Candida infections are among the most common fungal diseases worldwide and are associated with notable morbidity and mortality, particularly in immunocompromised and critically ill patients. Moreover, the emergence and spread of antifungal resistance pose an increasing threat to global public health. Therefore, evidence-based recommendations are urgently needed to guide the surveillance and control of Candida infections. A multidisciplinary guidance development group comprising experts of infectious diseases, clinical microbiology, pharmacology, infection control, and guideline methodology jointly developed the present clinical practice guidance. The process followed internationally recognized grading of recommendations, assessment, development and evaluation (GRADE) framework. Clinical questions were formulated based on priority issues or areas of uncertainty in current practice, and corresponding recommendations were developed after systematic review and synthesis of the best available evidence. The strength of recommendations was classified as strong or conditional (weak), and the certainty of evidence was graded from high to low. The guidance provides recommendations on diagnostic strategies, antifungal therapy, and infection prevention and control measures for Candida infections, integrating both global evidence and national clinical experience. The target users include clinicians, microbiologists, infection control practitioners, and policymakers involved in the management of fungal diseases. The guidance aims to support optimized clinical decision-making, improve antifungal stewardship, and strengthen infection control strategies to address the growing challenge posed by Candida infections.
Fragmented and siloed nature of healthcare data leads to insufficient recognition of infection control priorities and poor adherence to preventive measures. We evaluated the impact of a visualized and integrated online information system on the infection control practice and incidence of multidrug-resistant organisms (MDROs), antimicrobial consumptions, and clinical outcomes in a medical intensive care unit (ICU). Patients hospitalized in one medical ICU during July 1, 2023, to November 30, 2024, were collected, and were analyzed by clinical outcomes, the incidence rate of healthcare-associated MDROs, and the antimicrobial consumptions before and after the implementation of Infection Control Map (ICM). Another ICU was selected as comparison. A total of 775 patients were included and divided into two periods: Pre-intervention period (n = 262), and Intervention period (n = 513). There were no statistical differences among demographics except the Acute Physiologic Assessment and Chronic Health Evaluation II (APACHE II) score, which was higher in the Intervention period than that of Pre-intervention period (30.0 vs 25.0, p = 0.000). The incidence rate of MDROs decreased over time (tau = -0.53, p = 0.019), especially the methicillin-resistant Staphylococcus aureus (1.5 vs 0.3 per 1000 patient-days, incidence rate ratio = 0.2, p = 0.012), as well as the consumption of meropenem (tau = -0.53, p = 0.003). There was significant decrease in 30-day all-cause mortality after the ICM use by multivariate analysis. The implementation of the ICM significantly strengthened infection control practices, resulting in a marked reduction in healthcare-associated MRSA incidence, targeted antimicrobial usage, and 30-day all-cause mortality.
Group A Streptococcus (GAS; Streptococcus pyogenes), which causes a broad spectrum of diseases, has been found to invade cells to avoid host immune clearance and antibiotic killing. Our previous findings have shown that the virulence factors of GAS-NAD-glycohydrolase depletes intracellular NAD+ to inhibit xenophagy, and streptolysin O increases the production of intracellular reactive oxygen species (ROS) to promote ineffective LC3-associated phagocytosis (LAP), thereby impairing GAS clearance in endothelial cells. However, how endothelial cells counteract these strategies for GAS clearance has yet to be comprehensively investigated. We therefore speculated that resveratrol (RSV), a potent antioxidant and NAD+-dependent deacetylase-sirtuin activator, could be a potential antibacterial drug upon GAS infection in endothelial cells. To investigate the effect and the underlying mechanism of RSV on GAS infection, RSV was supplemented to human microvascular endothelial cell line-1 (HMEC-1) upon GAS infection, followed by detection of bacterial growth and examination the cellular regulation to LAP and xenophagy pathway. RSV significantly inhibited intracellular GAS multiplication in endothelial cells through increasing acidification and double-membrane formation of LC3-positive GAS-containing vacuoles. RSV upregulated the expression of autophagy-related proteins but downregulated the LAP-related proteins in GAS-infected endothelial cells. Knockdown of sirtuin 3 (SIRT3) dismissed the effect of RSV on enhancement of autophagic clearance of GAS and suppression of mtROS, which may participate in regulation of acidification of LC3-positive GAS-containing vacuoles and LAP-related proteins expression. RSV promotes intracellular GAS clearance in endothelial cells by shifting the ineffective LAP pathway to functional xenophagy through SIRT3-mediated inhibition of mtROS.
