搜索结果：Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy

Gram-positive anaerobic cocci (GPAC) account for 11-15% of anaerobic bacteremia. Parvimonas micra is one of the most commonly identified microorganisms in GPAC bacteremia. This study reviewed the clinical characteristics of P. micra bacteremia. We conducted a retrospective analysis of the records of 35 patients diagnosed with P. micra bacteremia at Hiroshima University Hospital between January 2011 and July 2024 and conducted a literature review, comparing our cases with previous reports. The median patient age was 70 years, and 74% (26/35) were male. All had immunosuppressive conditions such as solid organ malignancy (49%, 17/35) and diabetes mellitus (34%, 12/35). Of the patients evaluated by a dentist, 96% (22/23) had periodontitis. The most common source of P. micra bacteremia was intra-abdominal infections (31%, 11/35), followed by dental (20%, 7/35), lower respiratory tract (20%, 7/35), and skin and soft tissue infections (14%, 5/35). The prevalence of dental infections was higher than that reported previously, but the distribution of other sources of infection was comparable. Of the patients with P. micra bacteremia, 57% (20/35) had polymicrobial infections, with members of the Streptococcus anginosus group being the most frequently identified co-pathogens (45%, 9/20). The 30-day mortality rate was 26% (9/35). All P. micra isolates showed low minimum inhibitory concentrations for β-lactam antibiotics. Dental infection represented the second most frequent source of P. micra bacteremia, following intra-abdominal infection. In patients with P. micra bacteremia, clinicians should check for periodontitis and investigate the presence polymicrobial infections.

To evaluate the effect of booster vaccinations and prior infection on the symptoms of outpatients with mild cases of coronavirus disease (COVID-19). This retrospective, multicenter study was conducted across 15 Japanese medical institutions during the 2025 COVID-19 epidemic dominated by the NB.1.8.1 variant in Japan. Patients diagnosed with COVID-19 via rapid antigen testing between July 1 and September 30 were enrolled and given a questionnaire to collect the data for this analysis. The data of 375 patients was available for analysis: 40.9% were aged 40-59 years, 37.3% ≥ 60, 61.3% were female, and 47.2% had prior COVID-19. Of them, 6.4% had been vaccinated within the past twelve months, whereas 70.4% had received their last vaccination more than twenty-four months earlier. The maximum body temperature was significantly higher in patients last vaccinated more than twelve months before the current infection than in patients vaccinated within past twelve months (38.2-38.3 °C vs 37.8 °C, p = 0.02, respectively): this difference was also observed among patients without prior COVID-19 (multivariable regression analysis). Neither the number of vaccinations nor the interval since the last vaccination was significantly associated with a shorter duration of fever or symptoms. Among patients with prior COVID-19, fever duration was significantly shorter, and the frequencies of symptom persistence >7 and > 14 days were lower. Vaccination within the previous year was effective in reducing fever during the 2025 NB.1.8.1 variant dominant epidemic in Japan, particularly among patients without prior COVID-19.

Carbapenem-resistant Gram-negative bacteria represent a major global health threat, with Klebsiella pneumoniae carbapenemase (KPC) producers, such as Klebsiella variicola, being particularly concerning due to their association with poor clinical outcomes. Therefore, we aimed to characterize the genome and phenotype of clinical KPC-producing K. variicola isolates in Japan, where such strains are rare. We investigated three K. variicola isolates obtained from blood, urine, and stool samples from a patient with bloodstream infection. The isolates were assessed using antimicrobial susceptibility testing, DNA fingerprinting, whole-genome sequencing analysis, and conjugation assay. The three K. variicola isolates exhibited resistance or intermediate susceptibility to all β-lactam antibiotics, and DNA fingerprinting revealed identical banding profiles. The isolate from the blood sample harbored blaKPC-2 and blaCTX-M-15 on a hybrid IncP-6/IncR plasmid. Phylogenetic analysis revealed a close relationship between the clinical isolate and a K. variicola strain previously recovered from a sewage tank at the same hospital, despite differences in their antimicrobial resistance gene profiles. The IncP-6/IncR plasmid harbored multiple transposable elements. Additionally, the absence of conjugative transfer suggests that transposon-mediated horizontal gene transfer is the primary mechanism for resistance gene acquisition in the plasmid. This study highlights the emergence of carbapenemase-producing K. variicola in the clinical setting and its potential role as a reservoir for antimicrobial resistance genes. The identification of a novel blaKPC-2/blaCTX-M-15-carrying IncP-6/IncR hybrid plasmid underscores the need for continued surveillance in clinical and environmental contexts to better understand the evolving epidemiology and transmission dynamics of multidrug-resistant bacteria.

