Open Forum Infectious Diseases最新文献

{"title":"Illuminating the Challenges and Diagnostic Utility of Plasma Microbial Cell-Free DNA Sequencing in Suspected Infective Endocarditis: A Retrospective Observational Cohort Study.","authors":"Myeongji Kim, Pansachee Damronglerd, Sofia Molina Garcia, Zachary A Yetmar, Samrah Razi, Nischal Ranganath, Maryam Mahmood, Omar M Abu Saleh","doi":"10.1093/ofid/ofaf099","DOIUrl":"10.1093/ofid/ofaf099","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) is a life-threatening infection often challenging to diagnose, particularly in culture-negative cases. Plasma microbial cell-free DNA (mcfDNA) sequencing has shown potential for detecting pathogens in IE. However, its clinical utility, diagnostic impact, and limitations remain debated. This study evaluates its use in diagnosing and managing IE in a tertiary care setting.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included adult patients (≥18 years) who underwent mcfDNA sequencing via the Karius test for suspected IE at Mayo Clinic Rochester between December 2019 and February 2024. Diagnostic classification followed the 2023 Duke-International Society of Cardiovascular Infectious Diseases criteria. Data on demographics, clinical features, routine microbiologic workup, and mcfDNA sequencing results were collected. Statistical analysis was conducted to evaluate diagnostic utility and treatment impact.</p><p><strong>Results: </strong>Among 141 patients, 66 had a diagnosis of IE, with mcfDNA sequencing identifying pathogens in 60.6% of them, compared with 39.4% with routine workup. mcfDNA sequencing was the sole microbiologic test with positive results in 33.3% of patients, leading to antimicrobial adjustments in 50.0% of that group. Clinically insignificant mcfDNA sequence detection occurred in 28.6% of patients without a diagnosis of IE.</p><p><strong>Conclusions: </strong>mcfDNA sequencing is a valuable adjunctive tool for diagnosing culture-negative IE and guiding antimicrobial therapy when clinical suspicion is high. However, its utility depends on appropriate clinical context, highlighting the need for careful test interpretation and further prospective studies to assess patient-centered outcomes and cost-effectiveness.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf099"},"PeriodicalIF":3.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567713","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":"Evaluating Hospital Admission Data as Indicators of COVID-19 Severity: A National Assessment in Qatar.","authors":"Layan Sukik, Hiam Chemaitelly, Houssein H Ayoub, Peter Coyle, Patrick Tang, Mohammad R Hasan, Hadi M Yassine, Asmaa A Al Thani, Zaina Al-Kanaani, Einas Al-Kuwari, Andrew Jeremijenko, Anvar Hassan Kaleeckal, Ali Nizar Latif, Riyazuddin Mohammad Shaik, Hanan F Abdul-Rahim, Gheyath K Nasrallah, Mohamed Ghaith Al-Kuwari, Adeel A Butt, Hamad Eid Al-Romaihi, Mohamed H Al-Thani, Abdullatif Al-Khal, Roberto Bertollini, Laith J Abu-Raddad","doi":"10.1093/ofid/ofaf098","DOIUrl":"https://doi.org/10.1093/ofid/ofaf098","url":null,"abstract":"<p><strong>Background: </strong>Accurately assessing SARS-CoV-2 infection severity is essential for understanding the health impact of the infection and evaluating the effectiveness of interventions. This study investigated whether SARS-CoV-2-associated hospitalizations can reliably measure true COVID-19 severity.</p><p><strong>Methods: </strong>The diagnostic accuracy of SARS-CoV-2-associated acute care and ICU hospitalizations as indicators of infection severity was assessed in Qatar from 6 September 2021 to 13 May 2024. WHO criteria for severe, critical, and fatal COVID-19 served as the reference standard. Two indicators were assessed: (1) any SARS-CoV-2-associated hospitalization in acute care or ICU beds and (2) ICU-only hospitalizations.