Clinical Infectious Diseases最新文献

{"title":"Hematospermia in a Returning Traveler.","authors":"Isaie J Reuling, Michèle van Vugt, Caspar J Hodiamont","doi":"10.1093/cid/ciag237","DOIUrl":"https://doi.org/10.1093/cid/ciag237","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"83 3","pages":"e664-e666"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126944","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 the Urinary Myco\u0000 MEIA Aspergillus\u0000 Assay as an Aid to Diagnose Invasive Aspergillosis","authors":"Irina Baburina,Kieren A Marr,Yuri Vanbiervliet,Nitipong Permpalung,Chiung-Yu Huang,Robina Aerts,Patricia X Marques,Andrew F Shorr,M Hong Nguyen,Binghua Hao,John R Wingard,Johan Maertens,Sean X Zhang","doi":"10.1093/cid/ciag522","DOIUrl":"https://doi.org/10.1093/cid/ciag522","url":null,"abstract":"Abstract Background Invasive aspergillosis (IA) is difficult to diagnose, contributing to poor clinical outcomes and unnecessary antifungal therapies. The MycoMEIA Aspergillus assay (MycoMEIA), which detects Aspergillus glycans in urine, does not require invasive specimens. We report data that supported regulatory approval. Methods A case-control study and prospective cohort study were conducted to evaluate MycoMEIA as an aid to diagnose IA. Performance was assessed using consensus criteria of “proven” or “probable” IA and controls. Additional analyses evaluated positivity in “possible” IA, agreement with serum galactomannan (GM EIA), cross-reactivity, and timing of positivity relative to clinical diagnosis. Reproducibility was assessed across three laboratories. Results In brief, 469 urine samples from 50 IA cases and 240 controls demonstrated MycoMEIA 92% (95% CI 80.8–97.8) sensitivity and 87.6% (95% CI 82.8–91.8) specificity. All cases with positive serum GM EIA were positive by MycoMEIA. Urine testing identified 19/24 (79.2%) IA cases diagnosed by bronchoalveolar lavage (BAL) but negative by serum GM EIA and provided lead-time positivity of 5 days (range −21 to +14) before clinical diagnosis. Prospective testing confirmed a specificity of 89.7% (95% CI 75.8–97.1) and identified IA in 28/102 (27.5%) people with suspected “possible” IA. Some cross-reactivity was observed with other Ascomycetes fungi. Results were reproducible across sites. Conclusions MycoMEIA shows strong performance as an aid to diagnose IA. Its high sensitivity and negative predictive value may help reduce unnecessary empirical antifungals. Further studies are needed to define its role in screening and broader patient populations.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"33 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149089534","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":"Much Ado About Macrolides: Revisiting Empiric Atypical Coverage in Nonsevere Community-acquired Pneumonia.","authors":"Whitney Hartlage, Priya Nori","doi":"10.1093/cid/ciag223","DOIUrl":"10.1093/cid/ciag223","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"493-494"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615844","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":"The Phases of Clostridioides difficile Infection (CDI) in the United States: The History and Epidemiology of CDI From 1935 to Present.","authors":"Om B Kar, Daniel E Freedberg","doi":"10.1093/cid/ciag363","DOIUrl":"10.1093/cid/ciag363","url":null,"abstract":"<p><p>This review combines historical reports and surveillance data to contextualize Clostridioides difficile infection (CDI) in the United States as a phased epidemic, currently in the deceleration phase. C. difficile was first isolated in 1935. During a prolonged emergence phase, the organism attracted limited clinical attention. In 1978, C. difficile was established as the cause of antibiotic-associated pseudomembranous colitis and from 1978 to a peak in 2010, CDI was in an acceleration phase characterized by fluoroquinolone-resistant, toxin-overproducing strains, large hospital outbreaks, and incidence rates over 150 per 100 000 population. Beginning around 2010, CDI incidence decreased, with a shift from healthcare-associated to community-acquired CDI. Changes in diagnostics complicate incidence comparison between phases; only recently is it apparent that CDI has entered a deceleration phase characterized by infectious reservoirs and possible increases in immunity. It may behoove us to prepare for a different kind of CDI: community-based and insidious rather than hospital-predominant and explosive.