Clinical Infectious Diseases最新文献

{"title":"Empirical Antifungal Treatment of Critically Ill Patients With Influenza-Associated Acute Respiratory Distress Syndrome: A Bayesian Perspective.","authors":"Caroline Wilhelmer, Lisa Kriegl, Robert Krause, Stefan Hatzl","doi":"10.1093/cid/ciag662","DOIUrl":"https://doi.org/10.1093/cid/ciag662","url":null,"abstract":"<p><p>We reanalyzed 172 critically ill patients with influenza-associated ARDS in a Bayesian framework. Empirical mold-active antifungal treatment yielded a posterior median hazard ratio for influenza-associated pulmonary aspergillosis of 0.51 (95% credible interval 0.20-1.17; probability of benefit 94%), without mortality benefit. Findings remained consistent across skeptical, non-informative and externally informed priors.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206708","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":"Hypoalbuminemia and Pharmacokinetics: Revisiting Fundamental Principles and Clinical Perspectives.","authors":"Eun-Ju Jung, Jin Ju Park, Hong Sang Oh, Younghee Jung","doi":"10.1093/cid/ciag664","DOIUrl":"https://doi.org/10.1093/cid/ciag664","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206657","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":"Ertapenem in Hypoalbuminemia: Methodological and Pharmacokinetic Considerations.","authors":"Chen-Yu Wei, Yu-Te Tsai, Chun-Yu Lin, Yen-Hsu Chen, Po-Cheng Shih","doi":"10.1093/cid/ciag663","DOIUrl":"https://doi.org/10.1093/cid/ciag663","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206710","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":"HIV and Cancer Progression: Interpreting Real-World Evidence.","authors":"Derek Schneider, Nathan W Van Bibber, Jessica Y Islam, Anna E Coghill, Gita Suneja","doi":"10.1093/cid/ciag652","DOIUrl":"https://doi.org/10.1093/cid/ciag652","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191695","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":"Estimating Cancer Progression Risk by HIV Status: Design and Interpretation of Real-World Comparisons.","authors":"Ayu Kasamatsu, Yui Tomo","doi":"10.1093/cid/ciag651","DOIUrl":"https://doi.org/10.1093/cid/ciag651","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191732","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 piperacillin-tazobactam is behaving like a prognostic factor, but that does not negate the pharmacodynamic hypothesis.","authors":"Raneem H Pallotta, Samuel L Aitken, Jason M Pogue","doi":"10.1093/cid/ciag659","DOIUrl":"https://doi.org/10.1093/cid/ciag659","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191812","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 Piperacillin-Tazobactam MIC Behaves Like a Prognostic Marker, Not a Pharmacodynamic Exposure.","authors":"Alejandro Díez-Vidal","doi":"10.1093/cid/ciag658","DOIUrl":"https://doi.org/10.1093/cid/ciag658","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191831","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":"Prior Antibiotic Exposure and Subsequent Resistance in the Individual Patient: How Close Are We to the Bedside?","authors":"Michihiko Goto","doi":"10.1093/cid/ciag550","DOIUrl":"https://doi.org/10.1093/cid/ciag550","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191765","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":"Progressing From Association to Causation: Examining Prior Antibiotic Exposure and Antimicrobial Resistance Across Three US Health Systems Using Causal Machine Learning.","authors":"Aravind V Kuruvikkattil, Shikhar Shukla, Leo A Celi, Zanthia Wiley, Judy W Gichoya, Saptarshi Purkayastha","doi":"10.1093/cid/ciag549","DOIUrl":"https://doi.org/10.1093/cid/ciag549","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic exposure is hypothesized to drive antimicrobial resistance, but confounding by indication has limited causal inference from observational data. We estimated the effect of prior exposure on subsequent same-class nonsusceptibility across 7 antibiotic classes and 3 US health systems using a causal-inference framework.</p><p><strong>Methods: </strong>We analyzed 1 165 151 culture episodes from Mass General Brigham (MGB), Stanford Health Care, and Beth Israel Deaconess Medical Center (BIDMC; via MIMIC-IV). The causal effect of 90-day prior exposure on same-class resistance was estimated by double machine learning, adjusting for more than 35 confounders per site, including prior same-class resistant isolates, infecting-organism group, and calendar period. Robustness was assessed via inverse probability weighting, E-values, exposure-window and dose-response sensitivity, and negative-control pairs. Rates of microbiologically inactive empiric therapy were compared by prior same-class exposure.</p><p><strong>Results: </strong>Prior fluoroquinolone exposure was associated with increased nonsusceptibility by 11.9 and 12.6 percentage points at the primary sites (MGB, Stanford) and 8.6 points in validation (BIDMC) (all P < .001). Positive associations occurred for all 7 classes at all sites (sulfonamides indeterminate at Stanford), strongest at 30 days and attenuating through 365 days. Among patients with prior fluoroquinolone exposure receiving empiric fluoroquinolones for bloodstream infection, therapy was inactive in 50%-71% of episodes versus 27%-37% without prior exposure. Across classes, 3309 inactive empiric prescriptions were associated with prior same-class exposure. Median E-value was 2.5.</p><p><strong>Conclusions: </strong>Prior antibiotic exposure was consistently associated with increased same-class nonsusceptibility across antibiotic classes and health systems, paralleling higher rates of microbiologically inactive empiric therapy. These findings support prospective evaluation of antibiotic-history-informed empiric prescribing.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191715","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":"Outpatient Antibiotic Fills and 30-Day Readmission Following Patient-Directed Discharge in Drug Use-Associated Infective Endocarditis in a National Medicaid Cohort.","authors":"Fiona Gispen, Jialin Mao, Kenneth Karan, Yuhua Bao, Ximena A Levander, Elaine Wethington, Benjamin J Eckhardt, Brianna Sustersic, Shashi N Kapadia","doi":"10.1093/cid/ciag649","DOIUrl":"https://doi.org/10.1093/cid/ciag649","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic strategies for drug use-associated infective endocarditis (DUA-IE) are evolving, but data are limited regarding antibiotic access after patient-directed discharge (PDD). We examined antibiotic fill patterns and 30-day readmission among DUA-IE patients with and without PDD.</p><p><strong>Methods: </strong>Using national Medicaid data (2016-2022), we identified adults aged 18-64 with new DUA-IE episodes. We measured antibiotic fill rates among patients discharged to non-facility settings. We used a landmark design, requiring readmission-free survival for 3 days after discharge to observe antibiotic fills. We used multivariable logistic regression to assess associations between PDD and antibiotic fill with 30-day readmission, overall and stratified by PDD status.</p><p><strong>Results: </strong>Among 19,808 patients included, 5,519 (27.9%) left via PDD. Compared with non-PDD patients, PDD patients were younger, had fewer comorbidities, and had more polysubstance use. Only 17.1% of PDD patients had an antibiotic fill within 3 days versus 44.2% of non-PDD patients (adjusted odds ratio [aOR] 0.25; 95% CI, 0.20-0.33). PDD was associated with increased readmission (aOR 1.91; 95%CI, 1.65-2.21), while antibiotic fill was associated with reduced readmission (aOR 0.45; 95%CI, 0.40-0.50). In stratified analyses, antibiotic fill was associated with a larger magnitude of readmission reduction among PDD patients (aOR 0.27; 95%CI, 0.21-0.34) than among non-PDD patients (aOR 0.50; 95%CI, 0.46-0.55; p for interaction <.001).</p><p><strong>Conclusions: </strong>These findings highlight the need for proactive strategies that ensure treatment continuity including planning for potential PDD, bedside medication delivery, and expanded use of oral and long-acting intravenous antibiotics.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179911","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}