified as VRE, while 12 (25.5%) were classified as VVE. WGS and cgMLST analyses identified seven clusters of E. faecium, with sequence type (ST) 80 being the most prevalent. Various resistance genes and virulence factors were identified, and this study also highlighted intra- and inter-ward transmission of VRE strains. Conclusions: Our findings underscore the potential for virulence and resistance of both the VRE and VVE strains, and they highlight the importance of effective infection control measures to prevent their spread. VVE in particular should be carefully monitored as they often escape detection. Integrating molecular data with clinical information will hopefully enhance our ability to predict and prevent future VRE infections. Full article

Objectives: Burkholderia cepacia complex (Bcc), a Gram-negative organism, is a well-recognized cause of hospital outbreaks, often linked to a contaminated shared source, such as multidose medications. In this study, we report an outbreak of Bcc infections in a tertiary care hospital, associated with the intrinsic contamination of a prepared solution used in interventional radiology (IR) procedures. Additionally, we provide a detailed explanation of the interventions implemented to control and interrupt the outbreak. Methods: Records from the infection control committee from 1 January 2023 to 31 October 2024 were screened to identify cases with Bcc growth in cultured blood, urine, or respiratory samples. Clinical and laboratory data were collected in March 2025. Bacterial identification was performed using conventional methods and MALDI-TOF (Bruker Daltonics, Bremen, Germany). Controls were matched to cases by ward, date of initial growth, and duration of hospitalization. Demographic and clinical data of these patients were systematically collected and analyzed. Microbiological cultures were obtained from environmental objects of concern and certain medications. Results: A total of 82 Burkholderia species were identified. We enrolled 77 cases and 77 matched controls. The source of contamination was identified in ready-to-use intravenous medications (remifentanil and magnesium preparations) in the IR department. These preparations were compounded in advance by the team and were used repeatedly. Although the outbreak originated from contaminated IV medications used in IR, secondary transmission likely affected 28 non-IR patients via fomites, shared environments, and possible lapses in isolation precautions. The mortality rate among the cases was 16.9%. Infection with Bcc was associated with prolonged intensive care unit stays (p = 0.018) and an extended overall hospitalization duration (p < 0.001); however, it was not associated with increased mortality. The enforcement of contact precautions and comprehensive environmental decontamination successfully reduced the incidence of the Bcc outbreak. No pathogens were detected in cultures obtained after the disinfection. Conclusions: The hospital transmission of Bcc is likely driven by cross-contamination, invasive medical procedures, and the administration of contaminated medications. Implementing stringent infection control measures such as staff retraining, updated policies on medication use, enhanced environmental decontamination, and strict adherence to isolation precautions has proven effective in curbing the spread of virulent and transmissible Bcc. Full article