Infectious Diseases and Therapy最新文献

{"title":"Use of Hyperbaric Oxygen in Patients with Necrotizing Soft Tissue Infections: A Scandinavian Multicenter, Prospective, Observational Cohort.","authors":"Ole Hyldegaard, Michael Nekludov, Per Arnell, Torbjørn Nedrebø, Ylva Karlsson, Martin Bruun Madsen, Steinar Skrede, Vitor Martins Dos Santos, Mattias Svensson, Anders Perner, Julie Vinkel, Anders Kjellberg, Anders Rosén, Johan Douglas, Trond Bruun, Christopher Hardt, Anna Norrby-Teglund, Morten Hedetoft","doi":"10.1007/s40121-025-01184-5","DOIUrl":"https://doi.org/10.1007/s40121-025-01184-5","url":null,"abstract":"<p><strong>Introduction: </strong>Hyperbaric oxygen (HBO₂) treatment is regularly used as adjuvant treatment in patients with necrotizing soft tissue infections (NSTI). Several observational studies have suggested an association between hyperbaric oxygen (HBO₂) treatment and improved survival in patients with necrotizing soft tissue infections (NSTIs); however, the evidence remains inconclusive. Most patients with NSTI are severely ill, having sepsis or septic shock, and requiring mechanical ventilation and inotropic support in an intensive care unit (ICU). Although recent data suggest that the beneficial effect of HBO₂ may be largest in the most severely ill, not all patients may receive it due to hemodynamic instability, pressure chamber capabilities, and availability, thereby potentially introducing selection bias.</p><p><strong>Methods: </strong>From January 2013 until June 2017, we conducted a multicenter, prospective, consecutive, observational study (The INFECT study, ClinicalTrials.gov number; NCT01790698) enrolling NSTI patients at five clinical centers delivering HBO₂ to NSTI patients in an ICU setting in Denmark, Norway, and Sweden.</p><p><strong>Results: </strong>A total of 409 consecutive patients with necrotizing soft tissue infections were prospectively enrolled in the study, of whom 402 (98.3%) were admitted to the ICU. A total of 329 NSTI patients received HBO₂, and 80 patients did not. Median time from arrival at a specialized hospital to first HBO₂ was 4.3 h (IQR 2.5-7.7). Patients receiving HBO₂ had less often chronic liver disease, penetrating trauma within 4 weeks before NSTI, lower extremity NSTI involvement, and acute kidney injury and lower severity scores (Simplified Acute Physiology Score; SAPS-2 and Sequential Organ Failure Assessment score; SOFA score) than patients not treated with HBO₂. Patients receiving HBO₂ were more frequently on mechanical ventilation. All-cause 30- and 90-day mortality for the HBO₂-treated patients was 22/325 (7%) and 36/325 (11%) and for non-HBO₂-treated patients 34/80 (43%) and 37/80 (46%). In exploratory analyses, HBO₂ was associated with lower all-cause 30-day mortality in unadjusted and in that adjusted for sex, lactate, SAPS-2, and baseline norepinephrine infusion rate.</p><p><strong>Conclusions: </strong>Patients receiving HBO₂ in this cohort were less acutely ill than those not receiving HBO₂ likely influencing physicians' decisions thereby introducing selection bias. In exploratory analyses, the use of HBO₂ was associated with a reduced 30-day all-cause mortality. A randomized trial of HBO₂ treatment seems warranted in patients with NSTI.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov number NCT01790698.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Hospital Readmission Following Outpatient Parenteral Antimicrobial Therapy (OPAT).","authors":"Melanie Yousif, Matthew Geriak, Logan Vasina, George Sakoulas","doi":"10.1007/s40121-025-01182-7","DOIUrl":"https://doi.org/10.1007/s40121-025-01182-7","url":null,"abstract":"<p><strong>Introduction: </strong>A main goal of outpatient parenteral antibiotic therapy (OPAT) is to streamline patient care and minimize time spent in the inpatient hospital setting. The identification of characteristics of patients who return to the hospital after being discharged on OPAT may identify modifiable steps that can be taken to reduce risk of hospital readmission as a practice improvement strategy.</p><p><strong>Methods: </strong>We performed a retrospective analysis of adult patients prescribed OPAT for ≥ 14 days prescribed by infectious disease consultation for non-urinary tract infections (non-UTI). We compared characteristics including demographics, sites of infection, microbiology, and antimicrobial therapy prescribed.