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Long-term risk for malignancy is higher among solid organ transplant (SOT) recipients compared to the general population. Four non-hepatitis viruses have been recognized as oncogenic in SOT recipients—EBV, cause of EBV-associated lymphoproliferative diseases; human herpes virus 8 (HHV8), cause of Kaposi sarcoma, primary effusion lymphoma and multicentric Castleman disease; human papilloma virus, cause of squamous cell skin cancers, and Merkel cell polyomavirus, cause of Merkel cell carcinoma. Two of these viruses (EBV and HHV8) belong to the human herpes virus family. In this review, we will discuss key aspects regarding the clinical presentation, diagnosis, treatment, and prevention of diseases in SOT recipients associated with the two herpesviruses.

We report an outbreak of Candida auris across multiple healthcare facilities in Israel. For the period of May 2014-May 2022, a total of 209 patients with C. auris infection or colonization were identified. The C. auris incidence rate increased 30-fold in 2021 (p = 0.00015), corresponding in time with surges of COVID-19-related hospitalization. Multilocus sequence typing revealed hospital-level outbreaks with distinct clones. A clade III clone, imported into Israel in 2016, accounted for 48.8% of typed isolates after January 2021 and was more frequently resistant to fluconazole (100% vs. 63%; p = 0.00017) and voriconazole (74% vs. 5.2%; p<0.0001) than were non-clade III isolates. A total of 23% of patients had COVID-19, and 78% received mechanical ventilation. At the hospital level, outbreaks initially involved mechanically ventilated patients in specialized COVID-19 units and then spread sequentially to ventilated non-COVID-19 patients and nonventilated patients.

Background: Escherichia coli (E. coli) bacteremia is a significant cause of mortality, particularly in older adults. Limited data exists on clinical outcomes in octogenarians. This study aims to evaluate the clinical outcomes of E. coli bacteremia in octogenarians and determine whether appropriate empirical therapy leads to improved outcomes in this specific population. Methods: We conducted a retrospective cohort study of hospitalized patients with E. coli bacteremia at Beilinson Hospital from January 2012 to December 2022. Clinical characteristics, bacteremia sources, antibiotic resistance patterns, and patient outcomes were analyzed. The primary outcome was 30-day mortality. Multivariate regression was used to assess the impact of empirical antibiotic appropriateness on mortality. Results: The study included 2717 patients, of which 1042 (38%) were 80 years or older. Older patients had more comorbidities with increased rates of ischemic heart disease (20% vs. 14%, p < 0.01) and congestive heart failure (19% vs. 9%, p < 0.01). Patients with 3rd generation cephalosporin resistant strains were more likely to receive inappropriate empiric antibiotic therapy (54% vs. 23%, p < 0.01). Although appropriate empirical therapy was associated with improved survival in univariate analysis (19% vs. 28%, p < 0.01), it was not an independent predictor of 30-day mortality in multivariate analysis [adjusted OR = 1.10, 95% CI (0.64–1.81), p = 0.7]. A lower SOFA score [adjusted OR = 0.17, CI95% (0.01–0.31), p < 0.01] was associated with decreased 30-day mortality. Hypoalbuminemia was significantly associated with increased 30-day mortality [adjusted OR = 2.49, CI95% (0.1.56–3.97), p < 0.01]. Conclusions: E. coli bacteremia in octogenarians is associated with significant mortality. While timely appropriate antibiotic therapy is crucial, mortality appears to be more influenced by overall health status, comorbidities, and infection severity. Future research should focus on addressing these factors and developing personalized care strategies to improve survival in this high-risk group.

PurposeTo evaluate the impact of a multidisciplinary the “Endocarditis Team” (ET) on the course and outcome of infective endocarditis (IE) patients. MethodsA retrospective before–after study, including hospitalized patients with definite IE, managed before (01.2013–12.2015) and after (01.2016–07.2019) the introduction of an ET. The primary outcomes were defined as 30-day and 1-year mortality and the secondary as conservative vs. invasive strategy, the interval from clinical suspicion of IE to the performance of echocardiography, utilization of multimodality evaluation, time to an invasive procedure, and the duration of hospitalization. ResultsStudy population included 92 pre-ET and 128 post-ET implementation patients. Baseline characteristics were similar. During the post-ET period compared with pre-ET, we found higher rates of abscesses and extra-cardiac emboli (27.8% vs. 16.3%, p = 0.048); and a higher invasive procedures rate, including lead extraction (15.6% vs. 6.5%, p = 0.035) and noncardiac surgeries (14.8% vs. 6.5%, p = 0.05). Patients managed during the post-ET period had reduced short (8.5% vs. 17.4%, p = 0.048) and long-term mortality (Log-rank = 0.001). In multivariate analysis of risk factors for long-term mortality, period (pre- or post-ET) was not found to be significantly associated with the mortality. ConclusionEstablishment of an ET was associated with faster and more intensive evaluation of patients with IE. During the period of an ET activity, mortality rates were reduced compared with the previous period.

