Clinical Infectious Diseases最新文献

{"title":"Revisiting REVISIT: The Case for Ceftazidime/avibactam Plus Aztreonam.","authors":"Pranita D Tamma,Thomas P Lodise,Maria F Mojica,Federico Perez,Robert A Bonomo","doi":"10.1093/cid/ciaf239","DOIUrl":"https://doi.org/10.1093/cid/ciaf239","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"15 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling the impact and cost of a culture-dependent molecular test for antimicrobial resistance in resource-limited settings.","authors":"Joshua M Chevalier,Megan A Hansen,Benjamin Blumel,Veronicah Chuchu,Birgitta Gleeson,Cecilia Ferreyra,Shaukat Khan,Brooke E Nichols,Kyra H Grantz","doi":"10.1093/cid/ciaf236","DOIUrl":"https://doi.org/10.1093/cid/ciaf236","url":null,"abstract":"BACKGROUNDLimited diagnostic access in resource-limited settings contributes to poor health outcomes among bacterial sepsis patients and the spread of antimicrobial resistance (AMR). Molecular diagnostic profiling of AMR may enable faster targeting of antibiotic therapies, improving clinical outcomes, reducing AMR development, and saving costs.METHODSWe modeled the impact of a culture-dependent molecular diagnostic for pathogen identification and resistance testing among hospitalized bloodstream infection patients to guide effective and cost-efficient implementation of these tools. We evaluated patient mortality, antibiotic use, hospital-associated infections, hospital days, and costs under the standard-of-care (empiric therapy, blood culture, phenotypic susceptibility testing) compared to molecular diagnostics - varying culture and susceptibility testing coverage, culture turnaround time, and AMR prevalence.RESULTSThe greatest impact of the molecular diagnostic occurred with 100% diagnostic coverage of all patients, shorter culture turnaround time, and high AMR prevalence, reducing up to 6% of deaths [IQR: 0-12.1%], 5% of hospital days [IQR: 0.1-10.7%], and 21% of days on inappropriate antibiotic therapy [IQR: 18.2-24.4%]. The minimum cost per molecular diagnostic performed, offset by cost savings, ranged from $109 in India to $585 in South Africa across all modeled scenarios.CONCLUSIONSIn high AMR burden settings with blood culture infrastructure supporting fast turnaround times, a molecular diagnostic could improve bloodstream infection health outcomes. This impact is limited by delayed turnaround times and the effectiveness of empiric therapy. Molecular diagnostics implemented at $100 or less can generate healthcare system cost savings, supporting their adoption to improve health outcomes and reduce AMR while remaining cost neutral.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"37 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the optimal treatment of Metallo-Beta-Lactamase-producing Enterobacterales infections using aztreonam and avibactam.","authors":"Yehuda Carmeli,José Miguel Cisneros,Mical Paul,Joseph Chow,George L Daikos","doi":"10.1093/cid/ciaf240","DOIUrl":"https://doi.org/10.1093/cid/ciaf240","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"52 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Outcomes With an Oral Short Course Regimen for Rifampicin-resistant Tuberculosis in a High HIV Prevalence, Programmatic Setting in South Africa","authors":"Jacob A M Stadler, Johanna J Kuhlin, Síle F Molloy, Nomfuneko N Mtwa, Cindy C Hayes, Gary G Maartens, Robin R Warren, Graeme G Meintjes, Sean S Wasserman","doi":"10.1093/cid/ciaf112","DOIUrl":"https://doi.org/10.1093/cid/ciaf112","url":null,"abstract":"Background Bedaquiline-based oral short-course regimens (SCR) for rifampicin-resistant tuberculosis (RR-TB) are highly effective in clinical trials but outcomes in programmatic settings may be more modest. We evaluated clinical and bacteriological outcomes with a seven-drug, linezolid-containing SCR in a high-burden programmatic setting. Methods This prospective cohort study enrolled adults with newly diagnosed RR-TB who were started on the oral SCR in the Eastern Cape Province, South Africa. The primary outcome was World Health Organization-defined end-of-treatment