Volume 71, Issue 10, 15 November 2020

Sepsis epidemiology in sub-Saharan Africa (sSA) is poorly described. Using large databases from a Malawian teaching hospital, we present some of the first estimates of sepsis population incidence from sSA and find it to be high compared with high-income settings.

Whole-genome sequencing informed the detection of active and previously missed hospital clusters of Klebsiella oxytoca with GES-5; modes of spread were reinterpreted and GES-5 plasmid was found to be widely disseminated in other species of bacteria at remote locations.

Children and adolescents on tumor necrosis factor-ɑ inhibitors are prone to severe tuberculosis disease, especially miliary tuberculosis, resulting in significant morbidity. False-negative immunodiagnostic tests are common and a low threshold to initiate targeted investigations is recommended.

In a multistate cohort, Qualified Health Plans (QHPs) are associated with viral suppression for AIDS Drug Assistance Program (ADAP) clients. State ADAPs, especially those without Medicaid expansion, should consider investing in QHPs as an evidence-based intervention to improve viral suppression.

In this randomized, single-blind, phase 3 trial of fidaxomicin versus vancomycin for Clostridioides difficile infection in children and adolescents, fidaxomicin was well tolerated and was associated with significantly higher rates of global cure 30 days after the end of treatment.

Among people living with HIV in care at 7 sites in the Centers for AIDS Research Network of Integrated Clinical Systems between 2010 and 2016, clinic-level text appointment reminders and stigma support services were associated with better retention in care.

In a randomized, controlled trial, we evaluated whether colistin-meropenem combination therapy, compared to colistin monotherapy, for infections due to carbapenem-resistant Gram-negative bacteria reduces the emergence of colistin resistance. No evidence to support a reduction with combination therapy was found.

Same-day (SD) antiretroviral therapy (ART) after home-based human immunodeficiency virus diagnosis increased engagement in care with viral suppression at 12 months but not at 24 months due to later linkage in usual care. In SD ART, we observed no compensatory disengagement from care beyond 12 months.

Among 322 HIV-positive inpatients with tuberculosis, 2-month mortality was 31%, and dissemination was common. Older age, being male, taking antiretroviral therapy at admission, poor nutritional status, and positive urine diagnostics were associated with mortality. Interventions to reduce mortality are needed.

Transmission of Blastocystis by fecal microbiota transplantation (FMT) from colonized donors occurred in 50% of patients. Transfer did not result in development of gastrointestinal symptoms or affect the outcome of the FMT treatment in patients with recurrent Clostridioides difficile infections.

Among gay, bisexual, and other men who have sex with men prescribed PrEP, 43% received recommended STI screening at PrEP initiation, a level that may limit the impact of STI screening as part of PrEP care in reducing STI transmission.

Our study is the first to identify an inflammatory plasma 6-biomarker signature predictive of incipient TB in advanced HIV that occurs rapidly after the initiation of ART despite tuberculosis screening and preventive therapy.

The seminal cytokine profile of people who transmitted human immunodeficiency virus (HIV) to partners was statistically different from that of people who did not transmit HIV, even after correction for viral load. The cytokine profiles in blood were not different.

Respiratory samples from COVID-19 patients with > 8 days of symptoms and a SARS-CoV-2 E gene reverse-transcription polymerase chain reaction cycle threshold value > 24 may predict lack of infectivity of those patients in a clinical and community context.

In this cross-sectional study, we identified specific signatures of the fecal microbiota in COVID-19 patients, H1N1 patients, and healthy controls in a Chinese population by high-throughput 16S rRNA gene sequencing, to provide a theoretical basis for intestinal microbial intervention.

Forty-three percent (13/30) of confirmed SARS-CoV-2–infected individuals were asymptomatic, with the virus detected in both saliva and nasopharyngeal/throat swabs. Viral clearance was faster in asymptomatic individuals, but they still appeared able to pass the infection to others.

The neutralizing antibody responses to severe acute respiratory syndrome coronavirus 2 in patients with COVID-19 depends on time since onset and severity of disease.

Hypertensive patients using either angiotensin receptor blockers or angiotensin-converting enzyme inhibitors exhibit a lower risk of viral infection than nonusers.

