Infectious Diseases (all articles)
SR | Therapeutics for treating mpox in humans – still no evidence from randomized trials
15 Mar, 2023 | 15:20h | UTCTherapeutics for treating mpox in humans – Cochrane Library
Summary: Therapeutics for treating mpox – Cochrane Library
Updated recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission
15 Mar, 2023 | 15:22h | UTC
RCT | Intrapartum azithromycin fails to reduce neonatal sepsis and death
14 Mar, 2023 | 14:00h | UTCSummary: This randomized controlled trial aimed to evaluate the effectiveness of administering azithromycin during labor to reduce neonatal sepsis and mortality. The randomized trial involved 11,983 birthing parents and their infants in West Africa.
The study found no significant difference in the incidence of neonatal sepsis or mortality between the azithromycin and placebo groups. On the other hand, the rate of non-invasive infections, including skin infections in newborns, and mastitis and puerperal fever in parents, was lower in the azithromycin group in the following four weeks.
The authors concluded that these results do not support the routine introduction of oral intrapartum azithromycin to reduce neonatal sepsis or mortality. However, it is important to notice that a recent large study published in the New England Journal of Medicine showed conflicting results.
Article: Effect of Intrapartum Azithromycin vs Placebo on Neonatal Sepsis and Death: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries:
Azithromycin during labor doesn’t reduce sepsis, mortality in newborns – CIDRAP
Effect of antibiotics during pregnancy on neonatal sepsis and mortality – MedicalResearch.com
Related study with conflicting results: Azithromycin to Prevent Sepsis or Death in Women Planning a Vaginal Birth – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: Single-dose antibiotic prevents maternal sepsis and death – NIH News
Commentaries:
In large study, a single antibiotic dose slashed rate of sepsis in childbirth – STAT
Dose of azithromycin found to cut risk of maternal death, sepsis in childbirth – CIDRAP
Commentary on Twitter
Study results do not support routine introduction of oral intrapartum azithromycin to reduce neonatal sepsis or mortality. https://t.co/yDpg1CCGa2 pic.twitter.com/5Oc4HqZ4sX
— JAMA (@JAMA_current) March 7, 2023
Review | Orthostatic tachycardia after covid-19
14 Mar, 2023 | 13:48h | UTCOrthostatic tachycardia after covid-19 – The BMJ
Commentary: Key steps for diagnosis and management of orthostatic tachycardia after COVID-19 – News Medical
Risk factors for Carbapenem-Resistant Enterobacterales infections: a matched case-control study
14 Mar, 2023 | 13:43h | UTCSummary: The study aimed to investigate risk factors for infections caused by carbapenem-resistant Enterobacterales (CRE) and identify variables that increase the probability of CRE infection among admitted patients in hospitals with high CRE incidence.
The study was performed in 50 hospitals in Southern Europe from March 2016 to November 2018 and included patients with complicated urinary tract infection, complicated intraabdominal infection, pneumonia, or bacteremia from other sources due to CRE. Control groups were patients with infection caused by carbapenem-susceptible Enterobacterales and non-infected patients, matched according to the same criteria as the CRE group (type of infection, ward, and duration of hospital admission).
The results showed that the main risk factors for CRE infections were previous colonization with CRE, use of urinary catheters, and exposure to broad-spectrum antibiotics.
The study’s findings offer evidence to inform decisions about preventive measures and empirical treatment for patients with suspected CRE infections. Additionally, the study can guide the efficient design of future randomized trials focusing on high-risk patients.
Related:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
Review | Pathogenesis, epidemiology and control of Group A Streptococcus infection
14 Mar, 2023 | 13:38h | UTC
Commentary on Twitter
NEW??Pathogenesis, epidemiology and control of Group A Streptococcus infectionhttps://t.co/XFSKQrTe1P
Brouwer & co. summarize the epidemiological and clinical features of Group A Streptococcus infection, and the molecular mechanisms of GAS virulence and drug resistance. pic.twitter.com/qm23YgnKlg
— Nature Reviews Microbiology (@NatureRevMicro) March 10, 2023
CDC recommends HBV screening at least once in a lifetime for all adults aged ≥18 years
13 Mar, 2023 | 15:14h | UTCSummary: The Centers for Disease Control and Prevention (CDC) has issued new recommendations for screening and testing for hepatitis B virus (HBV) infection in the US.