</p><p><strong>Results: </strong>Of 233 adult OPAT patients with non-UTI infections receiving ID consultation, 61 (26%) were readmitted to the hospital (60 days), of which 37 (60%) were due to treatment failure. Ceftriaxone once daily was the most prescribed antimicrobial therapy. Microbiology and infection sites were similar between the two groups. Obesity (body mass index, BMI > 30 kg/m²) was more frequent among readmitted patients versus those not readmitted (odds ratio 3.6, 95% confidence interval 1.9-6.5, p < 0.0001). Polymicrobial infections were significantly more frequent among the readmitted group compared with the non-readmitted group (odds ratio 3.2, 95% confidence interval 1.7-6.0, p = 0.0004).</p><p><strong>Conclusions: </strong>Patients with obesity may not be receiving sufficient antimicrobial exposure with standard antibiotic dosing regimens, particularly with ceftriaxone. Antibiotic dosing in patients with obesity requires further study and optimization, particularly with cephalosporins.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Syndemics of Antimicrobial Resistance: Non-communicable Diseases, Social Deprivation, and the Rise of Multidrug-Resistant Infections.","authors":"Jacinda C Abdul-Mutakabbir, Raheem Abdul-Mutakabbir","doi":"10.1007/s40121-025-01188-1","DOIUrl":"https://doi.org/10.1007/s40121-025-01188-1","url":null,"abstract":"<p><p>Antimicrobial resistance (AMR) constitutes a global health emergency that results in significant morbidity, mortality, and economic burden. Despite its severity, this issue remains inadequately addressed in public health discussions worldwide. This commentary employs a syndemic perspective to explore the synergistic relationship between multidrug-resistant (MDR) infections and non-communicable chronic diseases (NCDs). NCDs, including cardiovascular disease, chronic respiratory conditions, cancer, and diabetes mellitus, are prevalent among socially deprived populations, creating conditions that facilitate bacterial colonization and worsen disease severity, thus heightening the risk of infection and resulting in poorer clinical outcomes. Conversely, MDR infections can also exacerbate NCDs by provoking inflammatory responses and disrupting homeostasis. The commentary further underscores how social determinants of health (SDoH), such as economic hardship, limited access to healthcare, and lower educational attainment, intensify this syndemic relationship, particularly in low- and middle-income countries (LMICs) and among socially deprived populations in high-income countries. In conclusion, we provide actionable recommendations for clinicians to consider when identifying and addressing syndemics in AMR. Embracing a syndemic approach to combat AMR may yield more effective strategies to alleviate the AMR \"silent pandemic,\" especially benefiting populations disproportionately impacted by overlapping social, economic, and health vulnerabilities.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stability of Ceftobiprole Medocaril in Portable Elastomeric Infusion Devices.","authors":"Beatriz Esteban-Cartelle, Brayan J Anaya, Covadonga Pérez Menéndez-Conde, Noelia Vicente-Oliveros, Dolores R Serrano, Ana Álvarez-Díaz, Jesús Fortún-Abete, Pilar Martín-Dávila","doi":"10.1007/s40121-025-01174-7","DOIUrl":"https://doi.org/10.1007/s40121-025-01174-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Ceftobiprole medocaril is a new fifth-generation cephalosporin commercially available as a prodrug. Since it is newly introduced in therapy, there is limited data on its physicochemical stability for outpatient parenteral antimicrobial therapy (OPAT). This work aimed to demonstrate the suitability of ceftobiprole medocaril in OPAT, determining the physicochemical stability within portable elastomeric infusion devices (Accufuser C0100L 10 mL/h 300 mL).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Physicochemical stability was evaluated in 6.25 mg/mL solutions in sodium chloride 0.9% and dextrose 5% at three temperatures (2-8 °C, 25 °C, and 32 °C) using a previously validated liquid chromatography triple quadrupole mass spectrometry (LC-QQQ-MS) method. Drug adsorption onto device walls was also determined at the end of the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ceftobiprole medocaril remained above 95% of the initial concentration in sodium chloride 0.9% for up to 24 h at both refrigerated (2-8 °C) and ambient conditions (25 °C). Stability was reduced in dextrose 5% solutions. While pH increased slightly over time, it remained within acceptable limits for intravenous administration, and no particle formation was detected. Drug adsorption to the elastomeric device was negligible (&lt; 0.1%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Ceftobiprole medocaril is suitable for administration in OPAT at 6.25 mg/mL in sodium chloride 0.9% over 24 h at 25 °C using Accufuser&lt;sup&gt;®&lt;/sup&gt; portable elastomeric infusion devices. These findings support the development of practical administration protocols for ceftobiprole medocaril in home-based antimicrobial therapy. Ceftobiprole medocaril is a new antibiotic used to treat serious infections. Because it was recently introduced, there is limited information about its stability when used for outpatient parenteral antimicrobial therapy (OPAT), a treatment that allows patients to receive intravenous antibiotics at home using portable elastomeric infusion devices. This study examined how stable ceftobiprole medocaril remains when stored and administered in portable elastomeric infusion devices. The antibiotic was diluted in two commonly used fluids (saline and dextrose) and kept at different temperatures: refrigerated (2-8 °C), room temperature (25 °C), and body temperature (32 °C). Researchers measured how much of the drug remained active over 24 hours and whether it adhered to the inside of the device. The results showed that ceftobiprole medocaril in saline solution (sodium chloride 0.9%) remained stable for 24 hours at room temperature and when refrigerated, keeping over 95% of its original amount. In dextrose, the drug was less stable. The pH changed slightly, but no harmful particles formed, and less than 0.1% of the drug stuck to the infusion device, confirming that the device is suitable for this use. On the basis of these findings, ceftobiprole medocaril can be safely administered in saline solutio","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Phase II, Randomised, Double-Blind, Placebo-Controlled Study to Evaluate the Efficacy of HEX17, a Novel Broad-Spectrum Antiviral Drug, in a Controlled Human Infection Model of Influenza Challenge.","authors":"Geoff Kitson, Marion Byford, Lindsey Cass, David Howat, Brigitte Köhn, Alessandra Bisquera, Andrew Catchpole, Nicolas Noulin, Douglas Thomson","doi":"10.1007/s40121-025-01179-2","DOIUrl":"https://doi.org/10.1007/s40121-025-01179-2","url":null,"abstract":"<p><strong>Introduction: </strong>Viral respiratory tract infections are of global concern, with an unmet need for a broad-spectrum antiviral prophylactic. HEX17, a multivalent carbohydrate-binding module, binds to sialic acid, a cell surface glycan used by many viruses for host cell entry. HEX17 represents a potential broad-spectrum antiviral prophylactic therapy.</p><p><strong>Methods: </strong>This phase II randomised double-blind, placebo-controlled study was conducted in a UK centre. Healthy adults (18-55 years) were randomised (3:3:4) to daily HEX17 for 3 days (2.8 mg HEX17 from day - 3 to - 1); single-dose HEX17 (2.8 mg HEX17 on day - 3; placebo on day - 2 and - 1); or daily placebo (day - 3 to - 1). Participants were challenged with influenza virus on day 0 and assessed from days 1 to 8. Primary outcomes were incidence and severity of symptomatic influenza in the pooled HEX17 arms versus placebo, in the per protocol population (PPP). Safety analysis included all participants receiving at least one dose of HEX17/placebo.</p><p><strong>Results: </strong>Of 104 participants enrolled between August 2022 and March 2023, 99 were included in the PPP (single-dose HEX17, n = 29; daily HEX17, n = 30; placebo, n = 40). Symptomatic influenza occurred in 16/40 (40.0%) participants in the placebo arm versus 12/59 (20.3%) in the pooled HEX17 arms (- 19.7% decrease; 95% confidence interval [CI] - 38.0, - 1.3; p = 0.0331). The median peak total symptoms score was 3.00 in the placebo arm and 2.00 in the pooled HEX17 arms (versus placebo: 95% CI - 2.00, 0.00; p = 0.1427). Unsolicited adverse events (AEs) occurred in 17/41 (41.5%), 10/32 (31.3%), and 9/31 (29.0%) participants in placebo, daily HEX17, and single-dose HEX17 arms, respectively (safety population). No deaths or serious AEs occurred.</p><p><strong>Conclusion: </strong>Prophylactic HEX17 reduced the incidence of symptomatic influenza infection and may protect at-risk patients against influenza infection.</p><p><strong>Trial registrations: </strong>EudraCT 2022-001853-22, Clinicaltrials.gov NCT05507567.