success. Secondary outcomes were TB-free survival (composite of alive, absence of a positive Mycobacterium tuberculosis culture, and treatment completed or in care) at 18 months and time to sputum culture conversion (SCC). Results In total, 248 participants were included, 173 (69.8%) of whom were human immunodeficiency virus (HIV) positive. Culture conversion by 90 days was 96.8% (median time to SCC: 29 days, 95% confidence interval [CI]: 27–31). Treatment success was 37.5% (93/248). Reasons for unsuccessful treatment included switching to individualised regimens (35.1%, 87/248), loss to follow-up (19.4%, 48/348), and death (8.1%, 20/248). At 18 months, 157 (63.3%) participants achieved TB-free survival, with a cumulative mortality of 21.6% (95% CI: 16.1–29.0). Baseline 3+ smear (adjusted odds ratio [aOR]: 3.38, 95% CI: 1.28–8.95), higher age (aOR: 1.05, 1.01–1.08), and lower albumin (aOR: 0.94, 0.88–0.99), but not HIV status, were associated with unfavourable outcome at 18 months. Conclusions The oral SCR performed poorly in a high-burden TB programme. Strategies to support the implementation of effective new regimens for RR-TB are needed to translate outcomes from clinical trials into practice.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"24 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Diagnosis and Management of Spinal Implant Infections.","authors":"","doi":"10.1093/cid/ciaf224","DOIUrl":"https://doi.org/10.1093/cid/ciaf224","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"31 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143921117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Pregnancy on Tuberculosis Treatment Outcomes: An Analysis of Brazilian National Surveillance Data 2016-2022.","authors":"Silvia S Chiang,Jonathon R Campbell,Daniele Maria Pelissari,Márcia C Bellotti de Oliveira,Anna Cristina C Carvalho,Sylvia M LaCourse,Clemax C Sant'Anna","doi":"10.1093/cid/ciaf233","DOIUrl":"https://doi.org/10.1093/cid/ciaf233","url":null,"abstract":"BACKGROUNDOver 200,000 pregnant people fall ill with tuberculosis (TB) annually. Little is known about the impact of pregnancy on TB outcomes.METHODSThis study used surveillance data from Brazil's Ministry of Health. We included women 11-49 years old newly diagnosed with drug-susceptible TB disease between 2016-2022, treated with a first-line anti-TB regimen, and with a known treatment outcome. Using multivariable regression, we estimated the age-stratified effect of pregnancy on (1) loss to follow-up and (2) death during TB treatment.RESULTSOf 96,868 women with TB, 1870 (1.9%) were pregnant, 79,361 (81.9%) were not pregnant, and 15,637 (16.1%) had unknown pregnancy status. Among pregnant women, 1432 (76.6%) experienced treatment success, 358 (19.1%), lost to follow-up, and 80 (4.3%) died. Among non-pregnant women, 79,262 (83.4%) experienced treatment success, 11,582 (12.2%) were lost to follow-up, and 4,154 (4.4%) died. In adolescents, pregnancy conferred higher odds of loss to follow-up (aOR 1.78, 95% CI: 1.29-2.44) and death (aOR 2.35, 95% CI: 1.27-4.37). Compared to non-pregnant women of the same age, pregnant women 20-29 and 30-39 years old experienced more loss to follow-up (respectively: aOR 1.39, 95% CI: 1.17-1.66 and aOR 1.79, 95% CI: 1.42-2.25), while those 40-49 years old were more likely to die (aOR 1.66, 95% CI: 1.04-2.66).CONCLUSIONSOur analysis revealed a significant association between pregnancy and poor TB treatment outcomes, highlighting the need for care providers to offer enhanced support and monitoring for pregnant women undergoing TB treatment. Further research is needed to identify the underlying reasons for these findings.