Clinical Infectious Diseases最新文献

{"title":"Emergence and Spread of Clostridioides difficile Isolates With Reduced Fidaxomicin Susceptibility in an Acute Care Hospital","authors":"Sarah N Redmond, Jennifer L Cadnum, Annette L Jencson, Claire E Kaple, Brigid M Wilson, Andrew M Skinner, Amy S Gargis, Munok Hwang, Hosoon Choi, Piyali Chatterjee, Chetan Jinadatha, Curtis J Donskey","doi":"10.1093/cid/ciaf028","DOIUrl":"https://doi.org/10.1093/cid/ciaf028","url":null,"abstract":"Background There have been several recent reports of Clostridioides difficile infection (CDI) due to isolates with reduced fidaxomicin susceptibility (minimum inhibitory concentration [MIC] ≥ 2 µg/mL). However, the clinical implications are uncertain because fidaxomicin achieves high concentrations in the intestinal tract. Methods In an acute care hospital, we conducted a 3-year cohort study of patients with CDI to determine the frequency of infection with isolates with reduced fidaxomicin susceptibility and the impact on response to fidaxomicin treatment. Stool specimens were cultured for C. difficile, and susceptibility testing was performed using agar dilution. Whole-genome sequencing was used to identify mutations associated with reduced fidaxomicin susceptibility and to determine relatedness of isolates. For genomically related susceptible and reduced susceptibility isolates from the same patient, we compared rates of growth, sporulation, and toxin production. Results Of 108 fidaxomicin-treated patients, 6 (5.6%) were infected with isolates that possessed reduced fidaxomicin susceptibility (MICs 8–32 µg/mL), including 3 with initially susceptible isolates followed by clinical failure with subsequent recovery of genomically related isolates with reduced susceptibility. Isolates with reduced fidaxomicin susceptibility harbored mutations in RNA polymerase associated with reduced susceptibility and exhibited reduced toxin production, and 20% to 40% of isolates tested had reduced growth and/or sporulation in comparison with susceptible isolates. Three patients were infected with genomically indistinguishable ribotype 097 isolates with reduced fidaxomicin susceptibility. Conclusions Our findings highlight the potential for the emergence on therapy of clinically relevant reduced fidaxomicin susceptibility in C. difficile and its spread via transmission to other patients.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"29 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546160","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":"Effects of the COVID-19 pandemic on TB outcomes in the United States: a Bayesian analysis","authors":"Nicole A Swartwood, Ted Cohen, Suzanne M Marks, Andrew N Hill, Garrett R Beeler Asay, Julie Self, Pei-Jean I Feng, C Robert Horsburgh, Joshua A Salomon, Nicolas A Menzies","doi":"10.1093/cid/ciaf092","DOIUrl":"https://doi.org/10.1093/cid/ciaf092","url":null,"abstract":"Background Tuberculosis (TB) notifications and deaths in the United States fluctuated substantially during the COVID-19 pandemic. We analyzed multiple data sources to understand the factors contributing to these changes and estimated future TB trends. Methods We identified four mechanisms potentially contributing to observed TB trends during 2020–2023: immigration, respiratory contact rates, rates of accurate diagnosis and treatment initiation, and mortality rates for persons experiencing TB disease. We employed a Bayesian approach to synthesize evidence on how these mechanisms changed during the pandemic and how they might have combined to produce observed 2020–2023 TB data, using a transmission-dynamic model to link mechanisms to TB outcomes. We also simulated a no-pandemic-counterfactual scenario that assumed mechanisms followed pre-pandemic trends. We estimated TB outcomes associated with the pandemic until 2035 to capture lagged effects. We evaluated additional scenarios to estimate the individual effect of each mechanism. Results Over 2020–2035, we estimate an additional 2,784 (95% uncertainty interval: 2,164–3,461) TB notifications and 1,138 (1,076–1,201) TB deaths in the United States associated with changes occurring during the COVID-19 pandemic. Mechanisms had offsetting effects – decreases in TB diagnosis rates led to more TB deaths and notifications, while reductions in contact rates reduced TB deaths and notifications. Immigration changes initially reduced TB deaths, but increased deaths and notifications over time. Higher TB mortality rates increased TB deaths, but decreased TB notifications. Conclusions While direct impacts of the COVID-19 pandemic occurred between 2020–2023, these changes may continue to influence TB incidence and mortality in future years.