Infectious Diseases and Therapy最新文献

{"title":"From Colonisation to Infection: Assessing the BSI Potential in Patients with KPC, NDM, VRE and CRAB Rectal Colonisation.","authors":"Marta Colaneri, Paola Giordani, Simone Milanesi, Sonia Lerta, Elena M Tosca, Aurelia Sangani, Vincenzo A Villano, Marco Rettani, Alba Muzzi, Marta Corbella, Patrizia Cambieri, Andrea Gori, Giuseppe De Nicolao, Raffaele Bruno","doi":"10.1007/s40121-025-01222-2","DOIUrl":"https://doi.org/10.1007/s40121-025-01222-2","url":null,"abstract":"<p><strong>Introduction: </strong>Multi-drug-resistant organisms (MDROs) that mostly contribute to nosocomial infections include carbapenem-resistant Enterobacterales that produce Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-β-lactamase (NDM), carbapenem-resistant Acinetobacter baumannii (CRAB) and vancomycin-resistant Enterococcus faecium (VRE). Patients colonised by these MDROs are at high risk for developing bloodstream infections (BSIs) by the same pathogen, emphasising the need for surveillance and intervention.</p><p><strong>Methods: </strong>This retrospective study included patients admitted to medical, surgical, and intensive care unit (ICU) wards in the IRCCS Policlinico San Matteo (Pavia, Italy) between January 2019 and October 2024 with rectal colonisation by KPC, NDM, VRE and CRAB. Demographic, clinical and microbiological data were extracted from electronic records. Logistic regression with stepwise model-building identified risk factors for BSI development.</p><p><strong>Results: </strong>A total of 1969 patients colonised with MDRO were identified: 79% of them were colonised by KPC, VRE, CRAB or NDM. Among the 1960 hospitalisations involving these specific rectal colonisations, the overall rate of BSIs was 9.4%, with CRAB and KPC showing the highest rates (20.0% and 12.6%, respectively). ICU hospitalisation was significantly associated with an increased risk of BSI in patients colonised with KPC, NDM and VRE. Haematological malignancies and bone marrow transplantation were independent risk factors for BSI in patients colonised with KPC (odds ratio [OR] = 3.22, p = 0.037) and VRE (OR = 4.07, p = 0.004) whereas solid organ transplantation increased BSI risk among patients colonised with CRAB (OR = 11.83, p = 0.034).</p><p><strong>Conclusions: </strong>Our findings show heterogeneous BSI risk among MDROs, with CRAB and KPC being the most dangerous, especially in patients in the ICU, followed by VRE in onco-haematological cases. These results support developing prevention strategies for critically ill and immunocompromised patients.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952806","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":"JC Polyomavirus Infection: A Narrative Review.","authors":"Meital Elbaz, Dafna Yahav, Yair Mina, Alaa Atamna","doi":"10.1007/s40121-025-01199-y","DOIUrl":"10.1007/s40121-025-01199-y","url":null,"abstract":"<p><p>Progressive multifocal leukoencephalopathy (PML) is a devastating and often fatal central nervous system infection caused by John Cunningham polyomavirus virus (JCPyV). PML results from JCPyV reactivation in the setting of impaired cellular immunity in patients with HIV, organ transplantation, severe inflammatory disease, and an increasing number of modern treatments for cancer and autoimmune diseases. The presence of clinical and imaging manifestations consistent with the diagnosis coupled with the demonstration of JCPyV by PCR in cerebrospinal fluid (CSF) are considered diagnostic. Since there are no effective antiviral treatments available, restoring immune function is a key component in PML treatment. Novel immunotherapeutic approaches can ameliorate PML. Immunotherapeutic interventions, such as use of checkpoint inhibitors and viral specific T-cell, have shown promising results, but additional data are needed. In this review, we summarize the available data on risk factors for JCPyV neurological syndrome, clinical, laboratory, and radiological features, and propose an algorithm for management.