Volume 67, Issue 8, 15 October 2018

Extended infusion of β-lactam antibiotics in patients with febrile neutropenia resulted in a higher rate of clinical success compared with standard bolus infusion. The benefit of extended β-lactam infusion was greatest among patients with pneumonia.

First-line raltegravir-containing combination antiretroviral therapy in 30 patients living with HIV-2 was well tolerated and yielded a median CD4 gain at 1 year of 87 cells/µL, and HIV-2 RNA <5 copies/µL in 13 of 15 participants.

A survey of antibiotic stewardship programs was performed to determine essential resources. Increasing physician and pharmacist staffing support predicted effectiveness, and effectiveness was mediated by ability to perform antibiotic review with prospective audit and feedback. Recommended staffing ratios are provided.

In this analysis of methicillin-resistant Staphylococcus aureus (MRSA) surveillance data from 9 US states, despite significant decreases in healthcare-associated invasive MRSA rates, racial differences did not change over time.

Protease inhibitors were independent predictors of cerebrospinal fluid (CSF) escape in antiretroviral therapy (ART)–experienced human immunodeficiency virus–infected adults. M184V/I combined with thymidine analog mutations were more frequent in adults with CSF escape compared to no escape. These findings suggest optimizing ART may reduce likelihood of CSF escape.

Giving oral azithromycin during labor (2 g) increased prevalence of maternal and neonatal carriage of azithromycin-resistant Staphylococcus aureus. Twelve months later, azithromycin resistance had returned to baseline values. Azithromycin resistance in Streptococcus pneumoniae was also similar between children from both arms.

In this randomized, double-blinded, placebo-controlled phase 2B trial, 2 doses of RBX2660 did not meet the primary endpoint of superiority to placebo for preventing recurrent Clostridium difficile infection. However, RBX2660 was safe, and a single dose was superior to placebo.

Deployment-related trauma infectious complications continue after initial hospital discharge and into Veterans Affairs healthcare (39% developed new post-discharge infection). Injury severity and occurrence of ≥1 inpatient infection were associated with a shorter time to development of a new post-discharge infection.

A whole-population study including 58794 episodes of acute otitis media (AOM) revealed a 22% reduction in all-cause AOM in children <3 years of age after initiation of 10-valent pneumococcal Haemophilus influenzae protein-D conjugate vaccine (Cox regression model, repeated events).

Early abdominal presentations of invasive meningococcal disease are increasingly reported. Our work increases the awareness of these forms by clinicians. Rapid management should reduce the high fatality rate that is associated with these presentations and avoid unjustified interventions (eg, appendectomy).

We report, for the first time, Encephalitozoon cuniculi in periprosthetic tissue from 39% of patients with revision hip arthroplasty. This suggests that E. cuniculi should be considered as a potential contributor to periprosthetic osteolysis and implant destabilization.

South African infants were followed longitudinally to interrogate mechanism for lower human immunodeficiency virus (HIV) transmission with exclusive breastfeeding. Our findings suggest that gut microbiota of exclusively breastfed infants is associated with low peripheral T-cell and mucosal immune activation.

This is the first randomized controlled dose-ranging trial investigating the safety and efficacy of ivermectin against Trichuris trichiura in preschool-aged and school-aged children. Ivermectin can be administered safely to both age groups, but it lacks sufficient efficacy as a monotherapy.

In 2006, universal BCG vaccination in Finland was discontinued. In our population-based retrospective study, childhood nontuberculous mycobacterial (NTM) infections increased drastically after the BCG policy change, suggesting that BCG offers protection against childhood NTM infection.

History of vulvar high-grade squamous intraepithelial lesions (HSIL)/cancer, immunosuppression, and concomitant genital HSIL/cancer were associated with abnormal anal cytology in women. Sensitivity of anal cytology for anal HSIL/cancer detection was significantly higher in those immunosuppressed and with more extensive disease.

Clinical stability was found to be transient in a large cohort of human immunodeficiency virus–infected patients. Differentiated service delivery models must be able to respond to the large number of patients who become unstable or experience lapses in care.

This population-level retrospective cohort study recruited 1914 patients with acute hepatitis A or E in 2000–2016. Patients with acute hepatitis E had higher mortality than their counterparts. Chronic hepatitis B infection was associated with liver-related mortality in acute hepatitis E.

Since the introduction of modern antibiotics, gonorrhea therapy has been shaped by continuously evolving antimicrobial resistance and the methods used for gonorrhea detection. For the past 50 years, the Centers for Disease Control and Prevention led surveillance and national treatment guidelines.

A comprehensive, public health–based sepsis prevention strategy is needed to merge existing infection prevention strategies with chronic disease management and improved education on the signs and symptoms of worsening infection and sepsis.