Human adenovirus type 21 (HAdV-21) is linked to severe pneumonia in adults, but adult data from China remain scarce. This study compared the molecular and clinical features of HAdV-21 against other genotypes in hospitalized adults. We retrospectively analyzed adults with HAdV respiratory infections at a Hangzhou tertiary hospital (January 2022-August 2024). Genotyping utilized hexon gene sequencing. Clinical, laboratory, and etiological data were compared. Multivariable logistic regression identified independent risk factors for severe illness. Among 75 genotyped cases, HAdV-21 was the most prevalent (38.7%; comprising 21a and 21b strains). Compared with other genotypes, HAdV-21 infection was associated with distinctive respiratory findings like dyspnea (62.1% vs. 19.6%). Laboratory abnormalities, like lymphocyte percentage (9.70% vs. 18.55%), PCT (0.48 vs. 0.13 ng/mL), and organ injury markers AST (32.00 vs. 19.00 U/L), were also more frequent in the HAdV-21 group. Severe illness (41.4% vs. 13.0%) and respiratory failure (34.5% vs. 6.5%) were significantly more common in the HAdV-21 group, along with a higher rate of coinfection. Overall multivariable analysis identified HAdV-21 (aOR 5.44, 95% CI 1.32-22.48) and older age (aOR 1.05 per year, 95% CI 1.01-1.09) as independent risk factors for severity. However, this association for HAdV-21 was not significant in the subgroup of patients with adenovirus mono-infection. HAdV-21 emerged as the predominant genotype among these hospitalized adults, associating with increased severe disease and respiratory failure. Importantly, this severity appears largely mediated by higher coinfection frequencies rather than HAdV-21's inherent viral pathogenicity alone.
Long-term care facilities (LTCFs) are highly vulnerable to healthcare-associated infections, yet evidence evaluating policy-driven, incentive-based infection prevention and control (IPC) programs in these settings remains limited. We conducted a retrospective policy evaluation using routinely collected on-site audit and administrative data from 59 LTCFs participating in the "2025 Taichung City On-site Inspection Program for Incentives to Strengthen Infection Control in Long-term Care Facilities". Facilities were assessed using standardized IPC indicators, including mandatory core indicators (Indicators 1-3) and voluntary incentive-based indicators (Indicators 4-6). Outcomes included indicator-level compliance, incentive qualification, reward distribution by facility type and bed-capacity category, and the results of post-audit appeals. Compliance with mandatory core IPC indicators was consistently high: all facilities met Indicator 1 (100%), and 58 facilities complied with Indicators 2 and 3 (both 98.3%). In contrast, non-compliance was more frequently observed among incentive-based indicators. Although 34 (57.6%) facilities applied for Indicator 4 and 48 (81.4%) for Indicator 5, non-compliance occurred in 8.8% and 4.2% of applicants, respectively. Indicator 6 demonstrated the greatest implementation gap, with 13 (76.5%) of 17 applicant facilities classified as non-compliant, primarily due to ineligibility of certified personnel. All nine appealed audit items were approved after review. Overall, 58 facilities (98.3%) qualified for incentive payments. A government-led, incentive-based IPC audit program was associated with near-universal compliance with core IPC standards in LTCFs. Linking structured audits, preparedness requirements, and financial incentives represents a feasible approach to strengthening IPC capacity in LTCFs.
