It is with both gratitude and anticipation that I write these words, looking back on almost 15 years of continued publication and marking the transition of GERMS into a new chapter through our collaboration with MDPI [...]

We are pleased to announce that, beginning with Volume 15, Issue 4 (2025), Germs (ISSN: 2248-2997) will now be published by MDPI [...]

Influenza remains a common cause of hospitalization among children, bringing substantial morbidity and mortality rates. Despite its soaring prevalence, a significant gap in therapeutic interventions persists, especially for the pediatric population. We present a literature review detailing clinical trials or case reports published in the last six years (since 2019) that discuss the prevention or treatment of influenza in children. We used search engines such as PubMed or Cochrane Library. All studies/case reports are written in English, and all the clinical trials are finished. In Europe, oseltamivir, zanamivir, and baloxavir marboxil are recommended for the treatment or prophylaxis of influenza in adults and children, while the Food and Drug Administration added intravenous peramivir to the list of anti-influenza drugs. Oseltamivir remains the first line of treatment and chemoprophylaxis. However, there are still discussions related to the duration of prophylaxis, with shorter periods of administration being explored, or the most efficient treatment dosage program (whether it is the conventional dosage of 3 mg/kg/dose for children <40 kg or 75 mg for adults, twice daily, compared to a double dosage administration program). When faced with an old disease, it is essential to constantly assess the efficacy of conventional molecules and dosages, along with new antivirals or complementary medication.

Genitourinary syndrome of menopause (GSM) and vulvovaginal atrophy (VVA) significantly impact women's quality of life, leading to symptoms such as vaginal dryness, irritation, dyspareunia, and urinary incontinence. While traditional treatments include hormonal therapy and surgical interventions, these approaches may not be suitable for all patients. Laser vaginal rejuvenation has emerged as a promising, minimally invasive alternative that enhances vaginal tissue health with minimal downtime. This retrospective study analyzes data from 53 patients who underwent internal, external, or combined laser vaginal rejuvenation. Patient demographics, medical and gynecological history, treatment indications, procedural details, and post-treatment outcomes were assessed. The most common reasons for seeking treatment included vaginal laxity (69.8%), urinary incontinence (47.2%), and vaginal discomfort (15.1%). The majority (90.6%) opted for combined internal and external treatment, with most undergoing three sessions. Post-procedure symptoms were minimal, limited to transient discomfort and minor, self-limiting bleeding in three patients. No patients developed wound infections. Findings suggest laser vaginal rejuvenation is a well-tolerated procedure, with high adherence and patient satisfaction rates. While our current study is limited by its descriptive nature and its single-center design, results align with existing literature, supporting the procedure's safety and efficacy.

This paper examines the use of local antibiotic therapy in one-stage septic revision surgery for late periprosthetic joint infections (PJIs). This case study suggests that morselized bone allografts impregnated with antibiotics in powder form are a preferable alternative to polymethyl methacrylate (PMMA) because they can generate higher local antibiotic concentrations. Current research also recommends using vancomycin and aminoglycosides as the preferred choice of antibiotics, as they may have low diffusion in tissues when administered intravenously, but are effective when administered locally. The article emphasizes the importance of achieving high local antibiotic concentrations to eradicate bacterial biofilms and provides guidelines for the preparation of bone allografts. The paper assesses the case study of a 68-year-old male patient who underwent two-stage total revision surgery for a late septic failure of the endoprosthesis (approximatively one year after implantation). The first stage involved removing the implant, debridement, lavage, and setting a fixed spacer manually made from polymethyl methacrylate impregnated with 4 g of vancomycin. The second stage of revision surgery utilized a morselized bone allograft impregnated with 4 g of vancomycin as a means of local antibiotic therapy and bone defect coverage. Systemic levels of vancomycin were measured at 4, 8, 12 and 24 hours respectively after surgery. During this period, no systemic vancomycin was administered. After the second stage was carried out and the testing was carried out, systemic vancomycin therapy was initiated and the plasma levels of the drug were assessed and subsequently therapeutic doses were adjusted. Vancomycin loaded bone allograft achieved higher systemic concentrations that its polymethyl methacrylate counterpart, when being manually loaded with the same amount of antibiotic. Nonetheless, the levels were well below nephrotoxic levels, indicating that this may be a valuable tool for local means of antibiotic therapy in selected patients that could not endure such a systemic therapeutic regiment. For septic revisions, antibiotic loaded bone allograft holds a valuable place in the surgical arsenal of local antimicrobial treatment, by far exceeding that of the polymethyl methacrylate.

