Clinical Infectious Diseases最新文献

{"title":"The Impact of Influenza on US Working-Age Adults: Exploring the Benefits of the Recombinant Influenza Vaccine","authors":"Laurence Torcel-Pagnon, Laurent Coudeville, Rebecca C Harris, Sandra S Chaves","doi":"10.1093/cid/ciaf200","DOIUrl":"https://doi.org/10.1093/cid/ciaf200","url":null,"abstract":"Background Despite universal influenza vaccine recommendation in the US, vaccination coverage rates (VCR) in working-age adults (18–64 years) remain suboptimal. Studies have suggested that recombinant influenza vaccines (RIV) offer better protection than standard-dose inactivated influenza vaccines (SD-IIV) in those ages. We explored the potential added benefit of recommending RIV for the US working-age population. Methods We gathered data on influenza burden, vaccine effectiveness, and VCR from the US-CDC (2012–2023, excluding 2020–2021). We conducted a retrospective analysis of the past 10 years to illustrate the influenza burden among adults 18–64 years. We performed an age-stratified analysis using prevalence of chronic conditions to assess their impact on influenza hospitalizations and deaths, and estimated reductions in hospitalizations if RIV had been used instead of SD-IIV during the study period, using an age and risk-group decision-tree model. Results Over the last decade, influenza caused a median of 151,021 hospitalizations (95% CI 139,750–164,130) per season among US working-age adults. Adults aged 50–64 years had 3- to 5-fold higher rates of hospitalization and death than those aged 18–49 years. The 14% of 18–49-year-olds with chronic conditions accounted for more than 28% of hospitalizations and deaths in this group. If RIV had been used instead of SD-IIV, an additional 10,000 hospitalizations could have been prevented each season in these populations. Conclusions Influenza significantly impacts US working-age adults, particularly 50-64-year-olds. Increases in longevity and chronic conditions prevalence are expected, making tailored public health vaccine recommendations important to support healthy aging.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"54 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841377","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":"Cost-Effectiveness of Hospital-at-Home and Fecal Microbiota Transplantation in Treating Older Patients With Clostridioides difficile.","authors":"Renée Hangaard Olesen,Emma Bendix Larsen,Tone Rubak,Simon Mark Dahl Baunwall,Sara Ellegaard Paaske,Merete Gregersen,Catherine Hauerslev Foss,Christian Erikstrup,Camilla Birch Krogh,Lars Holger Ehlers,Christian Lodberg Hvas","doi":"10.1093/cid/ciaf104","DOIUrl":"https://doi.org/10.1093/cid/ciaf104","url":null,"abstract":"BACKGROUNDClostridioides difficile infection (CDI) primarily affects older patients with comorbid conditions and has a high mortality rate. Fecal microbiota transplantation (FMT) is effective and cost-effective for CDI. In a recent study, we demonstrated the clinical benefits of combining hospital-at-home care with FMT for older patients with CDI, but its cost-effectiveness remains unknown. The current study aimed to evaluate the cost-effectiveness of the intervention in patients aged ≥70 years with CDI, compared with standard treatment.METHODSThe cost-utility analysis was conducted using data from a randomized clinical trial enrolling 217 patients, assessing the cost-effectiveness of the intervention over 90 days. Resource use was assessed from a healthcare sector perspective. Missing data were handled with proxy replacement and multiple imputation. Sensitivity analyses included probabilistic analysis, complete case analysis, adjustment of key unit prices, and a hospital perspective. A willingness-to-pay threshold was set to €22 994 or $24 863 per quality-adjusted life year (QALY).RESULTSIn the base case analysis, the intervention was dominant, with mean cost savings of €2556 ($2764) and a mean gain of 0.004 QALY. Although resource use was higher, the intervention resulted in an average reduction of 6 hospital admission days per patient and increased odds of clinical resolution. The results remained robust across different perspectives, the exclusion of patients with missing data, and variations in hospital admission costs.CONCLUSIONSIn patients aged ≥70 years with CDI, an intervention combining hospital-at-home care and FMT is cost-effective compared with standard treatment. The cost-effectiveness is mainly driven by fewer hospital admission days.