Clinical Infectious Diseases最新文献

{"title":"Revisiting the Evidence Base That Informs the Use of Adjunctive Therapy for Enterococcus faecalis Endocarditis: A Systematic Review and Meta-Analysis.","authors":"Connor Prosty, Mark Sorin, Khaled Katergi, Roy Khalaf, Clare Fogarty, Malick Turenne, Todd C Lee, Emily G McDonald","doi":"10.1093/cid/ciae379","DOIUrl":"10.1093/cid/ciae379","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend adjunctive gentamicin for the treatment of Enterococcus faecalis infective endocarditis (EFIE) despite a risk of toxicity. We sought to revisit the evidence for adjunctive therapy in EFIE and to synthesize the comparative safety and effectiveness of aminoglycosides versus ceftriaxone by systematic review and meta-analysis.</p><p><strong>Methods: </strong>For historical context, we reviewed seminal case series and in vitro studies on the evolution from penicillin monotherapy to modern-day regimens for EFIE. Next, we searched MEDLINE and Embase from inception to 16 January 2024 for studies of EFIE that compared adjunctive aminoglycosides versus ceftriaxone or adjunctive versus monotherapy. Where possible, clinical outcomes were compared between regimens using random effects meta-analysis. Otherwise, data were narratively summarized.</p><p><strong>Results: </strong>The meta-analysis was limited to 10 observational studies at high risk of bias (911 patients). Relative to adjunctive ceftriaxone, gentamicin had similar all-cause mortality (risk difference [RD], -0.8%; 95% confidence interval [CI], -5.0 to 3.5), relapse (RD, -0.1%; 95% CI, -2.4 to 2.3), and treatment failure (RD, 1.1%; 95% CI, -1.6 to 3.7) but higher discontinuation due to toxicity (RD, 26.3%; 95% CI, 19.8 to 32.7). The 3 studies that compared adjunctive therapy to monotherapy included only 30 monotherapy patients, and heterogeneity precluded meta-analysis.</p><p><strong>Conclusions: </strong>Adjunctive ceftriaxone appeared to be equally effective and less toxic than gentamicin for the treatment of EFIE. The existing evidence does not clearly establish the superiority of either adjunctive therapy or monotherapy. Pending randomized evidence, if adjunctive therapy is to be used, ceftriaxone appears to be a reasonable option.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"1162-1171"},"PeriodicalIF":8.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141747637","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":"Long-term Effectiveness of Financial Incentives for Not Prescribing Unnecessary Antibiotics to Children with Acute Respiratory and Gastrointestinal Infections: A Japan’s Nationwide Quasi-Experimental Study","authors":"Yusuke Okubo, Kazuhiro Uda, Isao Miyairi","doi":"10.1093/cid/ciae577","DOIUrl":"https://doi.org/10.1093/cid/ciae577","url":null,"abstract":"Background To address antibiotic overuse, the Japanese government implemented a novel financial incentive policy in 2018. The policy enables eligible healthcare facilities to claim 800 JPY (≈5.7 USD) per case wherein a rationale to not prescribe antibiotics is offered to children aged &amp;lt;3 years with acute upper respiratory tract infections or gastroenteritis. Although the short-term effect of this policy was observed in our previous study, its long-term effects have not been evaluated nationwide. Methods We conducted a quasi-experimental study using a staggered difference-in-differences design with propensity score matching. Data from 165,113 children born between April 2017 and March 2019 were extracted from two nationwide administrative databases. The study tracked these children until May 2022, comparing those exposed to the policy with those who were not. Results The introduction of financial incentives led to a 44.9% reduction (95%CI, 41.1% to 47.7%) in total antibiotic prescriptions within the first month and 19.5% reduction (95%CI, 8.7% to 29.1%) over 48 months. Broad-spectrum antibiotic use also decreased by 24.4% (95%CI, 14.0% to 33.6%) over the same period. The policy did not result in increased hospitalizations, after-hours visits, or healthcare costs, but was associated with a slight increase in the number of office visits. A dose-response relationship was observed, with reductions in antibiotic use leveling off after approximately five incentives. Conclusions Financial incentives effectively reduced antibiotic prescriptions in children without adverse health outcomes, demonstrating sustained benefits over four years. This antimicrobial stewardship intervention offers a scalable model for other countries aiming to curb antibiotic overuse and combat antimicrobial resistance.