Volume 79, Issue 2, 15 August 2024

We demonstrate how predictive modeling can mitigate inappropriate prescribing in uncomplicated urinary tract infection by providing insight into factors that increase risk of nonsusceptibility to commonly prescribed antibiotics and developing a risk categorization framework that may improve empiric treatment strategies.

This study evaluated the association between social vulnerability and Streptococcus pneumoniae antimicrobial resistance in US adults. Socioeconomic status and household characteristics were the Social Vulnerability Index (SVI) themes most closely associated with Streptococcus pneumoniae antimicrobial resistance.

In this analysis of commercial and Medicare Advantage claims, the proportion of US enrollees with ≥1 inappropriate antibiotic prescription declined after the COVID-19 outbreak but rebounded to prepandemic levels by December 2021, underscoring the continued importance of antibiotic stewardship initiatives.

In adults, community-acquired bacterial meningitis often involves otitis, with the leading pathogen being Streptococcus pneumoniae. The presence of otitis is associated with a favorable outcome, however the impact of ear surgery on the outcome remains unclear.

The ESC 2023 guidelines for the management of infective endocarditis (IE) need input from microbiologists. Several aspects of microbiological diagnostics and definitions are not correct. Input from relevant areas of expertise is needed to manage IE and to write guidelines.

The obligation to provide treatment to infectious patients has been debated by ethicists for the past century. In this review article, we found that ethics articles during COVID-19 were less likely to argue for a duty to treat.

In a randomized trial of standard-risk adults, metformin decreased severe acute respiratory syndrome coronavirus 2 viral loads by an average of 0.56 log₁₀ copies/mL over placebo. Metformin also caused a one-third lower risk of viral rebound at day 10.

We evaluated vaccine efficacy in mildly immunocompromised study participants across 4 harmonized, randomized, placebo-controlled COVID-19 vaccine trials. There was no difference in vaccine efficacy against symptomatic or severe COVID-19 between this group and those without immunocompromising conditions.

In this self-controlled risk-interval study, we found that COVID-19 vaccination was associated with reduced outpatient antibiotic prescribing among older adults. Moreover, our results suggest COVID-19 vaccination differentially reduces respiratory antibiotic prescriptions and benefits are accentuated during periods of high SARS-CoV-2 circulation.

The safety analysis from the randomized DisCoVeRy trial designed for hospitalized patients with moderate to severe coronavirus disease 2019 showed no significant association between remdesivir treatment compared with control in the occurrence of cardiac adverse events, including arrhythmias.

Children with preexisting immunocompromising conditions admitted to the pediatric intensive care unit for acute COVID-19 had higher mortality and longer duration of hospitalization than non-immunocompromised children. Reassuringly, most of these patients survived and were discharged home without new severe morbidities.

Among 48 210 working-age Cleveland Clinic employees, the 2023–2024 formula COVID-19 vaccine was 42% effective in preventing COVID-19 before, but only 19% effective after, the JN.1 lineage became dominant.

Infectious diseases clinicians are more frequently being consulted on infections in patients receiving extracorporeal membrane oxygenation. This review summarizes the most recent guidance on antimicrobial prophylaxis, infection control, diagnosis, and treatment of nosocomial infections in this population.

Point-of-care ultrasound offers noninvasive, bedside, immediate-result diagnostics, enhancing physical examinations and decision-making in infectious diseases, enabling prompt antimicrobial treatment initiation, and reducing patient discomfort, necessitating specialized training for infectious disease specialists.

The declining interest in infectious disease among applicants may be a reflection of the current zeitgeist of medicine in particular and society in general, where revenue generation, mainstream novelty, and conspicuous self-affirmation are increasingly emphasized.

Infective endocarditis was diagnosed in 20% of 851 episodes of streptococcal bacteremia. Sensitivity for HANDOC score >2 points, 2015 Duke-ESC, 2023 Duke-ISCVID, and 2023 Duke-ESC clinical criteria for diagnosing infective endocarditis was 95%, 65%, 81%, and 73%, respectively.

Our nonlinear model representing HCV dynamics in the US forecasts slightly decreasing HCV infections in children <13 years old and shows that increased screening and treatment in individuals aged 13–49 years could further reduce HCV infections in young children.

We found that women with HIV have higher cardiac magnetic resonance–determined myocardial fibro-inflammation, but not fibrosis or steatosis, compared with sociodemographically similar women without HIV, an association that was more pronounced in the setting of unsuppressed viremia or low nadir CD4+ count.

Cryptococcal meningitis remains a leading cause of mortality in high-HIV-prevalence settings. In Botswana, cryptococcal meningitis incidence declined with expanded antiretroviral coverage. Rapid cryptococcal antigen test was increasingly used, highlighting cryptococcal meningitis surveillance as an important metric of HIV programmatic success.

Pre–diabetes mellitus (DM) has been associated with negative health outcomes, including kidney disease. Among individuals with pre-DM, we show that people with human immunodeficiency virus (HIV) had a 3-fold higher risk of incident proteinuria than those without HIV.

Obesity reduces the exposure of long-acting cabotegravir/rilpivirine with a significant number of morbidly obese individuals predicted to have concentrations below the target thresholds at steady-state notably for the bimonthly administration. Therapeutic drug monitoring is advised to guide dosing interval adjustment.

Hospitalization and in-hospital mortality rates associated with HIV-related opportunistic infections (OIs) declined over time. The percentage of hospitalizations resulting in mortality did not change. Disparities existed for race/ethnicity subgroups, uninsured people, and US regions. Costs of HIV-related OI hospitalizations were high.

This network meta-analysis of 88 studies found that using rapid diagnostic tests in conjunction with antimicrobial stewardship programs may reduce mortality for patients with bloodstream infections compared to conventional blood culture systems, even in settings already using antimicrobial stewardship programs.

In 2022, the Clinical and Laboratory Standards Institute reassessed the amoxicillin-clavulanate (AMC) susceptibility criteria. Based on this contemporary reappraisal, the Enterobacterales breakpoints were retained, but dosing comments were revised. Here, we summarize the data and rationale for the AMC Enterobacterales breakpoints.

Among patients with multidrug-resistant tuberculosis (MDR-TB) and diabetes, a higher drug exposure/susceptibility ratio correlates with favorable outcome. Poor glycemic control correlates with reduced drug exposure and unfavorable outcomes. Glycemic control and optimal drug exposure may improve the MDR-TB treatment.

In this prospective cohort study of 257 people with pulmonary tuberculosis in Haiti, household food insecurity at treatment initiation was significantly associated with death or treatment failure after accounting for loss to follow-up, measured confounders, and nutritional status.

Humoral and cellular responses were similar when SARS-CoV-2 vaccination was initiated <4 months versus 4–12 months after cellular therapy. Pre–cellular therapy SARS-CoV-2 vaccination and baseline B-cell count were key predictors of post–cellular therapy immunity.

This scoping review identified all published outbreaks of vaccine-preventable diseases in healthcare workers between 2000 and 2022. Vaccine-preventable diseases were the 10 diseases for which vaccines are recommended for healthcare workers by the World Health Organization.

Delusional infestation is a condition in which patients have a fixed, false belief that they are infested with living creatures or nonliving objects. This paper provides evidence-based guidance for infectious diseases clinicians in the evaluation and management of these patients.