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Background: A plethora of antimicrobial stewardship (AMS) programs has been initiated during the past years, focusing on hospital settings. Primary-care physicians have seldom been addressed, although the majority of antibiotic prescriptions are issued for outpatients. We sought to investigate attitudes of primary-care physicians and the impact of a customized training course.Methods: Primary-care physicians in southwest Germany were invited to a multi-part training course on AMS in the primary-care setting. Participants were asked to answer a questionnaire about their attitude and factors that hinder them from implementing AMS or enable them to perform AMS. In addition, a knowledge assessment exam at the beginning and end of the training was conducted on selected infectious diseases/syndromes.Results: In total, 36 primary-care physicians participated in the training course. The predominant age group was 51–60 years old (36%; 13/36). The majority, 23/35 (66%), indicated never having had AMS training, while 22/35 (63%) acknowledged partly implementing AMS activitin their daily routine. The primary barrier was lack of expertise, while the main motives were reducing antimicrobial resistance and optimizing patient care. The provision of guidelines was regarded as more important than feedback on their prescription behavior. Exam performance improved from the initial to the final exam on all topics.Conclusion: Customized AMS training courses are a feasible and potentially complimentary tool to address antibiotic misuse in the primary-care setting.

Capnocytophaga canimorsus is a rare cause of serious infections with a high mortality of 10% to 30%. It is usually found in the oral cavity of cats and dogs and can cause severe sepsis in immunocompromised patients. An 81‐year‐old female Caucasian patient presented with C. canimorsus sepsis after a dog bite in her finger three days before presentation to our emergency department. She initially was presented to us with sepsis, thrombopenia, and schistocytes in her laboratory findings, suggesting the differential diagnoses of the multiple subtypes of thrombotic microangiopathy. She was admitted to the medical intensive care unit of the University Hospital of Saarland because of septic shock with circulatory insufficiency. The patient received plasmapheresis, antibiotics, and dialysis, under which she improved significantly. The fingertip of the affected finger developed necrosis and had to be amputated. Furthermore, the patient was diagnosed with a mitral valve endocarditis, a very rare complication of C. canimorsus infection. It was treated conservatively with antibiotics and was no longer detectable 8 weeks after the diagnosis. Surgical intervention was not needed. The case describes well that it is still difficult to distinguish between thrombotic thrombocytopenic purpura (TTP), disseminated intravascular coagulation (DIC), and sepsis‐induced coagulopathy (SIC), especially in the early phases of acute disease, especially in C. canimorsus-induced sepsis. [ABSTRACT FROM AUTHOR]

Background Host-response biomarkers to differentiate bacterial from viral etiology in children with respiratory infections have shown high accuracies, but are understudied in Mycoplasma pneumoniae (Mp) infections. Methods We compared BV scores (0–34 indicating viral etiology, and 66–100 indicating bacterial etiology), tumor necrosis factor–related apoptosis-inducing ligand (TRAIL; pg/mL), interferon-γ inducible protein 10 (IP-10; pg/mL), and C-reactive protein (CRP; mg/L) serum levels between Mp -positive (Mp +) and Mp -negative (Mp −) community-acquired pneumonia (CAP) patients. We performed receiver operating characteristic (ROC) curve analyses for clinical features and biomarkers. Results Of 80 CAP patients (median age, 6.3 years; 57.5% male), 26 had Mp +CAP. In Mp +CAP patients, compared to Mp −CAP patients, BV scores were lower (14.0 [3.0–27.8] vs 54.0 [12.0–84.8]; P =.0008), TRAIL levels were higher (86.5 [67.4–123.0] vs 65.5 [42.5–103.9]; P =.025), CRP levels were lower (12.9 [4.0–22.3] vs 36.7 [13.0–132.8]; P =.0019), and IP-10 levels were comparable (366.0 [150.2–603.8] vs 331.0 [154.3–878.8]; P =.73) (all median [interquartile range]). ROC analyses yielded a comparable discriminatory accuracy for the combination of age, fever duration, and duration of respiratory symptoms, with either procalcitonin or BV score (area under the ROC curve, 0.87 vs 0.86; P =.94). Conclusions Children with Mp +CAP have atypically low, viral levels of the BV score, underscoring the complementary role of microbiological testing. [ABSTRACT FROM AUTHOR]

