Infectious Diseases and Therapy最新文献

{"title":"PCV13-Serotype Breakthrough Pneumococcal Disease in Infants Receiving High-Valency Conjugate Vaccines: Population-Level Modeling in France.","authors":"Kevin M Bakker, Rachel J Oidtman, Natalie Banniettis, Kristen Feemster, Priscilla Velentgas, Tufail M Malik, Giulio Meleleo, Jessica Weaver","doi":"10.1007/s40121-025-01123-4","DOIUrl":"10.1007/s40121-025-01123-4","url":null,"abstract":"<p><strong>Introduction: </strong>Pneumococcal conjugate vaccines (PCVs) have been increasing in valency to protect against a larger number of serotypes; however, the addition of serotypes has come at the cost of reduced immunogenicity, which may lead to breakthrough disease.</p><p><strong>Methods: </strong>This study used a mathematical model to evaluate the impact of introducing routine vaccination with either PCV15 or PCV20 on breakthrough invasive pneumococcal disease (bIPD) incidence associated with PCV13 serotypes in infants aged 0-12 months in France. The model incorporated historical PCV introductions and calibrated age- and serotype-specific IPD data spanning 2000-2019. Serotype-specific vaccine effectiveness for PCV15 and PCV20 was predicted based on previously published analyses. The incidence of bIPD was evaluated across three serotype classes: PCV7 (serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F), PCV13-nonPCV7-nonST3 (serotypes 1, 5, 6A, 7F, and 19A), and ST3 (serotype 3). Results were compared to IPD incidence in 2019.</p><p><strong>Results: </strong>Twenty years following introduction into the childhood immunization program, the routine use of PCV15 in a 2 + 1 regimen led to fewer PCV13-nonPCV7-nonST3-associated bIPD cases in infants than the use of PCV20 in either a 2 + 1 or 3 + 1 regimen. PCV15 reduced bIPD incidence in all three serotype classes (- 28% to - 89%) in infants, with the largest impact on ST3. PCV20 in both regimens resulted in more bIPD cases from PCV7 serotypes (+ 65% to + 350%), while PCV13-nonPCV7-nonST3 and ST3 bIPD cases increased in a 2 + 1 regimen (+ 28% and + 6%, respectively) but decreased in a 3 + 1 regimen (- 23% and - 30%, respectively), in infants.</p><p><strong>Conclusions: </strong>Implementation of PCV15 in a 2 + 1 regimen could reduce bIPD incidence due to all PCV13 serotypes in infants, whereas PCV20 in a 2 + 1 regimen may lead to substantial increases in bIPD cases from PCV13 serotypes in infants. PCV20 in a 3 + 1 regimen could potentially lead to a resurgence of bIPD from PCV7 serotypes in infants.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"753-764"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663236","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":"The Impact of the COVID-19 Omicron Variant on Immunocompromised Patients: ICU Admissions and Increased Mortality.","authors":"Jan Pander, Fabian Termorshuizen, Dylan W de Lange, Wendy Beekman-Hendriks, Josien Lanfermeijer, Ferishta Bakhshi-Raiez, Dave A Dongelmans","doi":"10.1007/s40121-025-01122-5","DOIUrl":"10.1007/s40121-025-01122-5","url":null,"abstract":"<p><strong>Introduction: </strong>The corona virus disease 19 (COVID-19) pandemic has presented a global health challenge, and several consecutive variants of the severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) virus have been dominant. Previous studies highlighted decreased mortality rates during the predominance of the omicron variant; however, severely immunocompromised individuals remained at high risk due to limited vaccine response. This study aims to compare mortality rates during the omicron period between immunocompromised and non-immunocompromised patients in intensive care units (ICUs) in The Netherlands.</p><p><strong>Methods: </strong>Utilizing data from the Dutch National Intensive Care Evaluation (NICE) registry, this study analyzed ICU admissions due to COVID-19 from February 2022 to December 2023. Patients were categorized as immunocompromised based on recorded immunologic insufficiencies or associated conditions. A historical cohort of viral pneumonia patients from 2017 to 2019 was used for comparison. Logistic regression analyses, adjusted for age, gender, body-mass index (BMI), and acute physiology and chronic health evaluation IV (APACHE-IV) mortality risk, compared in-hospital and ICU mortality and length of stay between groups. A sensitivity analysis excluded early omicron period admissions to assess the consistency of findings.