Journal of Infection

ObjectivesPneumococcal surveillance typically focuses on invasive disease (IPD), collecting limited clinical data. We used a longitudinal adult cohort of IPD and non-invasive pneumococcal disease (non-IPD) patients in three hospitals between 2006-22, to describe clinical disease, including site of infection, and serotype distribution. MethodsThe demographics of IPD and non-IPD were compared and survival analysis performed. Features of IPD in different sites were compared and serotype distributi...

BackgroundWith the introduction of metagenomics in clinical diagnostics unfolding and the expanding role of pathogen genomics in national surveillance, the stage is set for its launch into public health surveillance. This report pilots the use of metagenomics for nationwide sentinel general practitioner (GP) monitoring and genomic characterisation of both anticipated and emerging respiratory viruses in primary care. MethodsThis prospective pilot study included a selection of 93 patients with ac...

BackgroundThe epidemiology of suspected pediatric meningoencephalitis has shifted in the era of conjugate vaccines and multiplex PCR diagnostics, with viral pathogens now predominating over bacterial causes. Updated epidemiologic data are essential to adapt diagnostic and therapeutic algorithms to current clinical practice. MethodsThis retrospective single-center study included children and adolescents <18 years who underwent lumbar puncture with cerebrospinal fluid multiplex PCR for suspected ...

ObjectivesDiagnosis of community-acquired Legionnaires disease (CALD) relies on microbiological testing. Routine testing in hospitalised CAP patients has low positivity rates. We externally validated a Legionella prediction score, assessed its applicability in routine care, and explored potential updates. MethodsWe analysed data from 196 CALD patients from 20 Swiss hospitals and 196 Legionella-negative CAP controls matched by date of diagnosis ({+/-}14 days; August 2022-March 2024). We assessed...

ObjectiveTo quantify the seasonal burden of acute respiratory viral infections among healthcare workers (HCWs), characterize virologic etiologies, and identify predictors of symptomatic illness and sick leave. MethodsWe conducted a prospective cohort study of HCWs during winter 2024-2025, with weekly surveys capturing acute respiratory infections (ARI) and sick leave. Nasal-throat multiplex PCR swabs were self-collected during symptomatic episodes. Incidence rate ratios (IRRs) for symptomatic e...

BackgroundsFollowing an increase in mpox clade Ib cases in several African countries, the World Health Organization recognized mpox as a public health emergency of international concern, highlighting the need for reliable and accessible diagnostic tools. As several mpox clades are co-circulating in endemic countries, the analytical sensitivity of diagnostic assays should be evaluated for all of them in a comparative manner. MethodsThis study evaluated the analytical sensitivity of three rapid t...

ImportanceRecent reports have highlighted an intense influenza activity related to the circulation of the influenza A(H3N2) subclade k variant. There is no data available on the impact of the emergence of H3N2 subclade k on the severity of the 2025-2026 epidemic or on the clinical phenotype of patients requiring admission to the intensive care unit (ICU). ObjectiveTo compare the clinical presentation, hospital mortality and virological characteristics of patients with laboratory-confirmed influ...

BackgroundKlebsiella pneumoniae complex (Kp) is a relevant neonatal pathogen colonizing preterm infants. While outbreak investigations often focus on multidrug-resistant strains, the epidemiology and genomic dynamics of wild-type Kp in nonoutbreak neonatal intensive care unit (NICU) settings remain elusive. MethodsWe conducted a 30-month (October 2021 to March 2024) cohort study with weekly active, unselective colonization surveillance of all NICU patients to identify risk factors for nosocomia...

Background and objectiveRespiratory Syncytial Virus (RSV) can cause severe illness in adults, leading to respiratory and non-respiratory complications, functional decline, hospitalisation, and death. This study describes French patients aged [&ge;]50 years hospitalised with RSV (2015-2022) and their care pathways, including hospitalisation and outpatient healthcare use and costs. MethodsData were extracted from the French National Health Data System (SNDS). Patients were classified into four ri...

BackgroundAntimicrobial resistance (AMR) represents one of the most serious threats to global public health, with a disproportionate burden borne by low- and middle-income countries. Rural healthcare settings in India remain under-represented in molecular AMR surveillance despite high antimicrobial use and limited diagnostic capacity. ObjectivesTo describe longitudinal phenotypic and molecular AMR patterns in clinical bacterial isolates from a rural district hospital in Gujarat, India, and to a...

