Infectious Diseases (all articles)
Review | The golden grapes of wrath – Staphylococcus aureus bacteremia
1 Mar, 2023 | 13:46h | UTC
Choosing Wisely internationally – 213 helpful recommendations for antimicrobial stewardship!
27 Feb, 2023 | 13:19h | UTCSummary: The article discusses the importance of antimicrobial stewardship (AMS) in the face of increasing antimicrobial resistance and the role of the Choosing Wisely campaign in promoting the rational use of antibiotics. The study evaluated 213 Choosing Wisely recommendations related to AMS practices in six countries (Australia/New Zealand, Canada, Italy, Switzerland, the USA, and Germany) and categorized them according to six categories: diagnostics, indication, choice of anti-infective drugs, dosing, application, and duration of therapy. Topics related to indication and diagnostics were most frequently addressed, and avoiding antibiotic treatment of asymptomatic bacteriuria and upper respiratory tract infections were central topics across all countries.
Article: Choosing Wisely internationally – helpful recommendations for antimicrobial stewardship! – Infection
See complete lists of low-value practices: Choosing Wisely U.S. / Choosing Wisely UK / Choosing Wisely Australia AND Choosing Wisely Canada
Study links proton pump inhibitor use to increased risk of acquiring drug-resistant bacteria in hospitalized patients
27 Feb, 2023 | 13:13h | UTCSummary: This case-control study investigated whether proton pump inhibitors (PPIs) are associated with an increased risk of acquiring extended-spectrum β-lactamase (ESBL) or carbapenemase-producing Enterobacterales among hospitalized patients. The study involved 2239 adult hospitalized patients. After controlling for confounding factors, patients who received PPIs within the previous 30 days had a nearly 50% increased risk (aIRR, 1.48) of acquiring ESBL- or carbapenemase-producing Enterobacterales compared with those who did not receive PPIs. The study has the limitations of an observational study but points to the need for judicious use of PPIs to mitigate the risk of acquiring drug-resistant Enterobacterales among hospitalized patients.
Commentaries:
Study links acid suppressants to colonization with multidrug-resistant bacteria – CIDRAP
Proton Pump Inhibitors Associated With Increased Risk of Drug-Resistant Infections – HCP Live
M-A | Adverse perinatal outcomes associated with antiretroviral therapy in women living with HIV
27 Feb, 2023 | 12:48h | UTC
Cluster RCT | Effect of an antibiotic stewardship intervention to improve antibiotic prescribing for suspected UTI in older adults
24 Feb, 2023 | 13:58h | UTCSummary: The study evaluated the effectiveness of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections (UTI) in frail older adults. The study was a pragmatic, parallel, cluster-randomized controlled trial conducted in four European countries and included 1041 frail older adults aged 70 or older. The intervention involved a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. The control group provided care as usual. The primary outcome was the number of antibiotic prescriptions for suspected UTI per person year, and secondary outcomes included incidence of complications, hospital referrals, admissions, and mortality. The results showed that the intervention group had a lower rate of receiving an antibiotic prescription for a suspected UTI (0.27 per person year) compared to the control group (0.58 per person year), with no increase in complications or adverse events.
Commentary: Trial: Stewardship intervention cuts antibiotic prescribing for suspected urinary infections – CIDRAP
Related:
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Guideline | Diagnosis and treatment of Helicobacter pylori
24 Feb, 2023 | 13:53h | UTCRelated:
SR | The impact of Antimicrobial Stewardship Programs in pediatric emergency departments and primary care
24 Feb, 2023 | 13:20h | UTC
Review | When and how to use MIC in clinical practice?
24 Feb, 2023 | 13:28h | UTCWhen and How to Use MIC in Clinical Practice? – Antibiotics
Commentary on Twitter
https://twitter.com/ABsteward/status/1616852667124400129
Mpox outbreak in advanced HIV cases | Global case series reveals higher mortality and clinical complications
23 Feb, 2023 | 13:44h | UTCSummary: This article discusses a case series investigating monkeypox (mpox) in people with HIV and low CD4 cell counts. The mpox outbreak in 2022 has affected a significant percentage of people living with HIV, and data suggest worse clinical outcomes and higher mortality in those with more advanced HIV. The case series includes data from 382 confirmed mpox cases in people living with HIV from 19 countries. The individuals included were predominantly cisgender men, with a median age of 35. Most individuals were adherent to antiretroviral therapy, and the median CD4 count was 211 cells per mm3. Severe complications were more common in those with lower CD4 cell counts, including necrotizing skin lesions, lung involvement, secondary infections, and sepsis. Approximately 28% of individuals were hospitalized, and 25% of those hospitalized died. All deaths occurred in people with CD4 counts of less than 200 cells per mm3. The study reinforces the importance of HIV and CD4 testing in mpox cases, prioritization of preventive mpox vaccination in people with HIV and a CD4 cell count of less than 200 cells per mm3, and the use of potential mpox antivirals where available. The authors suggest that a severe, disseminated, and necrotizing form of mpox should be considered an AIDS-defining condition in CDC and WHO HIV disease classifications. Clinicians should also be aware that starting antiretroviral therapy in people with advanced HIV and mpox could contribute to deterioration and possible death, possibly as part of an immune reconstitution syndrome.