Although inappropriate empirical antimicrobial therapy (IEAT) has been associated with increased mortality among patients with bloodstream infections (BSIs), comparative evidence regarding its prognostic impact between cirrhotic and non-cirrhotic patients remains limited. Of the matched cohort study consisted of cirrhotic and non-cirrhotic adults with community-onset BSIs (CoBSIs), clinical covariables were retrospectively captured, and etiologic pathogens were prospectively stored for accurately determining IEAT. Effects of IEAT on 30-day crude mortality were assessed by time-dependent Cox-regression models among the cirrhotic and non-cirrhotic adults, with respective adjustment for multivariable mortality determinants. The prognostic effect of IEAT between cirrhotic and non-cirrhotic patients was compared using an interaction term analyzed in Cox-regression models, after propensity-score matching to balance the baseline covariates at the onset of BSIs between the two patient groups. Of 649 cirrhotic and 1294 non-cirrhotic adults with CoBSIs, the similarities in BSI severity, antimicrobial susceptibilities, and the proportion of IEAT were disclosed, but the 15- and 30-day crude mortality rates were higher among cirrhotic patients than those among non-cirrhotic patients. IEAT had a significant prognostic impact among the cirrhotic (adjusted hazard ratio [AHR], 1.69; P = 0.001) and non-cirrhotic (AHR, 1.49; P = 0.02) patients. In the matched cohort, a significant difference in the prognostic impact of IEAT between the cirrhotic (n = 353) and non-cirrhotic (n = 706) patients was exhibited (P = 0.012). IEAT had more severe impacts on the short-term mortality of cirrhotic patients with CoBSIs, compared with those of non-cirrhotic patients.

The pathogenicity of Clostridioides difficile infection (CDI) is caused by C. difficile toxins; therefore, accurate assessment of toxin production is clinically important. Although confirmatory testing for CDI is commonly used when stool samples show glutamate dehydrogenase-positive but toxin-negative results, the clinical impact of the shift from toxigenic culture (TC) to nucleic acid amplification testing (NAAT) remains unclear. We retrospectively compared episodes confirmed using TC with those confirmed using NAAT between June 2021 and May 2025. The primary outcomes were CDI treatment rate and time to treatment initiation. The secondary outcomes were rates of isolation, contact precautions, and healthcare costs. A total of 209 episodes were analyzed. Among episodes with negative confirmatory test results, the NAAT group showed significantly lower rates of CDI treatment (TC vs. NAAT: 60.7% vs. 15.0%, p&#xa0;<&#xa0;0.001), isolation (69.6% vs. 36.4%, p&#xa0;=&#xa0;0.038), and implementation of contact precautions (88.9% vs. 50.0%, p&#xa0;<&#xa0;0.001). Multivariate analysis showed that the introduction of NAAT was independently associated with reduced CDI treatment rates. Among episodes with positive confirmatory test results, treatment was initiated earlier in the NAAT group (median, 1 day vs. 0 days; p&#xa0;<&#xa0;0.001). The healthcare costs were lower in the NAAT group. Changing the confirmatory test from TC to NAAT reduced unnecessary CDI treatment and infection control measures during episodes with negative confirmatory test results. Furthermore, among episodes with positive confirmatory test results, rapid reporting by the NAAT enabled earlier treatment initiation. Confirmatory test selection could affect the diagnosis of CDI.

