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Although there are several US Food and Drug Administration (FDA)-approved/cleared molecular microbiology diagnostics for direct analysis of patient samples, all are single target or panel-based tests. There is no FDA-approved/cleared diagnostic for broad microbial detection. Polymerase chain reaction (PCR)/electrospray ionization-mass spectrometry (PCR/ESI-MS), commercialized as the IRIDICA system (Abbott) and formerly PLEX-ID, had been under development for over a decade and had become CE-marked and commercially available in Europe in 2014. Capable of detecting a large number of microorganisms, it was under review at the FDA when, in April 2017, Abbott discontinued it. This turn of events represents not only the loss of a potential diagnostic tool for infectious diseases but may be a harbinger of similar situations with other emerging and expensive microbial diagnostics, especially genomic tests. [ABSTRACT FROM AUTHOR]

The clonal dissemination of VanB-type vancomycin-resistant Enterococcus faecium (VREfm) strains in three Swedish hospitals between 2007 and 2011 prompted further analysis to reveal the possible origin and molecular characteristics of the outbreak strain. A representative subset of VREfm isolates (n = 18) and vancomycin-susceptible E. faecium (VSEfm, n = 2) reflecting the spread in time and location was approached by an array of methods including: selective whole genome sequencing (WGS; n = 3), multi locus sequence typing (MLST), antimicrobial susceptibility testing, virulence gene profiling, identification of mobile genetic elements conferring glycopeptide resistance and their ability to support glycopeptide resistance transfer. In addition, a single VREfm strain with an unrelated PFGE pattern collected prior to the outbreak was examined by WGS. MLST revealed a predominance of ST192, belonging to a hospital adapted high-risk lineage harbouring several known virulence determinants (n≥10). The VREfm outbreak strain was resistant to ampicillin, gentamicin, ciprofloxacin and vancomycin, and susceptible to teicoplanin. Consistently, a vanB2-subtype as part of Tn1549/Tn5382 with a unique genetic signature was identified in the VREfm outbreak strains. Moreover, Southern blot hybridisation analyses of PFGE separated S1 nuclease-restricted total DNAs and filter mating experiments showed that vanB2-Tn1549/Tn5382 was located in a 70-kb sized rep17/pRUM plasmid readily transferable between E. faecium. This plasmid contained an axe-txe toxin-antitoxin module associated with stable maintenance. The two clonally related VSEfm harboured a 40 kb rep17/pRUM plasmid absent of the 30 kb vanB2-Tn1549/Tn5382 gene complex. Otherwise, these two isolates were similar to the VREfm outbreak strain in virulence- and resistance profile. In conclusion, our observations support that the origin of the multicentre outbreak was caused by an introduction of vanB2-Tn1549/Tn5382 into a rep17/pRUM plasmid harboured in a pre-existing high-risk E. faecium ST192 clone. The subsequent dissemination of VREfm to other centres was primarily caused by clonal spread rather than plasmid transfer to pre-existing high-risk clones. [ABSTRACT FROM AUTHOR]

A medical report is present on Earlier and more targeted treatment of neonatal sepsis. The article mentions about the mortality rates due to neonatal infections are unacceptably high; samples with a limited number of viable microorganisms due to slow-growing bacteria or pre-emptive antibiotic treatment may lead to false-negative results and detrimental effects.

Background: The prevalence of fungal bloodstream infections (BSI), especially candidaemia, has been increasing globally during the last decades. Fungal diagnosis is still challenging due to the slow growth of fungal microorganisms and need for special expertise. Fungal polymicrobial infections further complicate the diagnosis and extend the time required. Epidemiological data are vital to generate effective empirical treatment strategies., Objectives: The overall aim of this project is to describe the epidemiology of monomicrobial candidaemia and polymicrobial BSI, both with mixed fungaemia and with mixed Candida/bacterial BSIs., Methods: We conducted a single-centre retrospective epidemiological study that encompasses 950,161 blood cultures during the years 2010 to 2020. The epidemiology of monomicrobial and polymicrobial candidaemia episodes were investigated from the electronic records., Results: We found that 1334 candidaemia episodes were identified belonging to 1144 individual patients during 2010 to 2020. Candida albicans was the most prevalent species detected in candidaemia patients, representing 57.7% of these episodes. Nakaseomyces (Candida) glabrata and Candida parapsilosis complex showed an increasing trend compared to previous studies, whereas Candida albicans demonstrated a decrease. 19.8% of these episodes were polymicrobial and 17% presented with mixed Candida/bacterial BSIs while 2.8% were mixed fungaemia. C. albicans and N. glabrata were the most common combination (51.4%) in mixed fungaemia episodes. Enterococcus and Lactobacillus spp. were the most common bacteria isolated in mixed Candida/bacterial BSIs., Conclusions: Polymicrobial growth with candidaemia is common, mostly being mixed Candida/bacterial BSIs. C. albicans was detected in more than half of all the candidaemia patients however showed a decreasing trend in time, whereas an increase is noteworthy in C. parapsilosis complex and N. glabrata., (© 2024 The Authors. Mycoses published by Wiley‐VCH GmbH.)

Blood culture is the standard method for microbiological diagnostics in sepsis. In many countries, the traditional recommendation for blood culture has been collection of four blood culture bottles with two bottles from each of two venipunctures. New studies show that four blood culture bottles from the same venipuncture provides similar culture results and higher number of obtained blood culture bottles, than the traditional method. Thus, new national recommendations recommend collection of four blood culture bottles from the same venipuncture as the routine blood culture method in Sweden.

Background: Recent outbreaks of Candida auris further exemplify that invasive Candida infections are a substantial threat to patients and healthcare systems. Even short treatment delays are associated with higher mortality rates. Epidemiological shifts towards more resistant Candida spp. require careful surveillance., Objectives: Triggered by the emergence of C auris and by increasing antifungal resistance rates the European Confederation of Medical Mycology developed an international Candida Registry (FungiScope™ CandiReg) to allow contemporary multinational surveillance., Methods: CandiReg serves as platform for international cooperation to enhance research regarding invasive Candida infections. CandiReg uses the General Data Protection Regulation compliant data platform ClinicalSurveys.net that holds the electronic case report forms (eCRF). Data entry is supported via an interactive macro created by the software that can be accessed via any Internet browser., Results: CandiReg provides an eCRF for invasive Candida infections that can be used for a variety of studies from cohort studies on attributable mortality to evaluations of guideline adherence, offering to the investigators of the 28 ECMM member countries the opportunity to document their cases of invasive Candida infection. CandiReg allows the monitoring of epidemiology of invasive Candida infections, including monitoring of multinational outbreaks. Here, we describe the structure and management of the CandiReg platform., Conclusion: CandiReg supports the collection of clinical information and isolates to improve the knowledge on epidemiology and eventually to improve management of invasive Candida infections. CandiReg promotes international collaboration, improving the availability and quality of evidence on invasive Candida infection and contributes to improved patient management., (© 2019 Blackwell Verlag GmbH.)

Granulicatella and Abiotrophia spp. were known as nutritionally variant streptococci (NVS). Such strains have caused major diagnostic difficulties due to fastidious culturing and unspecific colony morphology. The present study is aimed at comparing the performance of laboratory available diagnostic methods for NVS isolates and determining the antimicrobial susceptibility of these isolates. Fourteen clinical invasive isolates, consisting of 10 Granulicatella adiacens, 1 Granulicatella elegans, and 3 Abiotrophia defectiva were in parallel analyzed by 2 matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems, i.e., Bruker MS and Vitek MS, as well as Vitek 2 for the species determination. 16S rRNA gene sequencing was applied as a reference method. The Vitek MS gave correct identification for all 14 isolates. The Bruker MS could correctly identify 8/10 G. adiacens, 0/1 G. elegans, and 3/3 A. defectiva isolates at the first analysis occasion, and all 14 isolates became identifiable after repeated tests. The Vitek 2 system could identify 6/10 G. adiacens, 1/1 G. elegans, and 2/3 A. defectiva isolates at the species level. Antimicrobial susceptibilities of 11 antibiotics were determined by Etest. Resistance against ciprofloxacin, ceftriaxone, rifampicin, and tetracycline were observed in 4, 10, 4, and 1 isolates, respectively. In conclusion, MALDI-TOF MS is a useful tool for the rapid diagnosis of NVS. Phenotypic testing by Vitek 2 is only partially effective for the accurate identification of such strains. The emergence of resistant NVS isolates indicates the necessity of monitoring antimicrobial susceptibilities of such uncommon pathogens., (© 2013.)

The purpose of this investigation was to evaluate the performance of 4 supplements: horse blood, fastidious organisms supplement (FOS), haemin isovitalex albumine (HIA), and brain heart infusion-haemin isovitalex albumine (BHI-HIA) and 5 blood culture bottles: Bactec Mycosis IC/F, Plus Aerobic/F, Peds Plus/F from the Bactec 9240 system, and BacT/Alert FA and BacT/Alert PF from the BacT/Alert 3D system, in detection of bacteria and Candida spp. in simulated sterile body fluids other than blood models. In total, 8 reference strains (Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Candida albicans, and Candida parapsilosis) and 11 clinical bacteria and yeast isolates (6 isolates from cerebrospinal fluid and 5 isolates from blood) were included in this study. Horse blood, FOS, and HIA were significantly better than no supplements (P < 0.0001, P < 0.0002, and P = 0.05, respectively) in detection of bacteria. Interestingly, there was no significant difference between BHI-HIA and bottles without any supplements. Sixty bottles analyzed of which 59 (98.33%) bottles with horse blood, 53 (88.33%) with FOS, 45 (75.00%) with HIA, and 43 (71.67%) with BHI-HIA signaled positive. The positivity rates with horse blood were significantly higher than with HIA and BHI-HIA (P < 0.0005 and P < 0.0001, respectively). Similarly, the blood culture bottles with horse blood had shorter time to detection (TTD) compared to bottles with FOS and HIA (P < 0.05 and P < 0.0001, respectively). When yeasts were analyzed, almost all (124/125) blood culture bottles with Candida spp. signaled positive even in the absence of supplements. Bactec Mycosis IC/F had significantly shorter TTD compared to Bactec Peds Plus/F, Bactec Plus Aerobic/F, BacT/Alert FA, and BacT/Alert PF bottles in detection of Candida spp. (P < 0.005, P < 0.05, P < 0.001, and P < 0.001, respectively). The present study showed that horse blood was the most effective supplement in growth of bacteria in the blood culture bottles that were analyzed in the study., (© 2013.)

In the present study we investigated transport times for blood cultures from three tertiary-care hospitals to Karolinska University Laboratory and identified predictors of long transport times. Concomitantly, consequences of delayed incubation on total detection time (TDT) were analyzed by in vitro sepsis models. A total of 909 blood cultures were studied. The median (interquartile range) transport time was 9 (3-15) h. The hospital accommodating the microbiology laboratory had the shortest transport time compared to the other two hospitals (P < 0.0001). Samples taken between 16:00-24:00 had longer transport times compared to samples taken between 8:00-16:00 and 24:00-08:00 (P < 0.0001). In vitro experiments showed that TDT was longer for samples pre-incubated at room temperature (RT) for 19 h compared to the ones pre-incubated for 2 h or 9.5 h (P < 0.0001). In conclusion, off-site location, time of sampling and number of transports per day were related to, and predictors of transport time., (Copyright © 2013 Elsevier Inc. All rights reserved.)