Open Forum Infectious Diseases最新文献

{"title":"Effect of Early and Delayed Treatment With Remdesivir on Mortality in Patients Hospitalized With COVID-19.","authors":"Steve R Makkar, Kristen Hansen, Nathan Hotaling, Andrew Toler, Hythem Sidky","doi":"10.1093/ofid/ofae740","DOIUrl":"10.1093/ofid/ofae740","url":null,"abstract":"<p><strong>Background: </strong>We applied a target trial emulation framework to estimate the association between early and delayed initiation of remdesivir (RDV) with mortality in hospitalized adults between May 1, 2020, and July 31, 2024, with varying coronavirus disease 2019 (COVID-19) clinical severity.</p><p><strong>Methods: </strong>Using electronic health records in the National COVID Cohort Collaborative (N3C) database, we emulated a sequence of randomized target trials initiated on each of the first 7 days of hospitalization. We identified 373 226 eligible person-trial hospitalizations, of which 53 959 were initiators and 319 267 were noninitiators of RDV treatment. Patients were divided into clinical severity subgroups based on baseline oxygenation, which included no supplemental oxygen (NSO), noninvasive supplemental oxygen (NISO), or invasive ventilation (IV). In each trial, initiators were matched with replacement to noninitiators receiving the same oxygenation type. Trials beginning on days 1-3 and days 4-7 of hospitalization were pooled separately to evaluate the effects of early and delayed initiation of RDV, respectively. Cox proportional hazards regression was used to estimate the marginal hazard ratio for mortality between initiators and noninitiators within each treatment delay.</p><p><strong>Results: </strong>Across trials, 53 449 initiators were matched to 26 600 unique noninitiators. Early, but not delayed, RDV treatment was associated with a reduction in 60-day mortality in the NSO (hazard ratio [HR], 0.89; 95% CI, 0.84-0.95) and NISO subgroups (HR, 0.91; 95% CI, 0.84-0.99), but not in those receiving IV. Results were consistent across sensitivity analyses.</p><p><strong>Conclusions: </strong>Early treatment with RDV is associated with reduced mortality risk in hospitalized COVID-19 patients either not on supplemental oxygen or receiving noninvasive supplemental oxygen.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofae740"},"PeriodicalIF":3.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878583/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557377","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":"Validation of Algorithms to Detect Acute and Disseminated Lyme Disease in U.S. Administrative Claims Data.","authors":"Sheryl A Kluberg, Noelle M Cocoros, June O'Neill, Thomas G Boyce, Maria E Sundaram, Anna Schotthoefer, Robert T Greenlee, Djeneba Audrey Djibo, Cheryl N McMahill-Walraven, John Aucott, Jennifer C Moïsi, Luis Jodar, Sarah J Willis, James H Stark","doi":"10.1093/ofid/ofaf109","DOIUrl":"10.1093/ofid/ofaf109","url":null,"abstract":"<p><strong>Background: </strong>Lyme disease (LD) is the most common vector-borne disease in the United States, though traditional LD surveillance underestimates the burden of disease. We validated algorithms for early localized and disseminated LD, with and without LD-specific diagnosis codes, in states with high incidence and their neighboring states with low LD incidence.</p><p><strong>Methods: </strong>We identified cohorts of potential incident LD cases in administrative insurance claims data, October 2015-October 2023, in 1 national and 1 regional insurer. Three algorithms were studied: a primary algorithm of an LD-specific diagnosis code and indicated antibiotic and 2 secondary algorithms for disseminated LD requiring a non-LD-specific musculoskeletal or neurologic diagnosis code, an antibiotic, and an LD diagnostic test. We included individuals from high LD-incidence states and neighboring low LD-incidence states. We validated the algorithms using medical records for a sample of potential cases, classifying them according to modified surveillance case definitions. We calculated positive predictive values (PPVs) for each algorithm.</p><p><strong>Results: </strong>Overall, we identified 9483 potential LD cases in claims data and reviewed 841 medical records. The PPVs for the primary algorithm were 90.7% and 81.3% in high-incidence and neighboring states, respectively, when suspect, probable, and confirmed cases were included; they were 76.6% and 28.0% when only confirmed and probable were included. For confirmed and possible cases, the secondary musculoskeletal algorithm PPVs were 12.9% and 4.1%, and the secondary neurologic algorithm PPVs were 6.2% and 1.8% in high-incidence and neighboring states, respectively.