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"401-407"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239061","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":"Changing Course.","authors":"Koray K Demir, Matthew P Cheng, Joanna Nelson","doi":"10.1093/cid/ciaf720","DOIUrl":"10.1093/cid/ciaf720","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"339-344"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146060502","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":"Prevalence and Outcomes of Bacterial Co-detections by Blood Culture Among Children and Adults Hospitalized With Laboratory-confirmed Influenza, Influenza Hospitalization Surveillance Network, 2022-2024.","authors":"Mark W Tenforde, Dawud Ujamaa, H Keipp Talbot, Alissa C O'Halloran, Shua J Chai, Darpun Sachdev, Isaac Armistead, Nisha B Alden, James Meek, Kimberly Yousey-Hindes, Lucy S Witt, Kyle P Openo, Patricia A Ryan, Maya L Monroe, Sue Kim, Val Tellez Nunez, Ruth Lynfield, Melissa McMahon, Caroline McCahon, Molly Bleecker, Grant Barney, Kaylee Mahoney, Brenda L Tesini, Maria A Gaitan, Denise Ingabire-Smith, Nancy E Moran, Melissa Sutton, M Andraya Hendrick, William Schaffner, Ryan Chatelain, Ashley Swain, Shikha Garg, Catherine H Bozio","doi":"10.1093/cid/ciag242","DOIUrl":"10.1093/cid/ciag242","url":null,"abstract":"<p><strong>Background: </strong>Influenza predisposes individuals to bacterial co-infections, which can result in disseminated infection and bacteremia. We describe the epidemiology and outcomes of blood culture co-detections among those hospitalized with influenza over 2 influenza seasons.</p><p><strong>Methods: </strong>We sampled individuals of all ages from FluSurv-NET, a US population-based surveillance network of persons hospitalized with laboratory-confirmed influenza, during the 2022-2023 and 2023-2024 seasons. Surveillance staff collected information on bacterial blood cultures within 3 days before or 3 days following admission. We described patient characteristics and in-hospital outcomes, stratified by culture positivity, number of positive cultures, and type of co-detection, using unweighted counts and weighted percentages to account for the complex survey design.</p><p><strong>Results: </strong>Overall, 14 316 patients were included, with a median (interquartile range) age of 57 (14-74) years, 53.6% female, 52.0% non-Hispanic White, and 25.6% with ≥4 categories of underlying medical conditions. Of these, 50.8% had ≥1 blood cultures obtained and 5.2% overall had ≥1 bacterial co-detections. Intensive care unit admission occurred for 9.6%, 19.2%, 31.2%, and 47.9% among patients with no blood cultures, negative cultures, 1 co-detection, and >1 co-detection documented, respectively; in-hospital mortality occurred in 1.5%, 3.3%, 9.4%, and 14.5%, respectively. Among patients with positive cultures, 22.1% had Staphylococcus aureus and 7.5% had Streptococcus pneumoniae co-detections; both were associated with severe illness (with 22.4% in-hospital mortality each).</p><p><strong>Discussion: </strong>Bacterial co-detections in persons hospitalized with influenza were associated with poor in-hospital outcomes. Efforts to prevent severe influenza and bacterial co-infections, including through vaccination, may reduce substantial morbidity and mortality from influenza.