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"78 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142694213","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":"Influence of Antibiotic Exposure Intensity on the Risk of Clostridioides difficile Infection.","authors":"Michael J Ray, Luke C Strnad, Kendall J Tucker, Jon P Furuno, Eric T Lofgren, Caitlin M McCracken, Hiro Park, Jeffrey S Gerber, Jessina C McGregor","doi":"10.1093/cid/ciae259","DOIUrl":"10.1093/cid/ciae259","url":null,"abstract":"<p><strong>Background: </strong>Antibiotics are a strong risk factor for Clostridioides difficile infection (CDI), and CDI incidence is often measured as an important outcome metric for antimicrobial stewardship interventions aiming to reduce antibiotic use. However, risk of CDI from antibiotics varies by agent and dependent on the intensity (ie, spectrum and duration) of antibiotic therapy. Thus, the impact of stewardship interventions on CDI incidence is variable, and understanding this risk requires a more granular measure of intensity of therapy than traditionally used measures like days of therapy (DOT).</p><p><strong>Methods: </strong>We performed a retrospective cohort study to measure the independent association between intensity of antibiotic therapy, as measured by the antibiotic spectrum index (ASI), and hospital-associated CDI (HA-CDI) at a large academic medical center between January 2018 and March 2020. We constructed a marginal Poisson regression model to generate adjusted relative risks for a unit increase in ASI per antibiotic day.</p><p><strong>Results: </strong>We included 35 457 inpatient encounters in our cohort. Sixty-eight percent of patients received at least 1 antibiotic. We identified 128 HA-CDI cases, which corresponds to an incidence rate of 4.1 cases per 10 000 patient-days. After adjusting for known confounders, each additional unit increase in ASI per antibiotic day was associated with 1.09 times the risk of HA-CDI (relative risk = 1.09; 95% CI: 1.06-1.13).</p><p><strong>Conclusions: </strong>The ASI was strongly associated with HA-CDI and could be a useful tool in evaluating the impact of antibiotic stewardship on HA-CDI rates, providing more granular information than the more commonly used DOT.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"1129-1135"},"PeriodicalIF":8.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921420","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}

{"title":"HIV-1 low-level viremia predicts viral failure in participants on antiretroviral therapy in the Swiss HIV Cohort Study.","authors":"Caroline Lanz, Jan Meier, Marcel Stöckle, Hansjakob Furrer, Alexandra Calmy, Matthias Cavassini, Enos Bernasconi, Patrick Schmid, Dominique L Braun, Roger D Kouyos, Tom Loosli, Katharina Kusejko, Huldrych F Günthard","doi":"10.1093/cid/ciae569","DOIUrl":"https://doi.org/10.1093/cid/ciae569","url":null,"abstract":"<p><strong>Background: </strong>Most individuals on combination antiretroviral therapy (ART) have HIV plasma viral loads below the limit of detection. However, episodes of low-level viremia (LLV) are observed in subsets of individuals, risk factors and clinical significance of which remain debated.</p><p><strong>Methods: </strong>We included participants enrolled in the Swiss HIV Cohort Study, starting ART between July 1999 and April 2023, with HIV RNA <200 copies/ml six months post ART initiation. Using longitudinally collected data, we applied a time-updated Cox proportional hazards model to determine the association of LLV with the risk of subsequent viral failure, defined as ≥200 copies/ml. LLV was quantified by the time-updated area under the curve (AUC) of HIV RNA values, segmented into categories undetectable, and based on AUC tertiles into low, intermediate, and high.</p><p><strong>Results: </strong>We included 8'132 participants with a total of 49'579 person-years of follow-up. Median follow-up time was 4.7 years, and median number of HIV RNA measurements was 16. Participants had a median age of 38 years, 75.9% were male, 74.4% had white ethnicity, and 45.9% had HIV-1 subtype B. LLV was associated with an increased risk for subsequent viral failure, with the highest LLV category showing the strongest association (hazard ratio = 3.3 compared to undetectable viral load) among all included variables including ethnicity, age, and ART.</p><p><strong>Conclusions: </strong>LLV was strongly associated with the risk for subsequent viral failure, even after adjusting for demographic and clinical characteristics, including adherence and treatment regimen. The detection of LLV should prompt appropriate measures to decrease the risk of subsequent viral failure.