BMC Infectious Diseases[JOURNAL]
Sun
200 papers
Ultrasound evaluation of urinary tract morbidity in adults living in a Schistosoma haematobium endemic region in Mozambique.
Serra JT, Conceição C, Silva C … +4 more , Sidat M, Belo S, Thompson R, Kaminstein D
BMC Infect Dis · 2026 Jun · PMID 42271298 · Full text
BACKGROUND: Ultrasound-based assessment of urinary tract morbidity remains central to the evaluation of Schistosoma haematobium infection, but the WHO Niamey protocol is operationally complex and has been used mainly in...
BACKGROUND: Ultrasound-based assessment of urinary tract morbidity remains central to the evaluation of Schistosoma haematobium infection, but the WHO Niamey protocol is operationally complex and has been used mainly in children and higher-transmission settings. We aimed to describe urinary tract structural abnormalities in adults living in an endemic area of Mozambique using a preliminary application of a modified Niamey-derived protocol adapted for point-of-care ultrasound (POCUS) and to compare these findings with parasitological and molecular evidence of infection. METHODOLOGY: We conducted a descriptive cross-sectional study between April and October 2018 among individuals aged 15 years or older living in the Chókwè Health and Demographic Surveillance System area, Mozambique. Schistosoma haematobium infection was defined by urine filtration and/or DNA detection. Urinary tract ultrasound was performed using a simplified Niamey-derived POCUS protocol. All examinations were performed by a trained investigator, and a subset of images was reviewed remotely for interobserver agreement. PRINCIPAL FINDINGS: Our study included 912 ultrasound exams. The prevalence of ultrasound detected urinary tract abnormalities was 37.9% (95% CI 34.8%-41.2%). Of these, 14.5% were positive for Schistosoma haematobium. We found that 11.8% (95% CI 9.7%-13.9%) had a lower urinary tract abnormality and 29.3% (95% CI 26.7%-32.7%) had an upper urinary tract abnormality. The renal pelvis was the most common location for ultrasound abnormalities (23.1%), followed by the ureters (20.4%) and the bladder wall (11.6%). Interobserver agreement was substantial for bladder findings (κ = 0.65), ureteral findings (κ = 0.78), and the final ultrasound score (κ = 0.63) and moderate for kidney findings (κ = 0.59). CONCLUSION: In this adult population from a historically endemic area, POCUS identified a substantial burden of urinary tract structural abnormalities despite a relatively low prevalence of current infection. In adults, particularly in low-prevalence or post-control settings, such abnormalities should not be interpreted as specific markers of active schistosomiasis, because they may reflect chronic sequelae, prior infection, or other urinary tract pathology. The study supports the feasibility of a simplified POCUS-adapted protocol under controlled research conditions with a trained operator; future implementation studies are needed before broader use by general clinicians can be recommended. CLINICAL TRIAL NUMBER: Not applicable.
A novel time-series modeling framework for predicting tuberculosis incidence in Sichuan, China.
Zhao D, Li S
BMC Infect Dis · 2026 Jun · PMID 42271291 · Full text
OBJECTIVE: Tuberculosis (TB) remains a major infectious disease and public health issue in Sichuan Province, China. This study aimed to explore and validate a novel adaptive hybrid model integrating Ensemble Empirical Mo...
OBJECTIVE: Tuberculosis (TB) remains a major infectious disease and public health issue in Sichuan Province, China. This study aimed to explore and validate a novel adaptive hybrid model integrating Ensemble Empirical Mode Decomposition (EEMD), Seasonal Autoregressive Integrated Moving Average (SARIMA), and Exponential Smoothing (ES), and apply it to forecasting TB incidence in Sichuan Province, China, for the first time. METHODS: We collected monthly TB incidence data from 2006 to 2020 in Sichuan Province, China, and divided the time series into training and test sets. The dataset comprised 180 monthly data points, which were split in an 8:2 ratio, with the training set covering 2006-2017 (144 months) and test set covering 2018-2020 (36 months). Subsequently, SARIMA, ES, and EEMD-SARIMA-ES hybrid models were developed based on the training set. The predictive performance was evaluated using a set of metrics, including the Mean Squared Error (MSE), Root Mean Squared Error (RMSE), and Mean Absolute Percentage Error (MAPE). RESULTS: The TB incidence from 2006 to 2020 exhibited distinct seasonal and cyclical patterns. The optimal ES model was the Holt-Winters additive (BIC=-0.845; residuals: Ljung Box Q = 22.721, p > 0.05). The optimal SARIMA model was SARIMA(1,0,0)(0,1,1) (AIC = 282.18, BIC = 293.71; residuals: Ljung Box Q = 0.079, p > 0.05). The constructed EEMD-SARIMA-ES hybrid model demonstrated superior predictive performance, achieving the lowest error metrics on both the training set (MSE = 3.5050, MAPE = 6.69%, RMSE = 4.9568) and test set (MSE = 0.6897, MAPE = 3.92%, RMSE = 0.9754), thereby outperforming either the ES or SARIMA model alone. CONCLUSIONS: The EEMD-SARIMA-ES hybrid model effectively captured the TB incidence trend in Sichuan Province, China. This model serves as an effective tool for TB surveillance and early warning in Sichuan Province.
Successful treatment of an NDM-5-producing, carbapenem-resistant Salmonella Kentucky ST198 infection with aztreonam and ceftazidime-avibactam in a patient with acute erythroid leukemia: a case report.
Qin Y, Lin L, Zhao H … +1 more , Hu X
BMC Infect Dis · 2026 Jun · PMID 42271265 · Full text
INTRODUCTION: Salmonella enterica serotype Kentucky (S. Kentucky) is a globally distributed food-borne zoonotic pathogen. It is increasingly associated with multi-drug resistance (MDR), notably to ciprofloxacin, a trend...