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"2007-2028"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425872/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the Value of Aztreonam-Avibactam in Treating Metallo-beta-Lactamase-Producing Enterobacterales Infections in Spain Using the STEDI AMR Value Framework.","authors":"Ricard Ferrer, Sonia Luque, Luis Martínez-Martínez, Alfonso de Lossada, Marta Maroto-Diaz, Carlota Moya-Alarcón, Maria Carmen de Ceano-Vivas, Yolanda Moreno, James Dennis, Silviya Nikolova, Evangelos Zormpas, Edward Broughton, Maria Gheorghe","doi":"10.1007/s40121-025-01202-6","DOIUrl":"10.1007/s40121-025-01202-6","url":null,"abstract":"<p><strong>Introduction: </strong>Treatments for serious infections caused by multidrug-resistant gram-negative bacteria, including metallo-β-lactamase-producing Enterobacterales (MBL-EB), are limited and aztreonam with avibactam (ATM-AVI) is the first β-lactam/β-lactamase inhibitor combination active against MBL-EB approved in Europe and approved for reimbursement by the Spanish National Health System (NHS). This study aims to estimate the value of adding ATM-AVI as a new first-line treatment into the current strategy (ATM-AVI → cefiderocol → colistin + meropenem) in patients with hospital-acquired/ventilator-associated pneumonia (HAP/VAP) and complicated intra-abdominal infections (cIAI), caused by MBL-EB from the Spanish NHS perspective.</p><p><strong>Methods: </strong>A dynamic disease transmission model was developed to assess the value of ATM-AVI considering the transmission, diversity and enablement components of the value framework for antibiotics, called STEDI (spectrum, transmission, enablement, diversity, insurance). Transmission and diversity value were described by estimating direct population-level impact on treatment outcomes and resistance development. Enablement value was estimated by linking population-level improvements in antimicrobial effectiveness into improved prophylactic effectiveness. Inputs for efficacy, resistance, adverse events, and costs were sourced from the REVISIT study, literature and expert opinion. A 10-year infection transmission horizon was used; quality-adjusted life years (QALYs) were estimated over a lifetime and valued using a willingness-to-pay (WTP) threshold of €25,000/QALY gained to calculate the net monetary benefit (NMB). Costs and benefits were discounted at a rate of 3%.</p><p><strong>Results: </strong>Over 10 years, the intervention strategy introducing ATM-AVI was dominant, leading to a 2.96% proportional reduction in resistance, 19,533 fewer infections and 4662 lives saved (47,319 QALYs gained) and a cost saving of €40.5 million. The NMB was €1.22 billion.</p><p><strong>Conclusions: </strong>In Spain, ATM-AVI is a highly cost-effective and urgently needed treatment option for patients with MBL-EB including HAP/VAP and cIAI infections. Using the novel STEDI framework unlocks the considerable value of a new antibiotic which is essential to support incentives for the development of new antimicrobials.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"2071-2092"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and Course of Clostridioides difficile Infections in Germany: Retrospective Analysis of German Health Claims Data.","authors":"Anna Seiffert, Sebastian Noack, Sebastian Wingen-Heimann, Julia Puschmann, Nils-Olaf Hübner, Jonas Krampe, Christoph Lübbert","doi":"10.1007/s40121-025-01223-1","DOIUrl":"https://doi.org/10.1007/s40121-025-01223-1","url":null,"abstract":"<p><strong>Introduction: </strong>Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated infectious diarrhea, with recurrence rates of 15-20% after standard treatment and ≥ 30% after a second relapse. In Germany, reliable epidemiological data remain limited.</p><p><strong>Methods: </strong>A retrospective claims data analysis of the period 2017-2022 was performed using the German Analysis Database for Evaluation and Health Services Research (DADB), which covers 4.1 million insured individuals. Incident CDI cases, recurrent cases, and mortality were assessed and stratified by diagnosis setting. A propensity-score-matched control group without CDI adjusted for age, sex, and comorbidities was created. Cox proportional hazards models were used to determine mortality risk factors.