</p><p><strong>Results: </strong>Among 1491 patients admitted to the ICU due to COVID-19, 29.5% were immunocompromised, showing significantly higher in-hospital adjusted odds ratio (OR_adj = 1.56, 95% CI 1.20-2.04) and ICU mortality (OR_adj = 1.64, 95% CI 1.25-2.17) compared to non-immunocompromised patients. The historical cohort exhibited lower mortality rates for immunocompromised individuals compared to the COVID-19 cohort. Sensitivity analysis confirmed these trends, with slight attenuation of odds ratios.</p><p><strong>Conclusion: </strong>Immunocompromised patients admitted to the ICU due to COVID-19 during the omicron period had higher mortality than non-immunocompromised patients. Additionally, immunocompromised patients with COVID-19 had higher mortality than immunocompromised patients with other viral pneumonias. Our results provide additional evidence that COVID-19 is still a significant health concern to immunocompromised individuals, which warrants specific and effective measures to protect this vulnerable group.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"881-888"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630385","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":"Risk of Severe COVID-19 in Four Immunocompromised Populations: A French Expert Perspective.","authors":"Paul Loubet, Ilies Benotmane, Slim Fourati, Florent Malard, Fanny Vuotto, Elodie Blanchard, François Raffi, Stéphanie Nguyen, Nicolas de Prost, Jérôme Avouac","doi":"10.1007/s40121-025-01124-3","DOIUrl":"10.1007/s40121-025-01124-3","url":null,"abstract":"<p><p>Immunocompromised patients are disproportionately impacted by severe disease, hospitalization, and mortality associated with coronavirus disease 2019 (COVID-19). To optimize the management of these patients in clinical practice, we convened an expert panel to review current evidence on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine responses and severe COVID-19 in immunocompromised populations. We identified four main immunocompromised groups-solid organ transplant recipients, patients receiving allogeneic hematopoietic stem cell transplantation or chimeric antigen receptor (CAR) T cell therapy, patients treated for hematologic malignancies, and patients treated for inflammatory diseases-who mount suboptimal humoral responses to SARS-CoV-2 vaccination and are at increased risk of severe COVID-19-related outcomes. A wide range of risk factors were associated with reduced vaccine responses and/or poor outcomes, most commonly older age, comorbidities, and the type and number of immunosuppressive therapies. We believe that early identification and close monitoring of these at-risk patients, plus regular booster vaccinations, prophylactic monoclonal antibody therapy, non-pharmacologic prevention measures, prompt antiviral treatment, and other risk mitigation strategies, are critical to protect against SARS-CoV-2 infection and severe COVID-19.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"671-733"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657163","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":"Economic Evaluation of Adolescent Vaccination with Serogroup ACWY and C Meningococcal Vaccines in Germany.","authors":"Sebastian Gruhn, Manuel Batram, Moritz Wick, Edith Langevin, Stefan Scholz, Wolfgang Greiner, Oliver Damm","doi":"10.1007/s40121-025-01132-3","DOIUrl":"10.1007/s40121-025-01132-3","url":null,"abstract":"<p><strong>Introduction: </strong>Invasive meningococcal disease (IMD) is a rare but serious condition caused by Neisseria meningitidis, with rising cases of serogroups W and Y in Germany. Currently, routine vaccination in Germany includes MenC vaccination in toddlers, and as of early 2024, MenB vaccination has been recommended in infancy. MenACWY vaccination, however, is currently only recommended for high-risk individuals. This study evaluates the potential public health impact and cost-effectiveness of introducing routine adolescent MenACWY or MenC vaccination in Germany.