Influenza remains a huge clinical issue, but new anti-influenza agents, such as baloxavir/marboxil (BXM), have recently become available in Japan. The objective of this study was to clarify the clinical differences of hospitalized patients treated by BXM and other anti-influenza agents (non-BXM), such as neuraminidase inhibitors (NAIs). The clinical data of patients who were severely ill with influenza and required hospitalization were gathered and analyzed between September 2019 and August 2024 (6 influenza seasons) using an internet surveillance system. From them, patients who were treated by BXM were extracted. Of the total 490 severe influenza patients, 57 (11.6%) were treated by BXM. The BXM-treated patients had more secondary bacterial pneumonia, but their general conditions were better, compared with the non-BXM-treated patients (433 patients, 88.4%). Age, male/female ratio, vaccination rate, intrafamilial transmission, virus type, and antibiotic use were similar between the two groups, but two or more anti-influenza agents were used more often in the BXM group than in the non-BXM group. Two fatal cases occurred in the BXM group; both were elderly, non-vaccinated, had underlying diseases, and received delayed anti-influenza agents without antibiotics. BXM was used for patients with secondary bacterial pneumonia, although their general conditions were better, and antibiotic use was similar, although more anti-influenza agents were used than in non-BXM-treated patients. BXM might be one of the treatment options for severe influenza patients requiring hospitalization in the real world.

Acrophialophora spp., especially Acrophialophora fusispora, is a dematiaceous fungus that rarely infects humans, except in some fulminant cases of immunocompromised conditions with lesions in the brain and lungs. Herein, we aimed to report a general autopsy case of systemic Acrophialophora sp. infection with central nervous system involvement in a patient with hematological malignancy and Parkinson's disease. Blood tests and imaging suggested a systemic fungal infection; however, owing to the patient's critical condition, sampling the infectious tissue for culture was impossible, and blood cultures did not detect any microorganisms. Empirical treatment with antibacterial and antifungal drugs failed to save the patient. For pathological investigation, microbiological and histological examinations were performed during general autopsy. Microbiological examination of the brain tissue identified the pathogenic microorganism Acrophialophora sp. based on genetic analysis, showing the closest match to Acrophialophora fusispora. Histological examination of the infectious tissues revealed the angioinvasive potential of this pathogenic strain. To the best of our knowledge, this report is the first of a pathogenic microorganism identified as Acrophialophora sp. during a general autopsy. Our case provides histopathological evidence that Acrophialophora sp., like other molds, exhibits strong vascular invasiveness; however, identifying it through blood cultures is clinically challenging. Our case demonstrates that histopathological analysis can provide important information for fungal infection and highlights issues that should be addressed to overcome this rare and difficult-to-treat infectious disease, including the importance of aggressive tissue sampling to obtain a definitive diagnosis.

Bordetella bronchiseptica rarely causes human disease, and bloodstream infection is exceptional. We describe a 69-year-old man with follicular lymphoma on lenalidomide-rituximab, complicated by hypogammaglobulinemia and bronchiectasis, who developed acute bronchopneumonia with B. bronchiseptica bacteremia. Despite pre-admission oral levofloxacin, he presented with fever and productive cough. Computed tomography of the chest revealed new ground-glass and consolidative opacities. Two aerobic blood-culture bottles yielded slender Gram-negative rods; direct matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) suggested B. bronchiseptica, concordant with subculture. The isolate showed high minimal inhibitory concentrations (MICs) to third-generation cephalosporins but low MICs to piperacillin, carbapenems, aminoglycosides, tetracyclines, and fluoroquinolones. Therapy was changed from ceftriaxone to piperacillin, followed by step-down to oral minocycline, with clinical resolution after a total of 14 days. There was no animal exposure. Because 16S rRNA sequencing alone cannot reliably distinguish classical Bordetella species, we reported the organism as most consistent with B. bronchiseptica based on composite evidence (phenotype, MALDI-TOF MS, 16S). A focused literature review identified few well-documented bacteremia cases, predominantly in immunocompromised hosts, most often with respiratory sources. This case underscores the need to consider B. bronchiseptica in immunocompromised patients with bronchiectasis, even in the absence of animal exposure, and highlights the limited activity of many &#x3b2;-lactams and macrolides, emphasizing the importance of susceptibility-guided therapy.

