Open Forum Infectious Diseases最新文献

{"title":"In Pursuit of the Optimal Antimicrobial Stewardship Practice Model: A Multihospital Analysis of Direct Patient Care Interventions to Characterize the Role of Infectious Diseases Pharmacists.","authors":"Harrison Phan, Jefferson Cua, Alice Margulis Landayan, Lourdes R Menendez Alvarado, Lee Amaya, Josh Caraccio, Timothy P Gauthier","doi":"10.1093/ofid/ofaf510","DOIUrl":"10.1093/ofid/ofaf510","url":null,"abstract":"<p><p>This retrospective analysis across 3 hospitals evaluates antimicrobial stewardship interventions by clinical pharmacists, specialist pharmacists, and infectious diseases specialist pharmacists. Findings highlight differences in intervention types, urgency, and complexity, underscoring the value of infectious diseases specialist pharmacists in optimizing patient care and antimicrobial use within a multitiered pharmacy practice model.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf510"},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intensified Treatment of Tuberculous Meningitis in Adults: A Systematic Review and Meta-analysis.","authors":"Andrea Llamas-Lopez, James A Seddon, Felicia C Chow, Caryn M Upton, Sanjay K Jain, Jan-Willem Alffenaar, Daniel J Grint, Kelly Dooley, Rob Aarnoutse, Fiona V Cresswell","doi":"10.1093/ofid/ofaf503","DOIUrl":"10.1093/ofid/ofaf503","url":null,"abstract":"<p><strong>Background: </strong>Tuberculous meningitis (TBM) remains the deadliest form of tuberculosis. Inadequate penetration of rifampicin and ethambutol into the brain and cerebrospinal fluid (CSF) may contribute to mortality. Over the last decade, research has focused on \"intensified\" treatment (higher-dose first-line drugs or addition of second-line drugs with good CSF penetration). This systematic review and meta-analysis evaluates the impact of intensified TBM treatment on mortality, disability, and safety.</p><p><strong>Methods: </strong>A systematic literature search was conducted of clinical trials examining intensified TBM treatments compared with a rifampicin-based standard-of-care regimen in adults. Odds ratios (ORs) were calculated using a random-effects model with mortality as the primary outcome, with OR <1 indicating lower mortality. Disability and safety were examined as secondary outcomes. Subgroup analyses included (1) higher-dose rifampicin, (2) addition of fluoroquinolones, and (3) addition of linezolid.</p><p><strong>Results: </strong>Ten trials meeting eligibility criteria, involving 1369 participants, were included. Higher-dose rifampicin (n = 1050; OR, 0.86; 95% CI, 0.54-1.35; <i>P</i> = .50), adjunctive fluoroquinolones (n = 1115; OR, 0.85; 95% CI, 0.56-1.27; <i>P</i> = .42), and linezolid (n = 79; OR, 0.73; 95% CI, 0.22-2.43; <i>P</i> = .61) did not significantly reduce TBM mortality. Due to heterogeneity in disability and safety endpoints, secondary outcomes could not be meta-analyzed.</p><p><strong>Conclusions: </strong>Current clinical trial evidence does not support the use of intensified TBM treatment in adults. However, these analyses are limited by diverse TBM case definitions, absence of MRC grading at enrollment, variable rifampicin dosing, limited data on linezolid and higher-dose isoniazid, and heterogeneous disability and safety outcomes. Use of uniform case definitions and consistent endpoints is essential to standardize data.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf503"},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Infectious Diseases in People Who Use Drugs Introduction.","authors":"Laura Marks","doi":"10.1093/ofid/ofaf557","DOIUrl":"10.1093/ofid/ofaf557","url":null,"abstract":"","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf557"},"PeriodicalIF":3.8,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fever in Sepsis Revisited: Is a Little Heat What We Need?","authors":"Alwin Tilanus, Wilmer Villamil","doi":"10.1093/ofid/ofaf608","DOIUrl":"10.1093/ofid/ofaf608","url":null,"abstract":"<p><p>Fever can be described as a coordinated rise in temperature in response to infectious and noninfectious causes, which varies with the anatomical site. This adaptive heat shock response has been conserved for millions of years in vertebrates. Elevated temperature stimulates and optimizes innate and adaptive immune responses. In addition, most microorganisms have shown thermal stress-related growth inhibition, and in vitro data indicate that β-lactam antibiotics in particular appear to have significantly improved susceptibility profiles in the presence of fever-range temperatures. Despite these favorable effects of fever, many physicians consider fever a harmful event that should be treated without discrimination of the underlying cause. Observational studies have indicated that attempts to lower the temperature in patients with sepsis are associated with increased mortality. This article aims to summarize the most relevant results of the existing clinical data and provide the clinician with guidance on how to manage fever in patients with sepsis.