Invasive pulmonary aspergillosis (IPA) is a severe fungal infection with high morbidity and mortality, primarily affecting immunocompromised individuals and patients with chronic underlying diseases. Current diagnostic methods, including histopathological examination, culture, and imaging studies, have significant limitations. Plasma Aspergillus-specific IgG antibody (Asp IgG) detection has recently gained attention for its high sensitivity in non-neutropenic patients and convenient blood sampling. This study aims to systematically evaluate the diagnostic value of plasma Asp IgG detection for IPA. This single-center, retrospective, and controlled study included 167 non-neutropenic patients with suspected IPA from July 2022 to March 2025, divided into IPA (n = 61) and non-IPA groups (n = 106). Missing bronchoalveolar lavage fluid (BALF) galactomannan (GM) data were handled using multiple imputation with predictive mean matching. The diagnostic values of tests for Asp IgG, serum GM, and BALF GM were evaluated, along with the potentials of combined testing strategies. At a cut-off value of ≥80 AU/mL, Asp IgG showed higher sensitivity than serum GM and BALF GM (65.6% vs. 29.5% and 47.5%, P < 0.001), but lower specificity (62.3% vs. 97.0% and 95.3%, P < 0.001). A receiver operating characteristic curve showed that Asp IgG had an optimal diagnostic value when the cut-off value was 92.74 AU/mL, and the sensitivity and specificity were 63.9% and 70.8%, respectively. At the same cut-off value, combined Asp IgG and GM testing improved diagnostic efficacy, with the "OR" rule increasing sensitivity to 90.2% and the "AND" rule raising specificity to 98.1%. Acinetobacter baumannii infection was an independent risk factor for Asp IgG false positivity in the non-IPA group (OR = 3.929, P = 0.026). Asp IgG testing exhibits high sensitivity for IPA diagnosis, making it suitable for non-neutropenic and critical patients. Combined testing strategies can optimize diagnostic performance based on clinical needs.
Vibrio vulnificus is a highly virulent pathogen associated with rapidly progressive sepsis and necrotising soft-tissue infection, particularly among patients with diabetes or chronic liver disease. Effective treatment options remain limited, especially in the setting of high bacterial burden or immunocompromis. We performed an integrated preclinical assessment of mitomycin C (MMC) alone and in combination with ciprofloxacin (CIP) using in vitro susceptibility testing and a neutropenic murine model challenged with increasing inocula of V. vulnificus. Myelotoxicity, organ-specific toxicity, and the development of resistance under subinhibitory MMC exposure were evaluated through haematological profiling and histopathology. MMC demonstrated potent in vitro activity and conferred complete protection in mice challenged with low bacterial inocula (103-104 colony-forming units (CFU)/mL). Although efficacy declined with increasing bacterial burden, combination therapy with MMC and ciprofloxacin significantly improved survival across all inoculum levels, achieving complete protection at concentrations up to 1.4 ⨯ 107 CFU/mL and partial protection at 4.3 ⨯ 107 CFU/mL. The combination regimen was not associated with dose-dependent myelosuppression, and no hepatotoxicity or nephrotoxicity was observed. Exposure to subinhibitory concentrations of MMC did not result in increased minimum inhibitory concentrations over time. MMC-CIP combination therapy demonstrated synergistic efficacy against severe V. vulnificus infection in a neutropenic mouse model and may represent a promising therapeutic option. Dose-limiting myelotoxicity and the potential for resistance necessitate cautious dosing and further clinical investigation. This study addresses a critical therapeutic gap in severe V. vulnificus infection by proposing a mechanistically rational, dose-optimized adjunctive strategy supported by robust preclinical evidence.
This study aimed to evaluate the ability of tuberculin skin test (TST) and interferon-gamma release assay (IGRA) to predict progression of latent tuberculosis (LTBI) to active tuberculosis. We searched PubMed, Embase, Web of Science, and the Cochrane Library for cohort studies published until October 6, 2024, that used both IGRA and TST to detect LTBI and reported data on active TB development. We assessed the predictive value of IGRA and TST for disease progression by calculating the risk ratio (RR), which compares the progression rates between positive and negative individuals for each test. Out of 2650 potentially eligible studies, 260 were reviewed in full text, and 44 studies with 25637 individuals were included. The pooled RR for disease progression was higher with IGRA than with TST (5.38 [95 % CI: 3.44-8.40] vs. 3.03 [95 % CI: 1.20-4.10]), although this difference did not reach statistical significance (p = 0.0713). PPV with IGRA vs TST: 2.50 % [95 % CI: 1.20 %-4.10 %] vs 1.30 % [95 % CI: 0.60 %-2.40 %] (p = 0.4852). NPV with IGRA vs TST: 99.70 % [95 % CI: 99.40 %-99.90 %] vs 99.60 % [95 % CI: 99.30 %-99.90 %] (p = 0.9630). Furthermore, the PPV of IGRA was similar to the progression rate of IGRA+/TST+ (2.00 % [95 % CI: 0.05 %-4.40 %] vs. 2.50 % [95 % CI: 0.40 %-6.10 %]). Finally, while IGRA identified fewer positive individuals (23.90 % [95 % CI: 18.50 %-29.80 %] vs. 52.20 % [95 % CI: 34.30 %-69.80 %]), the number of positive individuals progressing was similar (265 vs. 268), with similar results also observed in the untreated population. IGRA appears to have superior predictive value for TB progression compared to TST. Additionally, incorporating TST alongside IGRA does not seem to significantly enhance predictive accuracy. IGRA effectively reduces the number of individuals requiring treatment while seemingly not missing those at risk of progression.