Infectious mononucleosis (IM), typically caused by the Epstein-Barr virus, presents with a wide range of clinical manifestations. This diversity includes rare organ complications and the potential for false-positive syphilis serology results, making the diagnosis challenging. We report a rare and instructive case of IM presenting as acute acalculous cholecystitis (AAC). This case was complicated by concurrent false-positive syphilis serology results, prompting strong clinical suspicion for Fitz-Hugh-Curtis syndrome (FHCS). A 21-year-old woman presented with fever, right upper quadrant pain, and gallbladder wall thickening. The initial evaluation, including lymphocytosis with atypical lymphocytes, suggested IM. However, the clinical picture was obscured by a potent confounding factor: a false-positive syphilis serology and a concurrent diagnosis of pelvic inflammatory disease (PID) based on the presence of cervical motion tenderness and a positive Chlamydia trachomatis PCR result. These sexually transmitted infections-related indicators, when combined with the patient's right upper quadrant pain and liver dysfunction, created a diagnostic dilemma by strongly suggesting Fitz-Hugh-Curtis syndrome (FHCS), prompting empirical treatment. A false-positive syphilis serology was subsequently confirmed using other laboratory methods, establishing the final diagnosis of EBV-associated IM complicated by AAC, with a co-existing PID. This case highlights how IM can mimic other serious conditions such as FHCS, particularly when the rare complication of AAC is compounded by a strong diagnostic bias caused by false-positive syphilis serology results. Clinicians should be vigilant regarding the diverse clinical and laboratory manifestations of IM.

Respiratory syncytial virus (RSV) infection is difficult to diagnose in the elderly, which hinders accurate evaluation of its disease burden. This study aimed to evaluate the improvement in RSV detection by adding multiplex real-time RT-PCR testing of sputum specimens to routine diagnostics and to analyze clinical characteristics of RSV-positive cases in older adults. Single-center Design&#x3001;prospective cohort study was performed from April 2024 to March 2025. We evaluated the improvement in RSV detection achieved by adding real-time RT-PCR testing of sputum specimens to routine diagnostic testing in older adults during daily clinical practice and analyzed the clinical characteristics of cases identified to be RSV-positive. When RSV detection included real-time RT-PCR of sputum specimens, the number of RSV cases detected in 610 adults with lower respiratory tract infections increased by 1.7-fold from 32 (5.2%) to 53 (8.7%). Furthermore, RSV was detected in 6.7% of overall 1004 pneumonia cases, including those undergoing sputum PCR, and was frequently identified among nursing home residents and cases with aspiration pneumonia. In-hospital mortality was similar to that of influenza, with RSV-related pneumonia accounting for 10.3% of all pneumonia-related deaths. Fewer than half of patients aged &#x2265;80 years had returned to their former functional status 6 months later. Real-time RT-PCR using sputum specimens requires no additional invasive procedures and is suitable for detecting pneumonia in hospitalized or severely ill patients. Tracking in-hospital mortality and 6-month functional outcomes suggests the disease burden of RSV in the elderly may be greater than currently recognized.

High-concentration alcohol-based hand rubs (&#x2265;60% [v/v]) are strongly recommended to prevent healthcare-associated infections; however, their frequent use can aggravate hand eczema and reduce hand hygiene compliance. Therefore, low-irritant hand sanitizers with reduced alcohol content and alcohol-free formulations have been increasingly adopted in Japanese healthcare settings. Because these products typically contain benzalkonium chloride or chlorhexidine gluconate, along with ingredients that may affect bactericidal performance, this study evaluated the in vitro bactericidal and fungicidal activities of seven low-irritant sanitizers. Following the ASTM E2315 and guidelines of the Japanese Society for Infection Prevention and Control, testing was performed using four bacterial species (Escherichia coli, Pseudomonas aeruginosa, Enterococcus hirae, and Staphylococcus aureus) and one yeast species (Candida albicans) at contact times of 15 and 30 seconds. Efficacy was defined as a >5-log reduction in bacteria and >4-log reduction in yeast. The pH was weakly acidic for products C and D, neutral for products A, B, E, and G, weakly alkaline for product H, and strongly alkaline for product F (pH 12.2). Products A and F met the efficacy criteria against all organisms at 15 seconds. Product G met the bacterial criteria at 15 seconds and achieved fungicidal efficacy at 30 seconds. The other products did not meet the fungicidal criterion, and product C also failed to meet the efficacy criterion against S. aureus. Overall, efficacy was formulation-dependent and may be influenced by alcohol content, alkalinity, and other additives, in addition to benzalkonium chloride or chlorhexidine gluconate.