The recommendations include screening for HBV infection at least once in a lifetime for adults aged ≥18 years and more frequent testing for persons at increased risk for HBV infection. The risk groups include:
- Persons incarcerated or formerly incarcerated in jail, prison, or other detention settings.
- Persons with a history of sexually transmitted infections or multiple sex partners.
- Persons with a history of hepatitis C virus infection.
The CDC recommends using the triple panel (HBsAg, anti-HBs, and total anti-HBc) for initial screening to help identify persons who have an active HBV infection, have resolved infection and might be susceptible to reactivation, are susceptible and need vaccination, or are vaccinated.
Commentaries:
Universal Adult Hepatitis B Screening and Vaccination as the Path to Elimination – JAMA
CDC recommends hepatitis B screening for all adults – CIDRAP
CDC Recommends Universal Screening for Hepatitis B Virus – HCP Live
Commentary on Twitter
CDC recommends that all adults get tested for #HepatitisB at least once in their life. Ask your doctor if you’ve been tested. Learn more: https://t.co/kLBZyQYZtQ @CDCMMWR pic.twitter.com/EBkQ9s4MsQ
— CDC (@CDCgov) March 9, 2023
M-A | Routine anaerobic coverage for aspiration pneumonia: limited evidence of benefit
13 Mar, 2023 | 15:03h | UTCSummary: Treating aspiration pneumonia with antibiotics that cover anaerobic bacteria has become common practice in many services, but recent studies suggest that this may not necessarily improve prognosis.
Out of 2523 publications, this systematic review and meta-analysis only included one randomized control trial and two observational studies. The study found no clear benefit of anaerobic coverage and concluded that there is not enough data to evaluate the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia.
The authors suggest that covering anaerobic bacteria with antibiotics may not be needed as an initial treatment for aspiration pneumonia if there is no formation of abscess or empyema and the patient has good oral hygiene.
Related: BTS clinical statement on aspiration pneumonia – Thorax
ISCCM Guidelines for the use of procalcitonin for rational use of antibiotics
13 Mar, 2023 | 14:57h | UTC
RCT | Sulfadoxine-pyrimethamine vs. dihydroartemisinin-piperaquine for preventive treatment of malaria in pregnant women in Africa
13 Mar, 2023 | 14:43h | UTC
Review | How to use nebulized antibiotics in severe respiratory infections
10 Mar, 2023 | 14:31h | UTCHow to Use Nebulized Antibiotics in Severe Respiratory Infections – Antibiotics
RCT | Vaginal cleansing before unscheduled cesarean delivery did not reduce postoperative infections
10 Mar, 2023 | 14:23h | UTCVaginal cleansing before unscheduled cesarean delivery to reduce infection: a randomized clinical trial – American Journal of Gynecology & Obstetrics (link to abstract – $ for full-text)
Related studies with conflicting results:
Vaginal Cleansing Before Cesarean Delivery: A Systematic Review and Meta-analysis – Obstetrics & Gynecology (link to abstract – $ for full-text)
Commentary on Twitter
Vaginal Cleansing Before Unscheduled Cesarean Delivery to Reduce Infection: A Randomized Clinical Trial https://t.co/QuNWfCxl3D @acog pic.twitter.com/sauvsRq5C1
— AJOG (@AJOG_thegray) November 30, 2022
CDC Study | Estimates of serial interval and incubation period for mpox virus infection in the US
8 Mar, 2023 | 14:34h | UTCSummary:
Monkeypox cases have been reported globally since May 2022, with most transmission occurring through close physical contact associated with sexual activities among men who have sex with men.
This study presented the estimated mean serial interval and incubation period for monkeypox virus infection based on data collected from 12 US health departments. The serial interval is the time between symptom onset in a primary case-patient and symptom onset in the secondary case-patient. It is critical for estimating the effective reproduction number and forecasting incidence, both of which are important for understanding the course of an outbreak and the effect of interventions.
The results indicate that the mean estimated serial interval for symptom onset is 8.5 days, while the mean estimated incubation period is 5.6 days.