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"15 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846397","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":"Hepatotoxicity Among People Living with HIV and Receiving Isoniazid Preventive Therapy in Pregnancy and Postpartum: The Role of Antiretroviral Regimen and Pharmacogenetics","authors":"Grace Montepiedra, Lisa Aaron, Gerhard Theron, Katie McCarthy, Sarah Bradford, Tsungai Chipato, Tichaona Vhembo, Lynda Stranix-Chibanda, Deo Wabwire, Gaerolwe Masheto, Patrick Jean-Philippe, Timothy R Sterling, Adriana Weinberg, Amita Gupta","doi":"10.1093/cid/ciaf198","DOIUrl":"https://doi.org/10.1093/cid/ciaf198","url":null,"abstract":"Background TB APPRISE (IMPAACT P1078), a Phase IV randomized, multi-country non-inferiority trial assessing the safety of 28 weeks of isoniazid preventive therapy (IPT) initiated during pregnancy (immediate IPT) versus deferring to week 12 postpartum (deferred IPT) in people living with HIV on antiretroviral therapy, showed higher than expected hepatotoxicity. We investigated the potential roles of antiretrovirals, isoniazid, pharmacogenetics and other factors. Methods Hepatotoxicity was defined as Grade≥3 liver enzyme elevations; or Grade≥2 enzyme elevations with elevated bilirubin or symptomatic hepatitis. We performed Poisson regression of all-cause hepatotoxicity on study arm, antiretroviral regimen, pharmacogenetics of isoniazid and efavirenz metabolism (NAT2, CYP2B6) and other participant characteristics. Adjusted models included study arm and covariates with p<0.25 in unadjusted models. Antiretroviral regimen and pharmacogenetics interactions with study arm were evaluated. Results All 945 pregnant participants with follow-up liver function measurements were on antiretrovirals (85% with efavirenz, 13% with nevirapine); 63 (6%) experienced hepatotoxicity events; 29 (6%) in immediate and 34 (7%) in deferred arm; only 5 events (8%) occurred in pregnancy; 49 (78%) occurred between delivery and 24 weeks postpartum. Higher risk of hepatotoxicity was observed with nevirapine use in the immediate arm, but there was no difference by study arm in participants on efavirenz. Slow efavirenz metabolizers had increased risk of hepatotoxicity. Conclusions It is critical to monitor for hepatotoxicity in early postpartum, where there is higher risk compared to antepartum. ARV regimen and pharmacogenetics should also be considered in making decisions on when to initiate IPT in pregnant and postpartum populations.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"74 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143837115","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 2 Finger-Stick Blood Tests to Triage Adults With Symptoms of Pulmonary Tuberculosis: A Prospective Multisite Diagnostic Accuracy Study.","authors":"Jayne S Sutherland,Gian D van der Spuy,Jane A Shaw,Tracy Richardson,Elisa M Tjon Kon Fat,Awa Gindeh,Olumuyiwa Owolabi,Nguyen Thuy Thuong Thuong,Le Hong Van,Nguyen Hoang Van,Dang Thi Thanh Thao,Harriet Mayanja-Kizza,Mary Nsereko,AnnRitah Namuganga,Sophie Nalukwago,John Belisle,Emmanuel Moreau,Adam Penn-Nicholson,Guy Thwaites,Jill Winter,Hazel M Dockrell,Thomas J Scriba,Kim Stanley,Bronwyn Smith,Novel N Chegou,Stephanus T Malherbe,Annemieke Geluk,Paul Corstjens,Gerhard Walzl,","doi":"10.1093/cid/ciaf105","DOIUrl":"https://doi.org/10.1093/cid/ciaf105","url":null,"abstract":"BACKGROUNDNon-sputum-based, point-of-care triage tests for pulmonary tuberculosis could enhance tuberculosis diagnostic programs. We assessed the diagnostic accuracy of 2 finger-stick blood tests: the Cepheid 3 gene host-response cartridge (Xpert-HR), which measures 3 host messenger RNA transcripts, and the 3-host protein multibiomarker test (MBT).METHODSWe performed a prospective diagnostic accuracy study of consecutive participants with symptoms compatible with pulmonary tuberculosis in The Gambia, South Africa, Uganda, and Vietnam. A composite reference standard for active pulmonary tuberculosis incorporated chest radiography, symptom resolution, and sputum microbiological test results. A training-test set approach was used to evaluate test cutoff specificities at 90% sensitivity.RESULTSBetween 1 November 2020 and 1 May 2023, we screened 1262 participants aged 12-70 years with cough lasting >2 weeks and another symptom suggestive of tuberculosis. Of those who were classifiable by reference tests, 1154 participants had evaluable Xpert-HR results and 961 had evaluable MBT results. Xpert-HR had an area under the receiver operating characteristic (AUROC) curve of 0.92 at a cutoff of -1.275 or below, with a sensitivity of 92.8%, specificity of 62.5%, positive predictive value of 47.9%, and negative predictive value of 95.9%. The MBT had an AUROC of 0.91 at a cutoff of ≥0.42, with a sensitivity of 91.4%, specificity of 73.2%, positive predictive value of 52.0%, and negative predictive value of 96.4%.CONCLUSIONSOur results show that both Xpert-HR and the MBT are promising non-sputum-based point-of-care tests. The MBT met the World Health Organization target product profile for a triage test, which suggests it should be further developed.