Carbapenem-resistant Acinetobacter baumannii (CRAB) is a major cause of healthcare-associated infections, especially in intensive care units. Its rapid acquisition of antimicrobial resistance necessitates molecular epidemiology to inform infection control measures and treatment strategies. This study evaluated antimicrobial resistance phenotypes and the prevalence of resistance genes among clinical CRAB isolates in Thailand, complemented by MLST-based population structure analysis incorporating a temporal dimension of clonal distribution compared with previous reports. This study analyzed 316 clinical A. baumannii isolates from five regions across Thailand (2022-2023). Species confirmation was performed by PCR targeting blaOXA-51-like. Antimicrobial susceptibility testing against thirteen antibiotics followed CLSI 2024 guidelines. Resistance genes were identified by PCR, and MLST with PHYLOViZ goeBURST characterized population structure. All isolates demonstrated carbapenem resistance, with the majority exhibiting extensively drug-resistant (XDR) phenotypes. Isolates showed resistance to β-lactams, fluoroquinolones, aminoglycosides, tetracyclines, and sulfamethoxazole/trimethoprim, while remaining susceptible to minocycline. MLST revealed ST2 as the predominant clone (78.8%), followed by ST164 (8.9%) and ST16 (6.0%). Class A β-lactamase blaVEB was highly detected (95.3%), followed by Class D β-lactamase blaOXA-23-like (93.7%). Temporal distribution of clonal lineages revealed persistence of major STs without clonal shifts, with ST2, ST164, and ST25 remaining dominant across sampling periods. ST164 (IC11) notably exhibited high resistance gene carriage capacity. The results reinforce the predominance and persistence of ST2 (IC2) in the CRAB population circulating in Thailand and geographic dissemination of high-risk clones across different regions. This highlights the importance of continuous molecular surveillance to guide infection prevention and antimicrobial stewardship.
Cavitary lung disease caused by Mycobacterium tuberculosis (TB) and nontuberculous mycobacteria (NTM) presents overlapping radiologic features but potentially distinct immunopathologic mechanisms. Macrophage polarization and prothymosin-α (PTMA) expression may contribute to disease progression, but their roles in surgically treated patients remain unclear. We retrospectively analyzed 33 patients who underwent pulmonary resection for TB (n = 17) or NTM (n = 16) infection. Clinical characteristics, CT-based cavity wall thickening scores, and immunohistochemical staining for PTMA, CD68, iNOS, and Arginase-1 were compared. A monocyte migration assay was also performed to evaluate PTMA function. NTM patients exhibited lower body mass index and fewer comorbidities than TB patients but had a higher relapse rate. Cavity wall thickness correlated with increased PTMA and CD68 expression, particularly in NTM lesions. No significant difference in iNOS or Arginase-1 expression or M1/M2 ratio was observed. M. kansasii was more often linked to severe cavitary disease. PTMA enhanced monocyte migration in a dose-dependent manner in vitro. Radiologic cavity wall thickness may reflect underlying immune dynamics, particularly in NTM. PTMA and CD68 are associated with immune activation and cavity progression in chronic mycobacterial infections. PTMA may serve a dual role as both a histologic marker and a functional regulator of monocyte recruitment. Immunohistochemical analysis revealed no clear M1/M2 polarization shift, suggesting a non-classical or depolarized macrophage phenotype. These findings underscore the potential of PTMA as both a tissue marker and a bioactive mediator in chronic pulmonary infection.