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Immunogenicity of Monovalent Omicron KP.2-Adapted BNT162b2 COVID-19 Vaccine in Adults: Single-Arm Substudy from a Phase 2/3 Trial.","authors":"Oyeniyi Diya, Juleen Gayed, Francine S Lowry, Hua Ma, Vishva Bangad, Federico Mensa, Jing Zou, Xuping Xie, Yanping Hu, Mark Cutler, Todd Belanger, David Cooper, Xia Xu, Robin Mogg, Özlem Türeci, Uǧur Şahin, Kena A Swanson, Kayvon Modjarrad, Annaliesa S Anderson, Alejandra Gurtman, Nicholas Kitchin","doi":"10.1007/s40121-025-01185-4","DOIUrl":"https://doi.org/10.1007/s40121-025-01185-4","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 continues to cause substantial health burden, particularly among vulnerable populations. Vaccines remain a vital tool in preventing severe disease outcomes. As the causative pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve; therefore, updates may be needed to closely match COVID-19 vaccine composition to predominant circulating lineages to confer optimal protection.</p><p><strong>Methods: </strong>In this cohort from a substudy of an ongoing phase 2/3 trial, 102 healthy adults (18‒55 and > 55 years of age, n = 51 each) were vaccinated with Omicron KP.2-adapted BNT162b2. Serum neutralizing titers against Omicron KP.2, JN.1, and KP.3 were assessed before and through 1 month after vaccination. Immunogenicity in KP.2-adapted BNT162b2 recipients was compared with participants who received JN.1-adapted BNT162b2 in an earlier cohort of this substudy. Local reactions and systemic events through 7 days and adverse events (AEs) through 1 month are reported.</p><p><strong>Results: </strong>One month after vaccination, KP.2-adapted BNT162b2-elicited neutralizing titers against Omicron KP.2, JN.1, and KP.3 were numerically higher than those induced by JN.1-adapted BNT162b2. Geometric mean fold rises from before to 1 month after vaccination were numerically higher in those who received KP.2-adapted BNT162b2 compared with those who received JN.1-adapted BNT162b2 (9.4 vs. 6.8 for KP.2; 7.8 vs. 5.7 for JN.1; 9.2 vs. 7.0 for KP.3). Percentages of participants with seroresponses were numerically higher against KP.2 after KP.2-adapted BNT162b2 than JN.1-adapted BNT162b2 (75% vs. 65%) and similar against JN.1 and KP.3 for both vaccines (69% vs. 67% for JN.1; 74% vs. 73% for KP.3). Local reactions and systemic events were all mild to moderate in severity, AEs were infrequent, and no serious AEs or AEs leading to withdrawal were reported.</p><p><strong>Conclusions: </strong>Collectively, these immunogenicity, safety, and tolerability data support administration of KP.2-adapted BNT162b2 to protect against contemporaneous circulating lineages.</p><p><strong>Clinicaltrials: </strong></p><p><strong>Gov identifier: </strong>NCT05997290.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colistin Sulfate-Based Combination Therapy for Infections Caused by Carbapenem-Resistant Organisms in Intensive Care Units: A Multicenter, Prospective, Observational Clinical Trial.","authors":"Fan Zhang, Danyang Peng, Faming He, Ying Liu, Binbin Zang, Yanqiu Gao, Chao Qin, Suping Guo, Yawei Qi, Xisheng Zheng, Lin Guo, Tingting Zhao, Yue Jin, Rongqi Su, Juan Du, Jiazhan Pan, Bingyu Qin, Huanzhang Shao","doi":"10.1007/s40121-025-01176-5","DOIUrl":"https://doi.org/10.1007/s40121-025-01176-5","url":null,"abstract":"<p><strong>Introduction: </strong>With the rapid spread of carbapenem-resistant Gram-negative bacterial infections, polymyxins have reemerged as a critical \"salvage\" antibiotic option.</p><p><strong>Methods: </strong>This multicenter observational study assessed the effectiveness and safety of colistin sulfate-based treatment for carbapenem-resistant organism (CRO) infections in patients in intensive care across ten clinical sites in China. Clinical and microbiological responses, 28-day all-cause mortality, and associated risk factors were analyzed. Nephrotoxicity was assessed using Kidney Disease Improving Global Outcomes (KDIGO) criteria.</p><p><strong>Results: </strong>Of 240 critically ill adult patients with confirmed CRO infection, 91.3% had pulmonary infection, and 77.1% and 52.5% achieved clinical and microbiological response, respectively. Subgroup analyses showed associations between outcomes and patient age and colistin sulfate treatment duration. The 28-day all-cause mortality was 27.1%. Clinical response and mortality were significantly associated with Sequential Organ Failure Assessment (SOFA) score and colistin sulfate treatment duration. Analysis of the receiver operating characteristic (ROC) curve revealed that the thresholds for colistin treatment duration for predicting clinical response and survival were > 9.5 days (area under the curve [AUC] > 0.7). Nephrotoxicity was reported in 13.1% of patients not receiving continuous renal replacement therapy (CRRT), with no significant duration-dependent increase. Post-treatment serum creatinine (Scr) levels remained stable or improved across all renal function subgroups.