We describe detection of the previously rarely reported gram-positive bacterium Auritidibacter ignavus in 3 cases of chronic ear infections in Germany. In all 3 cases, the patients had refractory otorrhea. Although their additional symptoms varied, all patients had an ear canal stenosis and A. ignavus detected in microbiologic swab specimens. A correct identification of A. ignavus in the clinical microbiology laboratory is hampered by the inability to identify it by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Also, the bacterium might easily be overlooked because of its morphologic similarity to bacterial species of the resident skin flora. We conclude that a high index of suspicion is warranted to identify A. ignavus and that it should be particularly considered in patients with chronic external otitis who do not respond clinically to quinolone ear drop therapy. [ABSTRACT FROM AUTHOR]

Background: Liver diseases of infectious and non-infectious etiology cause considerable morbidity and mortality, particularly in low- and middle-income countries (LMICs). However, data on the prevalence of liver diseases and underlying risk factors in LMICs are scarce. The objective of this study was to elucidate the occurrence of infectious diseases among individuals with chronic liver damage in a rural setting of Côte d'Ivoire. Methodology: In 2021, we screened 696 individuals from four villages in the southern part of Côte d'Ivoire for hepatic fibrosis and steatosis, employing transient elastography (TE) and controlled attenuation parameter (CAP). We classified CAP ≥248 dB/m as steatosis, TE ≥7.2 kPa as fibrosis, and did subgroup analysis for participants with TE ranging from 7.2 kPa to 9.1 kPa. Clinical and microbiologic characteristics were compared to an age- and sex-matched control group (TE <6.0 kPa; n = 109). Stool samples were subjected to duplicate Kato-Katz thick smears for diagnosis of Schistosoma mansoni. Venous blood samples were examined for hepatitis B and hepatitis C virus. Additionally, an abdominal ultrasound examination was performed. Principal findings: Among 684 individuals with valid TE measurements, TE screening identified hepatic pathologies in 149 participants (17% with fibrosis and 6% with steatosis). 419 participants were included for further analyses, of which 261 had complete microbiological analyses available. The prevalence of S. mansoni, hepatitis B, and hepatitis C were 30%, 14%, and 7%, respectively. Logistic regression analysis revealed higher odds for having TE results between 7.2 kPa and 9.1 kPa in individuals with S. mansoni infection (odds ratio [OR] = 3.02, 95% confidence interval [CI] = 1.58–5.76, P = 0.001), while HCV infection (OR = 5.02, 95% CI = 1.72–14.69, P = 0.003) and steatosis (OR = 4.62, 95% CI = 1.60–13.35, P = 0.005) were found to be risk factors for TE ≥9.2 kPa. Conclusions/Significance: Besides viral hepatitis, S. mansoni also warrants consideration as a pathogen causing liver fibrosis in Côte d'Ivoire. In-depth diagnostic work-up among individuals with abnormal TE findings might be a cost-effective public health strategy. Author summary: At a global scale, chronic liver diseases such as liver fibrosis or cirrhosis are increasing. Causes and risk factors vary from one setting to another. In Europe, alcohol abuse, viral hepatitis, and fatty liver disease are the leading causes. Neglected tropical diseases, especially infections with parasites such as Schistosoma mansoni, are known to cause liver damage in low- and middle-income countries. Precise data on the relevance of infections with S. mansoni compared to other causes of liver fibrosis are scarce. In this study, we aimed to elucidate the infectious diseases etiology of chronic liver diseases in a schistosomiasis-endemic setting of Côte d'Ivoire. We screened residents from four villages in the southern part of Côte d'Ivoire with transient elastography, a non-invasive method that detects liver fibrosis or -cirrhosis by liver stiffness. Participants were tested for schistosomiasis and viral hepatitis, and a questionnaire was used to collect sociodemographic data. We found that liver fibrosis was common (17%), with S. mansoni being the most detected pathogen (30%). Liver diseases have a high morbidity and mortality, resulting in liver cancer or gastrointestinal haemorrhage. Schistosomiasis and hepatitis C, in particular, can be treated effectively today, so a screening program with transient elastography and subsequent treatment could prevent complications of liver disease. [ABSTRACT FROM AUTHOR]