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e641-e649"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13249409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980815","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":"Anti-Methicillin-Resistant Staphylococcus aureus (MRSA) Cephalosporins Plus Daptomycin as Initial Therapy for MRSA Bacteremia: Does a \"Hit Hard and Fast\" Strategy Improve Outcomes?","authors":"Davide Fiore Bavaro, Alessandra Belati, Davide Sacchet, Alessandro Cilli, Lucia Diella, Daria Pocaterra, Maddalena Casana, Diletta Barbanotti, Paola Morelli, Luisa Frallonardo, Francesco Di Gennaro, Luigi Ronga, Riccardo Bollini, Cristina Scuderi, Erminia Casari, Valeria Cento, Linda Bussini, Carolina Patrucco, Renato Pascale, Annalisa Saracino, Giovanni Berna, Sergio Carbonara, Maddalena Giannella, Pierluigi Viale, Michele Bartoletti","doi":"10.1093/cid/ciag228","DOIUrl":"10.1093/cid/ciag228","url":null,"abstract":"<p><strong>Background: </strong>The study aim was to evaluate the effectiveness of anti-methicillin-resistant Staphylococcus aureus (MRSA) cephalosporins in combination with daptomycin (anti-MRSA Ceph + DAP) compared to other antimicrobial regimens (OARs) as initial treatment of MRSA bloodstream infection (BSI).</p><p><strong>Methods: </strong>This retrospective observational study enrolled patients with MRSA-BSI from 1 January 2020 to 31 December 2024 at 4 large Italian hospitals. The primary endpoint was 90-day all-cause mortality. Cox regression was used for primary endpoint analysis; results were confirmed with inverse probability of treatment weighting (IPTW). Treatment efficacy was also assessed using the desirability of outcome ranking (DOOR) approach, assigning 1 additional point beyond recovery for 1 of the following negative outcomes: (i) persistent MRSA infection, (ii) persistent bacteremia (≥5 days), (iii) drug resistance, (iv) any adverse event, and (v) 90-day relapse. A score of 7 was assigned for death at any time point.</p><p><strong>Results: </strong>Overall, 465 patients were enrolled: Median age was 76 (IQR, 61-83) years, 59% male, with a Charlson Comorbidity Index score of 7 (IQR, 4-8). Of them, 50 (11%) and 116 (25%) patients had endocarditis and metastatic infection, respectively. Importantly, 90-day mortality occurred in 181 (39%) patients, while 260 (56%) experienced at least 1 negative outcome included in DOOR analysis. Overall, patients in the anti-MRSA Ceph + DAP arm had a 59.9% (95% CI, 52.4%-67.4%) probability of having a better outcome than those in the OAR arm. Particularly, anti-MRSA Ceph + DAP was associated with reduced mortality (aHR, 0.54 [95% CI, .34-.85]), confirmed after adjustment with IPTW analysis.</p><p><strong>Conclusions: </strong>Anti-MRSA Ceph + DAP could represent a valid initial therapy for MRSA-BSI, especially in patients with high risk of worse outcomes.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"376-387"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204324","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":"Immunogenicity and Safety of the Adjuvanted Respiratory Syncytial Virus Prefusion F Protein-Based Vaccine When Co-administered With the Adjuvanted Recombinant Herpes Zoster Subunit Vaccine in Adults ≥ 50 Years of Age.","authors":"Jean-François Roussy, Patrick Dennis, Anil K Gupta, Garry Wallace, Alexander Abitbol, Naresh Aggarwal, Joseph G Surber, Theodore Lee, Brian A Smith, Catherine Gérard, Hiwot Amare Hailemariam, Marie-Pierre David, Archana M Jastorff, Marie Van der Wielen","doi":"10.1093/cid/ciag208","DOIUrl":"10.1093/cid/ciag208","url":null,"abstract":"<p><strong>Background: </strong>Co-administration of AS01E-adjuvanted respiratory syncytial virus vaccine (adjuvanted RSVPreF3) and AS01B-adjuvanted recombinant herpes zoster subunit vaccine (RZV), although not contraindicated, has not been previously studied in clinical trials.</p><p><strong>Methods: </strong>This phase III, open-label, randomized (1:1) trial evaluated the immunogenicity, safety, and reactogenicity of adjuvanted RSVPreF3 when co-administered with RZV in ≥50-year-olds. The 2 vaccines were either co-administered at visit 1 (day [D] 1; Co-Ad), or were given sequentially, 1 month apart (RZV dose 1 at D1, adjuvanted RSVPreF3 at D31; Control). All participants received RZV dose-2 at D61. Non-inferiority of humoral immune responses was demonstrated if 95% confidence interval (CI) upper limits for geometric mean RSV-A/B neutralizing titers (GMT) and varicella-zoster virus anti-glycoprotein E (anti-gE) antibody concentration (GMC) ratios (Control/Co-Ad) were ≤1.5. Safety and reactogenicity were secondary endpoints.