INTRODUCTION: Salmonella enterica serotype Kentucky (S. Kentucky) is a globally distributed food-borne zoonotic pathogen. It is increasingly associated with multi-drug resistance (MDR), notably to ciprofloxacin, a trend largely attributed to antibiotic overuse in humans and livestock. CASE PRESENTATION: An acute erythroid leukemia (AML-M6) man was found to be infected with carbapenem-resistant (CR) Salmonella enterica after chemotherapy. Salmonella serum agglutination test showed that the strain belonged to S. Kentucky. Antimicrobial susceptibility test showed that this strain is an MDR strain (resistant to carbapenems, ciprofloxacin, third-generation cephalosporins). Carbapenemase production was assessed via a colloidal gold immunochromatography assay and indicated expression of an NDM enzyme. Whole genome sequencing (WGS) revealed that this strain carried blaNDM-5, blaCTXM-55, and blaTEM-1 genes. Based on the identification of an NDM carbapenemase, in vitro synergy testing was performed, which demonstrated a synergistic effect between aztreonam and ceftazidime-avibactam. The patient was successfully treated with this combination regimen and recovered. CONCLUSIONS: This report describes an unusual infection caused by an NDM-5-producing S. Kentucky in an immunocompromised host. It underscores the necessity of employing combined phenotypic, immunologic, and molecular diagnostics to rapidly elucidate resistance mechanisms in such complex cases. Guided by this comprehensive analysis, the combination of aztreonam and ceftazidime-avibactam proved to be an effective, mechanism-based therapeutic strategy, highlighting its value in managing challenging infections in patients with hematological malignancies. CLINICAL TRIAL NUMBER: Not applicable.
Amazonian toxoplasmosis complicated by severe hypoxemic pneumonia and myopericarditis in an immunocompetent adult.
Fréville B, Herrebrecht C, Samawak C … +3 more , Dia A, Clerc A, Massoure PL
BMC Infect Dis · 2026 Jun · PMID 42271263 · Full text
BACKGROUND: Amazonian toxoplasmosis (AT) is a severe form of acute toxoplasmosis occurring in the Guiana Shield and characterized by a high frequency of multivisceral involvement, even in immunocompetent individuals. Pul...
BACKGROUND: Amazonian toxoplasmosis (AT) is a severe form of acute toxoplasmosis occurring in the Guiana Shield and characterized by a high frequency of multivisceral involvement, even in immunocompetent individuals. Pulmonary, ocular, hepatic, and lymphatic manifestations are well documented, but cardiac involvement remains exceptionally rare and likely underdiagnosed. The diagnosis is challenging because the early symptoms are nonspecific and cardiac abnormalities may be clinically silent. We present a case of severe AT with documented myopericarditis in a previously healthy young adult (one of the few such cases reported in the literature), highlighting the diagnostic challenges and the importance of early recognition. CASE PRESENTATION: A 25-year-old immunocompetent male soldier deployed in the Amazonian Forest of French Guiana developed high-grade fever, headache with retro-orbital pain, myalgia, rash, and gastrointestinal symptoms (diarrhea). After an initial emergency department visit suggesting dengue fever, his condition deteriorated with respiratory distress, hepatosplenomegaly, hepatic cytolysis, hyponatremia, and radiologic evidence of bilateral pneumonia. Twelve days later, he progressed to septic shock requiring vasopressor support and high-flow oxygen therapy. Extensive infectious workup was negative except for positive serology and polymerase chain reaction for Toxoplasma gondii, supporting a diagnosis of acute toxoplasmosis. These findings were consistent with severe acute toxoplasmosis in the reported clinical context. During follow-up, cardiac troponin value progressively increased. Transthoracic echocardiography revealed a circumferential pericardial effusion, and cardiac magnetic resonance imaging confirmed recent myopericarditis. Colchicine and ramipril were introduced. The patient completed a 6-week course of antiparasitic therapy (trimethoprim-sulfamethoxazole) and was considered cured at the 4-months follow-up after symptom onset. CONCLUSIONS: This case illustrates that AT may lead to severe complications, including myopericarditis, even in previously healthy individuals, a presentation that is very rarely reported in the literature. The diagnosis is challenging due to nonspecific early symptoms, overlap with other tropical infections, and limited access to advanced imaging in remote areas. Clinicians practicing in endemic regions should consider toxoplasmosis in the differential diagnosis of unexplained pneumonia, pericarditis or myocarditis.
Survival analysis and mortality predictors of COVID-19 across the six-wave pattern of the pandemic in Monastir, Tunisia : COVID-19 mortality predictors in Monastir across six waves.
Ben Fredj M, Maatouk A, Dhouib W … +7 more , Kacem M, Bennasrallah C, Gara A, Zemni I, Bouanene I, Belguith Sriha A, Abroug H
BMC Infect Dis · 2026 Jun · PMID 42271262 · Full text
BACKGROUND: COVID-19 represents a serious health concern leading to considerable morbidity and mortality worldwide. The repercussion of COVID-19 was expected to be more severe in middle- and low-income countries. Few stu...
BACKGROUND: COVID-19 represents a serious health concern leading to considerable morbidity and mortality worldwide. The repercussion of COVID-19 was expected to be more severe in middle- and low-income countries. Few studies have examined survival patterns across six successive pandemic waves. The objective of this study was to analyze the survival rates during the first six waves of the pandemic in the Monastir governorate (Tunisia) and identify mortality predictors of COVID-19. METHODS: We conducted a prospective cohort study encompassing all COVID-19 patients admitted to healthcare facilities in Monastir between March 2020 and March 2022, spanning six full waves of infection. Patients were monitored throughout their hospital stay. Data were gathered using a questionnaire carefully filled out by trained residents. Survival analysis was performed to compare outcomes across the different waves. Cox model employing a stepwise variable selection approach in multivariate survival analysis was utilized to assess the risk factors associated with COVID-19 deaths. RESULTS: COVID-19 waves occurred between March 2020 and March 2022, resulting in a total of 58,861 infections, 5176 hospitalizations, and 1109 deaths in hospitals. The 30-day survival rate decreased progressively, reaching its minimum during W4 and W5 at 30.6% and 29.5%, respectively. The 30-day cumulative in-hospital mortality probability among COVID-19 hospitalizations was 57.4%. Based on Cox multivariate analysis, W4 and W5 demonstrated the highest mortality risk, with W3 and W6 showing a moderate and comparable level of risk, while W2 exhibited the lowest risk. Independent prognostic factors for early hospital death were age over 75 years (HR 3.44- 95% CI 2.62-4.52), cancer (HR 1.90-95% CI 1.17-3.01), and neurological symptoms (HR 1.30-95% CI 1.04-1.62). Fever (HR 0.69- 95% CI 0.60-0.81) and digestive symptoms (HR 0.73- 95% CI 0.56-0.94) were associated with lower observed mortality. CONCLUSION: Advanced age, cancer and neurological symptoms are associated factors for in-hospital mortality during COVID-19. Our findings emphasize the importance of early identification and need for targeted interventions for high-risk patients to optimize care and improve survival rates. This six-wave longitudinal analysis provides a comprehensive overview of temporal changes in survival and mortality risk across successive pandemic phases, offering valuable evidence to inform preparedness and response strategies in similar settings. CLINICAL TRIAL NUMBER: Not applicable.
