Clinical Infectious Diseases最新文献

{"title":"Impact of a Collaboration-Focused Intervention to Prevent Healthcare-Associated Infections Before and During the Coronavirus Disease 2019 Pandemic.","authors":"Karen M Jones,M Todd Greene,Jennifer Meddings,Julia Mantey,Sarah L Krein,Molly Harrod,Ana Montoya,John P Mills,Lona Mody","doi":"10.1093/cid/ciaf122","DOIUrl":"https://doi.org/10.1093/cid/ciaf122","url":null,"abstract":"BACKGROUNDNursing home (NH) residents are susceptible to healthcare-associated infections (HAIs). Alignment among NHs, hospitals, and health departments is critical for effective implementation of infection prevention efforts. We tested a collaborative model that engaged hospitals and NHs to reduce infections among NH residents.METHODSWe recruited 92 NHs and 15 hospitals over four 12-month cohorts (2018-2022). The intervention focused on HAI prevention; practices to reduce infection transmission; and effective communication among hospitals, NHs, and state health departments. NHs submitted data on urinary tract infection, catheter-associated urinary tract infection, Clostridioides difficile infection, methicillin-resistant Staphylococcus aureus infection, catheter use, and urine cultures. Changes in outcomes before and during the coronavirus disease 2019 (COVID-19) pandemic were assessed using multilevel negative binomial regression.RESULTSA total of 63 NHs (68%) partnered with 18 hospitals and submitted 2 or more months of outcome data. Forty NHs participated before COVID-19 (contributing to 1 364 492 resident-days, 56 258 device-days), and 23 NHs participated during COVID-19 (566 142 resident-days, 29 568 device-days). While reductions in the incidence of urine cultures (incidence rate ratio [IRR], 0.37; P < .001) and total composite infections (IRR, 0.68; P = .03) were observed before COVID-19, these reductions were not sustained during the pandemic.CONCLUSIONSPrior to COVID-19 pandemic, collaboration between NHs and referring regional hospitals with engagement from state health departments led to reductions in NH urine cultures and total infections. Although the pandemic significantly impacted our study, we demonstrate the importance of regional networks in promoting infection prevention in NHs.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"19 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889331","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":"Body mass index trajectories and association with tuberculosis risk in a cohort of household contacts in Southern Africa","authors":"Leyla Larsson, Claire J Calderwood, Edson T Marambire, Kathrin Held, Denise Banze, Alfred Mfinanga, Karlos Madziva, Phoebe Walsh, Joseph Jacob, Francisco Trinchan Fernandez, Patrick Lungu, Anita Mesic, Celso Khosa, Lilian T Minja, Junior Mutsvangwa, Madhavi Bhargava, Michael Lauseker, Rishi K Gupta, Norbert Heinrich, Katharina Kranzer","doi":"10.1093/cid/ciaf222","DOIUrl":"https://doi.org/10.1093/cid/ciaf222","url":null,"abstract":"Background Studies have demonstrated an inverse log-linear relationship between body mass index (BMI) and tuberculosis incidence. However, a person’s BMI is dynamic and longitudinal changes may be more informative than cross-sectional assessments. We evaluate the association between cross-sectional and changing BMI and risk of tuberculosis and describe longitudinal trajectories in a high-risk cohort. Methods ERASE-TB was a prospective longitudinal cohort study of household contacts ≥10 years in Southern Africa (Zimbabwe, Tanzania, and Mozambique), with 6-monthly follow-up up to 24 months. Associations between BMI and tuberculosis were investigated based on baseline (including haemoglobin) and changing BMI, using logistic, Poisson, and Cox models. Prevalent tuberculosis was defined as diagnosis during &amp;lt;30 days after recruitment. Growth mixture modelling (GMM) was used to model longitudinal latent trajectories. Results Of 2,107 recruited household contacts (621 [29.5%] adolescents and 1,310 [62.2%] female), 520 (24.7%) were underweight. There were 21 and 41 people diagnosed with prevalent and incident tuberculosis, of whom 5/21 (23.8%) and 12/41 (29.3%) were underweight. Being underweight and anaemic (aHR: 3.77, 95% CI: 1.50-9.51) and &amp;gt;10% negative change in BMI during follow-up (aIRR: 2.27 (95% CI: 0.22-22.9) were associated with increased risk of incident tuberculosis. The association between continuous BMI-for-age Z-scores were non-linear, with increased risk of tuberculosis with lower BMI. Four latent groups were defined in the GMM: increasing, decreasing, and low/high stable BMI. Conclusions Declining BMI, regardless of absolute value, is a strong predictor of tuberculosis among household contacts. Longitudinal measurements should be considered in active case finding among tuberculosis-affected households.