</p><p><strong>Results: </strong>A total of 644 176 SARS-CoV-2 infections were analyzed. The percent agreement between any SARS-CoV-2-associated hospitalization (acute care or ICU) and WHO criteria was 98.7% (95% confidence interval (CI), 98.6-98.7); however, Cohen's kappa was only 0.17 (95% CI, 0.16-0.18), indicating poor agreement. Sensitivity, specificity, PPV, and negative predictive value were 100% (95% CI, 99.6-100), 98.7% (95% CI, 98.6-98.7), 9.7% (95% CI, 9.1-10.3), and 100% (95% CI, 100-100), respectively. For SARS-CoV-2-associated ICU-only hospitalizations, the percent agreement was 99.8% (95% CI, 99.8-99.9), with a kappa of 0.47 (95% CI, 0.44-0.50), indicating fair-to-good agreement. Sensitivity, specificity, PPV, and negative predictive value were 46.6% (95% CI, 43.4-49.9), 99.9% (95% CI, 99.9-99.9), 47.9% (95% CI, 44.6-51.2), and 99.9% (95% CI, 99.9-99.9), respectively.</p><p><strong>Conclusions: </strong>Generic hospital admissions are unreliable indicators of COVID-19 severity, whereas ICU admissions are somewhat more accurate. The findings demonstrate the importance of applying specific, robust criteria-such as WHO criteria-to reduce bias in epidemiological and vaccine effectiveness studies.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf098"},"PeriodicalIF":3.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649557","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":"Disseminated <i>Ureaplasma urealyticum</i> Infection and Hyperammonemic Encephalopathy in a Patient With Activated PI3K Delta Syndrome 2.","authors":"Yi Wye Lai, Ray Junhao Lin, Matthias Maiwald, Gareth Zigui Lim, Pooja Rao, Tse Hsien Koh, Ser Hon Puah, Teck Choon Tan, Hwee Siew Howe, Xin Rong Lim","doi":"10.1093/ofid/ofaf084","DOIUrl":"10.1093/ofid/ofaf084","url":null,"abstract":"<p><p>Hyperammonemia syndrome (HS) from <i>Ureaplasma</i> infection is typically reported in posttransplant recipients, particularly lung transplant. We describe a young woman with activated PI3K delta syndrome 2 who presented with HS from disseminated <i>Ureaplasma urealyticum</i> infection with septic arthritis. We also performed a literature review of <i>Ureaplasma</i>-associated HS in nontransplant patients.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf084"},"PeriodicalIF":3.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557242","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":"Correction to: Pulmonary Coinfection of <i>Pneumocystis jirovecii</i> and <i>Aspergillus</i> Species.","authors":"","doi":"10.1093/ofid/ofaf083","DOIUrl":"https://doi.org/10.1093/ofid/ofaf083","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ofid/ofaf018.].</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf083"},"PeriodicalIF":3.8,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11832041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441584","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":"Doxycycline Postexposure Prophylaxis for Bacterial STIs: Prescribing Patterns, Use, Short-term Outcomes Among 2083 Patients in a Los Angeles Federally Qualified Health Care Program, and Implications for Widespread Use.","authors":"Joseph Osmundson, Ian W Holloway, Raul Macias Gil, J Trevor Jann, Chenglin Hong, Robert K Bolan","doi":"10.1093/ofid/ofaf089","DOIUrl":"10.1093/ofid/ofaf089","url":null,"abstract":"<p><strong>Background: </strong>Rates of bacterial sexually transmitted infections (STIs) have risen dramatically over the past decades. Doxycycline postexposure prophylaxis (DP) is a novel intervention to prevent bacterial STIs. Recent randomized controlled clinical trials reported high DP efficacy at preventing syphilis and chlamydia in cisgender men who have sex with men and transgender women.</p><p><strong>Methods: </strong>We abstracted data from the electronic health records of 2083 patients at the Los Angeles LGBT Center (the Center) who were prescribed DP between 2019 and June 2024. Patient information included race, income, gender, sex, DP prescriptions, and STI tests dating back to 1998.</p><p><strong>Results: </strong>More than half of the patients prescribed DP at the Center were White, and 48.1% were between 31 and 40 years old. Most of these patients were not diagnosed with an STI in the previous year but ever having an STI correlated with early DP initiation. We demonstrate high real-world DP effectiveness in preventing infections with syphilis (86.4%) and chlamydia (89.7%), and moderate effectiveness for gonorrhea (54.7%), all remarkably similar to published clinical trials. DP use was highly variable, and DP failure for syphilis or chlamydia occurred only in patients with low DP use. There was similar effectiveness for chlamydia and gonorrhea regardless of anatomical site (rectal or throat swabs or urine sample).