</p><p><strong>Results: </strong>Overall, 530 participants (Co-Ad = 265; Control = 265) were vaccinated. Neutralizing GMT ratios for RSV-A (1.1 [95% CI = 1.0-1.4]) and RSV-B (1.0 [0.8-1.2]), and anti-gE antibody GMC ratio (1.2 [1.1-1.4]) met non-inferiority criteria. Within 7 days post-vaccination, 71.7% (Co-Ad: post-RZV dose 1 and adjuvanted RSVPreF3; grade [Gr] 3 = 3.9%), 58.5% (Control: post-RZV dose 1; Gr3 = 1.9%), and 47.8% (Control: post-adjuvanted RSVPreF3; Gr3 = 1.2%) of participants reported solicited administration-site adverse events (AEs). Post-visit 1, 73.6% (Gr3 = 9.3%) of Co-Ad and 60.4% (Gr3 = 6.2%) of control participants reported solicited systemic AEs. Within 30 days post-any vaccination, 23.4% (Gr3 = 0.8%) of Co-Ad and 30.2% (Gr3 = 1.1%) of control participants reported unsolicited AEs. No fatal or related serious AEs were reported.</p><p><strong>Conclusions: </strong>Immunogenicity, reactogenicity, and safety data support the co-administration of adjuvanted RSVPreF3 and RZV.</p><p><strong>Clinical trials registration: </strong>NCT05966090.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e578-e588"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147764631","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":"Outcomes Associated With Empiric Azithromycin Use Among Patients Hospitalized With Nonsevere Community-Acquired Pneumonia: Emulation of a Target Trial.","authors":"Ashwin B Gupta, Emily Walzl, David Ratz, Jennifer K Horowitz, Elizabeth McLaughlin, Tara Pearlman, Tawny Czilok, Tejal Gandhi, Lindsay A Petty, Anurag N Malani, David Paje, Preeti Misra, Scott Kaatz, Steven Bernstein, Mariam Younas, Scott A Flanders, Valerie M Vaughn","doi":"10.1093/cid/ciag222","DOIUrl":"10.1093/cid/ciag222","url":null,"abstract":"<p><strong>Background: </strong>There remains equipoise regarding the benefit of empiric azithromycin with beta-lactam therapy in patients hospitalized with nonsevere community-acquired pneumonia (CAP).</p><p><strong>Methods: </strong>We performed a target trial emulation using a propensity-weighted cohort from 68 hospitals in Michigan. Adult patients hospitalized with nonsevere CAP receiving beta-lactam antimicrobial therapy with or without azithromycin were included. CAP was defined based on the International Classification of Diseases, Tenth Revision, discharge diagnosis code of pneumonia and ≥2 signs/symptoms of pneumonia with radiographic findings. The primary outcome was time (days) to clinical stability. Secondary outcomes included composite 30-day mortality and rehospitalization, intensive care unit (ICU) transfer, and antibiotic duration.</p><p><strong>Results: </strong>Of 66 657 patients hospitalized for CAP between September 2015 and July 2024, 28.5% (19 010) met inclusion criteria, of whom 93.8% (17 822 of 19 010) received empiric azithromycin. After inverse probability of treatment weighting, there was no difference in time to clinical stability for those reciving azithromycin (vs not) (3 [interquartile range, IQR 3-4] vs 3 days [IQR 3-4]; adjusted hazard ratio [aHR], 1.00 [0.96-1.05]; P = .91). Empiric azithromycin was associated with lower composite 30-day mortality and rehospitalization (10.8% vs 15.1%; aHR, 0.73 [0.62-0.87]; P = .0004). There were no differences in ICU transfer (0.9% vs 1.4%; aHR, 0.85 [0.48-1.49]; P = .57) or total antibiotic duration (6 [IQR 5-8] vs 7 [IQR 5-9] days, P = .23).</p><p><strong>Conclusions: </strong>Adding azithromycin to beta-lactam therapy in patients hospitalized with nonsevere CAP was not associated with time to clinical stability but was associated with lower composite 30-day mortality and rehospitalization.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"484-492"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615872","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":"The Challenges of Nocardia Research and a Call for Collaboration.","authors":"Zachary A Yetmar, Elena Beam","doi":"10.1093/cid/ciag249","DOIUrl":"10.1093/cid/ciag249","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"e672-e673"},"PeriodicalIF":8.3,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866909","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}