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"7 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884283","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":"Factors Affecting Risk of CVD Events in a Global CVD Prevention Cohort of People with HIV","authors":"Steven K Grinspoon, Maya Watanabe, Heather J Ribaudo, Gerald S Bloomfield, Carl J Fichtenbaum, Triin Umbleja, Sarah M Chu, Kathleen V Fitch, Marissa R Diggs, Sophia Zhao, Sara E Looby, Judith S Currier, Judith A Aberg, Carlos D Malvestutto, Kristine M Erlandson, Esteban Martinez, Olabimpe Asupoto, Samir K Gupta, Juan C Lopez-Bernaldo de Quiros, Daniel Nixon, Roger Bedimo, Michael T Lu, Pamela S Douglas, Markella V Zanni","doi":"10.1093/cid/ciaf210","DOIUrl":"https://doi.org/10.1093/cid/ciaf210","url":null,"abstract":"Background PWH face increased risks of major adverse cardiovascular disease (MACE), partially mitigated by statin therapy. Methods We characterized factors associated with MACE and MACE subcomponents among a global cohort of PWH in REPRIEVE. Our primary outcome measure was time-to-first primary MACE. Secondary outcome measures included time-to-first: a)hard MACE [cardiovascular disease (CVD) death, myocardial infarction (MI), or stroke]; b)MI; or c)stroke. For each outcome, Cox proportional hazards models were used to estimate the hazard of baseline risk factors. Results Among participants (N=7,769), median age was 50(Q1,Q3: 45,55) years, 31% female sex-at-birth (sex), 53% residence in high-income countries (HIC), median 10-year PCE ASCVD risk score 4.5(2.1,7.0)%. In fully adjusted models, risk for first MACE was higher for older individuals (50-59 and ≥60 vs. 40-49, HR’s(95%CI’s): 2.06(1.54,2.76) and 2.53(1.60,4.01)) and for those with Black or African American race (vs. white race, within HIC, HR: 1.65(1.19,2.27)), family history of premature CVD (HR: 1.53(1.16,2.03)), current cigarette smoking (HR: 2.27(1.65,3.13)), hypertension (HR: 1.77(1.36,2.30)), lower HDL cholesterol (HR: 1.21(1.10,1.34)), HIV-1 RNA ≥lower-limit-of-quantification (LLQ) (HR:1.40(1.0,1.97)), and a select ART regimen class combination (HR:1.53(1.01,2.31)). Individuals from HIC had a higher risk of first MACE vs. those from other regions, excepting South Asia. There was no apparent protective effect of female sex. Modelling for hard MACE, MI, and stroke yielded generally similar results for most variables. Conclusions Among PWH in REPRIEVE, modifiable risk factors associated with first MACE after accounting for statin effect included cigarette smoking, hypertension, lower HDL cholesterol, and HIV-1 RNA ≥LLQ. Female sex was not protective.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"78 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875810","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":"Effectiveness of the BPaL(M) Regimen for Drug-Resistant Tuberculosis in Ukraine under Programmatic Conditions","authors":"Victor Naestholt Dahl, Ole Skouvig Pedersen, Tetiana Butova, Mykhailo Kuzhko, Olena Raznatovska, Andrii Fedorec, Vitalii Vekshyn, Valentyna Hlynenko, Nataliia Yevsiukova, Leonid Hryshchuk, Svitlana Kornaha, Nataliia Chursina, Natalia Kondratyuk, Lyubov Markovtsiy, Vasyl Skryp, Artemii Bogomolov, Tetiana Klymenko, Daria Yankovska, Mykola Ostrovskyy, Iryna Makoida, Daria Levandovska, Yuulia Shpak, Vitalii Didyk, Olha Siomak, Dmytro Butov","doi":"10.1093/cid/ciaf214","DOIUrl":"https://doi.org/10.1093/cid/ciaf214","url":null,"abstract":"Bedaquiline, pretomanid, and linezolid, with or without moxifloxacin, have revolutionized treatment for drug-resistant tuberculosis. In Ukraine, we observed an 86% (n=394/460) success rate under programmatic conditions when drugs were accessible, exceeding prior estimates (58%) and aligning with trials (80–90%). However, access and implementation remain a concern in conflict-affected settings.