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Invasive liver abscess syndrome (ILAS) is caused by strains of hypervirulent Klebsiella pneumoniae (hvKp) and has emerged as the leading cause of liver abscesses in immuno-competent patients (L.K. Siu et al. Lancet Infect Dis 2012; 12: 881–87). ILAS is frequently associated with metastatic spread including the eyes, lungs, and the central nervous system. The morbidity and mortality of affected patients are increased compared to liver abscesses of other origin, especially in cases with concomitant diabetes mellitus (J. E. Choby et al. J Intern Med 2020; 287(3): 283–300). Immediate diagnosis and early intervention are essential for an optimal outcome. Therefore, ultrasound plays a crucial role if hvKp is suspected. However, experience with the characteristics of such abscesses on contrast-enhanced ultrasound (CEUS) is very limited.

Background: The diagnosis of SARS-CoV-2 infection relies on RT-PCR from nasopharyngeal swabs. The pre-analytical value of different methods of material harvesting for SARS-CoV-2 are unknown. Methods: We conducted a comprehensive investigation of the pre-analytical performance for different pharyngeal sampling procedures in hospitalized patients with confirmed SARS-CoV-2 infection. In addition to swabs taken simultaneously from different locations, saliva and pharyngeal lavages were also analyzed using RT-PCR.Results: In 10 COVID-19 patients, standard nasopharyngeal swabs detected 8 out of 10 positive patients, whereas swabs taken from the palatoglossal arch resulted in 9 correct-positive results. Brushing the posterior pharynx wall with swabs resulted in detection of 9 out of 10 positive patients with no difference using either dry swabs or liquid Amies medium. A strong correlation between Ct values of both swab materials was observed. Pharyngeal lavages yielded 6 out of 10 positive results in concordance with 85% of nasopharyngeal swabs in late-stage COVID-19 patients. Investigating 23 patients with early SARS-CoV-2 infection, pharyngeal lavages showed a concordance rate of 100% compared to nasopharyngeal swabs.Conclusions: The diagnostic performance of swabs taken from the palatoglossal arch in detecting SARS-CoV-2 infection is similar to that of specimens taken from the nasopharyngeal region. However, the former sampling method is associated with less discomfort and much easier to perform. Pharyngeal lavages may replace swabs for mass screening in early stages of SARS-CoV-2 infection. The predictive values are comparable, and the procedure is performed without exposing healthcare workers to transmission risks.

ObjectiveUnderstanding mild to moderate symptoms of coronavirus disease 2019 (Covid-19) is important in order to identify active cases early and thus counteract transmission.MethodsIn March 2020, Leipzig University Hospital established an outpatient clinic for patients potentially infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Confirmed cases with mild to moderate symptoms self-isolated at home and were followed-up by daily telephone calls for at least 14 days. Symptoms and course of illness of these patients are reported here.ResultsFrom March 20 to April 17, 2020, 1460 individuals were tested for SARS-CoV-2 by naso- or oropharyngeal swab for real-time polymerase chain reaction (RT-PCR). Covid-19 was confirmed in 91 (6.2%) patients, of which 87 were included in the final analysis. Patients presented for testing after a mean of 5.9 days (IQR = 2.0-8.5). The median age was 37.0 years (IQR = 28.5-53), and 48 (55.2%) were female. Five (5.7%) patients required hospital admission during the course of illness. Most frequently reported symptoms were fatigue (n = 64, 74%), cough (n = 58, 67%), and hyposmia/hypogeusia (n = 44, 51%). In contrast to previous reports, fever occurred in less than a third of patients (n = 25, 29%). By day 14, more than half of the patients had recovered completely (n = 37/70, 52.9%).ConclusionsFever seems to be less common in patients of relatively young age diagnosed with mild to moderate Covid-19. This suggests that body temperature alone may be an insufficient indicator of SARS-CoV-2 infection.

[This corrects the article DOI: 10.1371/journal.pone.0246312.].

BackgroundInstitution-specific guidelines (ISGs) within the framework of antimicrobial stewardship programs offer locally tailored decision support taking into account local pathogen and resistance epidemiology as well as national and international guidelines.ObjectivesTo assess the impact of ISGs for antimicrobial therapy on antibiotic consumption and subsequent changes in resistance rates and Clostridioides difficile infections (CDIs).MethodsThe study was conducted at the Leipzig University Hospital, a 1,451-bed tertiary-care medical center, and covered the years 2012 to 2020. Since 2014, ISGs were provided to optimize empirical therapies, appropriate diagnostics, and antimicrobial prophylaxis. We used interrupted time series analysis (ITSA) and simple linear regression to analyze changes in antimicrobial consumption, resistance and CDIs.ResultsOver the study period, 1,672,200 defined daily doses (DDD) of antibiotics were dispensed, and 85,645 bacterial isolates as well as 2,576 positive C. difficile cultures were collected. Total antimicrobial consumption decreased by 14% from 2012 to 2020, without clear impact of the deployment of ISGs. However, implementation of ISGs was associated with significant decreases in the use of substances that were rarely recommended (e.g., fluoroquinolones). Over the whole study period, we observed declining resistance rates to most antibiotic classes of up to 25% in Enterobacterales, staphylococci, and Pseudomonas aeruginosa. Switching from ceftriaxone to cefotaxime was associated with reduced resistance to third-generation cephalosporins. The number of CDI cases fell by 65%, from 501 in 2012 to 174 in 2020.ConclusionsWell-implemented ISGs can have a significant, immediate, and lasting impact on the prescription behavior. ISGs might thereby contribute to reduce resistance rates and CDI incidences in the hospital setting.