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf608"},"PeriodicalIF":3.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Laboratory Features of Hemophagocytic Lymphohistiocytosis in People With Disseminated Histoplasmosis.","authors":"Burton Mandrell, Tatsiana Savenka, Michael Saccente","doi":"10.1093/ofid/ofaf602","DOIUrl":"10.1093/ofid/ofaf602","url":null,"abstract":"<p><strong>Background: </strong>Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome involving pathologic excitation of the immune system. Disseminated histoplasmosis (DH) is a known trigger of HLH. However, the prevalence of HLH in DH is unknown. Limited data exist on risk factors and outcomes. The goals of this study are to determine the prevalence of HLH among participants with DH at a single center, identify risk factors for HLH in this population, and describe the treatment and outcomes of people with DH and HLH.</p><p><strong>Methods: </strong>We retrospectively identified cases of DH at our institution from 2014 to 2022 and reviewed electronic medical records. We used HLH-2004 criteria to identify those with HLH.</p><p><strong>Results: </strong>Among 110 participants with DH, 22 (20%) met criteria for HLH. In the subset who were hospitalized, 24% (22/93) had HLH. Compared to participants without HLH, the HLH cohort was more likely to have serum ferritin above the limit of quantification (LOQ) (>15 000 ng/ml), urine <i>Histoplasma</i> antigen above the LOQ (>19 ng/mL), serum 1,3 beta-D-glucan (BDG) above the LOQ (>500 pg/mL), and more likely to require intensive care. There was no significant difference in HIV/AIDS status, race, or sex. Mortality was numerically higher in the HLH cohort (18% vs 7%), but the difference was not statistically significant.</p><p><strong>Conclusions: </strong>Nearly a quarter of participants with DH admitted to our hospital had HLH. Extreme levels of serum ferritin, urine <i>Histoplasma</i> antigen, and serum BDG should prompt investigation for HLH. Further studies are needed to assess optimal treatment strategies.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf602"},"PeriodicalIF":3.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12530318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling the Potential Impact of Mentor Mother Programs on Vertical Transmission of HIV in Kenya.","authors":"Horacio A Duarte, James G Carlucci, Nadia A Sam-Agudu, Lisa L Abuogi, Eva A Enns, Jeanette K Birnbaum","doi":"10.1093/ofid/ofaf606","DOIUrl":"10.1093/ofid/ofaf606","url":null,"abstract":"<p><strong>Background: </strong>Peer support provided by \"mentor mothers\" (MM) may increase retention in care for pregnant and breastfeeding women (PBFW) living with HIV, which can lead to improved viral suppression and prevention of vertical transmission (PVT). The impact of MM on PVT may differ among PBFW subpopulations with different baseline risks of antiretroviral therapy (ART) interruption.</p><p><strong>Method: </strong>We used a microsimulation model of HIV progression and care for PBFW living with recently acquired HIV in Kenya to evaluate an MM program that reduced the cumulative risk of ART interruption between initiation of antenatal care and 18 months of postpartum breastfeeding by 40%. We conducted this evaluation in 2 maternal populations: (1) newly positive (NP) pregnant women who initiate ART during antenatal care and are at greater risk of ART interruption and (2) known positive (KP) women who initiate ART prior to conception. We simulated live births, maternal deaths, and vertical transmission with and without MM services to determine the impact of MM.</p><p><strong>Results: </strong>In the absence of MM services, infants acquired HIV at a rate of 609 vs. 459 per 10,000 live births in the NP vs. KP populations. MM services reduced vertical transmission by 15.1% among NP women, compared to a 6.5% reduction among KP women.