Article: Mpox in people with advanced HIV infection: a global case series – The Lancet (free registration required)
News Release: Clinicians identify severe form of mpox with high mortality in people with advanced HIV – Queen Mary University of London
Commentaries:
Mpox: Clinicians identify severe form with high mortality in advanced HIV patients – The BMJ
Commentary from the author on Twitter (thread – click for more)
? ? Our global case series on MPOX in people with advanced HIV infection is at #CROI2023 and in @TheLancet today: 382 cases of human MPOX infection in PLWH with CD4 counts <350 cells/mm3 in 19 countries
**We found MPOX is an opportunistic pathogen** /1https://t.co/WodDN4Ujoj pic.twitter.com/IlK7viABmy— Chloe Orkin (@profchloeorkin) February 21, 2023
WHO Report | Global trends in the 2022-23 Mpox (Monkeypox) outbreak
23 Feb, 2023 | 13:43h | UTCSummary: The report provides an overview of the 2022-23 monkeypox (mpox) outbreak worldwide as reported to WHO as of February 18, 2023. The report focuses on laboratory-confirmed cases and mentions that 86,019 cases and 1,389 probable cases, including 96 deaths, have been reported to WHO from 110 Member States across all 6 WHO regions, including some countries without previously documented mpox transmission. The outbreak primarily affects men who have sex with men, and no signal suggests sustained transmission beyond these networks. The WHO Director-General has determined that this outbreak continues to constitute a public health emergency of international concern and issued revised temporary recommendations in relation to the outbreak.
Report: 2022-23 Mpox (Monkeypox) Outbreak: Global Trends – World Health Organization
Commentary on Twitter
With over 86,000 total cases & 96 related deaths, #mpox outbreak has slowed down but is still ongoing in several countries.
Maintained surveillance & enhanced access to diagnostics, vaccines and treatments are key to stop the disease transmission globally https://t.co/mLHsVoWKBY pic.twitter.com/PcLFQjjrz7
— World Health Organization (WHO) (@WHO) February 21, 2023
M-A | Oral manifestation of the monkeypox virus
23 Feb, 2023 | 13:42h | UTCOral manifestation of the monkeypox virus: a systematic review and meta-analysis – eClinicalMedicine
M-A | COVID-19 convalescent plasma outpatient therapy may prevent hospitalizations
23 Feb, 2023 | 13:37h | UTC
152-week results of a RCT | Long-acting cabotegravir and rilpivirine dosed every 2 months in adults with HIV-1 infection
23 Feb, 2023 | 13:16h | UTC
Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment
23 Feb, 2023 | 13:13h | UTC
Antibiotic allergy de-labeling: a pathway against antibiotic resistance
23 Feb, 2023 | 13:12h | UTCAntibiotic Allergy De-Labeling: A Pathway against Antibiotic Resistance – Antibiotics
Related:
M-A: Most patients with allergy to Penicillin can be given Cefazolin
Podcast: A Clinical Pharmacologist’s Perspective on Penicillin Allergy
Study: Development and Validation of a Penicillin Allergy Clinical Decision Rule
NICE: Double Check Patients with ‘Penicillin Allergy’ to Avoid Increased MRSA Risk
RCT | An initial 8-week bedaquiline-linezolid regimen shows promise for the treatment of rifampin-susceptible tuberculosis
22 Feb, 2023 | 12:50h | UTCSummary: This randomized trial compared a standard 6-month rifampin-based tuberculosis treatment to a strategy that involved shorter initial treatment with extended therapy for persistent disease, monitoring, and retreatment for relapse. The results showed that the strategy involving an 8-week bedaquiline-linezolid regimen was noninferior to standard treatment for clinical outcomes. The experimental strategy was associated with a shorter total duration of treatment with no evident safety concerns.