Outsourced hospital services may pose underrecognized risks for healthcare-associated infections, particularly in high-risk areas such as neurosurgery. A cluster of Klebsiella aerogenes infections in a neurosurgical ward prompted an investigation to identify the source and transmission route. A retrospective outbreak investigation was conducted in the neurosurgical department of a 2600-bed tertiary care hospital in Taiwan between August 2023 and May 2024. The investigation included an epidemiological review, environmental sampling, and molecular typing using pulsed-field gel electrophoresis (PFGE). The index case, a 56-year-old woman who underwent craniectomy on August 31, 2023, developed K. aerogenes infection one week postoperatively and died 18 days later. Seventeen additional cases were identified-12 from September 2023 to January 2024, and 5 between April and May 2024. All patients had undergone preoperative hair shaving by an outsourced barber department. PFGE analysis of 10 patient isolates revealed that 8 shared clonal strain A. Environmental samples from two of four shampoo carts used by the outsourced barber service also yielded strain A. Although initial infection control efforts temporarily reduced case numbers, a resurgence in April 2024-with four new cases and repeated recovery of strain A from equipment-confirmed the ongoing transmission source. Staff stool samples were negative, implicating contaminated equipment rather than personnel. After discontinuing the barber service and replacing equipment, no further cases occurred as of November 2024. This outbreak highlights the importance of incorporating non-clinical outsourced services into infection surveillance and control programs, especially in high-risk clinical settings.
Type 1 diabetes mellitus (T1D) is an autoimmune disorder characterized by immune-mediated destruction of pancreatic β-cells, resulting in lifelong insulin dependence. Interleukin-17A (IL-17A), associated with T1D progression and complications, can mobilize and activate neutrophils to release lytic enzymes, reactive oxygen species, and cytokines, thereby promoting systemic inflammation and cell destruction; such neutrophil-driven responses have also been implicated in autoimmune diseases, including diabetes. This study aimed to compare the clinical characteristics and neutrophil stress of IL-17A-positive and -negative T1D patients. 37 patients were enrolled between May 2023 and April 2024 at Department of Pediatric Endocrinology, Changhua Christian Children's Hospital. In addition to clinical characteristics, peripheral blood neutrophils were isolated to analyze antioxidant-related protein, autophagy, and respiratory bursts. Serum cytokine profiles were also assessed. 27 patients were IL-17A-positive. At disease onset, they were younger and had lower absolute neutrophil counts. Years later, they showed higher LDL, with HDL declining over time and TG trending upward. All participants were Vitamin D insufficiency, and IL-17A levels correlated positively with vitamin D levels. Neutrophils in the peripheral blood displayed reduced xCT, GPX4, and HO-1, increased LC3II/LC3I ratios with decreased p62, and greater ROS production upon stimulation. Serum IL-5 levels were significantly higher, with eotaxin trending higher. IL-17A-positive T1D is associated with earlier onset. As the disease progresses, it leads to an increased risk of dyslipidemia and the development of type 2 inflammation. Furthermore, the neutrophils in these patients suggestive of ferroptosis, defining a distinct phenotype for potential targeted therapy.
Eosinophilic AECOPD is a specific phenotype; however, the clinical outcomes and the short-term changes in sputum microbiome remain unclear. We retrospectively included AECOPD patients admitted to National Cheng Kung Universal Hospital from January 2013 to December 2022. The primary outcome was respiratory failure rate. In addition, self-expectorated sputum was prospectively collected on days 1 and 5 of hospitalization between June 2020 and May 2021, and 16S rRNA gene segments (V3-V4) were amplified for sputum microbiome identification. Eosinophilic AECOPD were defined as blood eosinophils (bEOS) exceeding 2 % at admission. From the analysis of 202 AECOPD hospitalizations, patients with bEOS ≥2 % had shorter hospital stays and respiratory failure days (β-coefficient: 2.98 and -3.86, P < 0.001 and = 0.049, respectively), a lower risk of respiratory failure and intensive care unit admission (odds ratio: 0.29 and 0.35, P = 0.007 and = 0.029, respectively). In a sub-cohort of 30 AECOPD patients undergoing sputum microbiome analysis, 12 had bEOS ≥2 %, a significant decrease in Shannon diversity at the phylum level after 5 days of treatment was observed only in the bEOS <2 % group. Moreover, the relative abundance of Proteobacteria increased after treatment in the patients with bEOS ≥ 2 % while a trend of decrease was observed in those with bEOS<2 %. Patients with eosinophilic AECOPD demonstrate better short-term clinical outcomes. The sputum microbiota in the eosinophilic and non-eosinophilic patients also respond differently to the treatment for AECOPD.