We aimed to conduct a systematic review of the epidemiology of Escherichia coli in bloodstream infections (BSI) of hematopoietic stem cell transplantation patients. For a comprehensive search of studies that reported the prevalence of E. coli and antibiotic resistance in bloodstream infections from 2000 to January 1, 2024, databases such as PubMed, EMBASE, Google Scholar, Scopus, and Web of Science were searched. The main keywords used were: Escherichia coli, epidemiology, bloodstream infection, microbial resistance, antibiotic resistance, hematopoietic malignancy, hematopoietic stem cell transplantation. After applying eligibility criteria, and quality assessment of studies, data analysis was done by comprehensive meta-analysis (CMA) software. The prevalence of bacterial bloodstream infections amongst different studies varied between 8-51%. Also, bloodstream infections caused by E. coli varied between 2.5-57%. Prevalence of extended-spectrum β-lactamases (ESBLs) of Escherichia coli in bloodstream infections varied between 15-80%. As well, the mortality rate caused by Escherichia coli strains in bloodstream infection varied between 6.7-27.3%. Resistance to ciprofloxacin, cefepime, third- and fourth-generation cephalosporins, was reported to be the highest (prevalence of 100%), and the lowest was against amikacin, with a prevalence between 13-38%. The high prevalence of Escherichia coli-related BSI, and subsequent mortality, especially by multidrug resistance and ESBL strains, in patients undergoing hematopoietic stem cell transplantation, requires essential measures to prevent the spread of microbial resistance.

Neonatal candidemia is a life-threatening event in babies requiring ICU admission. Prompt diagnosis and appropriate treatment reduce mortality and morbidity. Worldwide, there is an emergence of drug-resistant rare Candida species causing neonatal sepsis that necessitates antifungal susceptibility testing in each case. We did a prospective study to isolate Candida species causing neonatal sepsis and to determine the predisposing risk factors and time to positivity for flagged positivity. We also determined fluconazole, itraconazole and amphotericin B minimum inhibitory concentration (MIC) against isolated Candida species by broth microdilution method using CLSI M27-A3 guidelines. A total of 107 neonatal candidemia events were noted. Prematurity was the most common predisposing risk factor. Most isolates were non-albicans Candida. Candida utilis, C. pelliculosa, C. tropicalis and K. ohmeri were the predominant fungi causing neonatal candidemia. A varied antifungal MIC against isolated Candida species was noted. However, 90% of the isolated Candida strains had <8 µg/mL fluconazole MIC. Moreover, ≥8 and ≥2 µg/mL MIC for fluconazole and amphotericin B respectively were also noted. Rare Candida species having varied fluconazole and amphotericin B MIC cause neonatal candidemia. Therefore, culture isolation and antifungal susceptibility testing should be done in each case of neonatal candidemia.

Crimean-Congo hemorrhagic fever (CCHF) is the widest emerging severe viral tick-borne disease affecting humans. Crimean-Congo haemorrhagic fever virus (CCHFV) circulates by routine enzootic tick-vertebrate hosts-tick transmission cycles. We aimed to evaluate the molecular prevalence of CCHFV in ticks on a global scale. A systematic procedure was used to perform this review and meta-analysis using PubMed, Google Scholar, and Web of Science databases from 1 January 2000 through 12 April 2023. Of the 2310 papers identified, 43 articles met the inclusion criteria for this study. The overall prevalence of CCHFV was 4.0% (95%CI: 2.7-6.0%) in ticks on the global scale, with heterogeneity (I2=96.387; p=0.0001). The genus Hyalomma was shown as the most frequent tick infected with CCHFV 5.4% (95%CI: 3.3-8.7%). We found that the pooled prevalence of CCHFV was higher in Hyalomma aegyptium 27.6% (95%CI: 22.7-33.2%). The pooled prevalence was higher in Asia 5.1% (95%CI: 3.3-7.7%), and Spain 21.0% (95%CI: 3.4-66.9). The locations with annual rainfall of 401-1000 mm 6.1% (95%CI: 2.6-13.5%) and latitude of 31-40° 6.0% (95%CI: 4.1-8.9%) were associated with the greatest pooled prevalence of CCHFV in ticks. Surveillance of CCHFV in ticks will give a better comprehension for the future implementation of public health interventions. The question of whether Hyalomma aegyptium is a plausible or certain vector should be the subject of further investigation.

Actinotignum schaalii is a Gram-positive coccobacillus, and a member of the normal human microbiota. A. schaalii is considered as an emerging pathogen causing urinary tract infections among the elderly. Because of an anaerobic growth requirement and lack of knowledge on pathogenic potential following conventional microbiology laboratory techniques, A. schaalii is difficult to identify. A previously well 24-year-old male presented to a tertiary care unit with fever, left flank pain, and dysuria for two days. He was initially treated with empiric oral ciprofloxacin by the general practitioner. Following admission, blood cultures and urine cultures were done, and empirical intra-venous piperacillin-tazobactam was started. X-ray of the pelvis revealed left-sided pyelonephritis and left ureteric calculi. A nephrostomy tube was inserted to relieve the obstruction which drained pus and was sent to microbiology laboratory in aerobic and anaerobic blood culture bottles. Two days later blood culture flagged positive for Gram-positive bacilli from the anaerobic bottle, and the pus from enriched anaerobic culture grew A. schaalii. The urine culture remained negative. By VITEK 2 anaerobic card and MALDI-TOF analysis, it was identified as A. schaalii. Following clinical improvement, he was discharged with oral doxycycline. Ureteric calculus was removed and remained sterile following 16s DNA analysis. The urine Gram staining may have a role in detecting and considering anaerobic media to isolate A. schaalii. The novel diagnostic platforms are important to speciate the pathogen. Also, the lack of pathogen-specific breakpoints for antimicrobial susceptibilities made it a problem to decide on appropriate therapy.