Article: Treatment Strategy for Rifampin-Susceptible Tuberculosis – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Shorter drug regimen shows promise in TB trial – CIDRAP
M-A | Past SARS-CoV-2 infection provides long-lasting protection against severe disease caused by all variants
22 Feb, 2023 | 12:48h | UTCSummary: The article describes a systematic review and meta-analysis of studies assessing protection from past SARS-CoV-2 infection against subsequent re-infection, symptomatic COVID-19 disease, and severe disease. The researchers identified 65 studies from 19 different countries and found that protection from past infection against re-infection from pre-omicron variants was high and remained so even after 40 weeks. However, protection was substantially lower for the omicron BA.1 variant and declined more rapidly over time than protection against previous variants. Protection from severe disease was high for all variants, estimated at 90·2% for ancestral, alpha, and delta variants, and 88·9% for omicron BA.1 at 40 weeks. The study highlights the importance of considering past infection in assessing future disease burden from COVID-19, providing guidance on when individuals should be vaccinated, and designing policies that mandate vaccination for workers or restrict access. The findings also suggest that individuals with a documented infection should be treated similarly to those who have been fully vaccinated with high-quality vaccines.
Commentaries:
Previous COVID-19 may slash severe illness at reinfection by 89% – CIDRAP
Case-Control Study | Current pyuria cut-offs may promote inappropriate UTI diagnosis in older women
22 Feb, 2023 | 12:43h | UTCSummary: The presence of pyuria is commonly used as the cornerstone of urinary tract infection (UTI) diagnosis. However, over 90% of asymptomatic bacteriuria (ASB) patients also have pyuria, which can lead to unnecessary treatment. This is especially problematic in older women who may have pre-existing lower urinary tract symptoms, cognitive impairment, and a high prevalence of ASB. This study examined the diagnostic accuracy of different pyuria thresholds for UTI in older women. The study found that current pyuria cut-offs (10 leukocytes/µl) are too low and promote inappropriate UTI diagnosis in older women. A threshold of 300 leukocytes/µl is suggested as a considerable improvement, increasing specificity to avoid overtreatment, while still maintaining a fair sensitivity. This has implications for patient care, antimicrobial stewardship efforts, and research. The impact of higher cut-off values on prescription behavior and UTI related outcomes in older women deserves further study.
Related:
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Commentary on Twitter
Presence of pyuria remains the cornerstone of UTI diagnosis However, >90% of ASB patients have pyuria,prompt unnecessary Rx
?️⚡️⚡️study: current pyuria cut-off is too low promote inappropriate UTI diagnosis in older women suggesting a new higher cut offhttps://t.co/qAGdwSTiU6 pic.twitter.com/Vr63RnuMv1— Antibiotic Steward Bassam Ghanem?? (@ABsteward) February 20, 2023
Article under a https://creativecommons.org/licenses/by-nc-nd/4.0/ license
RCT | Another study shows Ivermectin does not benefit patients with Covid-19
22 Feb, 2023 | 12:45h | UTCSummary: The study aimed to evaluate whether Ivermectin, at a maximum dose of 600 μg/kg daily for 6 days, shortened symptom duration or prevented hospitalization among outpatients with mild to moderate COVID-19. A total of 1206 US adults were enrolled in the double-blind, randomized, placebo-controlled platform trial, with follow-up data through November 10, 2022. The study found that the median time to sustained recovery was 11 days in both the ivermectin and placebo groups. Among those receiving Ivermectin, 5.7% were hospitalized, died, or had urgent or emergency care visits compared with 6.0% receiving placebo. These findings, along with all the previous studies to date, do not support using Ivermectin in patients with mild to moderate COVID-19.
Editorials:
At a Higher Dose and Longer Duration, Ivermectin Still Not Effective Against COVID-19 – JAMA
The Ethics of Clinical Research: Managing Persistent Uncertainty – JAMA
Related:
RCT | Ivermectin does not improve time to recovery in outpatients with mild to moderate COVID-19.
RCT | Metformin, Ivermectin, and Fluvoxamine are not beneficial for obese outpatients with Covid-19.
Ivermectin for COVID-19 Cochrane review update: 11 trials and no evidence of benefit shown.
RCT: Early treatment with ivermectin does not improve outcomes in patients with Covid-19.
Case Series: Toxic effects from ivermectin use associated with prevention and treatment of Covid-19.
Long-term consequences of the misuse of ivermectin data.
Ivermectin: How false science created a Covid ‘miracle’ drug.
Fraudulent ivermectin studies open up new battleground between science and misinformation.
