Lancet Infectious Diseases最新文献_第5页

Rapidly rising rates of oropharyngeal cancer and economic burden in the UK

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-24 DOI: 10.1016/s1473-3099(25)00181-1

Umar Rehman, Jacklyn Liu, Richard Oakley, James O'Mahony, F Chris Holsinger, Liam Masterson, Matt Lechner

引用次数: 0

Doxycycline to prevent bacterial sexually transmitted infections in the USA: final results from the DoxyPEP multicentre, open-label, randomised controlled trial and open-label extension

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-24 DOI: 10.1016/s1473-3099(25)00085-4

Anne F Luetkemeyer, Deborah Donnell, Stephanie E Cohen, Julia C Dombrowski, Cole Grabow, Grace Haser, Clare Brown, Chase Cannon, Cheryl Malinski, Rodney Perkins, Melody Nasser, Carolina Lopez, Robert J Suchland, Eric Vittinghoff, Susan P Buchbinder, Hyman Scott, Edwin D Charlebois, Diane V Havlir, Olusegun O Soge, Connie Celum

{"title":"Doxycycline to prevent bacterial sexually transmitted infections in the USA: final results from the DoxyPEP multicentre, open-label, randomised controlled trial and open-label extension","authors":"Anne F Luetkemeyer, Deborah Donnell, Stephanie E Cohen, Julia C Dombrowski, Cole Grabow, Grace Haser, Clare Brown, Chase Cannon, Cheryl Malinski, Rodney Perkins, Melody Nasser, Carolina Lopez, Robert J Suchland, Eric Vittinghoff, Susan P Buchbinder, Hyman Scott, Edwin D Charlebois, Diane V Havlir, Olusegun O Soge, Connie Celum","doi":"10.1016/s1473-3099(25)00085-4","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00085-4","url":null,"abstract":"<h3>Background</h3>Doxycycline post-exposure prophylaxis (doxy-PEP) is a promising intervention to reduce bacterial sexually transmitted infections (STIs). We evaluated the effect of doxy-PEP on STI incidence and antimicrobial resistance in men who have sex with men and transgender women for up to 12 months of follow-up, inlcuding an open-label extension.<h3>Methods</h3>DoxyPEP, an open-label trial in Seattle (WA, USA) and San Francisco (CA, USA) among men who have sex with men and transgender women with at least one bacterial STI in the past year, randomly assigned participants by clinic (with computer-generated variable block sizes) 2:1 to doxy-PEP (200 mg doxycycline delayed-release tablets 24–72 h after condomless sex) or standard care. The independent endpoint adjudication committee was masked to group assignment. The primary outcome was presence of one or more bacterial STIs (<em>Neisseria gonorrhoeae, Chlamydia trachomatis</em>, or early syphilis) each quarter. This outcome was assessed in the modified intention-to-treat cohort, which included participants with at least one follow-up quarter (ie, ∼3 months) in their as-randomised assignment. After early termination of the randomised phase for efficacy, all participants still enrolled were offered doxy-PEP in an open-label extension (OLE). We report quarterly incidence of bacterial STIs for the as-randomised and OLE periods. Safety was assessed in all participants with any follow-up data. The trial was registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT03980223</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and is completed.<h3>Findings</h3>From Aug 19, 2020, to May 13, 2022, we enrolled 637 participants; 592 participants completed at least one follow-up quarter in the randomised phase (411 in the doxy-PEP group and 181 in the standard-care group) and 282 in the OLE phase (207 in the doxy-PEP group and 82 in the standard-care group). STIs were present in 129 (12·0%) of 1077 quarters in the doxy-PEP group versus 139 (30·5%) of 455 quarters in the standard-care group during the as-randomised period, showing an absolute difference of 19 percentage points and a relative risk of 0·39 (95% CI 0·31–0·49, p<0·0001). During the OLE, STIs were diagnosed in 51 (13%) of 388 quarters among those continuing doxy-PEP and 25 (17%) of 145 quarters among standard-care participants who initiated doxy-PEP. Throughout all quarters for participants on doxy-PEP, there was one grade 2 laboratory abnormality and five grade 3 adverse events that were possibly or probably related to doxy-PEP. No serious adverse events were attribut","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"4 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

DoxyPEP open-label extension: well done is better than well said

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-24 DOI: 10.1016/s1473-3099(25)00146-x

Ann N Burchell, Troy Grennan

引用次数: 0

Rovina Ruslami—shortening tuberculosis treatment

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-22 DOI: 10.1016/s1473-3099(25)00168-9

Tony Kirby

引用次数: 0

Tuberculosis preventive therapy: scientific and ethical considerations for trials of ultra-short regimens

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-22 DOI: 10.1016/s1473-3099(25)00083-0

Timothy M Walker, James A Watson, David A J Moore, Mike Frick, Euzebiusz Jamrozik