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"9 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846405","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":"Learning From the Gaps: Rethinking Hepatitis C Virus Retreatment for People Who Inject Drugs.","authors":"Joanne M Carson,Gregory J Dore","doi":"10.1093/cid/ciaf083","DOIUrl":"https://doi.org/10.1093/cid/ciaf083","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"74 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836502","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":"Replacing Mycophenolate Mofetil by Everolimus in Kidney Transplant Recipients to Increase Vaccine Immunogenicity: Results of a Randomized Controlled Trial.","authors":"A Lianne Messchendorp,Luca M Zaeck,Pim Bouwmans,Dennis A J van den Broek,Sophie C Frölke,Daryl Geers,Céline Imhof,S Reshwan K Malahe,Katharina S Schmitz,Julian Reinders,Frederique E Visscher,Carla C Baan,Frederike J Bemelman,Ron T Gansevoort,Corine H GeurtsvanKessel,Marc H Hemmelder,Luuk B Hilbrands,Hanna Källmark,Meliha C Kapetanovic,Marcia M L Kho,Aiko P J de Vries,Arjan D van Zuilen,Marlies E Reinders,Debbie van Baarle,Rory D de Vries,Jan-Stephan F Sanders,","doi":"10.1093/cid/ciaf107","DOIUrl":"https://doi.org/10.1093/cid/ciaf107","url":null,"abstract":"BACKGROUNDVaccine immunogenicity is reduced in kidney transplant recipients (KTRs), especially in those using mycophenolate mofetil (MMF). Whether replacement of MMF by everolimus improves vaccine immunogenicity is unknown.METHODSKTRs were randomized 1:1 to continue MMF or switch to everolimus. Participants received one coronavirus disease 2019 (COVID-19) booster vaccination and two herpes zoster (HZ) vaccinations at 6, 10 and 14 weeks postrandomization. Primary outcome was the neutralizing antibody response 28 days after COVID-19 vaccination. Secondary outcomes included antibody and T-cell responses 28 days after COVID-19 and HZ vaccination, and safety.RESULTSIn 110 KTRs, COVID-19 vaccination resulted in comparable Omicron XBB.1.5 neutralizing antibody titers in the everolimus versus MMF group (308 [74.4-1314] vs 327 [115-897]; P = .83), whereas severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Spike-specific T-cell responses were slightly lower with everolimus (118 [32.1-243] vs 228 [113-381] spot-forming cells [SFCs]/106 peripheral blood mononuclear cells [PBMCs]; P = .02). HZ vaccination led to higher varicella zoster virus (VZV) glycoprotein E (gE)-specific immunoglobulin G titers with everolimus (2192 [888-4523] vs 1101 [440-2078] 50% endpoint titer; P = .004), while VZV gE-specific T-cell responses were similar (85.0 [27.5-155] vs 115 [50.0-258] SFCs/106 PBMCs; P = .24). Besides known side effects, everolimus led to more bacterial infections (27.3% vs 11.1%; P = .03).CONCLUSIONSSix weeks' replacement of MMF by everolimus in KTRs does not improve COVID-19 booster vaccine immunogenicity, whereas 10 weeks' replacement enhances humoral HZ vaccine immunogenicity. While replacing MMF by everolimus may improve vaccine responses, its timing and potential risks require careful consideration.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"27 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836570","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":"A Case-Control Study of Hepatitis C Virus Re-infection in Incarcerated Patients in California Receiving Medication for Opioid Use Disorder","authors":"Joey Shemuel, Amy Krawiec, Donna Kalauokalani, Kimberley D Lucas","doi":"10.1093/cid/ciaf192","DOIUrl":"https://doi.org/10.1093/cid/ciaf192","url":null,"abstract":"Background Incarcerated people are disproportionately burdened with hepatitis C virus (HCV) infection and experience elevated risk of re-infection following treatment. Medication for opioid use disorder (MOUD) has been shown to reduce, but not eliminate, re-infection. Research is lacking on patient-level factors associated with HCV re-infection in incarcerated populations in the United States receiving MOUD. Methods We conducted a case-control study from secondary data analysis of health records among people incarcerated in California state prisons who initiated HCV treatment, achieved sustained virologic response (SVR), and began MOUD before SVR. Case-patients were re-infected within one year; controls remained HCV-negative at one year. Results