Clinical Infectious Diseases最新文献

{"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}

{"title":"Retreatment of Hepatitis C Virus Among People Who Inject Drugs.","authors":"Aurielle M Thomas,Alain H Litwin,Judith I Tsui,Sophie Sprecht-Walsh,Kendra L Blalock,Karen T Tashima,Paula J Lum,Judith Feinberg,Kimberly Page,Shruti H Mehta,Arthur Y Kim,Brianna L Norton,Moonseong Heo,Ellen S Stein,Cristina Murray-Krezan,Julia Arnsten,Megan Groome,Emily Waters,Lynn E Taylor","doi":"10.1093/cid/ciaf082","DOIUrl":"https://doi.org/10.1093/cid/ciaf082","url":null,"abstract":"BACKGROUNDHepatitis C virus (HCV) is a leading cause of infectious disease death in the United States. Although highly effective direct-acting antiviral (DAA) regimens are well established, retreatment among people who inject drugs (PWID) has not been sufficiently studied. This study assessed DAA retreatment outcomes and associated factors.METHODSWe performed analyses of longitudinal data from the HERO Study, a US-based multi-site pragmatic randomized trial conducted in 8 states to evaluate effectiveness of 2 HCV care models among DAA treatment-naïve PWID in opioid treatment programs and community clinics. After initial HERO Study sofosbuvir/velpatasvir (SOF/VEL) treatment, participants eligible for retreatment were identified, from 15 September 2016 to 13 September 2021. This analysis characterizes participants who either did not achieve sustained virologic response (SVR) or were reinfected with HCV post-SVR. We compared categorical variables using Fisher exact test and continuous variables using the Welch 2 sample t test for means and an asymptotic 2-sample Mood median test.RESULTSOne hundred four participants were identified as eligible for retreatment. Less than half, 43 (41.3%), initiated retreatment. Among the 25 who initiated retreatment and for whom SVR results were available, 24 achieved SVR (96%). Participants who did not achieve SVR initiated retreatment more promptly than participants reinfected post-SVR (respectively, 471 vs 784 days on average, P < .001).CONCLUSIONSAfter reinfection or not achieving SVR with the first DAA regimen, retreated PWID achieved higher SVR rates than with initial DAA treatment. To attain HCV elimination and benefit individual and public health, assisting PWID with accessing prompt retreatment is crucial.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"1 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836573","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":"Application of Pragmatic Criteria to Assessments of Frailty and Physical Function among People with HIV","authors":"Grace L Kulik, Duncan C Mollner, Lauren Barbera, Jacob Walker, Sarah Gorvetzian, Dan Matlock, Kristine M Erlandson","doi":"10.1093/cid/ciaf193","DOIUrl":"https://doi.org/10.1093/cid/ciaf193","url":null,"abstract":"Routine screening for any condition in a clinical setting should be pragmatic, meaning that the screening is feasible, relevant, and actionable to patients and providers. Glasgow et al. proposed a set of criteria to evaluate whether or not a screening tool can be considered pragmatic. Although recent guidelines recommend screening for frailty among older adults with HIV, routine frailty screening may be challenging given that the tools are often time-consuming, and the diagnosis is not always directly actionable given that it can encompass multiple systemic deficits. Assessments of physical function, a component of frailty, may be more pragmatic for routine screening because they are generally less burdensome to administer, results are directly actionable, and objective results are responsive to change over time. The purpose of this viewpoint article is to assess frailty and physical function assessments through the lens of Glasgow’s pragmatic criteria.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"108 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832125","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":"Plasma Quantitative Microbial Cell-Free DNA for Staphylococcal Cardiac Implantable Electronic Device Infection - Too Soon?","authors":"Supavit Chesdachai,Daniel C DeSimone,Nischal Ranganath,Omar M Abu Saleh","doi":"10.1093/cid/ciaf195","DOIUrl":"https://doi.org/10.1093/cid/ciaf195","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"113 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836571","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}