Real-world effectiveness of doravirine-containing antiretroviral therapy in Chinese adults living with HIV-1: a retrospective study.
Long H, Yang X, He S … +13 more , Liu J, Zhang R, Sun L, Zhao H, Li Y, Fu Y, Peebles K, Liu Y, Sun F, Liao X, Wang Q, Chen F, Wu H
BMC Infect Dis · 2026 Jun · PMID 42271256 · Full text
BACKGROUND: Doravirine (DOR)-containing antiretroviral therapy (ART) has been recommended as first-line ART by China treatment guidelines since 2021. However, Real-world studies on DOR in China are scarce. We evaluated t...
BACKGROUND: Doravirine (DOR)-containing antiretroviral therapy (ART) has been recommended as first-line ART by China treatment guidelines since 2021. However, Real-world studies on DOR in China are scarce. We evaluated the real-world effectiveness of DOR-containing ART in Chinese people with HIV-1 (PWH), including treatment-naïve people regardless of viral load (VL) at baseline and treatment-experienced people regardless if they were virologic suppression (VS) or not. METHODS: This was a retrospective, multicenter, observational study using medical chart review in seven hospitals, covering top-tier infectious disease hospitals across regions in China. All the participants who initiated DOR-containing ART during August 2021 and September 2023 were included and followed until September 2024. RESULTS: At baseline, higher proportions of the 352 participants were male (84.9%), from west region (78.7%), and mean age was 40.0 years. Of the 271 participants with available VL data to confirm the achievement of VS at week 48 ± 8 (271/352), 22.1% were treatment-naïve and 77.9% had prior antiretroviral experience. The adherence rate of DOR in the regimen or DOR/3TC/TDF single tablet was ≥ 80% in 91.5% of participants. Overall, DOR-containing ART achieved a VS rate of 93.7% (95% confidence interval: 90.8%, 96.6%), with rates of 90.0% and 94.8% observed in treatment-naïve and treatment-experienced participants, respectively. Notably, among all six treatment-experienced people who were unsuppressed at baseline, 100% of participants were suppressed at week 48 ± 8. DOR-containing ART appeared to be well tolerated among Chinese PWH, with an adverse event profile consistent with that described in product label. CONCLUSION: DOR-containing ART is an effective treatment for Chinese PWH in real-world settings, regardless of their VLs and treatment experience at baseline. CLINICAL TRIAL NUMBER: EUPAS (registration number: EUPAS103993), registered on [2023-03-23]; NMPA (registration number: CTR20231040), registered on [2023-04-10].
Edwardsiella tarda infections in humans: a systematic review of reported cases and clinical outcomes.
Saeedi MA, Rostamian M, Bahrami Y
BMC Infect Dis · 2026 Jun · PMID 42271255 · Full text
BACKGROUND: Edwardsiella tarda, a rare human pathogen in the Enterobacteriaceae family, primarily inhabits aquatic environments and infects various animals. Human infections are uncommon but can lead to severe clinical o...
BACKGROUND: Edwardsiella tarda, a rare human pathogen in the Enterobacteriaceae family, primarily inhabits aquatic environments and infects various animals. Human infections are uncommon but can lead to severe clinical outcomes. This systematic review aims to consolidate and analyze reported human cases of E. tarda infection. METHODS: A comprehensive search was conducted across PubMed, Scopus, Embase, and Web of Science databases for studies published between January 2000 and October 2025. RESULTS: After applying exclusion criteria, 59 unique case reports were included. Cases spanned both genders, predominantly affecting older adults, with Japan reporting the highest number. A history of seafood consumption or contact with aquatic animals was common. Clinical presentations varied, though fever and abdominal pain were most frequent. Laboratory findings typically revealed elevated C-reactive protein and leukocytosis. Treatment regimens included antibiotics such as meropenem, ceftriaxone, ampicillin, metronidazole, and levofloxacin, the most frequently used. CONCLUSIONS: Despite its rarity, E. tarda can cause life-threatening infections. Awareness among clinicians regarding risk factors, diagnostic methods-particularly culture-based identification-and timely antibiotic therapy is crucial for improved outcomes. CLINICAL TRIAL NUMBER: Not applicable.
Primary care metronidazole prescription in public and private facilities of South Benin: a register-based cross-sectional study.
Tankpinou Zoumenou H, Affolabi D, Kohoun R … +2 more , Sandjakian L, Faucher JF
BMC Infect Dis · 2026 Jun · PMID 42265647 · Full text
BACKGROUND: Metronidazole (MTZ) is a first-line antibiotic for several enteric infections. Its use is common in low-income countries, where most primary-care consultations are conducted by nurses. However, increasing res...
BACKGROUND: Metronidazole (MTZ) is a first-line antibiotic for several enteric infections. Its use is common in low-income countries, where most primary-care consultations are conducted by nurses. However, increasing resistance among some enteric pathogens is a growing concern. Using WHO guidelines, we conducted a retrospective study to assess MTZ prescribing practices and their determinants in public and private primary healthcare facilities in South Benin. METHODS: We performed a register-based cross-sectional study covering the year 2020 in 11 primary healthcare facilities (5 public and 6 private) in Abomey-Calavi, South Benin, following WHO recommendations. In total, 200 visits per facility were selected using systematic random sampling. The primary outcome was the prevalence of MTZ prescription. Determinants of MTZ prescription were identified using multivariable logistic regression analysis. RESULTS: In total, 2,200 medical visits were analyzed. The median age of patients was 19 years, and 57% were female. Antimalarials were prescribed in 52% of visits. Antibacterial agents were prescribed in the majority of visits, with MTZ being the second most frequently prescribed antibiotic (18%), after aminopenicillins (27%). In multivariable analysis, digestive symptoms (adjusted odds ratio [aOR], 8.86; 95% confidence interval [CI], 6.64-12.0), genitourinary symptoms (aOR, 6.65; 95% CI, 3.09-14.7), and skin lesions (aOR, 2.33; 95% CI, 1.54-3.51) were independently associated with increased odds of MTZ prescription. In contrast, fever (aOR, 0.64; 95% CI, 0.48-0.85), respiratory symptoms (aOR, 0.43; 95% CI, 0.26-0.70), and malaria (aOR, 0.21; 95% CI, 0.15-0.28) were associated with decreased odds. Male sex (aOR, 1.35; 95% CI, 1.05-1.73) and visits in the private sector (aOR, 2.31; 95% CI, 1.78-3.02) were also associated with higher odds of MTZ prescription. CONCLUSION: MTZ is the second most commonly prescribed antibiotic in primary care in the study area, with its use largely driven by digestive symptoms. Further studies are needed to assess the appropriateness of this prescription. Additionally, research is warranted to understand better the determinants of higher antimicrobial prescribing in the private healthcare sector.