</p><p><strong>Results: </strong>CDI incidence decreased from 119 to 66 per 100,000 (2017-2022). First-recurrence rate declined from 15% to 11% and second-recurrence rate from 20% to 15%. Of all recurrences, 43% were managed in the outpatient setting. In 2022, severe CDI accounted for 38% of extrapolated statutory health insurance (SHI) cases. Metronidazole use in outpatients decreased from 79% to 53% for incident cases, while vancomycin prescriptions increased from 18% to 39%. In 2022, 72% of first CDI recurrences were treated with vancomycin, 20% with metronidazole, and 2% with fidaxomicin. Despite guideline recommendations, only 8% of patients with a second recurrence received fidaxomicin. In 2021, the 30-day mortality rate for secondary inpatient CDI cases was 20%, compared with 8% for primary inpatient cases and 4% for outpatient cases. Corresponding 1-year mortality rates were 44%, 32%, and 16%. In patients with CDI, 1-year mortality was 1.9 to 2.1 times higher than in controls (p < 0.001), with advanced age (≥ 65 years) being the strongest predictor (hazard ratio [HR] 12.21; 95% confidence interval [CI] 10.91-13.67).</p><p><strong>Conclusions: </strong>Despite declining incidence and recurrence rates, CDI remains a major health burden in Germany, especially for older adults. High severity, limited adherence to treatment guidelines, and excess mortality underscore the need for targeted prevention, individualized therapy, and improved guideline implementation.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952793","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":"Early Prediction of In-Hospital Mortality in Patients with Acute Infections: Development of the Acute Severity Infection Score (ASIs).","authors":"Alessio Comitangelo, Alfredo Vozza, Giovanna Ditaranto, Giuseppe Re, Ada Berloco, Erasmo Porfido, Carlo Custodero, Domenico Comitangelo, Sara Madaghiele, Andrea Portacci, Cosimo Tortorella, Giuseppina Piazzolla","doi":"10.1007/s40121-025-01200-8","DOIUrl":"10.1007/s40121-025-01200-8","url":null,"abstract":"<p><strong>Introduction: </strong>Early prognostic stratification in patients hospitalized for acute infections is a major clinical challenge. Existing tools, such as the Sequential Organ Failure Assessment (SOFA) score and Charlson Comorbidity Index (CCI), were not specifically developed for this purpose.</p><p><strong>Objectives: </strong>We aimed to design a novel multidimensional prognostic score, the Acute Severity Infection score (ASIs), to predict in-hospital mortality using routinely available clinical data.</p><p><strong>Methods: </strong>This retrospective cohort study included 149 adults admitted with acute infections to an internal medicine unit between January 2023 and December 2024. In-hospital all-cause mortality was the primary outcome. Demographic, clinical and laboratory variables obtained within 12 h of admission were analyzed. Variables significantly associated with mortality in both univariate and multivariate regression were incorporated into the ASIs, which ranges from 0 to 7 points. Its performance was compared to SOFA and CCI using ROC curve and Cox regression models.</p><p><strong>Results: </strong>In-hospital mortality occurred in 25.5% of patients. Five variables were independently associated with mortality: lactate ≥ 2.2 mmol/l, frailty composite (confined to bed status, long-term oxygen therapy or advanced malignancy), hemodynamic instability or need for non-invasive ventilation, age ≥ 79.5 years and symptom onset ≥ 3.5 days before admission. ASIs showed the highest discriminative ability (AUC = 0.883) compared to SOFA (AUC = 0.612) and CCI (AUC = 0.742). In multivariate models including all three scores, only ASIs retained independent prognostic significance.</p><p><strong>Conclusions: </strong>The ASIs is a simple tool for early prognostic stratification of patients hospitalized with acute infections. It outperforms existing scores and may enhance clinical decision-making in real-world medical settings.