</p><p><strong>Methods: </strong>This study presents a health economic evaluation based on a previously published dynamic transmission model, which simulates the introduction of MenACWY vaccination in adolescents in Germany. The evaluation incorporates costs and quality-adjusted life years (QALYs), and is conducted from a societal perspective. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the findings and to account for parameter uncertainty.</p><p><strong>Results: </strong>The introduction of adolescent MenACWY vaccination was estimated to prevent 1467 IMD cases and 156 deaths by 2060, leading to a total gain of 2333 QALYs. The MenACWY vaccination strategy was associated with incremental costs of approximately €306 million, resulting in an incremental cost-effectiveness ratio (ICER) of €131,150 per QALY gained. Scenarios assuming higher levels of carriage protection reduced the ICER to as low as €76,000 per QALY. In contrast, adolescent MenC vaccination had a comparatively minor impact on IMD incidence and mortality, with ICERs exceeding €1 million per QALY. Sensitivity analyses highlighted the significant influence of assumed vaccine carriage protection and duration of protection on the ICER.</p><p><strong>Conclusions: </strong>Adolescent MenACWY vaccination in Germany has the potential to reduce the incidence and mortality of IMD, particularly from serogroups W and Y. Although the cost-effectiveness of the strategy depends on several assumptions, particularly the extent of carriage protection, the ICER for MenACWY introduction appears favorable.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"819-832"},"PeriodicalIF":4.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11993512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735751","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":"Are All Pharmacokinetic Equations Created Equal? A Comparative Analysis of Trapezoidal and Non-Trapezoidal Methods for Estimating Day 1 Area Under the Curve in Adult Hospitalized Patients with Staphylococcus aureus Bacteremia.","authors":"Abdulwhab Shremo Msdi, Alireza Fakhri Ravari, Jacinda C Abdul-Mutakabbir, Karen K Tan","doi":"10.1007/s40121-025-01115-4","DOIUrl":"10.1007/s40121-025-01115-4","url":null,"abstract":"<p><strong>Introduction: </strong>This study compared the calculated vancomycin area under the curve (AUC_0-24) using trapezoidal and non-trapezoidal first-order pharmacokinetic equations.</p><p><strong>Methods: </strong>This retrospective observational study included adult patients with documented MRSA bacteremia who received ≥ 48 h of intravenous vancomycin and had two consecutive serum levels after the first dose. AUC_0-24 was calculated using trapezoidal and non-trapezoidal equations. Correlation and agreement between methods were assessed using Pearson's correlation coefficient (r) and Bland-Altman plots. Significant predictors (p < 0.05) from simple linear regression were included in a multiple linear regression model to evaluate their impact on AUC_0-24 for both methods.</p><p><strong>Results: </strong>Fifty-two patients were included. The median age was 63 years (interquartile range [IQR]: 50-73), and the median vancomycin clearance was 4 l/h (IQR: 2-6). Median vancomycin AUC_0-24 was 399 mg∙h/l (IQR: 257-674) for the trapezoidal method and 572 mg∙h/l (IQR: 466-807) for the non-trapezoidal method. There was a strong correlation between the methods (r = 0.87 [95% CI, 0.79-1]; P < 0.01), but Bland-Altman analysis showed poor agreement, with a bias of - 198 mg∙h/l and 95% limits of agreement from - 482 to 86 mg∙h/l. In multiple linear regression, total daily dose and vancomycin clearance were independent predictors of AUC_0-24 for both methods, with a stronger impact on non-trapezoidal AUC_0-24 (adjusted R² = 0.70) than trapezoidal AUC_0-24 (adjusted R² = 0.59).</p><p><strong>Conclusions: </strong>Trapezoidal and non-trapezoidal equations are not interchangeable for estimating vancomycin AUC_0-24. The trapezoidal method consistently results in lower AUC_0-24 estimates than the non-trapezoidal method.