</p><p><strong>Conclusions: </strong>This study found that claims-based algorithms requiring diagnosis codes for LD or for related symptoms, in addition to other criteria, can identify cohorts of true LD cases. These algorithms, adjusted for PPV, can be used to estimate LD incidence in the United States.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 4","pages":"ofaf109"},"PeriodicalIF":3.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753836","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":"Analyzing the Donor Dilemma: Outcomes of Kidney Transplant Recipients From Donors With Positive Blood Cultures Obtained at Organ Procurement.","authors":"Petros A Svoronos, R Alfonso Hernandez Acosta, Prakhar Vijayvargiya, Pradeep Vaitla, James Wynn, Christopher Anderson, Jason Parham, Elena Beam, M Rizwan Sohail, Zerelda Esquer Garrigos","doi":"10.1093/ofid/ofae694","DOIUrl":"10.1093/ofid/ofae694","url":null,"abstract":"<p><p>Based on expert consensus, the American Society of Transplantation recommends 7-14 days of preventive antibiotic therapy for solid organ transplant recipients from donors with positive blood cultures. We evaluated management and outcomes of kidney transplant recipients from these donors.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofae694"},"PeriodicalIF":3.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878561/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556921","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":"Three-Year Effectiveness of Bictegravir/Emtricitabine/Tenofovir Alafenamide as a Switch Strategy in the Real World.","authors":"Alejandro de Gea-Grela, Rafael Micán, Rosa de Miguel, Lucía Serrano, Cristina Marcelo, María Luisa Montes, Luis Ramos-Ruperto, Carmen Busca, María Del Mar Arcos-Rueda, Rocío Montejano, Jose Ramon Arribas, Juan Gonzalez-García, José Ignacio Bernardino, Luz Martín-Carbonero","doi":"10.1093/ofid/ofaf087","DOIUrl":"10.1093/ofid/ofaf087","url":null,"abstract":"<p><strong>Background: </strong>We previously described the effectiveness of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) as a switch strategy in real life in people with HIV (PWH) at 48 weeks. We did not find that previous nucleoside reverse transcriptase inhibitor (NRTI) resistance-associated mutations (RAMs) had an impact on efficacy. Herein we report response rates after 3 years of follow-up.</p><p><strong>Methods: </strong>This retrospective review comprised PWH who were treatment experienced and switched to B/F/TAF in a single-center cohort. HIV RNA <50 copies/mL was analyzed at 96 and 144 weeks in an intention-to-treat analysis (missing = failure) and per-protocol analysis; patients with missing data or changes for reasons other than virologic failure were excluded.</p><p><strong>Results: </strong>An overall 506 PWH were included: 16.2% were women, the median age was 52.3 years, the median time of HIV infection was 18.9 years, and 13.6% had documented preexisting NRTI RAMs. At 96 weeks of follow-up in the intention-to-treat and per-protocol analyses, HIV RNA <50 copies/mL was seen in 73.1% and 95.4%, respectively. At 144 weeks, these figures were 68.2% and 94%. There were no statistically significant differences between patients with and without previous NRTI RAMs. A total of 140 patients were excluded for the per-protocol analysis at week 144: 46 were lost to follow-up, 32 discontinued treatment due to toxicity, 34 simplified to dual antiretroviral therapy, 7 switched for other reasons, and 20 patients died (no death was B/F/TAF related).</p><p><strong>Conclusions: </strong>Through 3 years of follow-up, switching to B/F/TAF maintained high rates of virologic suppression in long-term PWH. These results were seen even in patients with preexisting NRTI RAMs.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf087"},"PeriodicalIF":3.8,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886859/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586582","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":"Clinicodemographic and Radiological Features of Infective Ring-Enhancing Brain Lesions: A 4-Year Retrospective Study at a Tertiary Referral Center.","authors":"Edwin Chong Yu Sng, Ling Ling Chan, Edwin Philip Conceicao, Min Jia Wong, Dorothy Hui Lin Ng, Hwee Kuan Lee, Candice Yuen Yue Chan","doi":"10.1093/ofid/ofaf095","DOIUrl":"10.1093/ofid/ofaf095","url":null,"abstract":"<p><strong>Background: </strong>The diagnostic evaluation of ring-enhancing brain lesions (REBLs) is challenging, especially in immunocompromised patients. We conducted a retrospective study to describe the clinicodemographic and radiological features among patients presenting with REBLs to a tertiary referral center.