</p><p><strong>Conclusions: </strong>Colistin sulfate in combination with other antimicrobials can be considered a reasonable and safe treatment option for CRO infections. Understanding the factors involved in this potential beneficial treatment can enable more careful follow-up of patients.</p><p><strong>Trial registration: </strong>ChiCTR, ChiCTR2100044866. Registered on 30 March 2021, https://www.chictr.org.cn/showproj.html?proj=124119 .</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144527799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protective Measures Taken in Residential Care Homes in England During the COVID-19 Pandemic. An Assessment of the Change in Mortality Rates Before and During the COVID-19 Pandemic Years.","authors":"Michael Stedman, Samuel Kitching, Martin B Whyte, Adrian Heald","doi":"10.1007/s40121-025-01183-6","DOIUrl":"https://doi.org/10.1007/s40121-025-01183-6","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Mortality rate increased in the period after 1 January 2020 because of the Sars-Cov-2 (coronavirus disease 2019, COVID-19) pandemic. A significant proportion of those deaths occurred within residential care homes who were mandated to put in place stringent preventative measures including vaccinations, regular testing and visitor restrictions, while maintaining access to front-line healthcare. Our question was, by how much did these measures mitigate this increase in mortality rate?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The Office of National Statistics (ONS) annually publish deaths, by age and sex, for each small geographic entity - the lower layer super output area (LSOA). A baseline of national average deaths per population in 2017-2019, by age group and sex, was calculated. This was then applied to local populations to calculate values of expected deaths and, when divided by the actual deaths, to create a standardised mortality rate (SMR). The change in standardised mortality rate (CSMR) was calculated as % change in SMR 2020-2022 compared with SMR 2017-2019. Excess deaths were then calculated on the basis of the assumption that CSMR would be 0% without the pandemic. The link between LSOA social deprivation index of multiple deprivation (IMD) score and CSMR was established by simple linear regression for each age group. The Care Quality Commission publish annually a register of residential care homes (RCH) which includes the post code location, which can be linked to an LSOA, and the number of beds split according to nursing care (CH) or purely residential homes (RH). Linking presence of RCH beds in LSOAs to outcome was evaluated in two ways, (1) by the amount with no RCH beds plus three tertiles of RCH bed number as the percent of older population (≥ 65 years) and (2) by the type of beds, those with RH only, CH only, or both RH and CH. CSMR was calculated for each of these cohorts. As RCH are mostly occupied by people aged ≥ 80 years, to estimate the impact of restrictions in care homes compared with the general community, the difference in CSMR between LSOAs with 'no RCHs' and 'with RCH' with baseline 0% CSMR were used to calculate the change in excess deaths.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall CSMR was 8.4%, (age group &lt; 40 years was 5.7%, 40-64 years 13.7%, 65-79 years 11.3%, and ≥ 80 years 5.9%). This reflected 128,385 excess deaths in 2020-2022 compared with 2017-2019 (by age group &lt; 40 years, 2106; 40-64 years: 26,120; 65-79 years: 49,301; and ≥ 80 years: 50,857). Social disadvantage had the most effect on CSMR in the age 80+ years group; in this group, the lowest five deciles (50%) of LSOAs by IMD score had CSMR of 4.5%, with the CSMR then increasing linearly up to 16% in the top IMD decile. In the age group of 80+ years, the 22,357 LSOAS with 'no RCH' had CSMR of 10.0% (as a result of 35,791 excess deaths), while in the 10,484 LSOAs 'with RCH' the CSMR was 3.3%, as a result of 17,840 excess deaths. In ","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144505593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender Differences in Antibiotic Prescriptions and Healthcare Visits Among Caregivers Accompanying Children with Respiratory Tract Infections: A Cross-Sectional Study.","authors":"Taito Kitano, Yusuke Asai, Ryuji Koizumi, Norio Ohmagari, Shinya