A rapid diagnosis of Campylobacter infections is important for managing infectious gastroenteritis. Although stool culture is considered the gold standard, its sensitivity is limited, and it requires prolonged incubation times. We conducted a prospective multicenter study at nine healthcare facilities in Japan to evaluate a Campylobacter rapid antigen test using stool specimens between March 2024 and August 2025. Patients with suspected infectious gastroenteritis were consecutively enrolled and tested using QuickNavi-Campylobacter, and the results were compared with those obtained using the FilmArray Gastrointestinal Panel as the reference method. Discordant results were further evaluated using cultures and additional PCR assays. A total of 410 patients were included in the final analysis. When the FilmArray Gastrointestinal Panel was used as the reference method, the positive concordance rate of QuickNavi-Campylobacter was 78.8%, and the negative and total concordance rates were 99.0% and 93.4%, respectively. The positive concordance rate decreased in specimens collected &#x2265;6 days after the onset of symptoms (50.0%). Among the 29 patients who received antimicrobial agents before testing, Campylobacter spp. Were detected by the FilmArray GI Panel in five patients, whereas only one of these patients was positive by the antigen assay. QuickNavi-Campylobacter showed acceptable concordance with the FilmArray Gastrointestinal Panel in a real-world multicenter setting, and its diagnostic utility may be more evident in the early phase of illnesses, although prior antimicrobial exposure may reduce its sensitivity.

Transgender and gender-diverse (TGD) individuals face elevated risks of HIV and sexually transmitted infections (STIs). In Japan, limited access to comprehensive sex education and the legal sterilization requirement for gender change may contribute to gaps in prevention awareness. We examined HIV/STI prevalence and clinical characteristics among TGD individuals in clinical settings. 560 TGD individuals made their first visit to our clinic for gender-affirming care between January 2023 and December 2024. Among them, 275 (49%), all asymptomatic, underwent voluntary, free testing. Data on age, sex assigned at birth, sexual behaviors, STI history, and pre- or post-exposure prophylaxis (PrEP/PEP) use were obtained from clinical records and questionnaires. Descriptive analysis was stratified by sex assigned at birth (assigned male at birth [AMAB] and assigned female at birth [AFAB]). Among 275 tested individuals (49 AMAB; 226 AFAB), HIV/STI positivity rates were 10.2% (5/49) for AMAB and 5.3% (12/226) for AFAB. Among valid responders, anal sex was reported by 65.6% (21/32) of AMAB and 10.2% (11/108) of AFAB. Positivity rates among those reporting anal sex were 14.3% (3/21) in AMAB and 36.4% (4/11) in AFAB. While sexual behaviors varied widely among both AMAB and AFAB individuals, higher HIV/STI positivity rates were observed among those who reported anal sex; however, these findings are based on small numbers and should be interpreted as exploratory observations. To improve the sexual health of TGD individuals, health care providers should inquire about specific types of sexual practices. Tailored sexual health education is essential to support TGD communities.

To characterize the antimicrobial resistance and genomic features of an OXA-48-producing Escherichia coli ST131 strain isolated in Japan from a patient without overseas travel history. An O25:H4-ST131 E. coli strain (KIPH_2110030) was isolated from an 88-year-old woman with a urinary tract infection in Osaka. Antimicrobial susceptibility testing was performed using broth microdilution and disk diffusion methods. Carbapenemase activity was assessed via the modified carbapenem inactivation method (mCIM) and inhibitor-based synergy tests. Whole-genome sequencing, PCR, and plasmid analysis were conducted to identify resistance genes, plasmid types, and clade assignment. The isolate exhibited resistance to multiple &#x3b2;-lactams and intermediate susceptibility to meropenem and imipenem, despite a positive mCIM result. Genomic analysis revealed the presence of blaOXA-48 on an IncFII-type plasmid and blaCTX-M-27 on an IncFIA-type plasmid. The OXA-48 plasmid (pKIPH-2110030) showed high sequence similarity to a plasmid from a Netherland E. coli strain of a different sequence type, suggesting horizontal gene transfer. Clade analysis assigned the isolate to the C1-M27 lineage, a major ST131 subclade in Japan, but not previously associated with blaOXA-48. This study is the first report of an OXA-48-producing ST131 E. coli C1-M27 strain isolated from a Japanese patient without a history of overseas travel. While the dissemination of blaOXA-48 is primarily associated with IncL-type plasmids, reports involving IncFII-type plasmids are rare. The high sequence similarity to a European-derived plasmid suggests international transmission of carbapenem resistance plasmids and highlights the potential risk of their further spread.