</p><p><strong>Methods: </strong>Radiological reports of all patients who underwent brain computed tomography or magnetic resonance (MR) imaging between 1 November 2013 and 31 October 2017 were filtered for terms indicative of REBLs. Infectious diseases physicians reviewed the medical records to confirm the diagnosis.</p><p><strong>Results: </strong>Over the 4-year study period, there were 42 patients with infective REBLs and 249 with neoplastic REBLs. Pyogenic brain abscesses (PBAs) (20 of 42 [47.6%]) were the most common cause of infective REBLs, followed by tuberculous brain abscesses (TBAs) (9 of 42 [21.4%]) and <i>Nocardia</i> brain abscesses (NBAs) (6 of 42 [14.3%]). The patients were predominantly male, with a mean age of 55.2 years. Fewer than half were febrile at presentation. Cerebrospinal fluid investigations established the microbiological diagnosis in fewer than half of those who underwent lumbar puncture or extraventricular drain insertion. Conversely, brain biopsy yielded the microbiological diagnosis in almost all patients (16 of 17) who underwent the operation. Median white blood cell counts and C-reactive protein were higher in those with PBAs or NBAs than in those with TBAs. All with PBAs and NBAs who underwent MR imaging had diffusion-weighted imaging-hyperintense lesions, compared with only about half of those with TBAs.</p><p><strong>Conclusions: </strong>Our study has revealed important distinguishing features between infective REBLs and neoplastic REBLs and between PBAs, TBAs, and NBAs.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf095"},"PeriodicalIF":3.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567777","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":"New All-Oral Short-term Regimen for Multidrug-Resistant Tuberculosis: A Semi-randomized Controlled Trial Conducted in China.","authors":"Wei Jing, Qingfeng Wang, Jun Wang, Liping Ma, Mailing Huang, Jing Wang, Yadong Du, Baoyun Cai, Wenhui Shi, Qi Li, Xuelian Li, Naihui Chu, Wenjuan Nie","doi":"10.1093/ofid/ofaf020","DOIUrl":"10.1093/ofid/ofaf020","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the efficacy and safety of an all-oral short-term regimen for treating multidrug-resistant tuberculosis (MDR-TB).</p><p><strong>Methods: </strong>In this semirandomized, controlled, multicenter clinical study, patients with MDR-TB who were sensitive to fluoroquinolones were assigned to treatment groups at enrollment. Patients were assigned to group C (4-6 months: bedaquiline + linezolid + clofazimine + moxifloxacin + cycloserine; 5 months: clofazimine + moxifloxacin + cycloserine) unless this protocol was unsuitable or unacceptable, in which case they were randomly assigned to group A (4-6 months: isoniazid + ethambutol + pyrazinamide + protionamide + amikacin + clofazimine + moxifloxacin; 5 months: ethambutol + pyrazinamide + clofazimine + moxifloxacin) or group B (4-6 months: isoniazid + ethambutol + pyrazinamide + protionamide + linezolid + clofazimine + moxifloxacin; 5 months: ethambutol + pyrazinamide + clofazimine + moxifloxacin). The primary outcome was the proportion of patients achieving successful outcomes.</p><p><strong>Results: </strong>From September 2020 to June 2023, 397 patients with MDR-TB were screened and 360 were enrolled. Among them, 90.3% of group C achieved good treatment outcomes, as compared with 57.1% in group A (control) and 75.0% in group B. Group C demonstrated higher sputum culture conversion and pulmonary cavity closure rates than group B, with group A showing the lowest rates. The most common adverse events were skin blackening (29.3%) and hyperuricemia (20.6%). Prolonged QT intervals were observed in 39 participants, predominantly in group C (24.3%).</p><p><strong>Conclusions: </strong>The all-oral 9- to 11-month short-term regimen shows promise as a new treatment option for MDR-TB. Incorporating bedaquiline into an orally administered regimen may improve treatment outcomes and reduce relapse rates. Despite certain limitations, these findings provide valuable insights for developing improved treatments for MDR-TB in China.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf020"},"PeriodicalIF":3.8,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557379","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":"A Novel Giant Magnetoresistance-Enabled Multiplex Polymerase Chain Reaction Assay for the Diagnosis of Invasive Fungal Infection.","authors":"Paschalis Vergidis, Eloy E Ordaya, Emma Porter, Hannah Sweet, Wei Wang, Anton F Evans, Chi Zhang, Jo-Anne H Young, Xiaoying Liu","doi":"10.1093/ofid/ofaf068","DOIUrl":"10.1093/ofid/ofaf068","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in clinical microbiology, the diagnosis of invasive fungal infections remains challenging. Giant magnetoresistance (GMR) is a novel technology that enables the detection of trace amounts of cell-free DNA (cfDNA). We evaluated a high-multiplex molecular diagnostic assay coupled with GMR-enabled lab-on-a-chip technology that can detect 18 different fungal species.