Clinical profiles and predictors of intensive care unit transfer among children hospitalized with severe Plasmodium falciparum malaria in a tertiary care hospital in Libreville, Gabon: a retrospective study.
Moutombi-Ditombi BC, Lembet Mikolo AM, Ndong Ngomo JM … +6 more , M'bondoukwé NP, Mihindou CJ, Moussavou Mabika DA, Mawili-Mboumba DP, Ategbo SJ, Bouyou-Akotet MK
BMC Infect Dis · 2026 Jun · PMID 42265612 · Full text
BACKGROUND: Severe Plasmodium falciparum malaria remains a major cause of paediatric morbidity in sub-Saharan Africa. While mortality has declined in many settings, severe disease requiring escalation of care persists. D...
BACKGROUND: Severe Plasmodium falciparum malaria remains a major cause of paediatric morbidity in sub-Saharan Africa. While mortality has declined in many settings, severe disease requiring escalation of care persists. Data on predictors of intensive care unit (ICU) transfer among children with severe malaria remain limited in Central Africa. This study aimed to describe the clinical and biological profiles of paediatric severe malaria in an urban Gabonese setting and to identify factors associated with ICU transfer as an early marker of clinical deterioration. METHODS: A retrospective analytical study was conducted at the Centre Hospitalier Universitaire Mère-Enfant Fondation Jeanne Ebori (CHUMEFJE) in Libreville, Gabon. Medical records of children below 17 years and hospitalised between January 2021 and July 2022 with microscopically confirmed P. falciparum malaria were reviewed. Severe malaria was defined according to WHO 2014 criteria. ICU transfer among survivors was the primary adverse outcome. Clinical, laboratory, and demographic variables were analysed using univariate and multivariable logistic regression. A cumulative count of WHO severe malaria criteria was used as an indicator of disease severity. RESULTS: Among 3.009 hospitalised children, 480 (15.9%) met WHO criteria for severe malaria and were included. The median age was 6 [1-10] years. Overall mortality was low (0.7%), while 8.5% (n = 41) required ICU transfer. Neurological manifestations (64.2%) predominated, particularly prostration (49.2%), impaired consciousness (10.8), and coma (4.2%). ICU transfer was significantly associated with delayed consultation (p = 0.01) and neurological signs (p < 0.01). In multivariable analysis, impaired consciousness (aOR: 14.86; 95%IC [5.58-42.40], p < 0.01) and coma (aOR: 53.3; 95%IC [10.9-178.1], p < 0.01) remained the strongest independent predictors of ICU transfer, whereas isolated biological abnormalities such as severe anaemia or hyperparasitaemia were not. The risk of ICU transfer increased markedly with the number of concurrent severe malaria criteria, especially beyond three criteria (aOR: 10.59; 95%IC [2.38-42.87], p < 0.01). CONCLUSION: ICU transfer was frequent and primarily driven by neurological and accumulated severity features. Assessing the number of concurrent WHO criteria offers a pragmatic tool for risk stratification. Although conducted in a referral centre capturing the city's transmission heterogeneity, multicentre studies are needed to validate these predictors across diverse healthcare systems. CLINICAL TRIAL NUMBER: Not applicable.
Clinical characteristics, healthcare-associated exposures, and antifungal susceptibility patterns of Candida auris colonization and invasive infections: a retrospective observational study at a single center in Turkey.
Timur D, Demir C
BMC Infect Dis · 2026 Jun · PMID 42265601 · Full text
BACKGROUND: Candida auris (Candidozyma auris) differs from other yeast species by its ability to persist for prolonged periods on environmental surfaces and human skin. This feature facilitates person-to-person transmiss...
BACKGROUND: Candida auris (Candidozyma auris) differs from other yeast species by its ability to persist for prolonged periods on environmental surfaces and human skin. This feature facilitates person-to-person transmission and contributes to healthcare-associated infections and outbreaks. In this study, both invasive C. auris infections and colonization were evaluated together. We aimed to compare clinical characteristics and healthcare-associated exposures between invasive and colonized cases and to assess antifungal susceptibility patterns in invasive infections. METHODS: A total of 79 patients with C. auris isolation between December 2022 and April 2025 were retrospectively analyzed. Species identification was confirmed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Patients with C. auris isolated from invasive specimens, such as blood or tissue, were classified as having invasive infection, whereas those with isolation from non-invasive specimens such as axilla/groin swabs, nasal swabs, urine, catheters, and sputum, without concurrent invasive positivity, were classified as colonized. Patients with both screening and invasive positivity were included in the invasive infection group for comparative analyses. Antifungal susceptibility to amphotericin B, fluconazole, micafungin, and anidulafungin was determined on invasive isolates using the Sensititre YeastOne colorimetric microdilution method. Interpretation of results was based on the tentative breakpoints defined by the United States Centers for Disease Control and Prevention and the epidemiological cutoff values established by the European Committee on Antimicrobial Susceptibility Testing. Demographic characteristics, clinical variables, and healthcare-associated exposures were compared between the invasive infection and colonization groups. RESULTS: A total of 91 C. auris isolates from 79 patients were evaluated. Invasive infection was detected in 41 patients (52%) and colonization in 38 patients (48%). Most cases were observed in intensive care and palliative care units. Among screening sites, axilla/groin swabs showed the highest positivity rate. Central venous catheter use, intubation, surgical history, and decubitus ulcer were numerically more frequent among invasive cases; however, none of these differences reached statistical significance. Echinocandin resistance developed in two patients during follow-up. The median age was significantly higher in the invasive group than in the colonized group (74 vs. 64.5 years; p = 0.002). CONCLUSION: Accurate identification of C. auris and continuous antifungal susceptibility surveillance are essential for infection control. Older age was the only variable significantly associated with invasive infection, while other clinical and healthcare-associated exposures were common in both groups but did not differ significantly. All isolates were resistant to fluconazole, and echinocandin resistance emerged in two isolates. Amphotericin B susceptibility findings should be interpreted cautiously, as the use of Sensititre YeastOne without confirmatory reference testing may have overestimated resistance. Larger multicenter studies are needed to better define factors independently associated with invasive infection.
Successful treatment by high dose glucocorticoid of miliary tuberculosis complicated with acute respiratory distress syndrome: a case report.