</p><p><strong>Conclusions: </strong>We show that DP is highly effective at STI prevention in a real-world setting and describe patterns of DP prescribing and use, in addition to STI testing, that can directly inform best clinical practice.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf089"},"PeriodicalIF":3.8,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567780","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":"An Observational Cohort Study of Bronchoalveolar Lavage Fluid Galactomannan and <i>Aspergillus</i> Culture Positivity in Patients Requiring Mechanical Ventilation.","authors":"Catherine A Gao, Nikolay S Markov, Chiagozie Pickens, Anna Pawlowski, Mengjia Kang, James M Walter, Benjamin D Singer, Richard G Wunderink","doi":"10.1093/ofid/ofaf090","DOIUrl":"10.1093/ofid/ofaf090","url":null,"abstract":"<p><strong>Background: </strong>Critically ill patients who develop invasive pulmonary aspergillosis (IPA) have high mortality rates despite antifungal therapy. Diagnosis is difficult in these patients and incidences vary in the literature. Bronchoalveolar lavage (BAL) fluid galactomannan (GM) is a helpful marker, although the optimal cutoff is unclear.</p><p><strong>Methods: </strong>This was a single-center cohort study of patients requiring mechanical ventilation in the medical intensive care unit (ICU) from June 2018 to March 2023. Demographics, BAL, and outcome data were extracted from the electronic health record and compared between groups of patients who grew <i>Aspergillus</i> from BAL, those who had elevated BAL GM levels (>0.5, >0.8, or >1.0) but did not grow <i>Aspergillus</i>, and those with neither.</p><p><strong>Results: </strong>Of >1700 BALs from 688 patients, only 18 BALs from 15 patients grew <i>Aspergillus</i>. Patients who grew <i>Aspergillus</i> had more intubated days (29 vs 11, <i>P</i> = .002) and more ICU days (34 vs 15, <i>P</i> = .002). BAL GM level was higher from samples that grew <i>Aspergillus</i> than those that did not (median optical density index: 7.08 vs 0.11, <i>P</i> < .001).</p><p><strong>Conclusions: </strong>In this large cohort of critically ill patients, we found a low rate of <i>Aspergillus</i> growth and variable BAL GM elevation. These data suggest that the pretest probability of IPA should be considered low in a general ICU population undergoing BAL evaluation to define the etiology of pneumonia. Elevated BAL GM may not reliably indicate invasive disease, but lack of culture positivity may also miss true infection. Improved scoring systems are needed to enhance pretest probability for diagnostic test stewardship purposes, and tests must be interpreted in their own clinical contexts.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf090"},"PeriodicalIF":3.8,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567774","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":"Early Experience and Effectiveness of Long-Acting Injectable Cabotegravir and Rilpivirine in a South Side Chicago HIV Clinic.","authors":"Geoffroy Liegeon, Christopher Kaperak, Eleanor E Friedman, Paul Djuricich, Alicia Dawdani, Kane Stafford, Sophie Plotkin, Jessica Schmitt, Aniruddha Hazra, Katerina A Christopoulos, John A Schneider, Moira C McNulty","doi":"10.1093/ofid/ofaf094","DOIUrl":"10.1093/ofid/ofaf094","url":null,"abstract":"<p><p>We describe referrals and uptake of long-acting injectable cabotegravir/rilpivirine at an academic clinic in Chicago. In a pharmacy-led model, 118 (18%) people with HIV were referred and 78 (12%) initiated long-acting injectable cabotegravir/rilpivirine from 1 January 2021 to 31 May 2023. Implementation, especially for people with HIV who were not virally suppressed, requires further support for patients, providers, and clinic systems.