Infectious Diseases (all articles) | Links Medicus Content Curation & Alerts in Medicine

Summary: The NATTINA trial, a pragmatic multicentre, open-label, randomized controlled study, sought to compare the clinical and cost-effectiveness of conservative management versus tonsillectomy in adults with recurrent acute tonsillitis. Conducted across 27 UK hospitals, 453 participants aged 16 or older were randomly assigned to either undergo immediate tonsillectomy or receive standard non-surgical care.

The main finding was that participants in the immediate tonsillectomy group had fewer days of sore throat over a 24-month period than those in the conservative management group (median 23 vs. 30 days). After adjusting for site and baseline severity, the incident rate ratio of total sore throat days in the immediate tonsillectomy group was significantly lower than in the conservative management group (0.53, 95% CI 0.43 to 0.65, p < 0.0001). The most common adverse event related to tonsillectomy was bleeding, which occurred in 19% of participants.

The NATTINA trial is the largest to date assessing the clinical and cost-effectiveness of tonsillectomy in adults. The results indicate that immediate tonsillectomy is clinically effective and cost-effective for recurrent acute tonsillitis. However, patients should weigh the benefits of fewer sore throat days against the risks of surgery.

Article: Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial – The Lancet

News Release: Tonsillectomy both clinically and cost effective for adults – Newcastle University

Commentary on Twitter

Compared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute #tonsillitis, suggests trial. https://t.co/LvSjn6XUx0 pic.twitter.com/yKzH9RqY5J

— The Lancet (@TheLancet) May 18, 2023

Ventilator associated tracheobronchitis and pneumonia: one infection with two faces

23 May, 2023 | 12:49h | UTC

Ventilator associated tracheobronchitis and pneumonia: one infection with two faces – Intensive Care Medicine

Editorial | Selective digestive decontamination – Pro

22 May, 2023 | 13:34h | UTC

Selective digestive decontamination – Pro – Intensive Care Medicine (free for a limited period)

Commentary on Twitter

#SDD? One of few areas in critical care where large RCTs/SRs demonstrate consistent advantage, without evident side effects. Pivotal
📃 standardized formulation/protocols
📚 education
🧫 ABT stewardship + rigorous IPC strategies, monitoring ABTs use/AMR
🖇️ https://t.co/VOqudX6E6k pic.twitter.com/YN5DuXknDL

— Intensive Care Medicine (@yourICM) May 21, 2023

Stenotrophomonas Maltophilia: review and meta-analysis of treatment options

22 May, 2023 | 13:25h | UTC

Stenotrophomonas maltophilia Infections: A Systematic Review and Meta-Analysis of Comparative Efficacy of Available Treatments, with Critical Assessment of Novel Therapeutic Options – Antibiotics

A humorous peek into HIV research papers: a quick guide

18 May, 2023 | 13:46h | UTC

Types of HIV Papers — A Quick Guide – HIV and Observations

Commentary on Twitter

In his latest HIV and ID Observations post, @PaulSaxMD presents a quick guide to the different types of HIV papers, comic style. https://t.co/RYW6MuubCd (H/T @xkcd) pic.twitter.com/Zlh7PJOh8o

— NEJM Journal Watch (@JWatch) May 16, 2023

RCT | ART intensification shows no benefit in treating HIV-associated neurocognitive impairment

18 May, 2023 | 13:31h | UTC

Antiretroviral Therapy Intensification for Neurocognitive Impairment in HIV – Clinical Infectious Diseases

RCT | Optimizing the timing of whooping cough immunization in mums through investigating pertussis vaccination in pregnancy

16 May, 2023 | 14:49h | UTC

Optimising the timing of whooping cough immunisation in mums (OpTIMUM) through investigating pertussis vaccination in pregnancy: an open-label, equivalence, randomised controlled trial – Microbiome

Consensus Paper | Diagnosis and antimicrobial treatment for infections post-ACL reconstruction

16 May, 2023 | 14:46h | UTC

Recommendations on diagnosis and antimicrobial treatment of infections after anterior cruciate ligament reconstruction (ACL-R) endorsed by ESSKA and EBJIS – Journal of Infection

RCT | Prophylactic antibiotics show no statistically significant survival improvement in severe alcohol-related hepatitis

15 May, 2023 | 13:21h | UTC

Summary: This multicenter, randomized, double-blind clinical trial aimed to determine the efficacy of amoxicillin-clavulanate combined with prednisolone compared to placebo combined with prednisolone on mortality in patients hospitalized with severe alcohol-related hepatitis. The study involved 284 patients from 25 centers in France and Belgium with biopsy-proven severe alcohol-related hepatitis, who were followed up for 180 days.