The global rise of carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) is alarming due to its link to increased morbidity and mortality from limited treatment options. This study evaluated the impact of virulence plasmid carriage on CRKP-BSI mortality. A matched case-control study was conducted among 93 CRKP patients, 23 of whom tested positive for virulence plasmids. The clinical and bacterial characteristics of CRKP-induced BSIs with and without virulence plasmids were analyzed. Virulence plasmids were present in 24.7 % of CRKP strains, with a 61.1 % mortality rate among patients with virulence plasmid-positive CRKP (pV-CRKP) infections. The ST11-KL64 subtype was predominant in Jiangxi Province. Molecular typing revealed pV-CRKP strains primarily had two identical genotypes, yet virulence plasmids were present across various PFGE genotypes, indicating polymorphic distribution. Logistic regression identified community-acquired infection, neurology department admission, and stroke as independent risk factors. G. mellonella and biofilm assays showed most CRKP strains with virulence plasmids exhibited increased virulence, though some strains did not. Virulence plasmids generally heighten CRKP strain virulence and directly affect the 7-day survival rate. Certain strains carry virulence plasmids without increased virulence. Community-acquired infection, neurology department admission, and stroke are independent risk factors for pV-CRKP strains. The presence of IncFrepB among pV-CRKP may promote the spread of virulence genes in ST11-type CRKP.
An accurate, rapid, non-invasive test is critically needed for Helicobacter pylori infection, particularly in under-resourced populations at increased risk of gastric cancer. This study compared the performance of Pylori DuoTect® to a spectrum of other tests. Serum samples collected from Chilean adults with gastrointestinal symptoms who had undergone esophagogastroduodenoscopy were tested with the Pylori DuoTect® test for anti-FliD (flagellar hook-associated protein) and anti-CagA (cytotoxin-associated antigen gene A) antibodies, and compared to testing by urease, histology, whole-cell ELISA, CagA ELISA, and H. pylori-NAPPA array. We calculated sensitivity, specificity, and agreement based on Cohen's kappa statistic of the Pylori DuoTect® test to other tests. Based on histology or rapid urease testing, 156 of 300 individuals (52%) were positive for H. pylori. Based on the Pylori DuoTect® test, 70 (45%) were seropositive for FliD, 94 (60%) for CagA, 127 (81%) for either FliD or CagA, and 37 (24%) for both. Sensitivity of either FliD or CagA detection for a positive H. pylori test by histology or urease testing was 81.1% and specificity was 29.2%. The Pylori DuoTect® test had the highest level of agreement with the CagA NAPPA and ELISA tests (81.3-82.0%). The Pylori DuoTect® test showed high sensitivity but low specificity for H. pylori detection compared to histology or urease testing. However, it aligned well with performance of CagA detection. While this assay may hold promise based on ease of use, it requires additional optimization and validation to better define the performance characteristics across diverse, global populations.
Acanthamoeba spp. are free-living amoebas commonly found in various environmental settings and are recognized as opportunistic pathogens in humans. Endosymbiosis within Acanthamoeba, particularly involving bacteria, can enhance the pathogenic potential of both the host and symbiont, influencing human health risks. This study aims to characterize the clinical Acanthamoeba isolate and to identify and localize the Acanthamoeba endosymbiont. Environmental and clinical Acanthamoeba isolates were collected and identified through morphological analysis and 18S rRNA gene sequencing. The presence of bacterial endosymbionts was determined using PCR amplification targeting 16S rRNA and gltA genes. Phylogenetic analysis characterized Acanthamoeba and the bacterial endosymbiont. PCR and cultivation methods identified Acanthamoeba in 40% of clinical samples, with phylogenetic analysis revealing that all isolated clinical strains belonged to the T4 genotype, while environmental strains were classified as T3, T4, and T5. Phylogenetic analysis of the DF3 region in Acanthamoeba 18S rDNA classified clinical and environmental isolates into six T4 sub-genotypes. Two clinical isolates harbored bacterial endosymbionts from the order Holosporales, as supported by 16S rRNA and gltA gene analyses. Fluorescence microscopy revealed the intracellular DNA-containing structures consistent with endosymbiont localization. Our study reveals the genetic diversity of Acanthamoeba isolates from clinical and environmental sources and highlights the widespread presence of bacterial endosymbionts. These findings underscore the need for continued surveillance and advanced genomic studies to understand endosymbiont-Acanthamoeba interactions and their potential impact on public health.