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf094"},"PeriodicalIF":3.8,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605813","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":"Correction to: Dynamics of Persistent Submicroscopic and Microscopic <i>Plasmodium falciparum</i> in Pregnant Women Under Intermittent Preventive Treatment: A Study Cohort in Benin.","authors":"","doi":"10.1093/ofid/ofaf071","DOIUrl":"https://doi.org/10.1093/ofid/ofaf071","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ofid/ofae762.].</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 2","pages":"ofaf071"},"PeriodicalIF":3.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11822677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414101","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":"Infective Endocarditis Caused by Non-HACEK Gram-Negative Bacteria, a Registry-Based Comparative Study.","authors":"Jasmina Al Janabi, Mohammed El Noaimi, Torgny Sunnerhagen, Ulrika Snygg-Martin, Magnus Rasmussen","doi":"10.1093/ofid/ofaf085","DOIUrl":"10.1093/ofid/ofaf085","url":null,"abstract":"<p><strong>Background: </strong>Infective endocarditis (IE) caused by non-HACEK gram-negative bacteria (nHGNB) is uncommon. In the 2023 Duke-ISCVID diagnostic criteria, <i>Pseudomonas aeruginosa</i> and <i>Serratia marcescens</i> were added as \"typical\" pathogens. We examine the consequences of this addition, the risk of IE in bacteremia from nHGNB species, and the features of IE caused by nHGNB.</p><p><strong>Methods: </strong>nHGNB IE cases reported to the Swedish Registry of Infective Endocarditis (SRIE) between 2008 and 2023 were identified. Episodes of bacteremia caused by nHGNB during the same period in Region Skåne were used as controls. Characteristics of IE caused by nHGNB were compared with those of other pathogens reported to the SRIE.</p><p><strong>Results: </strong>One hundred fourteen episodes of nHGNB IE, of which 98 (87%) were definitive, were identified (1.5% of all cases). <i>Escherichia coli</i> was the most common cause (28%), followed by <i>Pseudomonas aeruginosa</i> (13%) and <i>Klebsiella</i> (9%). Applying the Duke-ISCVID criteria, none of the possible IE episodes caused by <i>P. aeruginosa or S. marcescens</i> were reclassified as definitive IE. Comparing the proportion of nHGNB species in episodes with IE with the proportion of nHGNB species in episodes with bacteremia (n = 33 213), <i>E. coli</i> was more common in bacteremia than in IE, whereas <i>P. aeruginosa</i> and <i>Serratia</i> were more common in IE. Patients with nHGNB IE frequently had underlying diseases, and mortality was higher than in streptococcal IE.</p><p><strong>Conclusions: </strong>Our findings indicate that <i>P. aeruginosa</i> and <i>Serratia</i> are more common in IE than in bacteremia but that that their status as \"typical IE pathogens\" in the Duke-ISCVID criteria did not improve the performance of the criteria.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf085"},"PeriodicalIF":3.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586551","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":"Systematic Screening for Tuberculosis Using Molecular Testing on Stool Samples in Acutely Malnourished Children: A Pilot Implementation Study in a High-Burden Drug-Resistant Tuberculosis Country.","authors":"Joan Martínez-Campreciós, Juan Espinosa-Pereiro, Arlete Nindia, Maria Cerezuela, Marta Sales, Ermelinda Tchiloka, Elena Trigo, Elena Sulleiro, Nicolau Sicaleta, Maria Teresa Tórtola, Adrián Sánchez-Montalvá, Inés Oliveira-Souto, Maria Luisa Aznar, Israel Molina","doi":"10.1093/ofid/ofaf086","DOIUrl":"10.1093/ofid/ofaf086","url":null,"abstract":"<p><p>Systematic screening of tuberculosis (TB) using molecular testing on stool samples detected TB in 5.2% of acutely malnourished children, including cases without evident clinical symptoms. This screening strategy could enhance TB diagnosis and facilitate prompt treatment initiation in this population. Further studies are required to confirm long-term outcomes and cost-effectiveness.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf086"},"PeriodicalIF":3.8,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567820","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}