Lin F, Tang X, Fei X … +1 more , Guo J
BMC Infect Dis · 2026 Jun · PMID 42265561 · Full text
A 25-year-old previously healthy man presented with a productive cough for 2 months and progressive dyspnea for 1 week. He did not respond to initial anti-infective treatment at a local hospital. Chest computed tomograph...
A 25-year-old previously healthy man presented with a productive cough for 2 months and progressive dyspnea for 1 week. He did not respond to initial anti-infective treatment at a local hospital. Chest computed tomography (CT) demonstrated diffuse miliary nodules, ground-glass opacities throughout both lungs, and bilateral pleural effusion (more prominent on the right). Laboratory tests revealed type I respiratory failure, elevated inflammatory markers, hyponatremia, hypoproteinemia, and raised tumor markers (NSE, CYFRA21-1, SCC, CA125). Sputum acid-fast bacilli smears were negative, but pleural fluid analysis showed elevated adenosine deaminase and interferon-gamma, suggestive of tuberculous pleurisy. Percutaneous lung biopsy confirmed epithelioid granulomas with positive acid-fast staining, establishing the diagnosis of miliary tuberculosis, tuberculous pleurisy, severe pulmonary infection, and acute respiratory distress syndrome (ARDS). Anti-tuberculosis therapy was withheld initially due to elevated liver enzymes and was initiated once liver function normalized. High-dose methylprednisolone (160 mg/day) combined with noninvasive positive pressure ventilation (NIPPV) was added, yielding initial improvement. However, complications arose after 8 days of NIPPV, including pneumothorax, subcutaneous and mediastinal emphysema, and suspected disseminated intravascular coagulation (DIC). NIPPV was discontinued, subcutaneous incision and xiphoid puncture drainage performed, and supportive measures (cryoprecipitate, immunoglobulin, continued glucocorticoids) instituted. Symptoms and imaging gradually resolved. After 1 year of anti-tuberculosis treatment, the patient achieved complete clinical and radiological recovery. This case highlights that, alongside potent anti-tuberculosis therapy, high-dose glucocorticoids combined with NIPPV (with cautious management of barotrauma risks) can effectively control life-threatening miliary tuberculosis complicated by ARDS.
Effect of prior TB preventive therapy on all-cause mortality during TB treatment among people with HIV/TB in rural eastern Uganda: an observational causal analysis.
Izudi J, Bajunirwe F, Ssentongo SM … +2 more , Appeli S, Cattamanchi A
BMC Infect Dis · 2026 Jun · PMID 42260436 · Full text
BACKGROUND: Tuberculosis preventive therapy (TPT) is the cornerstone for preventing TB disease. However, it is uncertain whether prior TPT completion improves survival once TB disease develops in people with human immuno...
BACKGROUND: Tuberculosis preventive therapy (TPT) is the cornerstone for preventing TB disease. However, it is uncertain whether prior TPT completion improves survival once TB disease develops in people with human immunodeficiency virus (PWH) while on anti-retroviral therapy (ART). We evaluated the effect of prior TPT completion on all-cause mortality during TB treatment among PWH who developed TB disease while on ART in rural eastern Uganda. Prior TPT completion served as a marker of sustained engagement in HIV care. METHODS: We applied inverse probability of treatment weighting using propensity scores, a causal inference analysis approach, to mimic a randomized controlled trial using real-world retrospective cohort data. Inverse probability of treatment weighting addresses design flaws in observational studies, such as selection and confounding biases, providing less biased causal effect estimates. Individuals who had completed a full course of TPT before the start of the index TB treatment episode formed the intervention group, while the control group comprised those with no history of TPT before the index TB treatment initiation. Inverse probability of treatment weighting ensured balanced baseline covariates between the exposure groups. We estimated all-cause mortality rates using person-time methods and Kaplan-Meier curves and performed propensity-score weighted Cox proportional hazards analysis for cause-effect estimation. We reported adjusted hazard ratios (aHR) with 95% confidence intervals (CI). RESULTS: Of 719 participants, 296 (41.2%) had completed a full course of TPT before the start of the index TB treatment episode, and 83 (11.5%) had died. The mortality rate was 7.13 per 10,000 person-days, higher among participants without prior TPT than those with prior TPT completion (18.0% vs. 2.4%, log-rank χ² = 35.3, p < 0.001). Median survival was 277 days (95% CI: 213-689). Prior TPT completion was associated with an 87% lower hazard of all-cause mortality (aHR 0.13, 95% CI: 0.06-0.29). CONCLUSION: Prior TPT completion substantially reduced all-cause mortality among PWH who developed drug-susceptible TB disease while on ART. Therefore, there is a need to strengthen TPT completion and engagement in HIV care across HIV programs to lower all-cause mortality among PWH.
Pathogen-specific epidemiology and clinical trajectories of fungal infections after kidney transplantation: a prospective multicenter cohort study.
Schröter I, Schindler D, Morath C … +8 more , Renders L, Andrassy J, Kanzelmeyer N, Schork A, Zeier M, Giese T, Sommerer C, Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium
BMC Infect Dis · 2026 Jun · PMID 42260406 · Full text
BACKGROUND: Fungal infections contribute substantially to morbidity and mortality after kidney transplantation, yet pathogen-specific epidemiology and clinical risk profiles remain incompletely defined. We aimed to chara...
BACKGROUND: Fungal infections contribute substantially to morbidity and mortality after kidney transplantation, yet pathogen-specific epidemiology and clinical risk profiles remain incompletely defined. We aimed to characterize incidence, timing, and pathogen-specific risk factors in a contemporary multicenter cohort. METHODS: This prospective study, performed by the German Center for Infection Research, included 1,258 adult kidney transplant recipients across five German centers (2011-2022). Fungal infections were diagnosed using clinical, radiological, and mycological criteria. Cox regression identified pathogen-specific associations. Detailed clinical presentation was additionally analyzed in a predefined Heidelberg subcohort. RESULTS: The cumulative incidence of fungal infections was 6.7% (95% CI 5.3-8.5). The most frequent pathogens were Candida albicans (40.6%), non-albicans Candida (26.0%), Aspergillus fumigatus (13.5%), and Pneumocystis jirovecii (13.5%). Fever was absent in 79.2% of episodes, and 67.2% had preceding bacterial infections. Pneumocystis jirovecii pneumonia occurred predominantly between October and April, whereas Aspergillus fumigatus infections were observed year-round. ICU stay (HR 5.7, p < 0.01) and prolonged hospitalization were associated with Candida albicans. Prior linezolid exposure (HR 3.9, p = 0.037), delayed graft function (HR 2.9, p = 0.049), and pancreas-kidney transplantation (HR 5.0, p = 0.005) were linked with non-albicans Candida. Carbapenem exposure was associated with Pneumocystis jirovecii pneumonia (HR 6.8, p = 0.002) and invasive aspergillosis (HR 9.8, p < 0.001). Invasive aspergillosis showed the highest mortality (41.7%). In the Heidelberg subcohort (n = 495), invasive aspergillosis was diagnosed mainly during inpatient care or shortly thereafter, while Pneumocystis jirovecii pneumonia was primarily identified after outpatient care. CONCLUSION: Fungal infections after kidney transplantation show distinct epidemiological patterns with pathogen-specific risk profiles, supporting risk-adapted monitoring and diagnostics.