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"2053-2070"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can We Lower the Burden of Antimicrobial Resistance (AMR) in Heavily Immunocompromised Patients? A Narrative Review and Call to Action.","authors":"Matteo Bassetti, Antonella Cardone, Fatima Cardoso, Vanessa Carter, Oliver A Cornely, Marco Falcone, Daniel Gallego, Maddalena Giannella, Paolo Antonio Grossi, Livio Pagano, Nicola Silvestris, Nikolaos V Sipsas, Alex Soriano, Mario Tumbarello, Pierluigi Viale","doi":"10.1007/s40121-025-01204-4","DOIUrl":"10.1007/s40121-025-01204-4","url":null,"abstract":"<p><p>Effective antibiotics are a cornerstone of treatment for heavily immunocompromised patients such as those undergoing cancer treatment or transplantation procedures, as these patients are at particularly high risk of adverse outcomes from infections. However, rising antimicrobial resistance (AMR) threatens to undermine our ability to deliver modern treatments, and without action, recent advances in clinical care may be undone. In this narrative review, we examine the broad burdens of AMR for patients and healthcare systems, including excess mortality, underlying disease outcomes, economic costs and the damage to patients' quality of life. Despite the profound impact on individual wellbeing, the patient voice and patient-reported experience measures are largely absent from current research. To protect the everyday benefits of antibiotics, it is vital to educate all those involved in patient care on how we can combat AMR, including appropriate testing, use of effective antibiotics and infection control procedures. Moreover, given the high investment in novel anticancer treatments, good antimicrobial stewardship has the potential to deliver overall cost savings to healthcare systems while ensuring that patients can safely access and benefit from these therapies.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"2029-2052"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Health Outcomes of People with HIV Engaged in Chemsex: A Prospective Cohort Study on Drug Use, Sexual Behaviour, Sexually-Transmitted Infections and Vulnerability.","authors":"Lorena De La Mora, Montserrat Laguno, Berta Torres, Ivan Chivite, Alberto Foncillas, Alexy Inciarte, Júlia Calvo, Ana González-Cordón, Juan Ambrosioni, Leire Berrocal, Elisa De Lazzari, Esteban Martínez, José Luís Blanco, Rubén Mora, Estela Solbes, Ana Rodriguez, Pilar Callau, Laia Miquel, Jordi Blanch, Duncan Short, Josep Mallolas, Maria Martínez-Rebollar","doi":"10.1007/s40121-025-01201-7","DOIUrl":"10.1007/s40121-025-01201-7","url":null,"abstract":"<p><strong>Introduction: </strong>Chemsex, the intentional use of drugs to enhance sexual experiences among gay, bisexual, and other men who have sex with men (gbMSM), is linked to high-risk sexual behaviours and increased sexually transmitted infections (STIs). Data on its long-term evolution after implementing specific strategies in HIV settings are limited. We evaluated the incidence of drug use, sexual behaviour, STIs, and vulnerabilities over 3 years following a specific approach at the HIV Unit of Hospital Clinic in Barcelona, Spain.</p><p><strong>Methods: </strong>We included 209 gbMSM living with HIV who engaged in chemsex in a prospective cohort (2018-2022). Quarterly visits assessed sexual behaviours, drug use, and STIs screening. Data were collected via self-administered questionnaires, medical records, and microbiological tests. Statistical analyses included descriptive statistics and Poisson regression models.</p><p><strong>Results: </strong>Chemsex incidence decreased significantly (IRR 0.88, 95% CI 0.83-0.92, p < 0.001). People engaging in intravenous drug use (slamming) decreased in year 2 (IRR 0.71, 95% CI 0.52-0.98, p = 0.037) but rose non-significantly in year 3 (IRR 0.86, 95% CI 0.60-1.25, p = 0.434). High-risk sexual behaviours persisted, specifically unprotected anal sex (IRR 1.02, 95% CI 0.96-1.08, p = 0.481) and unprotected fisting (IRR 1.20, 95% CI 1.05-1.39, p = 0.010). Syphilis cases declined (IRR 0.40, 95% CI 0.26-0.60, p < 0.001). At baseline, 29% had HCV antibodies, with five new acute HCV cases. Concerns about chemsex decreased (IRR 0.52, 95% CI 0.43-0.63, p < 0.001), whereas the demand for sexuality-related assistance increased (IRR 1.53, 95% CI 1.20-1.94, p = 0.004). Loss to follow-up (21%) was greater among younger individuals, people engaging in intravenous drug use (slamming) (IRR 2.43 95% CI 1.33-4.42, p = 0.004), detectable HIV viral load (IRR 3.01, 95% CI 1.57-5.76, p = 0.001), and greater need for help (IRR 1.35, 95% CI 1.03-1.78, p = 0.03). Migrants and sex workers had higher rates of syphilis, lower education levels, and increased prevalence of STIs.