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"115 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kaposi Sarcoma-Associated Herpesvirus Risk and Disease in Kidney Donors and Transplant Recipients with HIV in the United States","authors":"Puja Nambiar, Tao Liang, Nazzarena Labo, Jonathan Hand, Emily A Blumberg, Meenakshi M Rana, Sander Florman, Brandy Haydel, Michele I Morris, Joanna Schaenman, Moreno M S Rodrigues, William A Werbel, Mary G Bowring, Rachel J Friedman-Moraco, Peter Stock, Valentina Stosor, Shikha Mehta, Alexander J Gilbert, Nahel Elias, Sapna A Mehta, Catherine B Small, Ghady Haidar, Maricar Malinis, Marcus R Pereira, Saima Aslam, David Wojciechowski, Ricardo La Hoz, Carlos A Q Santos, Senu Apewokin, Jose A Castillo-Lugo, Karthik Ranganna, Megan Morsheimer, Allan Massie, Dorry L Segev, Wendell Miley, Vickie Marshall, Denise Whitby, Aaron A A Tobian, Christine M Durand","doi":"10.1093/cid/ciaf229","DOIUrl":"https://doi.org/10.1093/cid/ciaf229","url":null,"abstract":"Background Due to high prevalence of Kaposi Sarcoma (KS)-Associated Herpesvirus (KSHV) among people with HIV, KSHV-associated disease (KAD) may be increased after kidney transplantation from donors with HIV (HIV D+) to recipients with HIV (HIV R+). Methods Anti-KSHV antibodies were measured in HIV R+ and donors with and without HIV (HIV D-) using a 30-antigen multiplex assay within three multicenter kidney transplantation studies. KSHV seropositivity was defined as reactivity to conventional KSHV antigens (≥1 ORF73 or K8.1); reactivity to expanded 5-antigen and 30-antigen panels were also reported. Risk factors were identified using modified Poisson regression. Recipients were monitored for post-transplant anti-KSHV antibody changes and KAD. Results KSHV seroprevalence was 40.6% (143/352) among HIV R+, 25.2% (33/131) among HIV D+, and 7.5% (4/53) among HIV D-. In the multivariable model, only men who have sex with men (MSM) was associated with KSHV seropositivity: relative risk 1.51 (95% confidence interval [CI] 1.07-2.14) in recipients and 2.39 (95%CI 1.03-5.53) in donors. Among 418 HIV R+ (215 HIV D+/R+, 203 HIV D-/R+), there were 5 KAD cases (incidence 0.63 cases/100 person-years, 95%CI 0.26-1.52): 3 skin-only KS, 1 multicentric Castleman disease, 1 allograft KS. The allograft KS occurred in a female HIV D+/R+ and was likely donor-derived. Remaining KAD cases occurred in male HIV D-/R+ and were likely recipient KSHV reactivation or acquisition. Conclusions In the United States, KSHV seroprevalence in donors and recipients with HIV was high, particularly among MSM. Reassuringly, KSHV-associated disease was rare, and primarily attributed to recipient rather than donor-derived KSHV.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"47 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143910217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustained Effectiveness of Doxycycline Post-Exposure-Prophylaxis in a Large Sexual Health Clinic over 96 Weeks: An Interrupted Time Series Analysis.","authors":"Matthew A Spinelli,Megan J Heise,Jorge Roman,Jason Bena,Michael P Barry,Susan P Buchbinder,Hyman M Scott","doi":"10.1093/cid/ciaf234","DOIUrl":"https://doi.org/10.1093/cid/ciaf234","url":null,"abstract":"Doxycycline post-exposure prophylaxis (doxy-PEP) reduced bacterial sexually transmitted infection (STI) incidence in a sexual health clinic over 96 weeks (n=4,592; 2,524 on doxy-PEP), particularly for chlamydia and syphilis, with smaller effects for gonorrhea. Continued surveillance for gonorrhea and antibiotic resistance is essential to evaluate doxy-PEP's long-term effectiveness.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"101 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virus-specific T-cell therapy for prophylaxis and treatment of cytomegalovirus infections after transplantation: a scoping review.","authors":"J S T Fung,R C Wright,D K Bharaj,A Alghamdi,D Hesson,J S Delisle,L Schweitzer,R K Avery,S Belga","doi":"10.1093/cid/ciaf232","DOIUrl":"https://doi.org/10.1093/cid/ciaf232","url":null,"abstract":"BACKGROUNDCytomegalovirus (CMV) infection is a leading complication following hematopoietic stem cell transplant (HSCT) and solid organ transplant (SOT). Virus-specific T-cells (VST) have been used for the prophylaxis and treatment of CMV infections. We conducted a scoping review to catalogue and characterize the existing literature.METHODSSystematic searches were performed in collaboration with an expert librarian. Inclusion criterion was the use of