Germs

Background: Clostridioides difficile infection (CDI) in liver transplant (LT) recipients often occurs during complex postoperative care. We compared clinical characteristics and total hospital length of stay (LOS) between LT-CDI and non-LT CDI records. Materials and Methods: We analyzed 562 CDI-associated hospital records from 2014 to 2024 (35 LT-CDI; 527 non-LT CDI). The primary endpoint was total hospital LOS; LOS > 30 days was the main secondary endpoint, and >60 and >90 days were post hoc exploratory thresholds for very prolonged stays. LOS was available in 35 LT-CDI and 521 non-LT records. Results: Median LOS was 59 versus 20 days. The crude median difference was 39.0 days (95% CI, 7.0 to 64.0), and the care/antimicrobial-adjusted difference was 28.5 days (95% CI, 0.5 to 50.3). Median LT-to-CDI time was 13 days [IQR, 7 to 36; n = 34]; in 25/35 records (71.4%), infection occurred within 30 days. The adjusted RR for LOS > 30 days was 1.15 (95% CI, 0.85 to 1.55); exploratory RRs were 2.33 (95% CI, 1.45 to 3.73) for >60 days and 2.28 (95% CI, 1.11 to 4.67) for >90 days. Conclusions: LT-CDI records had longer total LOS, clustered early after transplantation, and had a clinically complex course. These findings provide a same-center benchmark for overall hospitalization burden among CDI records by transplant status; estimating CDI-attributable LOS would require an LT group without CDI.

Background: Candida species are among the most frequently isolated fungi from respiratory specimens in hospitalised patients, yet the clinical significance of their presence—infection versus colonisation, treatment versus observation—remains an unresolved challenge in clinical microbiology. Data from dedicated pulmonology centres in Eastern Europe are scarce. This study aimed to characterise the three-year epidemiology, species distribution, temporal trends, colony-load profiles, and longitudinal mycological trajectories of fungal respiratory isolates at a Romanian tertiary pulmonology hospital. Methods: We retrospectively analysed 1000 microbiological records from bronchial aspirates and other respiratory specimens collected between January 2022 and December 2024. Variables included patient demographics, clinical ward, primary diagnosis, fungal species, and semi-quantitative colony counts. Patients with multiple records were identified and analysed as a longitudinal sub-cohort. Results: Candida albicans predominated (45.5%), with a declining proportional trend across the study period. Candida krusei—intrinsically resistant to fluconazole—increased from 5.3% of isolates in 2022 to 9.7% in 2024. The intensive care unit (ICU) accounted for 25.8% of all records. Patients were predominantly male (67.5%) with a mean age of 63.4 years; acute respiratory failure was the most frequent underlying diagnosis (41.7%). High-load colonisation (>100 colony-forming units/mL) was documented in 19.0% of quantified specimens. Among 91 patients with serial cultures, 26 demonstrated inter-sample species shifts—several consistent with antifungal selection pressure—and 29 showed escalating colony loads, suggesting progression from colonisation toward probable infection. Conclusions: In a clinical setting where fluconazole has historically served as the default empirical antifungal agent, a C. krusei proportion approaching 10% of annual isolates constitutes a clinically actionable finding. Species-level identification of all fungal respiratory isolates is strongly warranted, as it directly influences therapeutic decision-making in approximately one in ten cases.

Background: Human brucellosis remains an important One Health problem, yet no vaccine is licensed for human use despite decades of antigen discovery and experimental vaccine development. This review examines why promising Brucella vaccine candidates have not progressed toward human application, with particular attention to the relationship between immune-evasion mechanisms, experimental evidence of protection, and the barriers that arise during translation. Methods: A critical narrative review of peer-reviewed literature on Brucella immunopathogenesis, immune evasion, protective immunity, antigen discovery, vaccine platforms, and human translational requirements was conducted. The evidence was interpreted according to experimental maturity, distinguishing computational or hypothesis-generating studies, mechanistic in vitro or ex vivo evidence, animal immunogenicity studies without challenge, and challenge-supported protection. Additional consideration was given to safety, durability, cross-species protection, model relevance, manufacturing, and regulatory requirements. Results: Brucella uses multiple mechanisms to limit innate recognition, alter intracellular trafficking and antigen presentation, and modulate host immune responses. These mechanisms provide a biological rationale for mechanism-informed vaccine design, but direct evidence that individual vaccine strategies overcome specific immune-evasion pathways remains limited. Across the vaccine literature, many candidates remain at the computational, antigen-production, or immunogenicity stages, whereas fewer have demonstrated protection after experimental challenge. Even challenge-supported candidates rarely address durability, cross-species breadth, human-relevant correlates of protection, extended safety, reproducible manufacturing, or readiness for clinical development. Conclusions: The absence of a licensed human brucellosis vaccine is better explained by attrition across successive stages of development than by a shortage of candidate antigens or vaccine platforms. Progress is likely to depend on advancing fewer, better-supported candidates through an integrated evidence pathway that links mechanistic rationale and challenge protection with durability, safety, species breadth, product quality, and human clinical relevance.