Cervicovaginal cytokine profiles and their associations with colposcopic findings in adolescent girls and adult women in South Africa: an exploratory cross-sectional study.
Gumbi Z, Radebe P, Sibeko S … +16 more , Saruchera B, Maphumulo N, Masson L, Tanko R, Manhanzva M, Mehou-Loko C, Radzey N, Abrahams A, Harryparsad R, Meyer B, Matume N, Ngcapu S, Passmore JA, JaAuthorName H, Humphries H, Mkhize P
BMC Infect Dis · 2026 Jun · PMID 42260401 · Full text
BACKGROUND: Colposcopy is used to evaluate cervical inflammation and detect precancerous and other cervical lesions; however, access remains limited in many low-resource settings. Identification of cervicovaginal immune...
BACKGROUND: Colposcopy is used to evaluate cervical inflammation and detect precancerous and other cervical lesions; however, access remains limited in many low-resource settings. Identification of cervicovaginal immune biomarkers associated with specific colposcopic findings may provide insight into mucosal immune alterations linked to increased susceptibility to sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), although these associations do not imply diagnostic or predictive utility in a cross-sectional context. METHODS: In this exploratory cross-sectional study, 203 adolescent girls (14-19 years) and adult women (25-35 years) from KwaZulu-Natal (KZN; n = 105) and the Western Cape (WC; n = 98) underwent colposcopic assessment for cervical ectopy, discharge, injury/inflammation, and leukoplakia. Cervicovaginal cytokines were quantified using multiplex Luminex assays. Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and bacterial vaginosis (BV) were assessed. Logistic regression models identified correlates of colposcopic findings. Exploratory model performance metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated to describe within-dataset model behaviour. RESULTS: Overall, 75% of participants had at least one colposcopic finding. Leukoplakia was more prevalent in KZN (36% of adolescents and 22% of adults), while cervical discharge was most common in WC (36% in both age groups). In univariate analyses, injectable progestin use was associated with any colposcopic finding (OR = 2.10, p = 0.04), implant use was associated with ectopy in KZN (OR = 6.94, p = 0.04), and BV was associated with cervical discharge (OR = 3.37, p = 0.04). In the exploratory multivariable models, selected cervicovaginal cytokines showed finding- and site-specific associations with colposcopic outcomes. In KZN, higher granulocyte colony-stimulating factor (G-CSF) concentrations and parity were associated with cervical ectopy, while BV was associated with cervical discharge. In WC, interleukin-6 (IL-6) and macrophage inflammatory protein (MIP)-1β were associated with cervical ectopy, whereas lower MIP-1α concentrations were associated with leukoplakia. Measures of model performance varied across outcomes and sites, and should be interpreted within the context of the exploratory study design. CONCLUSION: Cervicovaginal cytokine profiles were differentially associated with specific colposcopic findings in a site-specific manner. These findings are exploratory and hypothesis-generating, highlighting potential biological correlates of cervical changes. Further validation in larger longitudinal cohorts is required to determine whether these cross-sectional associations are reproducible and biologically meaningful.
Urine antibiogram and antimicrobial susceptibility pattern in a provincial hospital of Nepal: a cross-sectional study.
Jha PK, Barma S, Jha PK … +8 more , Sapkota B, Chaudhary S, Ghimire B, Singh A, Khakurel B, Bidari P, Pathak P, Pandey B
BMC Infect Dis · 2026 Jun · PMID 42260392 · Full text
INTRODUCTION: The National Action Plan on antimicrobial resistance (AMR) strategic priority of Nepal focuses on strengthening the surveillance system for the containment of AMR within the country, as such, this study aim...
INTRODUCTION: The National Action Plan on antimicrobial resistance (AMR) strategic priority of Nepal focuses on strengthening the surveillance system for the containment of AMR within the country, as such, this study aims to report the prevalence of bacterial isolate and antimicrobial susceptibility pattern. METHOD: A hospital-based retrospective cross-sectional study was conducted using routine urine culture and antimicrobial susceptibility records from Hetauda Hospital, Nepal, from May 28, 2023, to September 8, 2023. Clinically significant uropathogens were identified using standard microbiological procedures, and antimicrobial susceptibility testing was performed using the modified Kirby-Bauer disk diffusion method. Susceptibility results were interpreted according to the CLSI M100 criteria used by the hospital laboratory during the study period. Data were analysed descriptively using frequencies, percentages, and relevant denominators. RESULT: Out of 3893 patient samples, 1162 (29.84%) bacterial isolates were detected. Gram-negative bacteria accounted for 67.81% of the isolates, with Escherichia coli (47.16%) being the most common, followed by Klebsiella sps. (14.54%). AST has revealed varying patterns across different antibiotics and bacterial species. Escherichia coli (E. coli) emerged as the predominant pathogen showing variable susceptibility across antibiotic classes, with highest sensitivity to amikacin (83.90%) and notable resistance to fluoroquinolones and cephalosporins, highlighting significant challenges in empirical therapy. Notably, 20.40% of the isolates were classified as MDR, with Proteus vulgaris showing the highest MDR rate (46.15%). CONCLUSION: This study highlights the prevalence of urinary bacterial isolates (E. coli) and multidrug-resistant strains (Proteus vulgaris) at Hetauda Hospital, with considerable resistance to cephalosporins and fluoroquinolones. These findings support AST-guided prescribing, local antimicrobial stewardship, and development of a hospital antibiogram. The results are contextually relevant to Nepal's AMR policy agenda, but they should be interpreted as hospital-level data rather than as provincial or national surveillance estimates.
Impact of Dolutegravir-based regimens on patient satisfaction and quality of life among people living with HIV: a systematic review and meta-analysis.