Commentary: 8.5 days elapse between successive mpox cases, study estimates – CIDRAP
RCT | Combination of intravenous doxycycline and azithromycin better than either drug alone for severe scrub typhus
8 Mar, 2023 | 14:36h | UTCSummary:
The study aimed to compare the efficacy of intravenous doxycycline, azithromycin, or a combination of both drugs in treating severe scrub typhus. The study randomized 794 patients with severe scrub typhus and at least one organ involvement to receive a 7-day course of intravenous doxycycline, azithromycin, or both.
The primary outcome was a composite of death from any cause at day 28, persistent complications at day 7, and persistent fever at day 5. The study found that combination therapy with intravenous doxycycline and azithromycin was a better therapeutic option for treating severe scrub typhus than monotherapy with either drug alone.
Article: Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus – New England Journal of Medicine (link to abstract – $ for full-text)
News Release: A combination therapy is found to be more effective on severe scrub typhus – University of Oxford
Commentary on Twitter
Original Article: Intravenous Doxycycline, Azithromycin, or Both for Severe Scrub Typhus https://t.co/uZ4Y51zoZ2#InfectiousDisease pic.twitter.com/xzmeAV8Tyi
— NEJM (@NEJM) March 4, 2023
FDA panel endorses 2 RSV vaccines for older adults, but flag at potential increased risk of Guillain-Barre
8 Mar, 2023 | 14:27h | UTCPfizer vaccine:
In close vote, FDA advisers recommend Pfizer RSV vaccine for those 60 and older – CIDRAP
GSK’s vaccine:
FDA panel recommends GSK’s RSV vaccine for ages 60 and up – CIDRAP
FDA advisors recommend GSK’s RSV vaccine for older adults, but flag potential safety risks – CNBC
See also: Rare neurological condition is ‘important potential risk’ of Pfizer’s RSV vaccine, FDA says – CNN
Perspective | How to not be completely wrong about masks
8 Mar, 2023 | 14:25h | UTCHow to not be completely wrong about masks – The Munro Report
Related:
SR | Physical interventions to interrupt or reduce the spread of respiratory viruses
Hospital masking should be optional – Sensible Medicine
RCT | Medical masks vs. N95 respirators for preventing COVID-19 among health care workers.
Commentary on Twitter
Excellent and sensible interpretation of the data, on both ends of the spectrum, and everything in between.
(Will forgive the split infinitive in the title. ?)
How to not be completely wrong about masks, by @apsmunro https://t.co/85Ot6oUOZF
— Paul Sax (@PaulSaxMD) March 2, 2023
Early diagnostic indicators of dengue vs. other febrile illnesses in Asia and Latin America: a multicenter, prospective, observational study
8 Mar, 2023 | 14:16h | UTCSummary:
The IDAMS study is a large, prospective, observational study conducted in eight countries in Asia and Latin America to investigate early diagnostic indicators of dengue compared to other febrile illnesses. The study included 7428 patients with undifferentiated fever, of whom 2694 were diagnosed with laboratory-confirmed dengue and 2495 with other febrile illnesses.
Platelet count, white blood cell count, and their changes over time were strongly associated with dengue, while cough and rhinitis were strongly associated with other febrile illnesses. The study found that a set of 14 clinical and three laboratory predictors can distinguish between dengue and other febrile illnesses during the early phase of symptoms, with sensitivities of 80-87% and specificities of 80-91%. The study also found that models that include laboratory markers outperform those based solely on clinical variables.
The study’s results provide important information for updating guidelines on the management of febrile illnesses, particularly in resource-limited settings where distinguishing between dengue and other febrile illnesses is crucial for patient management.
Invited Commentary: Differentiating dengue from other febrile illnesses: a dilemma faced by clinicians in dengue endemic countries – The Lancet Global Health
Commentary on Twitter
From the March Issue: Early diagnostic indicators of dengue versus other febrile illnesses in Asia and Latin America (IDAMS study): a multicentre, prospective, observational study https://t.co/xyvYpoiyWM (1/2) pic.twitter.com/xgvkA39PV5
— The Lancet Global Health (@LancetGH) February 23, 2023
M-A | Comparison of a short vs. long-course antibiotic therapy for ventilator-associated pneumonia
7 Mar, 2023 | 13:18h | UTCSummary:
This systematic review and meta-analysis of randomized controlled trials aimed to compare the rates of recurrence and relapse of ventilator-associated pneumonia (VAP) between short-course (≤8 days) and long-course (≥10-15 days) antibiotic therapy strategies. Five relevant studies involving 1069 patients were identified.