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"29 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546157","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":"Potential Impact of Doxycycline Post-Exposure Prophylaxis on Tetracycline Resistance in Neisseria gonorrhoeae and Colonization with Tetracycline-Resistant Staphylococcus aureus and Group A Streptococcus","authors":"Olusegun O Soge, Christina S Thibault, Chase A Cannon, Stephanie E McLaughlin, Tim W Menza, Julia C Dombrowski, Ferric C Fang, Matthew R Golden","doi":"10.1093/cid/ciaf089","DOIUrl":"https://doi.org/10.1093/cid/ciaf089","url":null,"abstract":"Background Doxycycline post-exposure prophylaxis (doxy PEP) is increasingly used among men who have sex with men (MSM). Its impact on antimicrobial resistance and the microbiome is uncertain. Methods We used Neisseria gonorrhoeae (NG) surveillance data from King County, WA and joinpoint regression to investigate trends in NG-tetracycline resistance (tetR), 2017-2024 and, among sexual health clinic (SHC) patients, evaluated the association of NG-tetR with doxy PEP use. We evaluated nasopharyngeal colonization with Staphylococcus aureus and Group A Streptococcus (GAS) 703 MSM SHC patients, August 2023-July 2024. Results Among 2,312 MSM with NG, tetR was stable 2017 to quarter 1 (Q1) 2023 (mean=27%) and thereafter rose to 70% in Q2 2024 (p<0.0001). (King County released doxy PEP guidelines in Q2 2023.) NG with high-level (HL) tetR increased Q1 2021 to Q2 2024 (2% to 65%) (p<0.0001). Taking >3 doses of doxy PEP/month was associated with both tetR and HL tetR (p≤0.01 for both), though any use of doxy PEP was not associated with tetR or HL tetR. S. aureus colonization was less common among doxy PEP users than non-users (27% vs. 36%, p=0.02), but colonization with both tetracycline-resistant S. aureus and GAS were more common among doxy PEP users than non-users (18% vs. 8%, p<0.0001 and 9% vs. 4%, p=0.008, respectively). Conclusions TetR in NG rapidly increased from 2021 to 2024, and most NG among King County MSM now have HL tetR. Doxy PEP use is associated with colonization with GAS and tetracycline-resistant S. aureus, suggesting that doxy PEP impacts off-target bacteria.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"16 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546159","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":"Ongoing Symptoms After Acute SARS-CoV-2 or Influenza Infection in a Case-Ascertained Household Transmission Study: 7 US Sites, 2021–2023","authors":"Ayla Bullock, Alexandra F Dalton, Melissa S Stockwell, Son H McLaren, Ellen Sano, Huong Q Nguyen, Suchitra Rao, Edwin Asturias, Karen Lutrick, Katherine D Ellingson, Yvonne Maldonado, Alexandra M Mellis, Sarah E Smith-Jeffcoat, Carlos G Grijalva, H Keipp Talbot, Melissa A R Rolfes, Jessica E Biddle, Yuwei Zhu, Karla Ledezma, Kathleen Pryor, Ana Valdez de Romero, Celibell Vargas, Joshua G Petrie, Michelle Floris-Moore, Natalie Bowman","doi":"10.1093/cid/ciaf026","DOIUrl":"https://doi.org/10.1093/cid/ciaf026","url":null,"abstract":"Background The prevalence and risk factors for ongoing symptoms following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [SCV2]) or influenza infection are not well characterized. We conducted a prospective cohort study of households wherein ≥1 individual was infected with SCV2 or influenza to evaluate prevalence of and factors associated with ongoing symptoms at 90 days. Methods Index cases and their household contacts provided baseline health and sociodemographic information and collected daily respiratory specimens for 10 days following enrollment. Participants completed a follow-up survey 90 days after enrollment to characterize ongoing symptoms. Results We analyzed 1967 participants enrolled between December 2021 and May 2023. The risk of ongoing symptoms did not differ by infection status in SCV2 (SCV2-positive: 15.6%; SCV2-negative: 13.9%; odds ratio [OR]: 1.14; 95% CI: .7–1.69) or influenza (influenza-positive: 8.8%; influenza-negative: 10.0%; OR: .87; 95% CI: .45–1.72) households. However, among study participants with a documented infection, SCV2-positive participants had nearly twice the odds of ongoing symptoms as influenza-positive participants (OR: 1.92; 95% CI: 1.27–2.97). Conclusions These results suggest that SCV2 households have a significantly higher prevalence of ongoing symptoms compared with influenza households (OR: 1.78; 95% CI: 1.28–2.47). Among participants with SCV2 infection, underlying conditions (adjusted OR [aOR]: 2.65; 95% CI: 1.80–3.90) and coronavirus disease 2019 (COVID-19)–like symptoms (aOR: 2.92; 95% CI: 1.15–7.43) during acute infection increased odds of ongoing symptoms at 90 days, whereas hybrid immunity reduced the odds of ongoing symptoms (aOR: 0.44; 95% CI: .22–.90).","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"43 