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"615-626"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440741","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":"Economic Evaluation of Transitioning to the 20-Valent Pneumococcal Conjugate Vaccine in the Dutch Paediatric National Immunisation Programme.","authors":"Esra Çakar, An Ta, Michel Peters, Elizabeth Vinand, Angela Waterval-Overbeek, Aleksandar Ilic, Johnna Perdrizet","doi":"10.1007/s40121-025-01109-2","DOIUrl":"10.1007/s40121-025-01109-2","url":null,"abstract":"<p><strong>Introduction: </strong>In 2024, the vaccination strategy against pneumococcal disease in the Dutch paediatric population was changed from the 10-valent pneumococcal conjugate vaccine (PCV) (PCV10) to a 15-valent PCV (PCV15) under a 2 + 1 schedule. We aimed to assess whether switching from PCV15 under a 2 + 1 schedule to 20-valent PCV (PCV20) under a 3 + 1 schedule in the Dutch paediatric national immunisation programme (NIP) would yield economic savings and health benefits.</p><p><strong>Methods: </strong>A multiple-cohort population model with an annual cycle and 10-year time horizon was adapted for the Dutch population from a societal perspective. Discounting was set at 3.0% and 1.5% for costs and benefits, respectively. Medical and societal costs were calculated, along with cases of invasive and non-invasive pneumococcal disease, and quality-adjusted life years (QALY) for PCV15 and PCV20, from which, the incremental cost-effectiveness ratio (ICER) per QALY was calculated for PCV20 versus PCV15 to determine the economic benefits of PCV20. The model assumptions were tested in probabilistic and deterministic sensitivity analyses, as well as a series of scenario analyses.</p><p><strong>Results: </strong>Both medical and societal cost of disease were substantially lower with PCV20 versus PCV15 (incremental cost-savings of €130,113,010 and €61,593,168, respectively), with total incremental cost-savings of €29,365,696 when considering the cost of the vaccination programme. With an overall QALY gain of 33,232, the ICER per QALY placed PCV20 as the dominant strategy, as it was both more effective and less costly than PCV15. PCV20 was estimated to result in 57,657 fewer pneumococcal disease cases across invasive and non-invasive disease and 1561 fewer disease-related deaths. The sensitivity and scenario analyses demonstrated the robustness of the model results.</p><p><strong>Conclusion: </strong>This cost-effectiveness analysis demonstrated that switching from PCV15 2 + 1 to PCV20 3 + 1 in the Dutch paediatric NIP would reduce both the clinical burden and projected costs of pneumococcal disease over 10 years.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"527-547"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364641","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":"Cefiderocol for the Treatment of Nosocomial Bloodstream Infections Caused by Stenotrophomonas maltophilia: A Case Series and Literature Review.","authors":"Antonio Vena, Laura Mezzogori, Nadia Castaldo, Silvia Corcione, Renato Pascale, Maddalena Giannella, Simone Mornese Pinna, Daniele Roberto Giacobbe, Davide Fiore Bavaro, Vincenzo Scaglione, Benedetta Fumarola, Gabriele Pagani, Francesco Giuseppe De Rosa, Michele Bartoletti, Matteo Bassetti","doi":"10.1007/s40121-025-01117-2","DOIUrl":"10.1007/s40121-025-01117-2","url":null,"abstract":"<p><strong>Introduction: </strong>The treatment of Stenotrophomonas maltophilia bloodstream infections (BSI) remains challenging due to the organism's intrinsic multidrug resistance and the potential side effects of commonly used first-line antibiotics.</p><p><strong>Methods: </strong>Here, we describe four cases of S. maltophilia BSI treated with cefiderocol (≥ 72 h) in different Italian hospitals. Additionally, we conducted a PubMed search to identify other studies reporting cases of S. maltophilia BSI managed with cefiderocol.</p><p><strong>Results: </strong>We reviewed a total of 8 cases of S. maltophilia BSI [median age 52.5 years (Q1-Q3 27.5-61.0), 50% males] treated with cefiderocol, including ours. BSI sources were mainly central venous catheters (62.5%) and the lower respiratory tract (25.0%). Cefiderocol was used as first-line therapy in 87.5% of patients (7/8), with a median treatment duration of 14 days (IQR 6.2-16.0). Combination therapy was administered in 62.5% of cases. Infection source control was required in 75.0% and achieved in 40.0%. Clinical success was observed in 62.5% of patients, with microbiological eradication in 87.5%. In-hospital mortality occurred in 37.5% of cases, with one death directly attributable to S. maltophilia. No significant differences were observed in terms of outcomes between cefiderocol monotherapy and combination therapy.