</p><p><strong>Methods: </strong>Analytical performance was evaluated in spiked plasma samples. After amplification, cfDNA was digested. Residual single-stranded DNA was flowed over a GMR sensor that was surface-coated with probes specific to different fungal species. After hybridization, magnetic beads bound to the probe complexes produced a GMR signal that was detected by the sensors. Clinical performance was determined using residual serum samples collected before the initiation of antifungal treatment from 20 patients with infection.</p><p><strong>Results: </strong>The limit of detection of the assay ranged from 5 to 50 copies per polymerase chain reaction (PCR) reaction. Nonspecific signals were not observed in the spiked samples. Fungal cfDNA was detected in 80% of patients with invasive candidiasis (3/4 with candidemia, 5/6 with invasive candidiasis without candidemia), all 3 cases of invasive pulmonary aspergillosis, and all 3 cases of disseminated histoplasmosis. cfDNA was not detected in 2 patients with cryptococcosis (both had negative blood cultures) and 2 patients with <i>Pneumocystis</i> pneumonia.</p><p><strong>Conclusions: </strong>We developed a novel GMR-enabled multiplex PCR assay detecting fungal pathogens that have been prioritized for public health action. Clinical sensitivity was highest in cases of presumed angioinvasion and dissemination. This technology has the potential for use in the clinical microbiology laboratory setting.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf068"},"PeriodicalIF":3.8,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143503104","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":"Prevalence of Injection-Related Bacterial and Fungal Infection Among People Who Inject Drugs: A Systematic Review and Meta-analysis.","authors":"Alice Wheeler, Jeffrey Masters, Alyssa Pradhan, Jess Monineath Roth, Louisa Degenhardt, Gregory J Dore, Gail V Matthews, Evan B Cunningham, Amy Peacock, Samantha Colledge-Frisby, Jason Grebely, Behzad Hajarizadeh, Marianne Martinello","doi":"10.1093/ofid/ofaf108","DOIUrl":"10.1093/ofid/ofaf108","url":null,"abstract":"<p><strong>Background: </strong>Despite the increasing burden of injection-related bacterial and fungal infections, there has been no recent synthesis of their epidemiology. We performed a systematic review and meta-analysis evaluating the prevalence and incidence of injection-related infections among people who inject drugs.</p><p><strong>Methods: </strong>We searched EMBASE, MEDLINE, Web of Science, and PsycINFO for articles published since 1 January 2010. Eligible studies assessed the prevalence or incidence of ≥1 injection-related infection among people who recently injected drugs. Random-effects meta-analysis was used to calculate pooled estimates of infection prevalence, according to infection type and prevalence period.</p><p><strong>Results: </strong>Of 8097 articles identified, 87 were eligible for inclusion (prevalence, 78; incidence, 9). Data were available for 25 countries, including 10 low- or middle-income countries. The prevalence of skin and soft-tissue infections (including skin abscess and cellulitis) was 13% in the past month (95% confidence interval [CI], 9%-19% [11 studies]), 30% in the past 3-12 months (23%-37% [23 studies]), and 47% across the lifetime (29%-66% [7 studies]). The prevalence of endocarditis was 2% in the past month (95% CI, 1%-3% [4 studies]), 2% in the past 3-12 months (2%-3% [5 studies]), and 6% across the lifetime (3%-10% [8 studies]). Prevalence of sepsis and/or bloodstream infection was 1% in the past month (95% CI, 1%-2% [2 studies]), 7% in the past 3-12 months (4%-13% [3 studies]), and 8% across the lifetime (3%-19% [5 studies]).</p><p><strong>Conclusions: </strong>Injection-related infections are a common complication of injecting drug use. Interventions to reduce their occurrence and associated disease burden are needed.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 4","pages":"ofaf108"},"PeriodicalIF":3.