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686272","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":"Increased severity of multidrug-resistant Shigella sonnei infections in people experiencing homelessness","authors":"Aleksandra Stefanovic, Mosaab E Alam, Nancy Matic, Ashley Larnder, Gordon Ritchie, Leah Gowland, Samuel D Chorlton, Elisa Lloyd-Smith, Michael Payne, Meena Dawar, Rohit Vijh, Victor Leung, Mark Hull, Kate S Baker, Christopher F Lowe, Marc G Romney","doi":"10.1093/cid/ciae575","DOIUrl":"https://doi.org/10.1093/cid/ciae575","url":null,"abstract":"Background Shigella sonnei has caused sexually transmitted enteric infections in men who have sex with men (MSM) in Vancouver. We recently observed a high rate of multidrug-resistant (MDR) S. sonnei bacteremia among persons experiencing homelessness (PEH). We aim to describe the wider epidemiology, clinical outcomes, and genomics of S. sonnei infections over time. Methods A retrospective review of 163 patients with S. sonnei infections was undertaken from 2015 –2022. We collected demographic, clinical, and microbiological data over two time periods: historical (2015-2020) and recent (2021-2022). Severe shigellosis definition included hospitalization, bacteremia, or death. Whole genome sequencing was performed to identify genotype, infer relatedness, and predict antimicrobial resistance. Results S. sonnei infections rose from 8.3 (historical-period) to 56.5 cases/year (recent-period). Over time, the primary population characteristics associated with shigellosis shifted from MSM (45, 98%) to PEH (86,77%). The population intersection between MSM and PEH historically and recently was similar and occurred in three (6%) and ten (9%) of patients, respectively. Severe shigellosis was significantly higher in the recent compared to historical period (69 [61%] versus 7 [14%], p&amp;lt;0.001). A dominant clone of MDR S. sonnei, 3.6.1.1.2 (CipR.MSM5), emerged with resistance to all first and second-line agents yet with susceptibility to ceftriaxone. Conclusion We observed a substantial increase in severe shigellosis and shift from sexually transmitted S. sonnei infections in MSM to likely environmental transmission among PEH. More severe disease associated with the 3.6.1.1.2 clone of MDR S. sonnei in PEH could be a result of underlying vulnerabilities of the affected population.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"36 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142684338","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":"Rapid HCV Engagement and Treatment in Hospitalized Patients.","authors":"Himain Perera, Alexa Keeshan, Haris Imsirovic, Jeremy Patern, Roselyn Castaneda, J Graydon Simmons, Sarah Mansour, Curtis Cooper","doi":"10.1093/cid/ciae574","DOIUrl":"https://doi.org/10.1093/cid/ciae574","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680414","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":"Association between use of a voluntary isolation centre and reduced household SARS-CoV-2 transmission: A matched cohort study from Toronto, Canada","authors":"Kevin A Brown, Ana Cecilia Ulloa, Sarah A Buchan, Nick Daneman, Effie Gournis, Rachel Laxer, Kevin L Schwartz, Jocelyn Edwards","doi":"10.1093/cid/ciae526","DOIUrl":"https://doi.org/10.1093/cid/ciae526","url":null,"abstract":"Background Throughout the COVID-19 pandemic, many jurisdictions established isolation centres to help reduce household transmission; however, few real-world studies support their effectiveness. We compared the risk of transmission among households where first cases used the Toronto Voluntary Isolation Centre (TVIC) compared to households receiving routine self-isolation guidance, prior to widespread vaccine availability. Methods Households with a first case having symptom onset between September 2020, and March 2021, that used TVIC, were propensity-score matched with up to 10 self-isolation households. Follow-up began for TVIC households on the day after check-in, or for matched self-isolation households, the equivalent delay since first case symptom onset. The outcome, 28-day secondary attack rate, was analyzed using proportional hazards models. Results 303 TVIC households were matched with 2,943 self-isolation households. Median duration from first case symptom onset to TVIC check-in was 3 days (IDR [interdecile range]=1-6 days); median check-out date was 11 days after onset (IDR=10-13 days). The attack rate among TVIC households was 5.2% (53/1,015) compared to 8.4% (787/9,408) among self-isolation households (hazard ratio [HR]=0.50, 95% confidence interval [CI]=0.28-0.90). Greater reductions were observed when first cases isolated sooner after symptom onset (HR=0.37, 95%CI: 0.13-1.04), and in larger (HR=0.30, 95%CI: 0.14-0.67) and more crowded (HR=0.34, 95%CI: 0.15-0.77) households. Conclusions Use of a voluntary isolation centre was associated with a 50% reduction in household SARS-CoV-2 attack rate, prior to the availability of vaccines. Beyond SARS-CoV-2, voluntary isolation centres may help control resurgences of other communicable infections, or future pandemic pathogens, in particular for individuals experiencing difficulties isolating.