CMV-VST for prophylaxis or treatment in HSCT and SOT patients. Major exclusion criteria were case reports and series with fewer than 5 cases. Databases were queried from inception to May 31, 2024. Of the 2587 identified abstracts, full text review was performed on 92 articles, and 67 studies underwent final data extraction.RESULTSMost studies were in the HSCT population. The CMV infection rate was 28% (IQR 14-44) when CMV-VSTs were used as prophylaxis. Response rates for non-refractory and/or resistant (R/R) infections and R/R infections in HSCT patients were 98% (IQR 70-100) and 70% (IQR 56-88), respectively. Four studies included SOT patients with R/R infections, demonstrating a response rate of 15-64%. Variables including donor/recipient serostatus and antiviral use were heterogeneously reported, and various definitions of CMV infection and response were used. CMV-VSTs were well-tolerated with minimal adverse events reported.CONCLUSIONCMV-VSTs are more commonly used in HSCT patients with limited data in SOT patients and differential reporting of key variables preclude extrapolation. A standardized registry should be considered for future studies with additional focus on the optimal dosing, timing, and interaction with concurrent antivirals.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"2 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Respiratory Syncytial Virus Co-Detection With Other Respiratory Viruses Is Not Significantly Associated With Worse Clinical Outcomes Among Children Aged <2 Years: New Vaccine Surveillance Network, 2016–2020","authors":"Justin Z Amarin, Ariana P Toepfer, Andrew J Spieker, Haya Hayek, Tess Stopczynski, Yasmeen Z Qwaider, Laura S Stewart, James D Chappell, Mary Allen Staat, Elizabeth P Schlaudecker, Geoffrey A Weinberg, Peter G Szilagyi, Janet A Englund, Eileen J Klein, Marian G Michaels, John V Williams, Rangaraj Selvarangan, Christopher J Harrison, Leila C Sahni, Vasanthi Avadhanula, Meredith L McMorrow, Heidi L Moline, Natasha B Halasa","doi":"10.1093/cid/ciaf194","DOIUrl":"https://doi.org/10.1093/cid/ciaf194","url":null,"abstract":"Background Risk factors for severe respiratory syncytial virus (RSV) illness include early infancy, premature birth, and underlying medical conditions. However, the clinical significance of respiratory viral co-detection is unclear. We compared the clinical outcomes of young children with RSV-only detection and those with RSV viral co-detection. Methods We conducted active, population-based surveillance of children with medically attended fever or respiratory symptoms at 7 US medical centers (1 December 2016–31 March 2020). Demographic and clinical data were collected through parental interviews and chart abstractions. Nasal swabs, with or without throat swabs, were systematically tested for RSV and 6 other common respiratory virus groups. We compared clinical outcomes, including hospitalization, and among those hospitalized, length of stay, intensive care unit admission, supplemental oxygen use, and intubation, between children aged &amp;lt;2 years with RSV-only detection and those with RSV co-detection. Results We enrolled 18 008 children aged &amp;lt;2 years. Of 17 841 (99.1%) tested for RSV, 5099 (28.6%) were positive. RSV was singly detected in 3927 children (77.0%) and co-detected in 1172 (23.0%). RSV co-detection with parainfluenza virus or adenovirus was associated with significantly lower odds of hospitalization (adjusted odds ratio, 0.56; 95% confidence interval [CI]: .33–.95; P = .031) and supplemental oxygen use (adjusted odds ratio, 0.66; 95% CI: .46–.95; P = .026), respectively, than RSV-only detection. For all other comparisons, we did not identify a significant association between RSV co-detection and worse clinical outcomes. Conclusions Co-detection of RSV with another respiratory virus was not significantly associated with worse clinical outcomes compared with RSV-only detection.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"290 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143927281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}