</p><p><strong>Conclusion: </strong>Chemsex incidence and syphilis rates declined, but persistent high-risk behaviours, subgroup vulnerabilities, and increasing demand for sexuality-related assistance require targeted interventions and comprehensive support.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"2113-2130"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144784260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cluster Randomized Study to Explore Case Definitions, Clinical Course and Consequences of RSV in Community-Dwelling Adults Aged ≥ 50 Years.","authors":"Alexander Domnich, Francesco Lapi, Andrea Orsi, Piero Luigi Lai, Alessio Signori, Luca Pestarino, Pier Claudio Brasesco, Marta Vicentini, Anna Puggina, Alen Marijam, Maria João Fonseca, Elisa Turriani, Carlo-Simone Trombetta, Giada Garzillo, Federica Stefanelli, Valentina Ricucci, Bianca Bruzzone, Donatella Panatto, Giancarlo Icardi","doi":"10.1007/s40121-025-01205-3","DOIUrl":"10.1007/s40121-025-01205-3","url":null,"abstract":"<p><strong>Introduction: </strong>In Europe, surveillance of respiratory syncytial virus (RSV) has been recently incorporated into existing influenza monitoring platforms that are based on influenza-like illness (ILI) or acute respiratory infection (ARI) case definitions. This study aims to compare RSV rates captured by ARI versus ILI case definitions and to describe the clinical and economic trajectories of RSV in older adults.</p><p><strong>Methods: </strong>The study was conducted in Italy during the 2023/2024 and 2024/2025 seasons. Thirty-eight general practitioners were randomized 1:1 to enroll individuals ≥ 50 years presenting for care and meeting the European criteria for ARI or ILI, respectively. Alternative definitions were also explored. All subjects were tested for respiratory pathogens. RSV-positive individuals were followed for up to one month.</p><p><strong>Results: </strong>Of 1431 patients (ARI: 741; ILI: 690) included, 5.2% tested positive for RSV. Odds of RSV in the ARI group (5.8%) was 26% higher than in the ILI group (4.6%) [odds ratio (OR) 1.26; 95% CI 0.60-2.65]. Exclusion of GPs with unexpectedly low enrollment rates increased the OR to 1.67 (95% CI 0.80-3.42). Conversely, adults in the ILI group showed higher rates of influenza A (OR 0.83; 95% CI 0.47-1.44) and SARS-CoV-2 (OR 0.57; 95% CI 0.34-0.95). A proposed alternative case definition, denoted as ARI with wheezing and/or productive cough and/or rhonchi and/or dyspnea was sensitive at 92.0% and specific at 30.8%. Among 75 RSV-positive outpatients, the case-complication, case-hospitalization and case-fatality rates were 30.7%, 2.7%, and 1.3%, respectively. The mean costs per RSV case were € 168.71 from the payer perspective and up to € 899.51 from the societal perspective.</p><p><strong>Conclusions: </strong>Compared to a highly sensitive ARI definition, ILI-based surveillance likely underestimates the incidence of RSV. Further qualifiers can enhance specificity of the ARI case definition. The study confirms a significant burden of RSV in older adults.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"2093-2111"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12426295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cohort Study of Pediatric Severe Community-Acquired Pneumonia Involving AI-Based CT Image Parameters and Electronic Health Record Data.","authors":"Mengyuan He, Jianpeng Yuan, Aijiao Liu, Rui Pu, Wenqi Yu, Yinzhu Wang, Li Wang, Xing Nie, Jinsheng Yi, Hongman Xue, Junfeng Xie","doi":"10.1007/s40121-025-01197-0","DOIUrl":"10.1007/s40121-025-01197-0","url":null,"abstract":"<p><strong>Introduction: </strong>Community-acquired pneumonia (CAP) is a significant concern for children worldwide and is associated with a high morbidity and mortality. To improve patient outcomes, early intervention and accurate diagnosis are essential. Artificial intelligence (AI) can mine and label imaging data and thus may contribute to precision research and personalized clinical management.