</p><p><strong>Conclusions: </strong>Based on our findings and a review of the literature, cefiderocol-based regimens show promise as an effective treatment option for S. maltophilia BSI, warranting further investigation in larger studies.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"657-669"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143541954","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":"Economic and Disease Burden Associated with Invasive Escherichia coli Disease in the United States.","authors":"Mark A Schmidt, Maxim Blum, Judy L Donald, Richard T Meenan, Elvira Carrió, Jan Poolman, Maureen P Neary, Thomas Verstraeten, Jeroen Geurtsen","doi":"10.1007/s40121-025-01112-7","DOIUrl":"10.1007/s40121-025-01112-7","url":null,"abstract":"<p><strong>Introduction: </strong>Invasive Escherichia coli disease (IED) incidence has increased over recent years among aging populations and has rising antimicrobial resistance. Here, we report on a comparative, cross-sectional, retrospective analysis of US patients with IED to quantify IED-related healthcare resource utilization (HCRU), costs, and impact on health-related quality of life (HRQoL).</p><p><strong>Methods: </strong>This study included Kaiser Permanente Northwest (KPNW) members aged ≥ 60 years enrolled between July 2019 and January 2020. Patients were divided into three groups: Group 1 had experienced a recent IED episode (≤ 3 weeks before enrollment); Group 2 had experienced a former IED episode (13-18 months before enrollment); Group 3 was at risk with no prior history of IED. Data were collected from electronic hospital records, a patient survey, and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire. Mean costs were adjusted according to individual follow-up.</p><p><strong>Results: </strong>Patient characteristics were generally consistent across Groups 1 (n = 289), 2 (n = 319), and 3 (n = 340). Inpatient hospitalization was observed in 84%, 44%, and 15% of patients in Groups 1, 2 and 3, respectively. Mean direct costs per patient (per 30-day follow-up) were $17,168, $2530, and $1094 in Groups 1, 2, and 3, respectively. Mean total costs per patient in the year following an IED episode (Group 2) were $35,034 vs. $16,163 in the at-risk Group 3. HRQoL was poor for patients with recent IED, with a mean EQ-5D-5L utility index value of 0.25 on the worst day of illness. During a 12-month follow-up period, rehospitalization rates and mean number of antibiotic prescriptions were ~ threefold higher for patients who recovered from IED vs. those at risk.</p><p><strong>Conclusions: </strong>These data demonstrate substantial short- and long-term impacts of IED on HCRU, IED-related costs, and HRQoL. Additional research is needed to further value the impact of novel IED prevention strategies.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"569-586"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373945","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":"Oral vs. Outpatient Parenteral Antimicrobial Treatment for Infective Endocarditis: Study Protocol for the Spanish OraPAT-IE GAMES Trial.","authors":"Guillermo Cuervo, Marta Hernández-Meneses, Arístides de Alarcón, Rafael Luque-Marquez, María M Alonso-Socas, Ana López-Lirola, Víctor González-Ramallo, Ane J Goikoetxea-Agirre, David Nicolás, Miguel A Goenaga, Esperanza Merino, Francesc Escrihuela-Vidal, Pilar Martín-Dávila, Belén Loeches, Lucía Boix-Palop, Oriol Gasch, Marta Camprecios, Alicia Hernández-Torres, Lara García-Álvarez, Marcos Pajarón, María Angels Ribas, Rosa Blanes-Hernández, Inmaculada López-Montesinos, Luis E López-Cortés, Bárbara Vidal, Mariana Fernández-Pittol, Dolores Navarro, Asunción Moreno, Coral Sala, Juan Ambrosioni, José M Miró","doi":"10.1007/s40121-025-01110-9","DOIUrl":"10.1007/s40121-025-01110-9","url":null,"abstract":"<p><strong>Introduction: </strong>The POET trial demonstrated that moving from intravenous to oral antibiotics in stable patients with left-sided infective endocarditis (IE) was noninferior to fully parenteral treatment. However, it did not compare outpatient strategies.