IntroductionInadequate antibody response to mRNA SARS-CoV-2 vaccination has been described among kidney transplant recipients. Immunosuppression level and specifically, use of antimetabolite in the maintenance immunosuppressive regimen, are associated with inadequate response. In light of the severe consequences of COVID-19 in solid organ transplant recipients, we believe it is justified to examine new vaccination strategies in these patients.Methods and analysisBECAME is a single-centre, open-label, investigator-initiated randomised controlled, superiority trial, aiming to compare immunosuppression reduction combined with a third BNT162b2 vaccine dose versus third dose alone. The primary outcome will be seropositivity rate against SARS-CoV-2. A sample size of 154 patients was calculated for the seropositivity endpoint assuming 25% seropositivity in the control group and 50% in the intervention group. A sample of participants per arm will be also tested for T-cell response. We also plan to perform a prospective observational study, evaluating seropositivity among ~350 kidney transplant recipients consenting to receive a third vaccine dose, who are not eligible for the randomised controlled trial.Ethics and disseminationThe trial is approved by local ethics committee of Rabin Medical Center (RMC-0192-21). All participants will be required to provide written informed consent. Results of this trial will be published; trial data will be available. Protocol amendments will be submitted to the local ethics committee.Trail registration numberNCT04961229.

Carbapenem-resistant Acinetobacter baumannii (CRAB) bacteremia is a critical health concern associated with high morbidity and mortality and limited treatment options. Whether early initiation of concordant antibiotic therapy upon recognition of sepsis improves outcomes remains unclear. Methods: We conducted a retrospective cohort study of 413 patients diagnosed with CRAB bacteremia to evaluate the impact of early concordant antibiotic treatment (i.e., administration of in vitro active antibiotics within 24 h of blood culture collection) on 30-day mortality. Multivariable logistic regression was conducted to identify predictors of early concordant treatment and to evaluate its association with 30-day mortality. To address potential confounding by early death, a sensitivity analysis was performed which included only patients who survived at least 48 h after blood culture collection. Results: Among the study cohort, 30% (122/413) received early concordant treatment (all received colistin), while 70% (291/413) received early discordant treatment. The median age of patients receiving early concordant treatment was 69 (interquartile range (IQR), 62–78) years vs. 71 (IQR, 62–81) years in the discordant group (p = 0.1). Patients who received early concordant treatment were more likely to be mechanically ventilated (52% vs. 40%, p = 0.03) and have rectal carriage of multidrug-resistant bacteria (16% vs. 9%, p = 0.06). The 30-day mortality was 63% (260/413). In univariate analysis, survivors were more likely to have received early concordant treatment (38% vs. 25%, p = 0.005); however, this association was not statistically significant in the multivariable model (adjusted odds ratio [aOR] 0.36, 95% confidence interval [CI] 0.13–1.02, p = 0.053). Significant factors associated with 30-day mortality included age ≥65 years (aOR 4; 95% CI 1.1–17, p = 0.04) and SOFA score ≥5 points (aOR 7.14; 95% CI 2–25, p < 0.01). In the sensitivity analysis limited to patients who survived at least 48 h after blood culture collection, early concordant treatment remained unassociated with 30-day mortality (aOR 1.8; 95% CI 0.5–7, p = 0.4). Conclusions: Early concordant antibiotic treatment was not significantly associated with 30-day mortality in patients with CRAB bacteremia. Older age and SOFA score were significant predictors of mortality. Whether this finding reflects the limited efficacy of colistin, which was the predominant empiric antibiotic in this cohort, remains unclear; nevertheless, more effective therapeutic options for CRAB bacteremia are urgently needed to improve patient outcomes.