</p><p><strong>Methods: </strong>The baseline characteristics of 230 children with severe CAP hospitalized from January 2023 to October 2024 were retrospectively analyzed. The patients were divided into two groups according to the presence of respiratory failure. The predictive ability of AI-derived chest CT (computed tomography) indices alone for respiratory failure was assessed via logistic regression analysis. ROC (receiver operating characteristic) curves were plotted for these regression models.</p><p><strong>Results: </strong>After adjusting for age, white blood cell count, neutrophils, lymphocytes, creatinine, wheezing, and fever > 5 days, a greater number of involved lung lobes [odds ratio 1.347, 95% confidence interval (95% CI) 1.036-1.750, P = 0.026] and bilateral lung involvement (odds ratio 2.734, 95% CI 1.084-6.893, P = 0.033) were significantly associated with respiratory failure. The discriminatory power (as measured by the area under curve) of Model 2 and Model 3, which included electronic health record data and the accuracy of CT imaging features, was better than that of Model 0 and Model 1, which contained only the chest CT parameters. The sensitivity and specificity of Model 2 at the optimal critical value (0.441) were 84.3% and 59.8%, respectively. The sensitivity and specificity of Model 3 at the optimal critical value (0.446) were 68.6% and 76.0%, respectively.</p><p><strong>Conclusion: </strong>The use of AI-derived chest CT indices may achieve high diagnostic accuracy and guide precise interventions for patients with severe CAP. However, clinical, laboratory, and AI-derived chest CT indices should be included to accurately predict and treat severe CAP.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"2131-2141"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of Fecal Microbiota, Live-jslm to Prevent Recurrent Clostridioides difficile Infection in Participants With Irritable Bowel Syndrome.","authors":"Olga C Aroniadis, Beth Guthmueller, Kaitlin Dehlin, Shivam Srivastava, Paul Feuerstadt, Anthony Lembo, Horst C Weber","doi":"10.1007/s40121-025-01208-0","DOIUrl":"10.1007/s40121-025-01208-0","url":null,"abstract":"<p><strong>Introduction: </strong>The safety and efficacy of microbiota-based products in patients with irritable bowel syndrome (IBS) and recurrent Clostridioides difficile infection (rCDI) has not been studied. Fecal microbiota, live-jslm (RBL; REBYOTA^®) is an FDA-approved, single-dose, microbiota-based product to prevent rCDI in adults following standard-of-care (SOC) antibiotic treatment. This was an exploratory subgroup analysis of PUNCH CD3-OLS, a phase 3, open-label, prospective study conducted in the United States (US) and Canada, to evaluate the safety and efficacy of RBL in participants with documented rCDI and concurrent IBS.</p><p><strong>Methods: </strong>Participants aged ≥ 18 years with a diagnosis of rCDI and who completed SOC antibiotic treatment were enrolled in this study. The primary endpoint of PUNCH CD3-OLS was the number of participants with RBL- or administration-related treatment-emergent adverse events (TEAEs). Secondary endpoints included treatment success at 8 weeks and sustained clinical response at 6 months. In this subgroup analysis, ongoing IBS was confirmed based on medical record documentation at the time of RBL administration.</p><p><strong>Results: </strong>Among the 697 RBL recipients, 90 had comorbid IBS. After RBL administration, 52 participants with IBS (57.8%) and 278 participants without IBS (45.8%) experienced TEAEs through 8 weeks. Most TEAEs were mild (22.2% with IBS, 20.1% without IBS) or moderate (26.7% with IBS, 18.8% without IBS). Serious TEAEs were reported by 1 participant with IBS (pneumonia reported to be unrelated to RBL) and 26 participants without IBS [most of which were related to preexisting conditions (3.1%)]. Among all participants, 68.9% with IBS and 75.6% without IBS had absence of CDI diarrhea through 8 weeks after RBL administration. Of the participants with treatment success, 82.3% with IBS and 92.2% without IBS had sustained clinical response through 6 months.</p><p><strong>Conclusion: </strong>RBL is a safe and efficacious option to prevent CDI recurrence in patients with concurrent IBS.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier, NCT03931941.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"2157-2169"},"PeriodicalIF":5.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}