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The optimal treatment duration for vancomycin-resistant enterococcal (VRE) bacteraemia is still a matter of debate. The aim of the present study was to compare short-course (≤9 days) and long-course (≥10 days) antibiotic treatments in hospitalized adult patients with uncomplicated VRE bacteraemia. This retrospective study was conducted in four university hospitals in Germany. Adult patients with a positive blood culture for a VRE were screened from 1 January 2016 to 31 December 2018. Only patients who received a VRE-active antibiotic for at least 48 hours were included. The exclusion criteria were a survival of <10 days and a deep-seated source of infection requiring prolonged treatment. To compare the outcome of short-course therapy with that of long-course therapy, 30-day and 90-day overall mortality, relapse within 90 days, duration of hospitalization, and potential antibiotic-related adverse events were analysed by inverse probability of treatment weighting using the propensity score and by additional covariate adjustment. Of the 363 patients screened, 219 (60.3%) patients were included in the final analysis. Among them, 48 (21.9%) patients had underlying haematological diseases. Seventy-eight (35.6%) patients received short-course treatment (median, 7 days; interquartile range, 5–8 days) and 141 (64.4%) patients received long-course treatment (median, 15 days; interquartile range, 12–23.5 days). Thirty-day mortality was similar in both groups (19.2% vs. 22.0%; adjusted OR, 1.15; p 0.773). Duration of hospitalization (in total and after onset of bacteraemia) was significantly shorter (p < 0.05) in the short-course treatment group, whereas other secondary outcome parameters did not differ between both groups. Our study suggests that short-course treatment might not be associated with a worse outcome in patients with uncomplicated VRE bacteraemia. [ABSTRACT FROM AUTHOR]

Classification of Staphylococcus aureus bacteraemia (SAB) as 'complicated' or 'uncomplicated' and management of both is based on low-quality evidence. The aim of the study was to determine the degree of agreement among infectious diseases physician experts in the management of patients with SAB. A stepwise RAND-modified Delphi procedure with two questionnaire rounds was performed. Four aspects of management in 22 clinical scenarios were addressed: (a) classification of SAB episodes; (b) value of combination therapy; and (c) timing of and (d) preferred antibiotics for oral stepdown therapy. Out of 90 approached experts, 33 (36.7%) from 14 different countries and 5 continents consented to participate. The experts considered any of the discussed implanted foreign material (with no evidence of infection), except for coronary artery stents, as relevant to the classification of a complicated SAB episode. Concerning antibiotic combination therapy, the experts strongly agreed that combination therapy with rifampicin is only relevant in patients with prosthetic valve endocarditis and prosthetic joint infection. The experts considered an oral stepdown therapy in patients with an uncomplicated SAB within 14 days and only thereafter in patients with a complicated SAB episode, but never in patients with prosthetic valve endocarditis. No single antibiotic of choice for oral stepdown therapy could be identified, neither for infections with methicillin-resistant S. aureus nor methicillin-susceptible S. aureus. The Delphi survey can help physicians in their day-to-day decision-making process, and it reveals open questions that must be investigated by further studies. [ABSTRACT FROM AUTHOR]

Due to a substantial proportion of asymptomatic and mild courses, many severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections remain unreported. Therefore, assessment of seroprevalence may detect the real burden of disease. We aimed to determine and characterize the rate of SARS-CoV-2 infections and the resulting seroprevalence in a defined population. The primary objective of the study was to assess SARS-CoV-2 antibody seroprevalence using six different IgG-detecting immunoassays. Secondary objectives of the study were: (a) to determine potential risk factors for symptomatic versus asymptomatic coronavirus disease 2019 courses, and (b) to investigate the rate of virus RNA-persistence. CoNAN is a population-based cohort study performed in the community Neustadt am Rennsteig, Germany, which was quarantined from 22 March to 5 April after six SARS-CoV-2 cases were detected in the village's population. The SARS-CoV-2 outbreak comprised 51 cases and 3 deaths. The CoNAN study was performed from 13 May to 22 May 2020, 6 weeks after a SARS-CoV-2 outbreak. We enrolled a total of 626 participants (71% of the community population) for PCR and antibody testing in the study. All actual SARS-CoV-2 PCR tests were negative. Fifty-two out of 620 (8.4%) participants had antibodies against SARS-CoV-2 in at least two different assays. There were 38 participants with previously PCR-confirmed SARS-CoV-2 infection. Of those, only 19 (50%) displayed anti-SARS-CoV-2 antibodies. We also show that antibody-positive participants with symptoms compatible with a respiratory tract infection had significantly higher antibody levels then asymptomatic participants (EU-assay: median 2.9 versus 7.2 IgG-index, p 0.002; DS-assay: median 45.2 versus 143 AU/mL, p 0.002). Persisting viral replication was not detected. Our data question the relevance and reliability of IgG antibody testing to detect past SARS-CoV-2 infections 6 weeks after an outbreak. We conclude that assessing immunity for SARS-CoV-2 infection should not rely on antibody tests alone. [ABSTRACT FROM AUTHOR]