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546158","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":"Chronic Pulmonary Aspergillosis and Nontuberculous Mycobacterial Pulmonary Disease: Two Peas in a Pod.","authors":"Minh-Vu H Nguyen, Charles L Daley","doi":"10.1093/cid/ciaf091","DOIUrl":"https://doi.org/10.1093/cid/ciaf091","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556049","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":"Chronic pulmonary aspergillosis is a differential diagnosis and co-infection with Nontuberculous Mycobacterial Pulmonary Disease.","authors":"David W Denning, Chris Kosmidis","doi":"10.1093/cid/ciaf090","DOIUrl":"https://doi.org/10.1093/cid/ciaf090","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556052","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":"Aztreonam-ceftazidime-avibactam may not be enough.","authors":"Niaz Banaei, Stanley C Deresinski","doi":"10.1093/cid/ciaf085","DOIUrl":"https://doi.org/10.1093/cid/ciaf085","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556045","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":"Giving aztreonam-ceftazidime-avibactam its best chance.","authors":"Andrew Chou","doi":"10.1093/cid/ciaf084","DOIUrl":"https://doi.org/10.1093/cid/ciaf084","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556054","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":"Is There Room for Metformin at COVID-19's Dinner Table? Updated Analysis of Clinical Trials.","authors":"Todd C Lee, David R Boulware","doi":"10.1093/cid/ciae284","DOIUrl":"10.1093/cid/ciae284","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"487-488"},"PeriodicalIF":8.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956515","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":"Early Detection of Cancer and Precancerous Lesions in Persons With HIV Through a Comprehensive Cancer Screening Protocol.","authors":"Félix Gutiérrez, Leandro López, Carlos Galera, Juan Manuel Tiraboschi, Joseba Portu, Lucio García-Fraile, Miguel García Del Toro, Enrique Bernal, Antonio Rivero, Javier García-Abellán, Juan Flores, Ana González-Cordón, Onofre Martínez, Joaquín Bravo, Dácil Rosado, Marta Montero, Guillem Sirera, Miguel Torralba, Maria José Galindo, Juan Macías, Inmaculada Gónzalez-Cuello, Vicente Boix, María Jesús Vivancos, Paula Dios, Jose Ramón Blanco, Sergio Padilla, Marta Fernández-González, Ana Gutiérrez-Ortiz de la Tabla, Esteban Martínez, Mar Masiá","doi":"10.1093/cid/ciae359","DOIUrl":"10.1093/cid/ciae359","url":null,"abstract":"<p><strong>Background: </strong>Non-AIDS defining malignancies present a growing challenge for persons with human immunodeficiency virus (HIV, PWH), yet tailored interventions for timely cancer diagnosis are lacking. The Spanish IMPAC-Neo protocol was designed to compare two comprehensive cancer screening strategies integrated into routine HIV care. This study reports baseline data on the prevalence and types of precancerous lesions and early-stage cancer among participants at enrolment. Acceptability of the procedure was additionally assessed.</p><p><strong>Methods: </strong>Cross-sectional analysis of a comprehensive screening protocol to detect precancer and cancer. The readiness of healthcare providers to implement the protocol was evaluated using a validated 4-item survey.</p><p><strong>Results: </strong>Among the 1430 enrolled PWH, 1172 underwent 3181 screening tests, with positive findings in 29.4% of cases, leading to further investigation in 20.7%. Adherence to the protocol was 84%, with HIV providers expressing high acceptability (97.1%), appropriateness (91.4%), and feasibility (77.1%). A total of 145 lesions were identified in 109 participants, including 60 precancerous lesions in 35 patients (3.0%), 9 early-stage cancers in 9 patients (0.8%), and 76 low-risk lesions in 65 subjects (5.5%). Adverse events related to screening occurred in 0.8% of participants, all mild. The overall prevalence of cancer precursors or early-stage cancer was 3.8% (95% confidence interval [CI], 2.74%-5.01%), with highest rates observed in individuals screened for anal and colorectal cancers.</p><p><strong>Conclusions: </strong>The baseline comprehensive cancer screening protocol of the IMPAC-Neo study successfully identified a significant proportion of PWH with precancerous lesions and early-stage cancer. High adherence rates and positive feedback from providers suggest effective implementation potential in real-world healthcare settings.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"371-380"},"PeriodicalIF":8.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11848275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141497338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}