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"3 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875809","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":"Into the Unknown: Practical Remdesivir Restriction in the Era of Widespread SARS-CoV-2 Seropositivity","authors":"Alyssa Christensen, Zachary Nelson, Sally Gustafson, Rachel Stoecker, Brent Footer, Nicole Trower, Laura Grangaard Johnson, Elizabeth B Hirsch, Stefan Collinet-Adler, Maxx Enzmann, Ethan Ryberg, Sarah Rebecca Peglow","doi":"10.1093/cid/ciaf217","DOIUrl":"https://doi.org/10.1093/cid/ciaf217","url":null,"abstract":"Background There is limited data to support routine remdesivir use in the contemporary era of SARS-CoV-2 with widespread seropositivity. Methods A restriction of remdesivir among adult immunocompetent patients was implemented across an 8-hospital health system. A pre-post quasi-experimental design was used to compare patients 12 months pre-intervention (June 2022 - May 2023) to 12 months post-intervention (July 2023 – June 2024). The primary outcome was 14-day all-cause mortality. Results 4,774 patients were included in the analysis (3,323 pre-intervention; 1,451 post-intervention). Significantly fewer patients in the post-intervention group received remdesivir (37.7% pre-intervention vs 4.1% post-intervention, p&amp;lt;0.001). When medium-risk covariates were modeled, there was no difference in 14-day all-cause mortality between pre- and post-intervention groups (OR, 1.8; 95% CI 0.54 to 5.8, p = 0.34). Similarly, there was no difference in 28-day all-cause mortality, 30-day readmission, or LOS. Intensive care unit (ICU) admission and mechanical ventilator (MV) use were different between groups. Remdesivir use was associated with a lower risk of ICU admission and MV pre-intervention and higher association with these outcomes post-intervention. Similar outcomes were observed when high-risk value covariates were modeled. Conclusion Restriction of remdesivir use in immunocompetent patients across a large health system was not associated with an increased risk of mortality. Remdesivir use was associated with an unexpected increased risk of ICU admission and MV within the post-intervention group only, which is likely explained by the higher-risk patient population that received remdesivir. Prospective studies would be needed to definitively determine if highly vaccinated, immunocompetent patients benefit from remdesivir.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"17 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875807","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":"Performance of a novel P. falciparum rapid diagnostic test in areas of widespread hrp2/3 gene deletion","authors":"Aynalem Mandefro, Xavier C Ding, Jocelyn Farge, Gezahegn Solomon Alemayehu, Geletta Tadele, Bacha Mekonen, Yirgalem Gebrehiwot, Nega Berhe, Berhanu Erko, Hannah C Slater, Greg T Bizilj, Rebecca Barney, Allison Golden, Gonzalo J Domingo, Lemu Golassa","doi":"10.1093/cid/ciaf212","DOIUrl":"https://doi.org/10.1093/cid/ciaf212","url":null,"abstract":"Background Rapid diagnostic tests (RDTs) have improved malaria diagnosis, however the emergence of hrp2/3 gene deletions threatens the reliability of HRP2-based RDTs. This study evaluated the diagnostic performance of a novel RDT detecting both HRP2 and PfLDH in a single test line. Method A cross-sectional study was conducted at two health centers in Ethiopia, recruiting 1004 study participants. Blood samples were tested using the novel and comparator RDTs, using microscopy and nested PCR as the reference standards. P. falciparum hrp2 and hrp3 genotyping and HRP2 and PfLDH antigen quantification were also conducted. Results In this study settings, characterized by 80% of P. falciparum infections showing hrp2 or hrp3 deletion, the novel RDT showed a sensitivity of 77.4% and a specificity of 96%, surpassing the HRP2-only comparators Bioline™ Malaria Ag Pf (55.9%) and Bioline™ Malaria Ag Pf/Pv (56.8%). Its performance was comparable to the three-line Bioline™ Malaria Ag Pf/Pf/Pv RDT, which detects HRP2, PfLDH, and PvLDH, at 77.7% sensitivity. Additionally, the novel RDT exhibited the ability to detect P. falciparum cases across a broader range of HRP2 and PfLDH antigen concentrations compared to the comparator RDTs. Conclusions The single-line, easy-to-interpret index malaria RDT outperforms conventional HRP2-only RDTs, making it a promising tool for enhancing malaria diagnosis in regions with high hrp2/3 deletion prevalence. The study is registered on ClinicalTrials.gov ID NCT05286359.