Eligible subjects (50 cases; 108 controls) were predominantly male (96.2%), Hispanic/Latinx (62.7%) or White (29.1%), and median age 36 (range 23–60) years. HCV re-infection was independently associated with injection drug use (aOR=3.4; 95% CI: 1.3–8.5), unsterile tattooing (aOR=3.4; 95% CI: 1.2–9.9), methamphetamine use (aOR=2.5; 95% CI: 1.0–6.1), younger age (aOR=0.7; 95% CI: 0.5–0.9; units=5 years), and lower adherence to adequately dosed (≥16mg/day) buprenorphine (aOR=0.7; 95% CI: 0.6–1.0; units=0.25, aOR=0.3; 95% CI: 0.1–0.9; units=1.0). Conclusions Even with complete MOUD adherence, conferring a 70% protective effect for HCV re-infection, patients reported ongoing risk behaviors. Injection drug use, methamphetamine use, and unsterile tattooing also increase the risk other blood-borne or skin and soft tissue infections and overdose. Improved health outcomes could be achieved with integrating enhanced monitoring of MOUD with expanded harm reduction including syringe services and contingency management for treatment stimulant use disorders.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"218 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832121","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":"Diagnosing Staphylococcal Cardiac Electronic Implantable Device Endocarditis: The Potential of Quantitative Plasma Cell-Free Microbial DNA.","authors":"Adolf W Karchmer,Sarah Y Park,Peter J Zimetbaum","doi":"10.1093/cid/ciaf196","DOIUrl":"https://doi.org/10.1093/cid/ciaf196","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"74 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836572","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":"Executive Orders and Caring for Our Transgender Patients.","authors":"Tara Vijayan","doi":"10.1093/cid/ciaf128","DOIUrl":"https://doi.org/10.1093/cid/ciaf128","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"5 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836574","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":"Frequency of Antibiotic Overtreatment and Associated Harms in Patients Presenting With Suspected Sepsis to the Emergency Department: A Retrospective Cohort Study.","authors":"Claire N Shappell,Tingting Yu,Michael Klompas,Anna A Agan,Laura DelloStritto,Brett A Faine,Michael R Filbin,Nicholas M Mohr,Steven T Park,Kamryn Plechot,Emily Porter,David Roach,Sarah E Train,Anne Zepeski,Chanu Rhee","doi":"10.1093/cid/ciaf118","DOIUrl":"https://doi.org/10.1093/cid/ciaf118","url":null,"abstract":"BACKGROUNDTreatment guidelines recommend rapidly treating all patients with suspected sepsis with broad-spectrum antibiotics. This may contribute to antibiotic overuse. We quantified the incidence of antibiotic overtreatment and possible antibiotic-associated harms among patients with suspected sepsis.METHODSWe reviewed the medical records of 600 adults treated for suspected sepsis with anti-methicillin-resistant Staphylococcus aureus and/or antipseudomonal β-lactam antibiotics in the emergency departments of 7 hospitals, 2019-2022, to assess their post hoc likelihood of infection, whether narrower antibiotics would have sufficed in retrospect, and possible antibiotic-associated complications. We used generalized estimating equations to assess associations between likelihood of infection and hospital mortality.RESULTSOf 600 patients, 411 (68.5%) had definite (48.0%) or probable (20.5%) bacterial infection and 189 (31.5%) had possible but less likely (18.3%) or definitely no (13.2%) bacterial infection. Among patients with definite/probable bacterial infection, 325 of 411 (79.1%) received antibiotics that were overly broad in retrospect. Potential antibiotic-associated complications developed in 104 of 600 (17.3%) patients within 90 days, most commonly new infection or colonization with organisms resistant to first-line agents (48/600 [8.0%]). Mortality was higher for patients with less likely/definitely no bacterial infection versus definite/probable bacterial infections (9.0% vs 4.9%; adjusted odds ratio [aOR], 2.25 [95% confidence interval{CI}, 1.70-2.98]), but antibiotic-associated complication rates were similar (14.8% vs 18.5%; aOR, 0.79 [95% CI, .60-1.05]).CONCLUSIONSAmong 600 patients treated with broad-spectrum antibiotics for possible sepsis, 1 in 3 most likely did not have a bacterial infection, 4 in 5 of those with bacterial infections were treated with regimens that were broader than necessary in retrospect, and 1 in 6 developed antibiotic-associated complications.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"26 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836569","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}