The primary outcome was all-cause mortality at 60 days, while secondary outcomes included mortality at 90 and 180 days, infection rates, hepatorenal syndrome, and changes in Model for End-stage Liver Disease (MELD) and Lille scores. The results showed no statistically significant difference in 60-day mortality between the two groups, with 17.3% in the amoxicillin-clavulanate group and 21.3% in the placebo group. However, infection rates at 60 days were significantly lower in the amoxicillin-clavulanate group compared to the placebo group.

It is worth noting that the study may have been underpowered, as the absolute risk difference of 4% did not achieve statistical significance. In conclusion, the combination of amoxicillin-clavulanate and prednisolone did not show a statistically significant improvement in 2-month survival in patients hospitalized with severe alcohol-related hepatitis compared to prednisolone alone. These findings do not support the use of prophylactic antibiotics to improve survival in this patient population, but the potential underpowered nature of the study should be considered.

Article: Effect of Prophylactic Antibiotics on Mortality in Severe Alcohol-Related Hepatitis: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentary on Twitter

Among patients with severe alcohol-related #hepatitis receiving prednisolone, amoxicillin-clavulanate did not improve survival at 60-day follow-up compared with placebo. https://t.co/4XkVL2CTsP #DDW pic.twitter.com/9sh5vennkK

— JAMA (@JAMA_current) May 9, 2023

RCT | Rivaroxaban doesn’t reduce thrombotic events, hospitalization, or death in outpatients with COVID-19

15 May, 2023 | 13:19h | UTC

Summary: The PREVENT-HD trial, a double-blind, placebo-controlled randomized study, was conducted to evaluate the effectiveness of prophylactic anticoagulation in reducing venous and arterial thrombosis, hospitalization, and death in nonhospitalized patients with symptomatic COVID-19 and at least one thrombosis risk factor. The trial took place between August 2020 and April 2022 across 14 US integrated healthcare delivery networks, with 1,284 patients enrolled and randomly assigned to receive either 10 mg of oral rivaroxaban or placebo daily for 35 days.

However, the study was terminated prematurely due to enrollment challenges and lower-than-expected event rates. The primary efficacy outcome, a composite of various hazardous events, occurred in 3.4% of the rivaroxaban group and 3.0% of the placebo group, with no significant difference between the two groups (hazard ratio, 1.16 [95% CI, 0.63–2.15]; P=0.63). No critical-site or fatal bleeding was observed, and only one patient in the rivaroxaban group experienced a major bleed.

In conclusion, rivaroxaban prescribed for 35 days in nonhospitalized patients with symptomatic COVID-19 at risk for thrombosis does not appear to reduce the composite end point of venous and arterial thrombotic events, hospitalization, and death. The study’s premature termination and lower-than-expected event rates may limit the generalizability of these findings.

Article: Rivaroxaban for Prevention of Thrombotic Events, Hospitalization, and Death in Outpatients With COVID-19: A Randomized Clinical Trial – Circulation

Commentary on Twitter

#OriginalArticle: In this #RCT, Rivaroxaban did not appear to reduce a composite endpoint of venous and arterial thrombotic events, hospitalization, and death among non‐hospitalized patients with symptomatic COVID‐19 #AHAJournals https://t.co/PhdXnTJ0V9 pic.twitter.com/f04uYu2M5f

— Circulation (@CircAHA) May 10, 2023

RCT | Cognitive behavioral therapy proves effective for severe post-COVID-19 fatigue

15 May, 2023 | 13:16h | UTC

Efficacy of cognitive behavioral therapy targeting severe fatigue following COVID-19: results of a randomized controlled trial – Clinical Infectious Diseases

News Release: Cognitive behavioral therapy lessens post-viral fatigue after COVID-19 – Amsterdam UMC

Commentary on Twitter

Efficacy of Cognitive Behavioral Therapy Targeting Severe Fatigue Following COVID-19: Results of a Randomized Controlled Trial

✅ Just Accepted
🔓 Open Access@amsterdamUMC https://t.co/P1jwLOcfvw

— Clinical Infectious Diseases (@CIDJournal) May 13, 2023

Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection

15 May, 2023 | 12:39h | UTC

Development of evidence-based guidelines for the treatment and management of periprosthetic hip infection – Bone & Joint Open

RCT | Investigational 4-Antigen Staphylococcus aureus vaccine fails to prevent infections in spinal surgery

12 May, 2023 | 13:12h | UTC

Efficacy of a 4-Antigen Staphylococcus aureus Vaccine in Spinal Surgery: The STRIVE Randomized Clinical Trial – Clinical Infectious Diseases

Commentary on Twitter

Efficacy of a 4-Antigen Staphylococcus aureus Vaccine in Spinal Surgery: The STRIVE Randomized Clinical Trial

✅ Just Accepted
🔓 Open Access
🔗 https://t.co/eFVufc7rzi pic.twitter.com/XdylTWa66v

— Clinical Infectious Diseases (@CIDJournal) May 3, 2023

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