</p><p><strong>Conclusions: </strong>MM services can reduce vertical transmission among PBFW living with HIV, with greater potential for PVT among NP women compared to KP women. More research evaluating MM programs in these 2 maternal populations will help refine estimates of their PVT impact.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf606"},"PeriodicalIF":3.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12534729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145329688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Clinical Outcomes of Multiple Viral Infections After Allogeneic Hematopoietic Cell Transplantation.","authors":"Kar Yee Yong, Shio Yen Tio, Beatrice Z Sim, Joe Sasadeusz, Alex Rivalland, Lynette Chee, Jeff Szer, Tim Spelman, Monica Slavin, David Ritchie, Michelle K Yong","doi":"10.1093/ofid/ofaf597","DOIUrl":"10.1093/ofid/ofaf597","url":null,"abstract":"<p><strong>Background: </strong>Recipients of allogeneic hematopoietic cell transplantation (alloHCT) are at risk of multiple viral infections. However, our knowledge about the clinical impact of viruses following alloHCT is predominantly focused on outcomes of a single viral infection such as cytomegalovirus (CMV). This retrospective cohort study aimed to evaluate the incidence, risk factors, and clinical outcomes of multiple viral infections in the first year following alloHCT.</p><p><strong>Methods: </strong>All microbiologically confirmed viral infection of CMV, Epstein-Barr virus (EBV), BK polyomavirus (BKV), varicella zoster virus, human herpesvirus 6, herpes simplex virus, and various respiratory viruses were reviewed up to 12 months post-alloHCT.</p><p><strong>Results: </strong>Among 430 alloHCT recipients, 744 viral infections were observed within the first year posttransplantation, predominantly CMV (55%), followed by EBV (51%) and BKV (21%). Eighty-five percent of patients had at least 1 viral infection, of which 34% had 2 and 24% had ≥3 viruses. Independent risk factors of multiple viral infections included CMV serostatus (R⁺/D^-: hazard ratio [HR], 2.59 [95% confidence interval {CI}, 2.03-3.30]; R^-/D⁺: HR, 2.25 [95% CI, 1.66-3.05]), haploidentical donor (HR, 1.56 [95% CI, 1.18-2.06]), T-cell depletion use (HR, 1.44 [95% CI, 1.11-1.88]), and grade III-IV acute graft-versus-host disease (HR, 1.44 [95% CI, 1.15-1.80]). Patients experiencing multiple viral infections (≥3 vs 2 vs 1) had an earlier time to onset of first infection (median, 18 vs 25 vs 40 days), were hospitalized for an increased number of days (median, 53 vs 40 vs 37 days), and had lower survival probability at day 270 following infusion (<i>P</i> = .044).</p><p><strong>Conclusions: </strong>Multiple viral infections were frequently observed, with a significant impact on morbidity and mortality following alloHCT.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf597"},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absence of Macrolide-Resistant Mutations in <i>Bordetella pertussis</i> in Antananarivo (Madagascar) and Cambodia During the Last Pertussis Cycle Before the COVID-19 Pandemic.","authors":"Florence Campana, Mahdi Rajabizadeh, Mallorie Hide, Gauthier Delvallez, Samrach Han, Lala Rafetrarivony, Bunnet Dim, Aina Harimanana, Gaelle Noel, Mohand Ait-Ahmed, Jean-Marc Collard, Laurence Borand, Nicole Guiso, Fabien Taieb","doi":"10.1093/ofid/ofaf566","DOIUrl":"10.1093/ofid/ofaf566","url":null,"abstract":"<p><p>Macrolides are the first-line treatment against pertussis. The high prevalence of macrolide-resistant <i>Bordetella pertussis</i> (MRBP) strains reported in China is concerning. MBRP might be underestimated in other countries. Looking for the mutation causative for MRBP in retrospective studies conducted in Madagascar and Cambodia, we found no MRBP.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf566"},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Bacillus Calmette-Guérin Vaccination and Impact on HIV-1 Latent Reservoir Size in People With Treated HIV-1 Infection.","authors":"Emily West, Sandra E Chaudron, Doris Russenberger, Christina Grube, Karin J Metzner, Kathrin Neumann, Jasmin Tschumi, Marisa Kälin, Terence K Tutumlu, Cédric Dollé, Roger D Kouyos, Huldrych F Günthard, Dominique L Braun, Johannes Nemeth","doi":"10.1093/ofid/ofaf611","DOIUrl":"https://doi.org/10.1093/ofid/ofaf611","url":null,"abstract":"<p><strong>Background: </strong>Bacillus Calmette-Guérin (BCG) vaccination, used against tuberculosis, is recognized for its immunomodulatory properties, a phenomenon referred to as \"trained immunity.