Abubakar MM, Okoye CO, Jeminiwa R … +11 more , Ifeorah IK, Ezeja L, Dauran Y, Musa S, Joel SU, Bello AM, Ngige AP, Ezenri G, Isah A, Ikhile I, Ukoha-Kalu BO
BMC Infect Dis · 2026 Jun · PMID 42260389 · Full text
BACKGROUND: Despite the global scale up of dolutegravir (DTG)-based regimens as the preferred first-line therapy for persons living with HIV (PLHIV), no comprehensive evidence exists on its effect on patient-reported out...
BACKGROUND: Despite the global scale up of dolutegravir (DTG)-based regimens as the preferred first-line therapy for persons living with HIV (PLHIV), no comprehensive evidence exists on its effect on patient-reported outcomes such as Quality of Life (QoL) and patient satisfaction (PS). We conducted a systematic review and meta-analysis to provide the first comprehensive quantitative synthesis of the effect of DTG-based regimens on QoL and PS among PLHIV. METHOD: We conducted literature search on PubMed, Scopus, Embase and Cochrane Library databases for peer-reviewed, primary studies published from January 2015 to January 2025. Studies using validated tools to evaluate QoL and PS among PLHIV exposed to DTG were eligible. Standardised Mean Differences (SMD) were computed using DerSimonian-Laird random-effects model. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. The study protocol was registered on PROSPERO (CRD42025643301). RESULTS: Seventeen out of the 214 (n = 4064) identified studies met the inclusion criteria, with six contributing to the QoL meta-analysis and four to the PS meta-analysis. The pooled QoL estimate showed a small improvement favoring DTG-based regimens compared to other antiretroviral therapy (ART) though not statistically significant (SMD: 0.094, 95% CI: -0.034-0.223; p = 0.15; GRADE: Very Low). With the WHOQOL-HIV BREF tool subgroup, a positive directional effect was also observed (SMD: 0.09, 95% CI: -0.042-0.22, p = 0.18; I2 = 0.0%) compared to other ART, though not statistically significant. DTG-based regimens were associated with a statistically significant improvement in PS (SMD = 0.3; 95% CI: 0.2-0.4; p < 0.001; I2 = 10.7; GRADE: Low). Among studies that used the HIV Treatment Satisfaction Questionnaire to evaluate PS, the effect of DTG-based regimens was also statistically significant (SMD: 0.32, 95% CI: 0.2-0.45, p < 0.001; I2 = 34%). CONCLUSION: This review identified a directional improvement in QoL and a statistically significant small improvement in PS among PLHIV on DTG-based regimens. Findings from this study were supported by low between-study heterogeneity. However, findings should be interpreted in the context of low and very low certainty of evidence for both outcomes. Additionally, results from this study are best characterized as hypothesis-generating and supportive of person-centered HIV care, underscoring the need for more well-designed trials to generate high-certainty evidence on patient-reported outcomes among PLHIV. CLINICAL TRIAL NUMBER: Not applicable.
Impact of United Kingdom guidelines for stratification of risk in adult hospital inpatients identified with sepsis - an observational cohort study.
Dalrymple KV, Grant D, Retter A … +7 more , Wilson E, Tomasi I, Kviatkovske O, Calvert SH, Deep A, Wang Y, Glover GW
BMC Infect Dis · 2026 Jun · PMID 42260387 · Full text
BACKGROUND: United Kingdom National Institute for Health and Care Excellence (NICE) guidelines for evaluation of sepsis risk remain to be validated. This study aims to model the impact of the updated guidelines in patien...
BACKGROUND: United Kingdom National Institute for Health and Care Excellence (NICE) guidelines for evaluation of sepsis risk remain to be validated. This study aims to model the impact of the updated guidelines in patients identified as having a risk of sepsis based on the original guidelines. METHODS: A single centre cohort study, between 2019 and 2022. Adult inpatients at risk of sepsis defined by red / amber flags in the original guideline were included. NICE criteria, based upon aggregate National Early Warning Score (NEWS2) and additional risk-factors (NEWS2 single parameter score three, lactate ≥2mmol/l, skin changes, acute kidney injury or deteriorating trajectory) were applied to this cohort to derive a revised risk classification. The primary outcome was the net reclassification index (NRI). Secondary outcomes were the association with a composite of critical care admission or death in hospital and the association with ICD-10 sepsis / Sepsis-3 status. RESULTS: 1303 hospital inpatients were included. Between red flag sepsis and NICE High-risk classification, there was agreement in 57.6%. The NICE model decreased the risk-classification in 471 (42.4%), of whom 216 experienced the composite outcome. The event RI deteriorated (-0.321), whilst the non-event RI improved (0.355). NICE High-risk had a similar C-statistic (0.57(0.55,0.60) vs. 0.56(0.54,0.58)) but with lower sensitivity (59.1% vs. 91.2%), higher specificity (55.1% vs. 20.2%) and PPV (55.9% vs. 52.1%) as compared to red flags. NICE High-risk had a greater C-statistic for association with Sepsis-3 status (0.66 (0.63, 0.69) vs. 0.55 (0.54, 0.57)). CONCLUSIONS: As implemented in this study, NICE criteria decreased the number of patients in a high-risk sepsis category, compared to a model using red flag criteria. These criteria decreased sensitivity and increased specificity for the outcome of critical care admission or death, whilst strengthening the association with Sepsis-3 criteria. Limited predictive performance advocates for clinically-led sepsis assessment.
Magnitude of multidrug resistant Mycobacterium tuberculosis and associated risk factors among pulmonary tuberculosis patients in Tigray region, Ethiopia.
Weldemariam GF, Mulaw MA, Tessema TS
BMC Infect Dis · 2026 Jun · PMID 42260386 · Full text
BACKGROUND: Multidrug resistant Mycobacterium tuberculosis (MDR-TB) is the main public health problem in resource constrained settings particularly in the Tigray region of Ethiopia, where diagnostic and treatment service...
