Beverly Buffart

Introduction: Borderline oxacillin-resistant Staphylococcus aureus (BORSA) represents a rare and poorly characterized phenotype of S. aureus. Its detection remains challenging, even in modern clinical laboratories. Moreover, there is no consensus on the optimal therapeutic approach, and treatment strategies remain controversial. In this report, we present a rare case of BORSA bacteremia and discuss potential approaches to improve its detection and management. Case presentation: A 39-year-old woman with systemic lupus erythematosus was admitted for a suspected exacerbation, complicated by multiple serositis and nephritis. She was on chronic treatment with methylprednisolone and hydroxychloroquine. On admission, she was afebrile. Laboratory investigations revealed elevated C-reactive protein and increased D-dimer levels. Later, she developed a septic peripheral venous thrombophlebitis, and treatment was adjusted to amoxicillin–clavulanate. Blood cultures grew S. aureus, prompting a switch to intravenous oxacillin based on a negative penicillin-binding protein 2a test. A discrepancy in the antimicrobial susceptibility test was observed, with cefoxitin showing susceptibility and oxacillin resistance. Further characterizations were carried out, confirming a BORSA infection. Treatment was switched to linezolid and ciprofloxacin with good recovery. Conclusions: This case highlights the complexity of managing a patient with an uncommon and poorly documented infection. The lack of data on BORSA infections and the difficulties in detecting and treating them led to a prolonged delay in the appropriate management of this patient.

Article Improvement in the turnaround time of PTH(1–84) as part of the intraoperative PTH monitoring for parathyroidectomy was published on August 22, 2025 in the journal Clinical Chemistry and Laboratory Medicine (CCLM) (volume 0, issue 0).

Purpose Viral hepatitis remains a leading cause of infectious mortality worldwide. This study aimed to improve the serological screening process by reducing unnecessary testing and healthcare costs by optimizing the assay threshold. Methods Three methods (Elecsys^® Anti-HCV II, Alinity s Anti-HCV and Ortho^® HCV 3.0) were compared against a composite gold standard on 260 samples. The best-performing was used to establish an optimal S/CO cut-off for our screening method (Elecsys^® Anti-HCV II), predictive of true-positivity. A confirmatory assay (Vidas^® anti-HCV) was used to differentiate true from false positives. A simulation of the use of this cut-off was conducted on a retrospective cohort to assess its effectiveness in terms of diagnosis and healthcare costs. Results The Alinity s Anti-HCV II assay showed the highest sensitivity (100%) and specificity (98.2%). This assay was used to establish the cut-off threshold for our method. The best Youden’s index was obtained with a value of 17.8 (sensitivity (95.6%), specificity (96.4%)). In a retrospective cohort of 667 patients with a positive initial HCV screening, 124 had an S/CO ratio of ≤ 17.8. Of these, Vidas^® anti-HCV confirmed 105 negative results (15.74% of the cohort), eliminating the need for PCR testing for these patients. The estimated theoretical savings for a 7-month assessment period is € 7186,2. Conclusions An S/CO cut-off of 17.8 was established for the Elecsys^® Anti-HCV II assay, accurately predicting true positives in 97% of cases and reduced the need for unnecessary PCR confirmatory testing, resulting in cost savings.

Background: At the dawn of the pandemic, severe forms of COVID-19 were often complicated by thromboembolisms. However, routine laboratory tests cannot be used to predict thromboembolic events. The objective of this study was to investigate the potential value of the thrombin generation test (TGT) in predicting hypercoagulability and thrombotic risk in the aforementioned set of patients. Methods: The study panel comprised 52 patients divided into two groups (26 COVID-19 positive and 26 COVID-19 negative); COVID-19-positive patients were further grouped in “severe” (n = 11) and “non-severe” (n = 15) categories based on clinical criteria. The routine blood tests and TGT of these patients were retrospectively analyzed. Results: All 26 COVID-19-positive patients showed decreased lymphocyte, monocyte and basophil counts and increased lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and alanine transaminase (ALT) compared with control patients. Conversely, we did not observe statistically significant differences between severe and non-severe patients despite anecdotal variations in the distribution patterns. TGT without thrombomodulin (TM) addition showed statistically significant differences in the thrombin peak heights between COVID-19-positive and negative patients. After addition of TM, peak height, Endogenous Thrombin Potential (ETP) and velocity index were increased in all COVID-19-positive patients while the percentage of inhibition of ETP was reduced. These trends correlated with the severity of disease, showing a greater increase in peak height, ETP, velocity index and a drastic reduction in the percentage of ETP inhibition in more severely affected patients. Conclusions: Our data suggest that all COVID-19 patients harbor a hypercoagulable TGT profile and that this is further pronounced in severely affected patients.