Nocardiosis remains diagnostically challenging in immunocompromised patients. We report disseminated nocardiosis due to Nocardia brasiliensis, supporting the role of repeat deep sampling and specimen concentration by cytocentrifugation in enhancing diagnostic yield. An 80-year-old man with myelodysplastic syndrome with low blasts and ring sideroblasts and type 2 diabetes mellitus presented with a three-week history of progressive pain and swelling of the right thigh and left lower leg. One week before symptom onset, the patient received a five-day course of oral levofloxacin for urinary frequency. Contrast-enhanced computed tomography (CT) demonstrated abscesses in the right thigh musculature, the subcutaneous tissue of the left lower leg, and the prostate. An initial smear from the left subcutaneous lesion was negative. Repeat aspiration of the intramuscular abscess in the right thigh, followed by cytocentrifugation, showed beaded, branching, Gram-positive filamentous bacilli, consistent with Nocardia. 16S ribosomal RNA gene sequencing subsequently identified N. brasiliensis. Antimicrobial susceptibility testing supported treatment with oral trimethoprim-sulfamethoxazole, which led to clinical improvement and a decrease in the size of the abscesses on follow-up contrast-enhanced CT. The patient was discharged on hospital day 23. In immunocompromised patients, nocardiosis may involve atypical anatomic sites. When the initial smear is negative, especially after prior antibiotic exposure, prompt repeat sampling with adequate volume from a deeper or alternative site, combined with cytocentrifugation, is essential to avoid delays in diagnosis and treatment.

Parechovirus A (PeV-A) is a significant cause of sepsis-like illnesses in neonates and infants. Although PeV-A3 has a known association with severe diseases, severe cases of PeV-A5 infection have recently been reported. We present herein a case of PeV-A5 infection in a 23-day-old neonate who presented with sepsis-like symptoms, including fever, irritability, abdominal distension, and a reticular rash. An erythematous rash developed and spread from the trunk to the extremities after the patient's admission. Blood cultures were negative, and the patient's symptoms rapidly improved with supportive therapy. Polymerase chain reaction testing of pharyngeal and rectal swabs confirmed PeV-A5 infection, as well as the presence of PeV-A5 in the serum during the acute phase. PeV-A5 RNA was undetectable in serum at follow-up testing, whereas stool specimens showed higher detection sensitivity, indicating that the time from symptom onset and specimen selection influence diagnostic accuracy. Whole-genome analysis suggested a recombinant PeV-A5 strain with structural protein regions similar to those of PeV-A5 and nonstructural regions similar to those of PeV-A3. This genomic feature may explain the patient's clinical presentation resembling that of a PeV-A3 infection. PeV-A5 may cause sepsis-like symptoms in early infancy, the pathogenicity of which may be affected by genetic recombination. Further case studies are required to elucidate the clinical features and pathogenicity of PeV-A5 infection.