BACKGROUND: Multidrug resistant Mycobacterium tuberculosis (MDR-TB) is the main public health problem in resource constrained settings particularly in the Tigray region of Ethiopia, where diagnostic and treatment service are limited. Therefore, we aimed to examine post-war prevalence of MDR-TB in Tigray region. METHODS: A cross-sectional study was conducted in Tigray Region between February 2024 and January 2025. 163 GeneXpert tested positive sputum samples were collected, transported and processed for acid-fast bacilli staining, culture and drug susceptibility testing. The 106 (65%) MTBC samples culture positive isolates were subjected to drug susceptibility test using 1st- and 2nd- line anti-TB drugs using molecular line probe assay. Descriptive statistics, binary and multivariable logistic regression were done. A statistical test was regarded as significant when the P value was ˂0.05. RESULT: MDR-TB was detected at the rate of 18.9. Patients who smoke cigarettes (AOR = 15.64, 95% CI = 3.05580.126) were 15.64 times more likely to develop MDR-TB than those who did not smoke. HIV positive patients (AOR = 5.31, 95%CI 1.305-21.615) were 5.31times more than to develop MDR-TB than those who did not have HIV. Single TB patients were less likely to develop MDRTB compared to married and divorced TB patients. CONCLUSION: The prevalence of Multidrug-Resistant Tuberculosis (MDR-TB) was high in Tigray region, especially in previously treated TB cases. This warrants urgent public health intervention to prevent the transmission of MDR-TB in the community.
Epidemiological characteristics of varicella in Xuzhou from 2015 to 2024: surveillance study.
Jin G, Song X, Lou H … +6 more , Sun Y, Gu Y, Han S, Min M, Zhao Y, Liu D
BMC Infect Dis · 2026 Jun · PMID 42260377 · Full text
BACKGROUND: Varicella remains a major public health challenge in China, with limited evidence on long-term urban-rural epidemiological trends. This study analyzes varicella characteristics in Xuzhou, Jiangsu, 2015-2024,...
BACKGROUND: Varicella remains a major public health challenge in China, with limited evidence on long-term urban-rural epidemiological trends. This study analyzes varicella characteristics in Xuzhou, Jiangsu, 2015-2024, focusing on incidence, seasonality, and public health emergency events (PHEEs). METHODS: This surveillance study analyzed population-based varicella case data and public health emergency events (PHEEs) in Xuzhou City, China, from January 2015 to December 2024. Data were extracted from the China Disease Prevention and Control Information System and the National Notifiable Disease Reporting System. Varicella PHEEs were defined as ≥ 10 cases occurring in a collective unit within one week. We employed descriptive statistics, chi-square tests, and chi-square trend tests (for temporal trends of incidence rates) to analyze temporal trends and demographic distribution; the Mann-Kendall trend test was used to assess trends in PHEE-related indicators (duration, reporting latency, and case counts per event). RESULTS: Annual incidence increased sharply to a peak of 65.01 per 100,000 in 2019, decreased in 2020, transiently rebounded in 2021, and then showed an overall declining pattern through 2024; overall, annual incidence varied significantly over the 10-year period (trend χ = 6789.65, p < 0.001). Two peaks emerged: a winter peak (Oct-Jan, 52.74% of cases) and a minor early summer peak (May-Jul, 26.36%). Urban areas had higher case counts but lower attack rates than rural areas (1.52% vs. 1.81%, p < 0.001). Males had an incidence rate 1.24 times that of females (p < 0.001). Children aged 0-14 years accounted for 83.22% of cases, with the highest rate in 5-9-year-olds (219.26/100,000), while adults aged ≥ 30 years showed a significant upward trend in case proportion (trend χ = 260.09, p < 0.01). All reported varicella PHEEs emerged in educational sites, 90.29% in primary schools and kindergartens, with 67.96% involving 10-30 cases. Kindergartens had the highest attack rate (5.60%). PHEE duration, case count, and reporting latency correlated strongly (Spearman's ρ=0.97-0.99, p < 0.01). CONCLUSIONS: Xuzhou's varicella epidemiology features seasonal clustering, age-specific vulnerability, and school-associated outbreaks. Strengthening rural/childhood vaccination and improving school PHEE responses are critical for control. CLINICAL TRIAL NUMBER: Not applicable.
Effect of adding metronidazole to meropenem on clinical efficacy in complicated intra-abdominal infections: a retrospective study.
Nakashima H, Miyazaki M, Nishimura N … +3 more , Maeyama R, Yoshikuni K, Imakyure O
BMC Infect Dis · 2026 Jun · PMID 42260373 · Full text
BACKGROUND: Complicated intra-abdominal infections (cIAI), often caused by a diverse range of organisms, are commonly managed with appropriate empiric antimicrobial therapy, particularly broad-spectrum agents such as mer...
BACKGROUND: Complicated intra-abdominal infections (cIAI), often caused by a diverse range of organisms, are commonly managed with appropriate empiric antimicrobial therapy, particularly broad-spectrum agents such as meropenem (MEPM). Anaerobes contribute to 30%-80% of the causative pathogens, and Bacteroides fragilis, a typical anaerobe, has been reported to exhibit increased resistance to antimicrobial agents. Metronidazole (MNZ) has shown significant antibacterial activity against anaerobes and a different mechanism of action; therefore, its addition to MEPM may improve its clinical efficacy. This study aimed to evaluate the impact of adding MNZ to MEPM on the clinical efficacy of empiric antimicrobial therapy for cIAI. METHODS: This retrospective study spanned 9 years and included 114 patients who underwent empiric antimicrobial therapy with MEPM monotherapy or MEPM plus MNZ combination therapy for cIAI caused by lower gastrointestinal perforation in conjunction with surgery or percutaneous drainage. Propensity score matching was applied to adjust for background factors. The primary outcome was the cure rate, while secondary outcomes included 28-day mortality and the duration of hospitalization following surgical intervention. RESULTS: There were no significant differences in the cure rates, 28-day mortality or hospitalization durations between the MEPM monotherapy group and the MEPM plus MNZ group [cure rates: 91.2% (83/91) vs. 91.3% (21/23), respectively, p = 0.999; 28-day mortality: 2.2% (2/91) vs. 4.3% (1/23), respectively, p = 0.495; hospitalization durations, median (interquartile range): 18 days (11.5-26.5) vs. 20 days (15.5-32.0), respectively; p = 0.214]. Twenty patients were selected for each group using propensity score matching. No significant differences were observed in cure rates, 28-day mortality, or hospitalization durations between the MEPM monotherapy group and the MEPM plus MNZ group [cure rates: 85.0% (17/20) vs. 95.0% (19/20), respectively, p = 0.605; 28-day mortality: 10% (2/20) vs. 5% (1/20), respectively, p = 0.999; hospitalization durations, median (interquartile range): 16 days (11.8-24) vs. 20.5 days (16.3-38.3), respectively; p = 0.184]. CONCLUSION: In this single-center retrospective cohort, there was no evidence that adding MNZ to MEPM improved clinical efficacy in empiric antimicrobial therapy with infection-source control in cIAI. CLINICAL TRIAL NUMBER: Not applicable.
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