Clinical Infectious Diseases最新文献

{"title":"Shorter Antibiotic Duration for Pseudomonas Bacteremia: A Call for Future Trials.","authors":"Arthur M Albuquerque, Carolina Santolia, Fernando G Zampieri, James M Brophy, Todd C Lee","doi":"10.1093/cid/ciag646","DOIUrl":"https://doi.org/10.1093/cid/ciag646","url":null,"abstract":"<p><p>In bacteremia, 7-day treatment has been demonstrated as non-inferior to 14-days for mortality in most patients with uncomplicated Gram-negative bacteremia. This post-hoc Bayesian analysis found that the shorter antibiotic course may behave differently in patients with Pseudomonas aeruginosa bacteremia versus other gram-negatives. Future trials should generate more data in these infections.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134643","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":"Urinary Antigen Testing for Invasive Aspergillosis: Promise and Remaining Questions.","authors":"Zoe Freeman Weiss, Jessica S Little","doi":"10.1093/cid/ciag527","DOIUrl":"https://doi.org/10.1093/cid/ciag527","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.3,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134672","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":"Legionella Pneumonia in the Modern Era: Clinical Features and Predictors of Mortality.","authors":"Aaron M Pulsipher, Georges Khattar, Hunter VanDolah, Michael Gotway, Kealy Ham, Shehabaldin Alqalyoobi, Rodrigo Cartin-Ceba, Robin Patel, Patricia J Simner, Ayan Sen, Holenarasipur R Vikram","doi":"10.1093/cid/ciag085","DOIUrl":"10.1093/cid/ciag085","url":null,"abstract":"<p><strong>Background: </strong>Legionella pneumonia is an important cause of severe pneumonia, yet contemporary data describing its clinical phenotype, diagnostic patterns, and outcomes in the modern era are limited.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter cohort study of adults with laboratory-confirmed Legionella pneumonia across an integrated health system between January 2019 and September 2025. The primary outcome was 30-day mortality. Severe disease was defined as having a requirement for high-flow nasal cannula, noninvasive ventilation, mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). Univariate and multivariable logistic regression were used to identify predictors of mortality and severe disease.</p><p><strong>Results: </strong>There were 344 patients with laboratory-confirmed Legionella pneumonia during the study period. The median age was 66.6 years, and 45.1% were immunocompromised. Most patients required hospital admission (94.2%), with 36.1% admitted to the intensive care unit; 22.7% required mechanical ventilation and 1.5% ECMO. Thirty- and 90-day mortality were 11.9% and 16.6%, respectively. In multivariable analysis, cirrhosis (OR 10.2, 95% CI 2.15-48.3, P = .003), immunocompromised status (odds ratio [OR] 2.24, 95% CI 1.05-4.77, P = .036), age (OR 1.03, 95% CI 1.00-1.06, P = .031), and lymphopenia at presentation (OR 2.09, 95% CI 1.02-4.24, P = .043) were independently associated with increased 30-day mortality. Among patients who were polymerase chain reaction (PCR) or culture positive, urinary antigen testing was positive in only 25.6%.</p><p><strong>Conclusions: </strong>Legionella pneumonia was associated with substantial short-term mortality. Cirrhosis, age, immunocompromised status, and lymphopenia at presentation emerged as independent predictors of 30-day mortality, underscoring the importance of host vulnerability in determining outcomes.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"473-480"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257571","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":"Three Months of Weekly Rifapentine and Isoniazid Versus Four Months of Daily Rifampicin for Tuberculosis Infection: A Randomized Controlled Trial.","authors":"Vicky W L Chang, Qingbin Li, David Barnes, Anthony L Byrne, Jin-Gun Cho, SooWei Foo, Hazel Goldberg, Timothy Gray, Zinta Harrington, Lydia M Rofail, Evan Ulbricht, Gregory J Fox","doi":"10.1093/cid/ciag306","DOIUrl":"10.1093/cid/ciag306","url":null,"abstract":"<p><strong>Background: </strong>Treatment of tuberculosis infection (TBI) is a key pillar of the World Health Organization End TB Strategy. Two short-course rifamycin-based regimens-3 months of weekly isoniazid plus rifapentine (3HP) and 4 months of daily rifampicin (4RIF)-are widely recommended; however, they have not previously been directly compared in a randomized controlled trial. We compared treatment completion between 3HP and 4RIF among individuals with TBI.