{"title":"Tuberculosis preventive therapy: scientific and ethical considerations for trials of ultra-short regimens","authors":"Timothy M Walker, James A Watson, David A J Moore, Mike Frick, Euzebiusz Jamrozik","doi":"10.1016/s1473-3099(25)00083-0","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00083-0","url":null,"abstract":"Preventive therapy remains key to the elimination of tuberculosis and is typically offered to people with presumptive <em>Mycobacterium tuberculosis</em> infection to prevent active disease. Although the duration of tuberculosis preventive therapy has been reduced substantially over time, it remains long in absolute terms, and uptake remains low. Treatment-shortening trials using non-inferiority designs have so far led to the implementation of effective regimens of 1–4 months’ duration. Such regimens are a substantial improvement on the previous 6–9 months’ duration standard of care but still far too long given potential toxicity and the very low baseline risk of disease for most individuals. The efficacy of even shorter tuberculosis preventive therapy regimens, including ultra-short regimens shorter than 2 weeks’ duration, is yet to be explored, but optimal public health outcomes might be achieved even if the efficacy of such regimens is lower than that of the standard of care. Greater acceptability could lead to higher population uptake, and, potentially, to more cases of tuberculosis avoided. Nonetheless, the optimal duration of ultra-short tuberculosis preventive therapy regimens cannot be explored through classic two-arm non-inferiority trials. Instead, the relationship between different durations and efficacy of tuberculosis preventive therapy will need to be characterised, requiring some participants to be randomly assigned to no (or delayed) therapy in order to characterise the number of tuberculosis cases averted by the shortest options. We argue that such trials are needed to identify the optimal trade-off between efficacy and acceptability and would be ethically acceptable provided there were appropriate risk mitigation measures for participants, including careful monitoring for the development of active disease. In this Personal View, we discuss some of the scientific and ethical considerations around the investigation of ultra-short-course preventive therapy for tuberculosis.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"94 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tuberculosis groups struggle with loss of US funding

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-22 DOI: 10.1016/s1473-3099(25)00222-1

Ed Holt

引用次数: 0

The burden of β-lactam allergy labels in health care: a systematic review and meta-analysis

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-20 DOI: 10.1016/s1473-3099(25)00019-2

Mengyuan Fu, Lin Hu, Kexin Han, Gengchen Wang, Huangqianyu Li, Zhuo Ma, Haishaerjiang Wushouer, Luwen Shi, Xiaodong Guan

{"title":"The burden of β-lactam allergy labels in health care: a systematic review and meta-analysis","authors":"Mengyuan Fu, Lin Hu, Kexin Han, Gengchen Wang, Huangqianyu Li, Zhuo Ma, Haishaerjiang Wushouer, Luwen Shi, Xiaodong Guan","doi":"10.1016/s1473-3099(25)00019-2","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00019-2","url":null,"abstract":"<h3>Background</h3>Unverified β-lactam allergy labels (BALs) pose a considerable barrier to optimal antimicrobial treatment and represent a growing public health concern. However, no comprehensive meta-analysis has been conducted to explore the associations between BALs and clinical outcomes. We aimed to evaluate existing evidence on the clinical outcomes associated with BALs to determine their global burden.<h3>Methods</h3>In this systematic review and meta-analysis, we searched PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), and Embase from Jan 1, 2000, to Nov 30, 2024. We included observational and interventional studies that compared clinical outcomes related to the presence or absence of a BAL (as reported or documented in any clinical record), irrespective of patient age or clinical setting. The outcomes assessed included the incidence of surgical site infections, the incidence of infections or colonisation due to multidrug-resistant organisms (MDROs) or <em>Clostridioides difficile</em>, mortality, and length of hospital stay. Pooled estimates were calculated using random-effects models, with subgroup analyses conducted by region, country income level, type of BAL, hospital setting, sample size, age group, and quality of evidence. Publication bias was assessed using Begg's funnel plots and Egger's regression test. This study is registered with PROSPERO (CRD42023484030).<h3>Findings</h3>63 studies were included in this systematic review, of which 60 (95%) were from high-income countries. Studies were done in the Americas (41 [65%]), Europe (15 [24%]), and the Western Pacific region (seven [11%]). Seven studies were of moderate quality and none were classified as low quality. No significant publication bias was detected for most outcomes, except for length of hospital stay (p=0·0062). Overall, BALs were associated with increased rates of surgical site infection (OR 1·60, 95% CI 1·27–2·01; p<0·0001; <em>I</em><sup>2</sup>=70·3%), rates of infection or colonisation with both MDROs (1·42, 1·22–1·64; p<0·0001; <em>I</em><sup>2</sup>=84·4%) and <em>C difficile</em> (1·26, 1·16–1·37; p<0·0001; <em>I</em><sup>2</sup>=56·4%), and length of hospital stay (standardised mean difference 0·06 days, 95% CI 0·05–0·08; p<0·0001; <em>I</em><sup>2</sup>=86·1%). BALs were also associated with death at or after 180 days but not with overall, in-hospital, or 30-day mortality.<h3>Interpretation</h3>BALs are associated with an array of adverse health outcomes, especially surgical site infection and infection or colonisation with MDROs and <em>C difficile</em>. Although BALs were associated with longer hospital stays, the observed difference was unlikely to be clinically relevant. The heterogeneity and methodological limitations of the included studies could limit the robustness of some of our conclusions. However, these findings underscore the need to develop and evaluate public health initiatives to curb inaccurate allergy labell","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"22 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Tackling the burden of β-lactam allergy labels

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-20 DOI: 10.1016/s1473-3099(25)00091-x

Philip H Li, Kimberly G Blumenthal

引用次数: 0

Threat of HIV and tuberculosis drug resistance after US funding cuts

IF 56.3 1区医学

Lancet Infectious Diseases Pub Date : 2025-03-20 DOI: 10.1016/s1473-3099(25)00209-9

Max McClure, Monica Gandhi

引用次数: 0

Expanding human papillomavirus vaccine options