Compared to long-course therapy, short-course therapy increased the number of antibiotic-free days without any impact on recurrence and relapses of VAP, 28 days mortality, mechanical ventilation duration, number of extra-pulmonary infections, and length of ICU stay.
However, the study’s limitations, such as the small sample size and the lack of standardized definitions of the assessed outcomes, should be considered when interpreting the results.
Commentary: Study finds benefits in short-course antibiotics for ventilator-associated pneumonia – CIDRAP
Myocarditis or pericarditis events after BNT162b2 vaccination in individuals aged 12 to 17 years in Ontario, Canada
7 Mar, 2023 | 13:13h | UTCSummary:
A population-based cohort study was conducted to estimate the incidence of reported myocarditis or pericarditis after BNT162b2 vaccination in adolescents aged 12 to 17 years in Ontario, Canada, and to describe the clinical information associated with these events. The study analyzed data from 1.65 million doses of BNT162b2 vaccinations administered between December 14, 2020, and November 21, 2021.
According to the study, 77 adolescents were reported to have developed myocarditis or pericarditis after receiving the vaccine, and there was a greater occurrence of these events among those aged 16 to 17 years compared to those aged 12 to 15 years. Additionally, adolescents with shorter intervals between vaccine doses had a higher incidence of myocarditis or pericarditis.
Most cases of myocarditis and pericarditis were mild, and the adolescents required either no treatment or were treated conservatively with nonsteroidal anti-inflammatory drugs.
CDC Interim Guidance | Treatment considerations for severe manifestations of Mpox
7 Mar, 2023 | 13:08h | UTCCommentary: CDC recommendations and clinical considerations for the treatment of severe Mpox – News Medical
Guidelines for the diagnosis, treatment, prevention and control of infections caused by carbapenem-resistant gram-negative bacilli
7 Mar, 2023 | 13:00h | UTCRelated:
RCT | Colistin monotherapy vs. combination therapy for carbapenem-resistant organisms
BTS Clinical Guidance | Aspiration pneumonia
6 Mar, 2023 | 14:36h | UTCBTS clinical statement on aspiration pneumonia – Thorax
BTS Clinical Guidance | Prevention and management of community-acquired pneumonia in people with learning disability
6 Mar, 2023 | 14:34h | UTC
Cohort Study | Risk factors for serious infections in ANCA-associated vasculitis
2 Mar, 2023 | 12:52h | UTCRisk factors for serious infections in ANCA-associated vasculitis – Annals of the Rheumatic Diseases
Commentary from the author on Twitter
Just published in @ARD_BMJ (https://t.co/mZVZ7HZaLC) – risk of severe infections in #AAV. The prophylactic use of low-dose TMP/SMX may reduce this risk. A work I am really proud of. Many thanks to all my co-authors, especially to my friend @AKronbichler for his endless support!
— Balazs Odler (@odlerb) January 26, 2023
RCT | Long-term effects of early antiretroviral therapy initiation in HIV infection highlight the importance of early treatment
1 Mar, 2023 | 14:12h | UTCSummary: The article discusses the long-term results of the Strategic Timing of AntiRetroviral Treatment (START) trial, which aimed to determine the effects of early initiation of antiretroviral therapy (ART) for individuals with HIV and CD4+ counts above 500 cells/mm3 compared to those who deferred treatment until their CD4+ count was below 350 cells/mm3. The trial found that immediate ART initiation reduced the risk of AIDS and serious non-AIDS (SNA) conditions compared to deferred treatment. The study’s long-term results also found that a persistent excess risk of AIDS and SNA conditions remained even after ART was initiated in those who initially deferred treatment. The study highlights the importance of early diagnosis and prompt initiation of ART for individuals with HIV.
Article: Long-Term Benefits from Early Antiretroviral Therapy Initiation in HIV Infection – NEJM Evidence
Original Study: Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection – New England Journal of Medicine