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"15 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872690","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":"Untangling the Sources of HIV-related Cardiovascular Risk.","authors":"Sonya Krishnan,Eileen P Scully","doi":"10.1093/cid/ciaf211","DOIUrl":"https://doi.org/10.1093/cid/ciaf211","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"49 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880206","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":"Cryptococcal Meningitis Treatment Beyond HIV: Recognizing the need for Individualized Immune-Based Strategies","authors":"Hyunah Yoon, Liise-anne Pirofski, David R Boulware","doi":"10.1093/cid/ciaf218","DOIUrl":"https://doi.org/10.1093/cid/ciaf218","url":null,"abstract":"The promising results of the Ambition-CM trial in persons with HIV have sparked interest in treating non-HIV-associated cryptococcal meningitis with single 10mg/kg liposomal amphotericin B, combined with oral flucytosine and fluconazole. However, caution is warranted when applying this approach to non-HIV organ transplant recipients, whose immune status may vary due to the effects of immunosuppressive drugs. In these patients, cryptococcal disease, which generally occurs after initial immunosuppressant doses are reduced, may be driven by fungal growth, an immune response to cryptococcal antigens, or both. The latter is particularly relevant as potent antimicrobial therapy can lyse Cryptococcus, releasing antigens that trigger inflammation and cause host-mediated damage. Reducing iatrogenic immunosuppression may enhance host immune responses, which, in the context of neuro-infections, may be fatal. This highlights the importance of understanding the immune status of non-HIV organ transplant recipients within the context of the Damage-Response Framework to guide personalized treatment strategies.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"15 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143875866","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":"Case series of patients with laboratory confirmed Marburg virus disease, 2023 Equatorial Guinea","authors":"Florentino Abaga Ondo Ndoho, Luca Fontana, Candido Ondo Ondo Avomo, Ladislao Ekiri Ngomo Mikue, Domitila Ñadang Fuga Eyemam, Micaela Ayang Nguere, Ilda Elobe Mometolo, Rosalia Nazang Bibang Nzang, Damaso Mitogo Nguema Maye, Yosbanis Hernandez Suarez, Salvador Eduardo Esono, José Antonio Miko Ayang, Ruggero Giuliani, Frédérique Jacquerioz, Hans-Joerg Lang, Richard Kojan, Antoine Chaillon, Stephanie Ngai, Olivier le Polain de Waroux, Anna Silenzi, Michele Di Marco, Anaïs Legand, Pierre Formenty, Maria E Negron, John D Klena, Mary J Choi, Oren Mayer, Florine E M Scholte, Stephen R Welch, Emily Zielinski Gutierrez, Janet Diaz","doi":"10.1093/cid/ciaf208","DOIUrl":"https://doi.org/10.1093/cid/ciaf208","url":null,"abstract":"Background Marburg virus disease (MVD) is a severe viral infection caused by the Marburg marburgvirus species. In February 2023, Equatorial Guinea declared its first outbreak. This case series describes the natural history of MVD in five laboratory confirmed patients. Methods Patients with confirmed MVD admitted to the national treatment center in Bata, Equatorial Guinea, were monitored for vital signs and symptoms. Comprehensive clinical data was collected to understand the progression and outcome of the disease. Results Five patients were confirmed to have MVD. Three male healthcare workers were diagnosed early in their disease and subsequently survived. The other two patients, both females, were admitted later in their disease progression and died within 24 hours of admission. Four patients received remdesivir under a protocol for the Monitored Emergency Use of Unregistered and Experimental Interventions. The early symptoms were non-specific, with rapid progression to more severe conditions in the later stages of the disease. Early treatment with remdesivir showed the drug to be well tolerated. Conclusions Contrary to some reports and the recommended case definition for MVD, our patients presented with a rash but did not exhibit vomiting or diarrhea. Hemorrhagic signs were solely observed in the terminal stage, preceding demise. Despite the limited sample size, these findings emphasize the importance of tailoring the case definition to the specific outbreak. Further evidence on the efficacy and safety of therapeutics for MVD, including remdesivir, should be gathered through well-designed trials during future epidemic responses.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"8 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143872693","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":"Too Much Coffee: A Rare Cause of Sore Throat.","authors":"Sebastian Sanchez-Lopez,María Susana Cerino-Peñaloza,John M Scott,Jacob Hodges,Suzuki Hiroyuki","doi":"10.1093/cid/ciaf123","DOIUrl":"https://doi.org/10.1093/cid/ciaf123","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"4 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866825","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}