The lesson of ivermectin: meta-analyses based on summary data alone are inherently unreliable.
Ivermectin: Cochrane’s most talked about review so far, ever. Why?
Flawed ivermectin preprint highlights challenges of COVID drug studies.
Systematic review: no evidence to support the use of Ivermectin for treating or preventing COVID-19.
Why was a major study on ivermectin for covid-19 just retracted?
RCT: Ivermectin does not prevent hospitalizations in patients with COVID-19.
RCT: Ivermectin does not improve time to resolution of symptoms among adults with mild COVID-19
Bacteriuria in older adults triggers confusion in healthcare providers: a mindful pause to treat the worry
22 Feb, 2023 | 12:42h | UTCRelated:
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
Commentary on Twitter
FANTASTIC⚡️⚡️
The evidence base for refraining from screening for or treating ASB in elderly is strong,but both practices remain prevalent
Bacteriuria in older adults triggers confusion in healthcare providers:A mindful pause to treat the worry #IDTwitter https://t.co/7ispdtFeFB pic.twitter.com/kOB5eGKkAc— Antibiotic Steward Bassam Ghanem?? (@ABsteward) January 10, 2023
Under a http://creativecommons.org/licenses/by/4.0/ license
Review | Comorbidities, multimorbidity and COVID-19
22 Feb, 2023 | 12:39h | UTCComorbidities, multimorbidity and COVID-19 – Nature Medicine
Bacteremia | ED presentations, evaluation, and management
22 Feb, 2023 | 12:25h | UTCBacteremia: ED Presentations, Evaluation, and Management – emDocs
Cohort Study | One third of patients hospitalized with Covid-19 persist with lung abnormalities after 2 years
21 Feb, 2023 | 11:47h | UTCSummary: The study aimed to assess changes in chest CT abnormalities and pulmonary function in patients two years after recovery from SARS-CoV-2 infection. The prospective study followed 144 participants discharged from the hospital after SARS-CoV-2 infection between January 15 and March 10, 2020. The participants underwent serial chest CT scans and pulmonary function tests at 6 months, 12 months, and 2 years after symptom onset. The study found that 39% of participants had persistent interstitial lung abnormalities at 2 years, and this was associated with respiratory symptoms and decreased diffusion pulmonary function.
Editorial: Radiologic Findings after COVID-19 and the Correlation with Lung Function – Radiology
Commentaries:
Post-COVID-19 CT scans show lung abnormalities persist two years later – News Medical
COVID’s aftermath: Persistent organ damage at 1 year, lung abnormalities at 2 – CIDRAP
Phase 2b RCT | Ad26.RSV.preF–Respiratory Syncytial Virus preF protein vaccine is immunogenic in older adults
17 Feb, 2023 | 13:30h | UTCSummary: A phase 2b clinical trial evaluated the Ad26.RSV.preF–RSV preF protein vaccine’s efficacy, immunogenicity, and safety in preventing RSV-mediated lower respiratory tract disease in adults aged 65 years and older. The vaccine was effective in preventing the disease and immunogenic, as demonstrated by the increase in RSV A2 neutralizing antibody titers after vaccination. The vaccine was associated with higher rates of adverse events than the placebo, but most were of mild to moderate severity. The trial concluded that Ad26.RSV.preF–RSV preF protein vaccine was effective in preventing RSV-mediated lower respiratory tract disease in older adults.*
Article: Efficacy and Safety of an Ad26.RSV.preF–RSV preF Protein Vaccine in Older Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Ad26.RSV.preF-RSV preF Protein Vaccine Immunogenic in Seniors – HealthDay
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.
RCT | Respiratory Syncytial Virus prefusion F protein vaccine provides protection for older adults
17 Feb, 2023 | 13:32h | UTCSummary: A phase 2b clinical trial evaluated the Ad26.RSV.preF–RSV preF protein vaccine in adults aged 65 years and older. The vaccine was effective and immunogenic, as demonstrated by the increase in RSV A2 neutralizing antibody titers after vaccination. The vaccine was associated with higher rates of adverse events than the placebo, but most were of mild to moderate severity.*
Article: Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Respiratory syncytial virus causes clinically significant illness in children and adults. In a placebo-controlled trial, a prefusion stabilized F protein vaccine led to an 83% lower risk of RSV infection. https://t.co/aU9BV0LXBU pic.twitter.com/0zy1hu0VH6
— NEJM (@NEJM) February 15, 2023
*Note: This summary was created through the collaboration of a medical editor and ChatGPT.