</p><p><strong>Methods: </strong>The OraPAT-IE GAMES trial is a noninferiority, multicenter, randomized, open-label study aimed to compare partial oral versus outpatient parenteral antibiotic therapy (OPAT) for consolidation of antibiotic treatment in left-sided IE. A total of 342 stable patients with IE caused by selected micro-organisms will eventually be included. After a minimum of 10 days of parenteral treatment, stable patients are randomized to oral therapy or OPAT. The primary end-point is a composite of all-cause mortality, unplanned cardiac surgery, relapse of positive blood cultures and/or unplanned hospital admission. Patients are followed-up for 6 months after completing antibiotic therapy.</p><p><strong>Planned outcome: </strong>This trial seeks to demonstrate the equivalent efficacy of the two outpatient strategies currently available for stable patients with IE in the consolidation phase of antibiotic treatment.</p><p><strong>Conclusion: </strong>In a global context of limited healthcare resources and a sustained increase in elderly and frail patients, it is of great importance to demonstrate the effectiveness and safety of outpatient management strategies that could reduce the duration of conventional hospitalizations with their potential complications and inherent costs.</p><p><strong>Trial registration: </strong>EudraCT: 2020-001024-34.</p><p><strong>Clinicaltrials: </strong>gov identifier: NCT05398679.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"643-655"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143536517","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":"Modelling the Epidemiological Impact of Different Adult Pneumococcal Vaccination Strategies in the United Kingdom.","authors":"Rachel J Oidtman, Giulio Meleleo, Oluwaseun Sharomi, Ian R Matthews, Dionysios Ntais, Robert B Nachbar, Tufail M Malik, Kevin M Bakker","doi":"10.1007/s40121-025-01111-8","DOIUrl":"10.1007/s40121-025-01111-8","url":null,"abstract":"<p><strong>Introduction: </strong>Pneumococcal conjugate vaccines (PCVs) were first introduced in the paediatric United Kingdom (UK) immunisation programme in 2006 which led to significant declines in invasive pneumococcal disease (IPD) caused by targeted serotypes. Although paediatric PCVs provide some indirect protection to adults, a significant IPD burden remains in older adults. Here, we compared three adult (65+ years-old) and risk group (2-64-year-old) vaccination scenarios, namely a continuation of the status quo with PPSV23 vaccination, using the recently licensed-in-adults PCV20, or using the new adult-focused 21-valent PCV, V116.</p><p><strong>Methods: </strong>A population-level compartmental dynamic transmission model (DTM) was adapted to the UK setting. The model described Streptococcus pneumoniae carriage transmission dynamics and disease progression in the presence of age- and serotype-specific pneumococcal vaccines. We calibrated the DTM to age- and serotype-specific IPD data in the UK and used the model to make projections under the different adult vaccination scenarios while keeping PCV13 immunisation in children.</p><p><strong>Results: </strong>The calibrated model yielded reasonable parameter values and model fits that closely matched observed IPD dynamics. Among 65+ year-olds, 10-year model projections predicted that the routine use of V116 would reduce IPD incidence by 15.5%, while PCV20 would reduce IPD incidence by 8.9% and the continued use of PPSV23 would increase incidence by 3.83%. There was a notable decrease in IPD incidence in the serotypes unique to V116. In the serotypes included in PCV20 but not V116, the model did not predict a resurgence of IPD.</p><p><strong>Conclusions: </strong>Projections revealed that in adults, V116 led to significantly greater reductions in IPD in the 65+ year-old population compared with PCV20 or PPSV23.</p>","PeriodicalId":13592,"journal":{"name":"Infectious Diseases and Therapy","volume":" ","pages":"587-602"},"PeriodicalIF":4.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390864","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}