This study evaluated the correlation between cytomegalovirus (CMV) IgG avidity measured by chemiluminescent microparticle immunoassay (CMIA) and enzyme-linked immunosorbent assay (ELISA), and assessed the usefulness of CMIA for predicting congenital CMV (cCMV) infection, compared with ELISA. A total of 130 serum samples, previously tested for CMV IgG avidity using ELISA, were selected. Thirty samples were obtained from pregnant women positive for both CMV-specific IgG (CMV IgG) and IgM, and 100 samples were obtained from pregnant women positive for CMV IgG but negative for CMV IgM. CMV IgG avidities in these stored sera were measured by CMIA and compared with the ELISA results. A strong positive correlation was observed between CMV IgG avidities measured by ELISA and CMIA among the 30 pregnant women positive for both CMV IgG and IgM (Spearman's &#x3c1;&#xa0;=&#xa0;0.78, p&#xa0;=&#xa0;3.8&#xa0;&#xd7;&#xa0;10-7). Additionally, in 121 women (93.1%), the CMIA classifications of low and high avidities (low: <50%Avi, high: &#x2265;60%Avi) were consistent with those from ELISA (low: <35%, high: >40%). Among the 18 pregnant women whose newborns had cCMV infection, eight and six were classified as having low avidities by ELISA and CMIA, respectively. The high concordance rate in classifying CMV IgG avidities as low or high between ELISA and CMIA suggests that both methods exhibit similar clinical usefulness in predicting cCMV infection resulting from primary maternal CMV infection.

Our previous study suggested that carbapenem therapy may be effective for bacteremia caused by susceptible Klebsiella pneumoniae (non-ESBL-producing and non-carbapenem-resistant isolates), but its comparative efficacy versus non-carbapenem empirical therapy remains unclear. Therefore, in this study, we aimed to compare the efficacy of carbapenem and non-carbapenem empirical therapy for bacteremia caused by susceptible K. pneumoniae. We conducted a multicenter retrospective study in patients (&#x2265;18 years) with K. pneumoniae bacteremia between January 2020 and December 2024, classifying them into a carbapenem or non-carbapenem empirical therapy group. Baseline characteristics were adjusted using propensity score matching, and mortality and survival outcomes were compared between the two groups. Of the 398 included patients, 192 were analyzed after propensity score matching (64 and 128 in the carbapenem and non-carbapenem groups, respectively). The 30-day mortality rate was 14.1% in the carbapenem group and 8.6% in the non-carbapenem group, with no significant between-group difference (P&#xa0;=&#xa0;0.358). Similarly, no significant difference was observed in 90-day mortality (26.3% vs. 20.7%, P&#xa0;=&#xa0;0.439). Overall survival did not differ significantly between the groups (P&#xa0;=&#xa0;0.453). For bacteremia caused by susceptible K. pneumoniae, no significant difference in efficacy was detected between carbapenem and non-carbapenem empirical therapy. Although equivalence cannot be confirmed, empirical non-carbapenem therapy is a reasonable option, particularly in patients without risk factors for multidrug-resistant organism involvement, thereby preserving carbapenem use and mitigating the risk of multidrug-resistant organism emergence.

Coprinopsis cinerea (C. cinerea, also known as Hormographiella aspergillata) is a rare basidiomycete that causes invasive fungal infections in immunocompromised patients and is often difficult to diagnose microbiologically. We report a case of breakthrough proven invasive pulmonary fungal infection caused by C. cinerea during antifungal prophylaxis in a patient with acute myeloid leukemia undergoing induction chemotherapy. During the neutropenic phase, chest computed tomography (CT) revealed a nodular lesion in the right lower lobe that progressed despite antifungal prophylaxis, raising suspicion of invasive mold infection. Antifungal therapy was switched to liposomal amphotericin B. Transbronchial lung biopsy demonstrated septate fungal hyphae, although fungal cultures remained negative. Molecular analysis using polymerase chain reaction on paraffin-embedded lung tissue subsequently identified C. cinerea. Radiological findings worsened after initiation of liposomal amphotericin B and reached peak severity on the first follow-up CT, followed by early radiological improvement on the subsequent CT examination, after which step-down therapy with isavuconazole was initiated for safety and tolerability. To eliminate residual infection and minimize the risk of post-transplant relapse, thoracoscopic lobectomy was performed, and pathological examination showed granulomatous inflammation without viable fungal elements. The patient subsequently underwent cord blood transplantation and remains in remission without recurrence of fungal infection. This case highlights the importance of tissue diagnosis, molecular identification, appropriate antifungal therapy, and surgical intervention in controlling breakthrough invasive fungal infection and enabling successful hematopoietic stem cell transplantation.