\" Given these effects, there is increasing interest in evaluating its safety and impact on immune function in people living with HIV-1 (PWH). Historically, BCG was contraindicated in PWH due to safety concerns in immunocompromised individuals. This study aims to assess both the safety of BCG in PWH and its effects on the HIV-1 latent reservoir size.</p><p><strong>Methods: </strong>This Phase IIA randomized, double-blind, placebo-controlled, single-center trial enrolled 60 PWH with a suppressed viral load and CD4 T-cell count >350/μL. Participants were randomized in a stepped-wedge design into equal groups for early or late BCG vaccination. Each participant received a single intradermal dose of BCG vaccine followed by a placebo 3 months later, or vice versa. The HIV-1 latent reservoir was quantified at 3-month intervals to day 270. The primary endpoint was the HIV-1 reservoir size 6 months postvaccination, with secondary endpoints including safety outcomes.</p><p><strong>Results: </strong>No significant differences were found in intact proviral HIV-1 DNA levels at 6 months compared to baseline. Local reactions occurred in 96% of participants, leading to scarring in 73%. No systemic infections or serious BCG-related adverse events were observed.</p><p><strong>Conclusions: </strong>BCG vaccination is safe in PWH, but local skin reactions including scarring are common. There was no significant effect on the HIV-1 reservoir. These findings provide valuable insights into the safety profile of BCG vaccination in PWH, emphasizing its potential for broader immunological studies.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf611"},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12538675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145346393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Features of Carbapenem-resistant Gram-negative Bacterial Infections in Japan Based on the Setting of Onset.","authors":"Yuya Kawamoto, Yusuke Asai, Aki Sakurai, Yasufumi Matsumura, Ryota Hase, Hideaki Kato, Takashi Matono, Naoya Itoh, Takehiro Hashimoto, Go Yamamoto, Momoko Mawatari, Takeya Tsutsumi, Tetsuya Suzuki, Shinya Tsuzuki, Koji Ohyama, Masahiro Suzuki, Kayoko Hayakawa, Kohei Uemura, David van Duin, Norio Ohmagari, Yohei Doi, Sho Saito","doi":"10.1093/ofid/ofaf585","DOIUrl":"10.1093/ofid/ofaf585","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Gram-negative bacilli (CR-GNB) are a major public health threat, traditionally linked to hospital settings. However, infections are increasingly reported in the community, and the clinical distinctions between community-associated (CA) and healthcare-associated (HA) infections remain unclear.</p><p><strong>Methods: </strong>We conducted a prospective multicenter study of hospitalized patients with CR-GNB infections across 13 Japanese tertiary hospitals between April 2019 and March 2024. Infections were categorized as CA, HA, or hospital-onset (HO) using standardized criteria. We compared patient demographics, microbiological findings, infection sites, and clinical outcomes based on the setting of onset.</p><p><strong>Results: </strong>Among 425 patients, 43 had CA, 59 HA, and 323 HO infections. <i>Pseudomonas aeruginosa</i> was the predominant pathogen in all groups. <i>Aeromonas</i> species were more frequently associated with CA than HO cases (23.3% of CA vs 2.2% of HO cases), whereas <i>Stenotrophomonas maltophilia</i> was detected almost exclusively among HO cases. Hospital-onset infections were associated with longer median hospital stays compared with CA infections (68 vs 17 days) and a trend toward higher 30-day mortality (23.9% vs 9.5%). In contrast, HA infections demonstrated no significant differences from CA infections in either hospital length of stay (23 vs 17 days) or 30-day mortality rate (10.3% vs 9.5%).</p><p><strong>Conclusions: </strong>Community-associated CR-GNB infections are an emerging concern in Japan, showing distinct pathogen profiles and infection sites compared to HO cases. Importantly, HA infections resembled CA infections in terms of clinical characteristics and outcomes, suggesting a need to reexamine the clinical relevance of current HA classification criteria for guiding therapy and risk stratification.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 10","pages":"ofaf585"},"PeriodicalIF":3.8,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12527233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145308835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}