Tsuzuki","doi":"10.1007/s40121-025-01175-6","DOIUrl":"https://doi.org/10.1007/s40121-025-01175-6","url":null,"abstract":"<p><strong>Introduction: </strong>Women are more often prescribed antibiotics than men for a number of health conditions. Adults' behaviours in engaging with healthcare for themselves, especially when attending appointments with a child with a respiratory tract infection for whom they provide care, may contribute to the gender differences in antimicrobial use. This study aimed to evaluate gender differences in caregivers' attendance at healthcare visits for children with respiratory tract infections, their behaviours in engaging with healthcare for themselves and their children, and associated antibiotic prescriptions.</p><p><strong>Methods: </strong>An online survey was conducted among Japanese caregivers, asking about children's healthcare visits and prescriptions for antimicrobials associated with respiratory tract infections, who accompanied them and whether the caregiver attended a simultaneous healthcare visit for themselves. We used multivariable logistic regression analysis to evaluate factors associated with caregivers' attendance at children's healthcare visits and responders' simultaneous healthcare visits.</p><p><strong>Results: </strong>Among the 1664 participants, 1091 accompanied their children to healthcare visits. Female responders were significantly more likely to accompany their child (adjusted odds ratio (aOR) 6.76 [95% confidence interval (CI) 5.00-9.15], p < 0.001). Participants with higher education levels were less likely to require a simultaneous healthcare visit (aOR 0.56 [95% confidence interval (CI) 0.33-0.94], p = 0.029). Other covariates, including participants' gender, were not significantly associated with simultaneous healthcare visits.</p><p><strong>Conclusion: </strong>Women were more likely to accompany a child to a healthcare visit for a respiratory tract infection. However, they were no more likely to require a simultaneous healthcare visit, or receive antibiotics at those simultaneous visits.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning for the Early Diagnosis of Candidemia.","authors":"Daniele Roberto Giacobbe, Sabrina Guastavino, Anna Razzetta, Cristina Marelli, Sara Mora, Chiara Russo, Giorgia Brucci, Alessandro Limongelli, Antonio Vena, Malgorzata Mikulska, Alessio Signori, Antonio Di Biagio, Anna Marchese, Ylenia Murgia, Marco Muccio, Nicola Rosso, Michele Piana, Mauro Giacomini, Cristina Campi, Matteo Bassetti","doi":"10.1007/s40121-025-01171-w","DOIUrl":"https://doi.org/10.1007/s40121-025-01171-w","url":null,"abstract":"<p><strong>Introduction: </strong>Candidemia carries a heavy burden in terms of mortality, especially when presenting as septic shock, and its early diagnosis remains crucial.</p><p><strong>Methods: </strong>We assessed the performance of a deep learning model for the early differential diagnosis between candidemia and bacteremia. The model was trained on a large dataset of automatically extracted laboratory features.</p><p><strong>Results: </strong>A total of 12,483 episodes of candidemia (1275; 10%) or bacteremia (11,208; 90%) were included. For recognizing candidemia, a deep learning model showed sensitivity 0.80, specificity 0.59, positive predictive value (PPV) 0.18, weighted PPV (wPPV) 0.88, and negative predictive value (NPV) 0.96 on the training set (area under the curve [AUC] 0.69), and sensitivity 0.70, specificity 0.58, PPV 0.16, wPPV 0.87, and NPV 0.95 on the test set (AUC 0.64). Then, the learned discriminatory ability was tested in the subgroup of patients with available serum β-D-glucan (BDG) and procalcitonin (PCT) values to explore additive or synergistic effects with these more specific markers. Both feature selection and transfer learning did not improve the diagnostic performance of a model based on BDG and PCT only.</p><p><strong>Conclusions: </strong>A deep learning model trained on nonspecific laboratory features showed some discriminatory ability to differentiate candidemia from bacteremia, highlighting the ability of deep learning to exploit complex patterns within nonspecific laboratory data. However, the learned patterns did not improve the diagnostic performance of more specific markers. Further exploration of candidemia prediction using laboratory features through machine learning techniques remains a promising area of research, serving as a valuable complement to the development of large-scale models that also incorporate clinical features.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}