Infectious Diseases (all articles)
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
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: