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The post diarrheal hemolytic uremic syndrome (HUS) is a major complication of enteric infections with Shiga toxin producing (STEC). According to the present recommendations, antibiotic therapy of acute bloody diarrhea caused by STEC is generally discouraged. These recommendations are based on historically conflicting results describing the potential induction of HUS by antibiotic treatment during the early phase of infection with enterohemorrhagic O157 whereas no guidelines are available for the use of antibiotics in cases of already fully established HUS or in asymptomatic long term STEC carriers. In 2011, a large outbreak of hemorrhagic colitis complicated by HUS occurred in northern Germany caused by a STEC strain of serotype O104:H4 harbouring both a phage encoding Stx 2 as well as a plasmid mediated enteroaggregative phenotype. The majority of infections were observed in adults, complicated by the highest number of HUS cases ever encountered. Due to different newly introduced therapeutic strategies (e.g. complement blockade) antibiotic therapy was used in many patients once HUS was established. The outbreak therefore provided important new insights for the understanding of antibiotic therapy of STEC associated HUS in adults and for decolonization of long term STEC carriers. This review highlights new aspects concerning use of antibiotics in STEC infection and colonization.

Background: Little is known about the infrastructure to translate advances in the management of patients at risk to develop invasive opportunistic fungal diseases. To assess the current state of Medical Mycology support in Germany, we conducted a survey among all 36 academic medical centres. Methods: The survey consisted of a 3‐pages questionnaire sent out in the first half of 2019. Information included details of infrastructure, education and teaching; consultation services and interdisciplinary conferences; research activities and participation in network groups; radiology, microbiology and pharmacology support; publication activity; and European Confederation for Medical Mycology (ECMM) Excellence Center designation, if assigned. Results: Information was returned from 24 centres (67%). Thirteen institutions (54%) reported an independent infectious disease, and two a separate Medical Mycology department (8%); a Medical Mycology working group was reported for nine institutions (38%). An infectious disease consultation service was existent in 16 institutions (67%) and a multidisciplinary conference in 13 (54%). Fifteen institutions reported a separate study office with activities in infectious disease studies (63%). Laboratory capability for fungal identification and susceptibility testing was confirmed by all 24 institutions; testing of galactomannan by 23 (96%), cryptococcal antigen by 21 (88%), ß‐D‐Glucan by 9 (38%), and panfungal and Pneumocystis PCR by 21 and 22 (88% and 92%), respectively. Therapeutic drug monitoring of voriconazole was reported to be available in 15 (63%) institutions with a turnaround of ≤24 h during weekdays in 10 (42%). Two of the 24 University hospitals (8%) reported ECMM Diamond Excellence Status. Conclusions: The results of this survey document the continuing need to improve the availability of specialised Medical Mycology support in German academic medical centres. [ABSTRACT FROM AUTHOR]

We determined DNA sequences of the mitochondrial cytochrome b gene for 44 specimens of the common frog, Rana temporaria parvipalmata, from 14 localities in Galicia, northwestern Spain. We found a low differentiation among all studied individuals, with a maximum of four mutational steps between haplotypes, including those from the southernmost isolated populations on the Manzaneda-Queixa and Trevinca-Segundeira massifs which thus probably originated by a rather recent colonization and likely maintained intermittent gene flow to more northern populations during climatically colder, glacial periods with a higher habitat connectivity. [ABSTRACT FROM AUTHOR]

Background: The rise of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in low- and middle-income countries limits treatment options, leading to the frequent use of broad-spectrum antibiotics. Reducing time-to-result for a urinary infection can facilitate correct antibiotic treatment and support antimicrobial and diagnostic stewardship measures. This study compared two simplified enrichment methods for detecting CTX-M directly from urine specimens., Methods: Two enrichment methods, namely centrifugation of 2 mL urine and filtration of 1 mL urine using the DirecTool adaptor, were compared using 20 culture-positive urine samples (20 suspected ESBL-E and 20 non-ESBL-E). CTX-M production was detected using a lateral flow assay (LFA), NG-Test ® CTX-MMULTI. The presence of bla CTX-M genes was confirmed by whole-genome sequencing (WGS)., Results: The results of both enrichment methods were identical, with a sensitivity of 87.5% and a specificity of 100%. In 19/20 (95%) of the urine samples, the results of the CTX-M LFA were identical with the phenotypic confirmation and WGS. Both methods could detect ESBL-E bacteriuria with ≥10 4 cfu/mL. All ESBL-E-negative samples were identified accurately. Both enrichment methods yielded negative results in one ESBL-E-positive (CTX-M-15) sample despite phenotypic and genotypic confirmation of ESBL production. High leukocyte count (>500 cells/µL), the presence of boric acid or polymicrobial samples did not appear to impact the performance of both enrichment methods., Conclusions: Our study underscores the feasibility of directly detecting CTX-M in urine. Simplified enrichment methods, particularly with a filtration kit, enhance the assay's practicality, rendering it suitable for use in primary care, emergency departments or remote laboratories without sophisticated equipment., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)