</p><p><strong>Methods: </strong>We conducted a multicenter, open-label, parallel-group randomized controlled trial across 7 tuberculosis clinics in Sydney, Australia, between July 2019 and June 2024. Participants of any age with TBI were randomized 1:1, stratified by site, to receive either weekly 3HP or daily 4RIF. All doses were self-administered. Participants in the 3HP group received weekly Short Message Service (SMS) adherence reminders; both groups received standard clinic follow-up. The primary outcome was treatment completion, defined as ingestion of ≥90% of prescribed doses. Analyses were conducted on an intention-to-treat basis.</p><p><strong>Results: </strong>A total of 210 participants were enrolled (106 assigned to 3HP and 104 to 4RIF). Treatment completion was significantly higher in the 3HP group (84.9%) than in the 4RIF group (65.4%; relative risk, 1.30 [95% confidence interval, 1.22-1.38]; P < .001). Adverse events of any grade occurred in 24.5% of participants receiving 3HP and 20.2% receiving 4RIF. No treatment-related deaths were reported.</p><p><strong>Conclusions: </strong>Weekly 3HP supported by SMS reminders achieved significantly higher treatment completion than daily 4RIF, with similar safety. These findings support broader implementation of 3HP to optimize adherence and outcomes in TBI treatment programs.</p><p><strong>Clinical trials registration: </strong>Australian New Zealand Clinical Trials Registry (ACTRN12618001672246).</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e539-e547"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147940451","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":"Real-World Experience of Hepatitis C Treatment With Glecaprevir-Pibrentasvir During Pregnancy.","authors":"L Madeline McCrary, Megan R Curtis, Jeannie C Kelly, Jessica Elrod-Gallegos, Patrick Kojima, Patricia Werner, Jennifer L Mullersman, Tracey Habrock-Bach, Michael J Durkin, Laura R Marks","doi":"10.1093/cid/ciag422","DOIUrl":"10.1093/cid/ciag422","url":null,"abstract":"<p><p>Guidelines endorse antenatal hepatitis C virus treatment following shared decision making. No clinical trial or real-world data exist for glecaprevir-pibrentasvir (GLE/PIB). We report our experience with prenatal GLE/PIB in 14 patients. Ten patients completed treatment; all achieved virologic response by or at delivery, with no maternal or neonatal safety concerns.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e533-e536"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705737","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":"Treatment Timing May Challenge the Apparent Benefit of Intrathecal Therapy in Tuberculous Meningitis","authors":"Ercan Yılmaz,Nezihe Koker Özer,Erdem Topal","doi":"10.1093/cid/ciag635","DOIUrl":"https://doi.org/10.1093/cid/ciag635","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"36 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089533","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":"Current State of Knowledge on Medical Cannabis Use and Risk for Infections: A Practical Guide for Clinicians.","authors":"Kailey Hughes Kramer, Will Garner, Cornelius J Clancy, M Hong Nguyen","doi":"10.1093/cid/ciag343","DOIUrl":"10.1093/cid/ciag343","url":null,"abstract":"<p><p>Patients and clinicians broadly support medical cannabis, but acknowledge limited understanding of products, efficacy, and safety. Here, we review cannabis products, regulatory issues, microbial contamination of cannabis, and infections linked to cannabis. In the United States, cannabis is regulated by a patchwork of federal and state laws. Three pharmaceutical-grade cannabinoids are US Food and Drug Association (FDA)-approved, and non-FDA-approved medical cannabis products are legal in 40 states. There are no uniform standards for testing products for microbes or validated safety thresholds from state to state. Reports of cannabis-associated fungal and bacterial infections have been published. However, only a single case report used genome sequencing to conclusively link a disease-causing fungus (Cryptococcus neoformans) to cannabis consumed by the patient. Therefore, infections can clearly complicate cannabis use, but extent of risk and specific risk factors are unknown. There is urgent need for harmonized cannabis regulation, standardized product testing and safety criteria, and clinical and translational research on infectious risks.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"419-428"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053104","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":"Phase 2a Randomized Placebo-Controlled Human Challenge Trial of the Respiratory Syncytial Virus L-Protein Inhibitor S-337395 for Respiratory Syncytial Virus Infection.","authors":"Stuart Byrne, Takamichi Baba, Nao Kawaguchi, Atsuko Yamamoto, Yoshiyuki Nakano, Caroline Dorrepaal, Brandon Londt, Alex Mann, Nikolay Veselinski, Takeki Uehara","doi":"10.1093/cid/ciag367","DOIUrl":"10.1093/cid/ciag367","url":null,"abstract":"<p><strong>Background: </strong>S-337395 is a novel inhibitor of the respiratory syncytial virus (RSV) L-protein, and a potential oral antiviral against RSV. This phase 2a, randomized, double-blind, placebo-controlled, single-center, proof-of-concept trial conducted in the United Kingdom (April-October 2024) evaluated the efficacy, safety, and dose-response relationship of S-337395 against RSV infection in a human challenge model.