The occurrence of foreign body (FB) infections in patients with Staphylococcus aureus bacteraemia (SAB) can lead to serious complications. We therefore sought to evaluate the host risk factors and bacterial determinants associated with FB infection following SAB. We retrospectively included patients hospitalized with a SAB and carrying FB, over a four-year period. Factors associated with FB infection were assessed with multivariable logistic regression analysis. Bacterial determinants (lineage and virulence factors) were determined using whole genome sequencing. We included 104 patients of whom 40 patients (38.5%) with FB infection. Factors associated with FB infection were community-acquired SAB (OR = 3.8; 95% confidence interval, CI [1.36-10.59]; p = 0.011), Charlson's score >3 (OR = 0.39; 95% CI [0.16.-0.99]; p = 0.048 and unknown source of infection (OR = 3.54; 95% CI [1.34-9.33]; p = 0.011). No clonal complex or virulence gene was associated with a risk of FB infection in patients with SAB. FB infection is frequent in patients with SAB, particularly when the bacteremia is community-acquired. Our results suggest that bacterial characteristics (clonal complex or virulence factors) are not involved in the occurrence of FB infection in patients with SAB.
Chryseobacterium indologenes bacteremia poses significant therapeutic challenges due to intrinsic multidrug resistance and the absence of established Clinical and Laboratory Standards Institute breakpoints for fluoroquinolones. We aimed to develop machine learning models to predict mortality and guide fluoroquinolone treatment decisions. In this retrospective study of 61 patients, we compared Logistic Regression, Conservative Random Forest, and two Calibrated Random Forest variants (Sigmoid/Isotonic) using Borderline Synthetic Minority Over-sampling Technique and conservative parameter settings to address small-sample limitations. Mortality was 21.3%, with shock identified as the strongest predictor (p < 0.001). Conservative Random Forest achieved the highest area under the curve (0.908) and good calibration stability. Notably, complex calibration methods yielded unstable probability curves, revealing a "calibration paradox" in small-sample settings. A risk stratification system based on optimal models successfully identified low-risk patients suitable for fluoroquinolone therapy. For rare infections with limited data, robust, conservative RF demonstrated a trend of stable calibration characteristics. This study provides an objective clinical decision support tool for Chryseobacterium indologenes treatment when standard susceptibility interpretation is unavailable.
Epidural analgesia (EA) is widely used during labor and frequently associated with maternal intrapartum fever, often prompting neonatal sepsis evaluations. Data from East Asia is scarce; we evaluated whether EA is associated with increased neonatal infection risk and related complications in a Taiwanese cohort. This retrospective cohort study included 2375 full-term, singleton vaginal deliveries at a tertiary medical center in Northern Taiwan from 2018 to 2021. Neonatal outcomes were compared between mothers who received EA and those who did not. Neonatal infection was operationalized as admission to the NICU for suspected infection, and prolonged antibiotic therapy (>48 h) was evaluated as a secondary outcome. Neonates in the EA group had a slightly higher rate of NICU admission for suspected infection than non-EA infants (4.04% vs 2.81%; p = 0.157), but this difference was not statistically significant. Maternal intrapartum fever occurred significantly more often with EA (28.3% vs 11.4%; p < 0.001), whereas neonatal fever was rare and similar between groups (1.79% vs 1.58%), and only one infant had culture-confirmed infection. In the NICU subgroup (EA N = 63; non-EA N = 23), low Apgar scores and meconium aspiration occurred only in EA-exposed infants, but these rare events and neonatal fever were not independently associated with EA in exploratory Firth logistic regression. Stratified analyses instead suggested that maternal intrapartum fever, rather than EA exposure, was more closely linked to neonatal fever. In this cohort, EA was associated with frequent precautionary neonatal sepsis evaluation without an increase in culture-confirmed infection. Potential residual confounding suggests that these findings should be interpreted as exploratory rather than causal. These findings highlight the need for cautious evaluation to prevent unnecessary antibiotic use in neonates.