This is the fourteenth chapter of the guideline “Calculated initial parenteral treatment of bacterial infections in adults – update 2018” in the 2 updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience.Bacterial gastrointestinal infections are still the leading cause of death worldwide. The chapter describes the etiology of bacterial gastrointestinal infections in Germany and their frequency. Recommendations are given for the calculated therapy of these infections and for targeted antibiotic therapy for known pathogens. Particular attention is paid to . The diagnostic and therapeutic options of antibiotic therapy of the various infection patterns in this pathogen are discussed.

We report on a 33-year old Polish truck driver who was admitted as a COVID-19 suspicion case to our hospital after a short stay in northern Italy and was eventually diagnosed with fulminant Capnocytophaga canimorsus sepsis. In retrospect, the patient always had his dog with him in the truck cab and was regularly licked in the face. Following adequate therapy, the patient recovered completely after 8 weeks and was discharged from the hospital in good general condition.

BackgroundMultidrug-resistant Gram-negative bacteria (MDRGN) are found with rising prevalence in non-hemodialysis risk populations as well as hemodialysis (HD) cohorts in Asia, Europe and North America. At the same time, colonization and consecutive infections with such pathogens may increase mortality and morbidity of affected individuals. We aimed to monitor intestinal MDRGN colonization in a yet not investigated German HD population.MethodsWe performed cross-sectional point-prevalence testing with 12 months follow-up and selected testing of relatives in an out-patient HD cohort of n = 77 patients by using microbiological cultures from fresh stool samples, combined with Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF-MS) and antimicrobial susceptibility testing.ResultsWe detected MDRGN in 8 out of 77 patients (10.4%) and 1 out of 22 relatives (4.5%), indicating only colonization and no infections. At follow-up, 2 patients showed phenotypic persistence of MDRGN colonization, and in 6 other patients de-novo MDRGN colonization could be demonstrated. Pathogens included Escherichia coli and Klebsiella pneumoniae (with extended-spectrum beta-lactamase [ESBL]-production as well as fluoroquinolone resistance), Stenotrophomonas maltophilia and Enterobacter cloacae.ConclusionsIn a single-center study, MDRGN colonization rates were below those found in non-HD high-risk populations and HD units in the US, respectively. Reasons for this could be high hygiene standards and a strict antibiotic stewardship policy with evidence of low consumption of fluoroquinolones and carbapenems in our HD unit and the affiliated hospital.

ObjectiveTo assess usage patterns, perceived usability, and effects of institution-specific guidelines (ISGs) for antimicrobials on clinicians' prescribing behavior and the additional benefits of the mobile application (app), a single-center survey among medical doctors was performed.MethodsThe study was carried out in a 1451-bed tertiary-care academic medical center in Leipzig, Germany. To ensure optimal empirical antibiotic therapies, appropriate diagnostics, and targeted antimicrobial prophylaxis, ISGs were provided as printed pocket guides (since 2014), a PDF version on ward computers, and a mobile app (since 2017). For the survey, we used an electronically structured cross-sectional questionnaire with 31 items, ordinal Likert scales, and percent bars, allowing for quantitative comparisons.ResultsOf the 914 doctors contacted by email, 282 (31%) responded, and 254 (28%) surveys were eligible. ISGs were reported to be the most commonly used source of information for antimicrobial prescribing among the respondents. Ninety-four percent used ISGs at least once and 55% at least weekly. On average, participants reported using them in 38% of antibiotic prescriptions and to adhere to consulted recommendations in 87% of cases. Young clinicians (≤ 30 years) reported significantly higher use of the ISGs than their older colleagues (47% vs. 35% of antibiotic prescriptions, p = 0.004). Ninety-six percent of users found ISGs to be user-friendly, and nearly 100% recommended ISGs to other colleagues. Forty-five percent regarded the app as the most user-friendly way to access ISGs, and app users were significantly more likely to use ISGs regularly (p = 0.024). Eighty-four percent reported behavioral changes regarding at least one aspect of antimicrobial therapy (e.g. duration, application mode, prescription frequency), while 54% reported changes regarding the choice of specific substance groups.ConclusionsISGs are used regularly and appear to have a relevant impact on clinicians' prescribing habits. A mobile app may be the most effective way to provide ISGs, although multiple platforms seem to add value. While the majority of participants reported perceived effects on their prescribing behavior, this study does not allow any conclusions to be drawn about the extent of the effects of ISGs on antibiotic use and patient outcomes.