Volume 56, Issue 11, 1 June 2013

Mass therapy with azithromycin for trachoma is associated with increased risk of antibiotic-resistant Streptococcus pneumoniae carriage among young children in the 6 months following treatment. Studies are needed assess the clinical relevance of azithromycin-associated resistance on treatment of pediatric infections.

Relapse is observed in one fifth of miltefosine-treated visceral leishmaniasis (VL) patients in Nepal. The authors monitored clinical outcomes of VL treatment and here discuss the role of patient compliance, drug resistance, and reinfection.

In this retrospective study, combination therapy with an oral cephalosporin and azithromycin was comparable to intramuscular ceftriaxone alone or with azithromycin for the treatment of pharyngeal gonorrhea. Combination therapy with doxycycline was associated with a higher risk of recurrent infection.

This clinical trial of a cytomegalovirus (CMV) DNA test standardized to the First World Health Organization International Standard for CMV in solid organ transplant patients undergoing treatment for CMV disease found that viral suppression is predictive of shorter time to CMV disease resolution.

Serum antibody responses against Staphylococcus aureus α-hemolysin serve as a marker for protective immunity against recurrent communityonset disease, highlighting an opportunity to define and stratify risk for subsequent infection and to modify disease risk through development of immunization programs.

In the setting of methicillin-resistant Staphylococcus aureus bacteremia with a vancomycin minimum inhibitory concentration >1 µg/mL, an early switch to daptomycin based solely on vancomycin susceptibility was associated with significantly less clinical failure, compared to continued vancomycin.

We retrospectively describe successful outcomes in 8 of 9 children with refractory invasive coccidioidomycosis who were treated with combination voriconazole and caspofungin salvage therapy between January 2000 and June 2012 after failing conventional therapy.

A retrospective observational study of 33 children hospitalized with coccidioidomycosis identified 31 with various pulmonary manifestations, 5 with osteomyelitis, and 2 with meningitis. Mediastinitis with purulence and abscessed/necrotic lymph nodes occurred in 21% of patients and resulted in longer hospitalizations.

Clostridium difficile genotype predicts 14-day mortality in 1893 enzyme immunoassay–positive/culture-positive adults. Excess mortality correlates with genotype-specific changes in biomarkers, strongly implicating inflammatory pathways as a major influence on poor outcome. Polymerase chain reaction ribotype 078/ST 11(clade 5) is associated with high mortality; ongoing surveillance remains essential.

Recent FDA approval of tenofovir-emtricitabine for HIV prevention has led to concern about implementation of this approach. We review the social and medical history of the oral contraceptive pill, which has many parallels with the current debate about pre-exposure prophylaxis.

Rapid detection of multidrug-resistant organism (MDRO) carriers remains a work in progress. Future efforts should be on developing rapid tests to detect gram-negative MDROs and on performing studies to determine how to incorporate rapid MDRO detection into infection prevention efforts.

We propose that a multinational case-control study be performed on incident patients with infections with trimethoprim-sulfamethoxazole (TMP-SMZ)–susceptible organisms occurring in patients receiving biologics. Such a study could identify high-risk patients who may benefit from TMP-SMZ prophylaxis.

This review summarizes the relevant issues with pegylated interferon and ribavirin, with a particular focus on side effects profile and management, as well as their continued role in therapy given the emergence of interferon-free regimens.

Virologic suppression was well maintained when HIV patients receiving 3TC/ABC with a boosted protease inhibitor were switched to emtricitabine/tenofovir disoproxil fumarate (FTC/TDF). Subjects randomized to FTC/TDF) had fewer virologic failures; in addition, improvements in lipids and Framingham risk scores were noted, while slight declines in estimated GFR were observed.

The achievement of sustained virologic response following pegylated interferon plus ribavirin treatment is associated with a marked reduction of the risk of hepatic decompensations and overall mortality in HIVinfected patients with compensated hepatitis C virus–related cirrhosis.

Considering HIV-2 phenotypic data and experience from HIV-1 and from the follow-up of HIV-2–infected patients, European experts developed a rule set and an automated tool for HIV-2 drug resistance analyses freely available on the Internet.

This study offers a framework by which patients can be switched to a maraviroc-containing regimen while maintaining an undetectable viral load. Patients confirmed as having CCR5-tropic HIV according to DNAbased tropism methods had significantly better responses to maraviroc compared to those where CXCR4-using virus was detected in cells.

Low-frequency HIV variants are increasingly recognized as a key factor that increases the risk of HIV treatment failure. This article will provide a review of HIV minority variants, including their demonstrated clinical impact and areas of controversy.

The street drug “bath salts” is a psychoactive mixture of cathinone derivatives. We report 3 cases of disseminated Staphylococcus aureus infection with cardiac involvement (2 endocarditis and 1 pericarditis), secondary to intravenous bath salts use.