Volume 62, Issue 7, 1 April 2016

This is the first time a comprehensive, multipathogen, quantitative and qualitative molecular approach for respiratory bacteria and viruses has been compared with traditional diagnostic methods on a large hospitalized pneumonia cohort, with estimation of potential effects on antibiotic prescribing.

Guidelines recommend that pregnant women be vaccinated against pertussis between gestational weeks 26 and 36. We show that this narrow window can be widened, as optimal neonatal antibody concentrations and expected infant seropositivity rates are elicited between weeks 13 and 33.

The sensitivity of a rapid diagnostic test (RDT) for malaria was compared with that of a polymerase chain reaction assay in pregnant West African women. The sensitivity of the RDT was high at enrollment but lower at delivery.

In a population-based analysis, diabetes in all races and extreme obesity in whites were associated with increased risk of invasive group A Streptococcus (iGAS). Obesity, but not diabetes, was associated with increased odds of death in persons with iGAS.

This randomized trial compared peripheral and central fat changes 96 weeks after a first-line regimen containing darunavir/ritonavir, atazanavir/ritonavir, or raltegravir. Similar and significant increases were seen in all arms. Pre-treatment HIV-1 RNA level was the strongest predictor of fat gains.

Development of necrotizing enterocolitis (NEC) has been associated with altered intestinal bacterial colonization. Via a prospective case-control study a NEC-associated gut microbiota was identified in meconium samples. Clostridium perfringens and Bacteroides dorei are associated with NEC development starting immediately after birth. In post-meconium samples increased numbers of staphylococci are negatively associated with NEC.

In a prospective cohort study, pneumococci were the most frequent cause of severe sepsis or septic shock in asplenic patients, accounting for 42% of infections. Most patients with pneumococcal sepsis had not received pneumococcal vaccination and many developed purpura fulminans.

A subgroup of patients infected with nontyphoidal Salmonella develops a persistent infection. Most of these are presented as symptomatic relapse gastroenteritis, illuminating a previously overlooked manifestation. During persistence, Salmonella gains genetic and phenotypic changes, affecting antibiotic resistance, and host-pathogen interactions.

Partial lung resection, but not pneumonectomy, was associated with improved treatment success among patients with multidrug-resistant tuberculosis. Although improved outcomes may reflect patient selection, partial lung resection after culture conversion may improve treatment outcomes, alongside optimal medical therapy.

Detection of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies by enzyme immunoassay improves the sensitivity for the diagnosis of acute pulmonary histoplasmosis. The highest sensitivity was achieved by testing for antigen and of IgM and IgG antibodies.

Although fecal microbiota transplant (FMT) is a highly effective therapy for recurrent Clostridium difficile infection, numerous technical, logistical, and regulatory issues have hampered development of FMT capability at many sites. We describe how to establish such a service using a frozen stool bank.

While the clinical case for tenofovir alafenamide (TAF) over tenofovir disoproxil fumarate (TDF) appears solid, we find that the increased cost that TAF might merit over TDF is modest, ~$1000. Under alternative assumptions where TDF toxicity leads to fewer events or better quality of life, or when TDF becomes generically available, the defensible price differential related to TAF may be even smaller.

Trial results are used to support licensure, inform cost-effectiveness analyses, and guide clinical decision making. We found the majority of coinfected patients were not included in clinical trials of direct-acting antivirals, raising concerns about the generalizability of these trial results.

Discordant viremia results near human immunodeficiency virus type 1 RNA 50 copies/mL by the TaqMan 2.0 assay led to significantly lower efficacy rates in clinical trials and increased patient management decision points compared with the historical standard Amplicor assay.

Retention after starting antiretroviral therapy is best understood by examining multiple outcomes including stopping care, deaths in care, deaths out of care, and silent transfers.