The emergence of vaccine covered serotypes causing invasive pneumococcal disease (IPD) is a serious concern worldwide. We investigated the unexpected rise of serotype 4 causing IPD primarily in non-vaccinated young adults after the COVID-19 pandemic that further spread to adults [&ge;] 65 years in recent years. For this purpose, we conducted a retrospective study of serotype 4 IPD cases (n=827) reported in Spain between 2009 and 2024. Whole-genome sequencing was performed to assess clonal lineag...

BackgroundNeonatal IgM antibodies reflect an in-utero immune response to Treponema pallidum and may offer added diagnostic value. This study evaluated the test performance of treponemal IgM levels measured by the research-use-only (RUO) DPP Syphilis TnT point-of-care (POC) assay for CS risk stratification. MethodsConducted from May 2023 to May 2025, this study tested neonatal serum samples from infants born to mothers with syphilis using the DPP Syphilis TnT RUO POC assay, which reports trepone...

BackgroundNorovirus causes substantial burden to healthcare systems. England experienced high activity in recent seasons alongside a shift in the dominant genotype from GII.4 to GII.17. It remains unclear whether this increased burden reflects changes in severity or other transmission mechanisms associated with the strain replacement. MethodsIndividual-level testing and mortality data in England from 2022/23-2024/25 seasons were linked from national surveillance systems. Piece-wise exponential ...

BackgroundMpox has spread to 35 countries in Africa, yet many face challenges achieving nationwide PCR-based testing due to cost and limited access in remote and rural areas. Point-of-care antigen-based rapid diagnostic tests (AgRDTs) may help improve diagnostic access. ObjectivesTo evaluate the diagnostic accuracy of five mpox AgRDTs manufactured by Beijing Hotgen Biotech (China), Contipharma (Belgium), Hangzhou Testsea Biotechnology (China), Guangdong Wesail Biotech (China), and NG Biotech (F...

BackgroundHealthcare-associated carbapenemase-producing Enterobacterales (CPE) outbreaks are a major healthcare challenge. Epidemiological studies have identified patient-level risk factors for CPE transmission, and genomic studies have highlighted high-risk lineages or mobile genetic elements (MGEs); however, a unified dissemination risk-prediction framework is lacking. ObjectivesTo synthesise available data on epidemiological, microbiological and genomic risk factors to quantify healthcare-as...

BackgroundEpstein-Barr virus (EBV) establishes latency in most adults and can be reactivated under conditions of co-infection and immune dysregulation. COVID-19 has been associated with EBV reactivation, primarily in hospitalized cohorts, but EBV shedding in the oral cavity and the extent to which these dynamics trigger a systemic anti-EBV antibody response during acute COVID-19 remain poorly understood. MethodsWe conducted a nested cohort study of 69 community-based participants including 56 S...

Asymptomatic TB represents half of prevalent TB yet frequently remains undetected. We assessed the performance of plasma IL-6 and CRP as diagnostic biomarkers for asymptomatic TB identified by community-based screening. Both proteins were elevated in asymptomatic TB compared to community controls, but neither performed well as a diagnostic biomarker.

ObjectiveThe rapid availability of phenotypic antimicrobial susceptibility results is crucial for the timely detection of multidrug-resistant Gram-negative organisms and for guiding optimized treatment strategies. Recently, novel methods have been introduced that enable direct antimicrobial susceptibility testing (AST) from positive blood cultures. However, their performance has not yet been systematically compared in head-to-head evaluations. This study aimed to assess the analytical performanc...

BackgroundThe number and timing of pneumococcal conjugate vaccine (PCV) primary doses can impact infant immune responses. This descriptive post hoc analysis evaluates the immunogenicity of the 20-valent PCV (PCV20) by vaccination timing in healthy infants in 2 key phase 3 trials. MethodsImmunogenicity endpoints from study B7471012 comparing PCV20 to 13-valent PCV (PCV13) in a 2+1 schedule were examined by timing of vaccination subgroup; the 2,4m subgroup (participants vaccinated at 2, 4, and 11...

AO_SCPLOWBSTRACTC_SCPLOWO_ST_ABSBackgroundC_ST_ABSEnsuring appropriate access to essential antibiotics is a critical global public health goal. The UN General Assembly agreed that 70% of global antibiotic use should be WHO Access group. A standard method to estimate optimal antibiotic use based on burden of disease, resistance and local context is needed to inform national policies. MethodsUsing data from multiple global datasets, we clustered 186 countries, territories and areas (CTAs) into p...