</p><p><strong>Methods: </strong>Healthy adults aged 18-55 years meeting predefined eligibility criteria were inoculated with RSV-A Memphis 37b on Day 0. Nasal washes were collected for quantitative reverse-transcriptase polymerase chain reaction (qRT-PCR) assessment twice daily on Days 2-12 and once on Day 13. Participants were randomized 5:13:13:13:13 to receive S-337395 (1, 10, 30, or 300 mg) or placebo, once daily for 5 days upon evidence of infection. Efficacy analyses were conducted in participants with confirmed RSV infection in intent-to-treat infected (ITT-I) set. Safety was assessed in all randomized participants. Dose-response was evaluated across a wide dose range (1-300 mg).</p><p><strong>Results: </strong>Of 114 randomized participants, 60 comprised the ITT-I set. Covariate-adjusted mean viral load area under the curve (VL-AUC) was significantly lower in the 30- and 300-mg groups by qRT-PCR (64.87% and 88.94% reductions, respectively, both P < .05) and by viral culture assay (72.32% and 86.17% reductions, respectively, both P < .05). Total symptom score AUC was 78.15% lower in the 300-mg group (P < .05). S-337395 was well-tolerated without any safety concerns.</p><p><strong>Conclusions: </strong>S-337395 significantly reduced viral load, viral titer, and symptoms, and was well-tolerated in this human challenge study. Clinical Trial Registration: ISRCTN24865912.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e652-e660"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249144","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":"Multidimensional Poverty and Implementation Reach of Household Contact Tracing for Tuberculosis in South Africa: Analysis of a Randomized Trial.","authors":"Giridhar Mohan, Colleen F Hanrahan, Pablo Martinez-Amezcua, Christopher J Hoffmann, Patrick Biché, Neil A Martinson, David W Dowdy","doi":"10.1093/cid/ciag321","DOIUrl":"10.1093/cid/ciag321","url":null,"abstract":"<p><strong>Background: </strong>Household contact tracing (HHCT) is a widely recommended intervention for tuberculosis (TB) but is poorly implemented. Multidimensional poverty, encompassing deprivations in health, education, and living standards, may hinder implementation success.</p><p><strong>Methods: </strong>Using a cluster-randomized trial in South Africa, we examined the relationship between household multidimensional poverty as a composite deprivation score and HHCT reach as (1) initiation (at least one household contact screened); (2) continuous proportion of eligible household contacts screened; and (3) completion (all eligible household contacts screened once initiated). We performed multilevel mixed-effects modeling with modified Poisson and ordered beta regression.</p><p><strong>Results: </strong>Despite near-universal comfort with HHCT (97%) among 3392 households, only 43% initiated HHCT and 19% completed screening. Greater multidimensional poverty was significantly associated with lower HHCT initiation in urban households (adjusted prevalence ratio [aPR]: 0.903, 95% confidence interval [CI]: 0.831, 0.984, per 10% higher deprivation; P = .021), but not in rural households (aPR: 1.06, 95% CI: 0.99, 1.13; P = .083). Across all households, we observed a modest but statistically significant association between greater poverty and lower predicted proportion of household contacts screened (adjusted average marginal effect [aAME]: -1.22% [-2.20%, -0.236%], per 10% higher deprivation; P = .015). Among households that initiated HHCT, multidimensional poverty was not significantly associated with screening completion (aPR: 0.945, 95% CI: 0.865, 1.03; P = .207).</p><p><strong>Conclusions: </strong>Stated comfort with HHCT may not directly translate into implementation success. Multidimensional poverty was a significant structural barrier for HHCT initiation in an urban, South African township. Once initiated, getting all household contacts screened may require targeting additional operational and health system barriers.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e559-e568"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263597","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":"Test First, Treat Later: Could Shifting the Pneumonia Treatment Paradigm Help Us Better Realize the Potential Benefits of Rapid Molecular Panels?","authors":"Michael Klompas, Chanu Rhee","doi":"10.1093/cid/ciag330","DOIUrl":"10.1093/cid/ciag330","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e472-e474"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223606","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}