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11952969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753777","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":"Metformin Treatment and Immune Reconstitution in People With HIV and Type 2 Diabetes: A Matched Retrospective Study.","authors":"Tintin Bäckdahl, Pontus Hedberg, Jan Vesterbacka, Christina Carlander, Anders Sönnerborg, Piotr Nowak","doi":"10.1093/ofid/ofaf110","DOIUrl":"10.1093/ofid/ofaf110","url":null,"abstract":"<p><strong>Background: </strong>Despite effective antiretroviral treatment (ART), HIV infection is associated with immune dysfunction and inflammation. Metformin has shown beneficial immunological and anti-inflammatory effects, including in people with HIV (PWH). We studied the potential association between metformin treatment and immune reconstitution in PWH.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study set in Stockholm, Sweden. PWH with T2DM who initiated metformin treatment after at least 2 years on effective ART (exposed individuals) and metformin-naïve PWH (controls) were matched in a 1:1 ratio based on age, sex, baseline immune status, and duration of ART. Outcomes included mean values of CD4 cell counts and CD4/CD8 ratios from 1.5 years to 3.5 years after compared with 2 years before the exposed individual started metformin treatment (index date).</p><p><strong>Results: </strong>Among 1332 PWH, 43 metformin-exposed individuals (median age, 48 years; 11 years since start of ART) with T2DM and 43 nondiabetic controls (median age, 47 years; 11 years since start of ART) were included in the matched analyses. The median (interquartile range) change in CD4 T-cell count was 35 (-21 to 125) cells/μL among exposed individuals and 48 (-18 to 100) cells/μL among controls (<i>P</i> = .96). The corresponding numbers were 0.10 (0.03 to 0.20) and 0.08 (0.02-0.16) for CD4/CD8 ratio (<i>P</i> = .18). No differences were observed in subgroup analyses of PWH with low CD4 T-cell counts and CD4/CD8 ratios.</p><p><strong>Conclusions: </strong>No significant differences in immune reconstitution were observed between metformin-treated individuals and matched controls over the 2-year follow-up period.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 4","pages":"ofaf110"},"PeriodicalIF":3.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11950528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753725","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":"Levofloxacin to Prevent Bacterial Infection in Patients With Acute Myeloid Leukemia Treated by Venetoclax and Azacitidine: A Toulouse-Bordeaux DATAML Registry Study.","authors":"Xavier Brousse, Nicolas Rasandisona, Emilie Bérard, Harmony Leroy, Karen Delavigne, Nathan Mottal, Suzanne Tavitian, Thibaut Leguay, Léopoldine Lapierre, Eric Delabesse, Audrey Bidet, Martin Gauthier, Diane Lara, Anne Banos, Jennifer Guiraud, Pauline Floch, Leila Ghenim, Audrey Sarry, Anne-Charlotte de Grande, Clémentine Béranger, Christian Récher, Arnaud Pigneux, Sarah Bertoli, Pierre-Yves Dumas","doi":"10.1093/ofid/ofaf105","DOIUrl":"10.1093/ofid/ofaf105","url":null,"abstract":"<p><strong>Objectives: </strong>Antibiotic prophylaxis for patients with cancer remains a controversial issue and is not broadly recommended for hematological malignancies. The venetoclax (VEN) and azacitidine (AZA) combination allows for high rates of complete remission in acute myeloid leukemia (AML) but enhances the incidence of febrile neutropenia (FN) compared to AZA alone, making primary antibiotic prophylaxis a relevant question.</p><p><strong>Patients and methods: </strong>Patients with AML who received VEN-AZA were selected from the DATAML registry to investigate the use of levofloxacin (LEVO) prophylaxis, administered at 500 mg/day from day 10 following the first course of VEN-AZA, until neutrophil recovery (>0.5 × 10⁹/L).</p><p><strong>Results: </strong>A cohort of 258 patients was identified (median age 69.8 years, interquartile range 20.4-87.4), with 72 having received LEVO and 186 treated with standard of care (SOC). VEN-AZA was used for newly diagnosed AML in 52.7% of cases. FN occurred in 33.3% of LEVO patients versus 37.1% of SOC patients (<i>P</i> = .572). Time from day 10 VEN-AZA to FN was significantly delayed in LEVO patients (12.5 days vs 8 in SOC; <i>P</i> = .037). Pulmonary infections were considerably reduced by LEVO (10.2% vs 1.4%, <i>P</i> = .018) as well as those involving Enterobacterales (9.1% vs 1.4%; <i>P</i> = .029). No early increase in fluoroquinolone resistance was detected (<i>P</i> = .142).</p><p><strong>Conclusions: </strong>Levofloxacin as primary prophylaxis in patients with AML treated with VEN-AZA seems to decrease the rate of documented infections even if the incidence of FN was not significantly decreased. This prophylaxis shaped a different clinical and microbiological landscape without significant increase of antibiotic resistance.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf105"},"PeriodicalIF":3.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605826","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}