In a multicenter, nationwide, retrospective study of patients hospitalized with spotted fever group rickettsiosis in Israel during 2010-2019, we identified 42 cases, of which 36 were autochthonous. The most prevalent species was the Rickettsia conorii Israeli tick typhus strain (n = 33, 79%); infection with this species necessitated intensive care for 52% of patients and was associated with a 30% fatality rate. A history of tick bite was rare, found for only 5% of patients; eschar was found in 12%; and leukocytosis was more common than leukopenia. Most (72%) patients resided along the Mediterranean shoreline. For 3 patients, a new Rickettsia variant was identified and had been acquired in eastern, mountainous parts of Israel. One patient had prolonged fever before admission and clinical signs resembling tickborne lymphadenopathy. Our findings suggest that a broad range of Rickettsia species cause spotted fever group rickettsiosis in Israel.

Obesity is associated with an increased susceptibility to infections. Several studies have reported adverse clinical outcomes of influenza among obese individuals. Our aim was to examine the association between obesity and the clinical outcomes of hospitalized adult patients ill with seasonal influenza. Consecutive hospitalized adult patients between 10/2017 and 4/2018 with laboratory confirmed influenza A and B were divided into an obese group (body mass index (BMI) ≥ 30 kg/m2) and controls. The primary outcome was a composite endpoint of 30-day all-cause mortality, vasopressor use, mechanical ventilation, ICU admission, and severe influenza complication (myocarditis and encephalitis). Secondary outcomes encompassed all the components of the primary outcome, 90-day all-cause mortality, occurrence of pneumonia, length of hospital stay, and 90-day readmission rates. The study comprised 512 hospitalized adults diagnosed with laboratory-confirmed influenza A (195/512) and B (317/512). Within this group, 17% (86/512) were classified obese; the remaining 83% (426/512) were controls. Results of the composite outcome (7/85, 8% vs. 45/422, 11%; p=0.5) and the crude 30-day all-cause mortality rate (5/86, 6% vs. 34/426, 8%, p=0.5) were similar between the two groups. The multivariate analysis demonstrated that obesity was not a significant risk factor for influenza adverse events (OR=1.3, CI 95% 0.3–3.3; p=0.5), whereas advanced age, chronic kidney disease, and hypoalbuminemia were significant risk factors (OR=1.03, OR=2.7, and OR=5.4, respectively). Obesity was not associated with influenza-related morbidity and mortality among the hospitalized adults during the 2017–2018 influenza season. Further studies researching different influenza seasons are essential.

Background: Klebsiella species are a leading cause of Gram-negative bacteremia associated with nosocomial infections. They exhibit higher antimicrobial resistance compared to other Enterobacterales, emphasizing their role as a “sentinel organism”. While the impact of inappropriate empiric therapy has been studied, data specific to Klebsiella bacteremia are limited due to small sample sizes. This study aims to provide high-resolution data on Klebsiella bacteremia and assess the impact of appropriate empirical therapy on clinical outcomes. Methods: We conducted a retrospective study of patients with Klebsiella bacteremia hospitalized at Beilinson Hospital between 2012 and 2022. Patients were categorized into two groups based on the appropriateness of empiric therapy. The primary outcome was 30-day all-cause mortality; subgroup analyses evaluated mortality in ESBL bacteremia treated with either carbapenems or piperacillin-tazobactam, and carbapenems versus aminoglycosides. Propensity score weighting and inverse probability treatment-weighted models were used to adjust for confounding. Results: Among 1132 patients, 79% received appropriate empirical therapy. This therapy was associated with reduced 30-day mortality (OR = 0.59, 95% CI: 0.46–0.76) and a shorter hospital stay (median 7 vs. 11 days, p < 0.001). Other significant risk factors for mortality included a higher Charlson comorbidity score (OR = 1.06), assistance with ADL (OR = 2.16), prior hospitalization (OR = 1.31), and a higher SOFA score (OR = 1.32). No significant mortality differences were observed in ESBL subgroups treated with carbapenems versus piperacillin-tazobactam (p = 0.2) or carbapenems versus aminoglycosides (p = 0.9). Conclusions: Early appropriate empirical therapy significantly reduces 30-day mortality in Klebsiella bacteremia. These findings highlight the importance of timely, appropriate empirical therapy and suggest choosing less broad-spectrum therapy. However, the lack of molecular data on resistance mechanisms limits the ability to assess strain-specific outcomes and may affect generalizability. Despite this, the study offers valuable insights for optimizing empirical therapy and advancing antimicrobial stewardship in the era of rising resistance.