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"43 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142678253","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":"Predicting risk of tuberculosis disease in people migrating to a low-TB incidence country: development and validation of a multivariable dynamic risk prediction model using health administrative data","authors":"Joseph H Puyat, Sarah K Brode, Hennady Shulha, Kamily Romanowski, Dick Menzies, Andrea Benedetti, Raquel Duchen, Anjie Huang, Jiming Fang, Liane Macdonald, Ted K Marras, Elizabeth Rea, Jeffrey C Kwong, Michael A Campitelli, Jonathon R Campbell, Kevin Schwartzman, Victoria J Cook, James C Johnston","doi":"10.1093/cid/ciae561","DOIUrl":"https://doi.org/10.1093/cid/ciae561","url":null,"abstract":"Background Tuberculosis (TB) incidence remains disproportionately high in people migrating to Canada and other low TB incidence countries, but systematic TB screening and prevention in migrants is often cost-prohibitive for TB programs. We aimed to develop and validate a TB risk prediction model to inform TB screening decisions in foreign-born permanent residents of Canada. Methods We developed and validated a proportional baselines landmark supermodel for TB risk prediction using health administrative data from British Columbia and Ontario, two distinct provincial healthcare systems in Canada. Demographic (age, sex, refugee status, year of entry, TB incidence in country of origin), TB exposure, and medical (HIV, kidney disease, diabetes, solid organ transplantation, cancer) covariates were used to derive and test models in British Columbia; one model was chosen for external validation in the Ontario cohort. The model’s ability to predict 2- and 5-year TB risk in the Ontario cohort was assessed using discrimination and calibration statistics. Results The study included 715,423 individuals (including 1,407 people with TB disease) in the British Columbia derivation cohort, and 958,131 individuals (including 1,361 people with TB disease) in the Ontario validation cohort. The 2- and 5-year concordance statistic in the validation cohort was 0.77 (95%CI: 0.75-0.78) and 0.77 (95%CI: 0.76-0.78), respectively. Calibration-in-the-large values were 0.14 (95% CI: 0.08-0.21) and -0.05 (95% CI: -0.12-0.02) in 2- and 5-year prediction windows. Conclusions This prediction model, available online at https://tb-migrate.com, may improve TB risk stratification in people migrating to low incidence countries and may help inform TB screening policy and guidelines.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"18 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142672863","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":"Closing the gap in race-based inequities for seasonal influenza hospitalizations: a modeling study.","authors":"Erin Stafford, Dobromir Dimitrov, Susan Brown Trinidad, Laura Matrajt","doi":"10.1093/cid/ciae564","DOIUrl":"10.1093/cid/ciae564","url":null,"abstract":"<p><strong>Background: </strong>BIPOC (Black, Indigenous, and other People of Color) communities bear a disproportional burden of seasonal influenza hospitalizations in the United States.</p><p><strong>Methods: </strong>We developed a race-stratified (5 racial-ethnic groups) agent-based model of seasonal influenza transmission and quantify the effects of 5 idealized interventions aimed at reducing inequities in symptomatic infections and hospitalizations. The interventions assumed (i) equalized vaccination rates, (ii) equalized comorbidities, (iii) work-risk distribution proportional to the distribution of the population, (iv) reduced work contacts for all, or (v) a combination of equalizing vaccination rates and comorbidities and reducing work contacts.</p><p><strong>Results: </strong>Our analysis suggests that symptomatic infections could be greatly reduced (by up to 17% in BIPOC adults aged 18-49) by strategies reducing work contacts or equalizing vaccination rates. All tested interventions reduced the inequity in influenza hospitalizations in all racial-ethnic groups, but interventions equalizing comorbidities were the most effective, with over 40% less hospitalizations in BIPOC groups. Inequities in hospitalizations in different racial-ethnic groups responded differently to interventions, pointing to the need of tailored interventions for different populations. Notably, these interventions resulted in better outcomes across all racial-ethnic groups, not only those prioritized by the interventions.</p><p><strong>Conclusions: </strong>In this simulation modeling study, equalizing vaccination rates and reducing number of work contacts (e.g., improving air filtration systems, tailored vaccination campaigns) reduced both inequity and the total number of symptomatic infections and hospitalizations in all age and racial-ethnic groups. Reducing inequity in influenza hospitalizations requires different interventions for different groups.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667008","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 for 87482 - cix169.","authors":"","doi":"10.1093/cid/ciae505","DOIUrl":"https://doi.org/10.1093/cid/ciae505","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638622","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}