In this retrospective review of 3477 symptomatic employees tested at high-throughput testing centers, 185 (5.3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Of those, 6 reported coronavirus disease 2019–related hospitalization. The prevalence of SARS-CoV-2 among symptomatic healthcare workers was comparable to that of symptomatic nonfrontline staff.

Nosocomial superinfections, including antimicrobial-resistant infections, will likely occur in an appreciable minority of severe coronavirus disease 2019 (COVID-19) cases. Stewardship will be crucial for limiting broad-spectrum antimicrobial use in hospitalized patients. Congressional COVID-19 legislation is considering reforms to antimicrobial reimbursement and development.

Molecular assays have revolutionized the diagnosis of acute respiratory tract infections. However, many unanswered questions about the optimal use and cost-effectiveness of these tests remain. Additional prospective diagnostic studies are needed to measure impact on medical decision making and clinical outcomes.

This narrative review summarizes evidence demonstrating transmission of severe acute respiratory syndrome coronavirus 2 by asymptomatic individuals and their contribution to coronavirus disease 2019 pandemic. Targeting universal testing of those with high frequency exposure should be a public health priority.

Lefamulin, a semisynthetic pleuromutilin antibiotic with oral and intravenous formulations, was recently approved for community-acquired bacterial pneumonia. In this review, we discuss its antimicrobial activity, clinical trial data, safety, and potential place in the therapeutic armamentarium.

We investigated the sources of multidrug-resistant (MDR) tuberculosis (TB) in patients with isoniazid-resistant TB treated with first-line anti-TB therapy and show that reinfection with a new MDR-TB strain was just as common as the emergence of rifampicin resistance among these patients.

We evaluated the association of antiretroviral therapy (ART) on cervical intraepithelial neoplasia (CIN2+) detection at follow-up among women living with human immunodeficiency virus (HIV) and found that ART was associated with a decreased risk of CIN2+ detection at follow-up, particularly in high-income countries and following excisional CIN management.

Some integrase strand transfer inhibitors promote peripheral and central fat/weight gain in people with HIV. We used unique simian and human adipose tissue models and in vitro adipocytes and revealed that dolutegravir and raltegravir induced adipogenesis, oxidative stress, lipogenesis, fibrosis, and insulin resistance.

Multistate analyses that account for patient transitions across human immunodeficiency virus (HIV) care cascade steps over time can provide more complete depictions of longitudinal treatment outcomes and highlight care gaps that will still need to be addressed even with universal HIV treatment.

During 2007–2016, approximately three-fourths of US-born adults were susceptible to hepatitis A virus infection. Susceptibility and nonvaccination among risk groups remained high and stable over time. Improving vaccination coverage among risk groups is urgently needed to mitigate current outbreaks.

It is critical to diagnose strongyloidiasis prior to solid-organ transplantation (SOT) to prevent severe strongyloidiasis syndromes. This cross-sectional study evaluated serum biomarkers for eosinophil activation and intestinal inflammation to provide insight into the pathogenesis of strongyloidiasis in SOT patients.

An algorithm selecting Hepatitis B e Antigen (HBeAG)-positive and HBeAg-negative women with ALT ≥40 IU/L could be an effective strategy to identify pregnant women with hepatitis B virus (HBV) eligible for antiviral preventive treatment in countries where HBV DNA quantification is not routinely available.

Treatment options directed toward respiratory syncytial virus (RSV) are limited. This first-in-child dose-escalation study of the direct-acting RSV antiviral treatment JNJ-53718678, demonstrated the potential for effective regimens, with an acceptable safety profile, to treat pediatric patients with RSV infection.

Direct oral anticoagulant (DOAC) prescribing has increased substantially in people living with human immunodeficiency virus (PWH). Clinicians need to be aware of potential DOAC and antiretroviral interactions to select the most appropriate oral anticoagulant and monitoring plan for PWH.

In this population-based cohort, whole-exome sequencing identified known and unknown, rare, predicted pathogenic variants in primary immunodeficiency genes in 1 of 5 children with proven sepsis. Future studies need to validate whether these variants contribute to sepsis susceptibility.

Mycoplasma genitalium (MG) infection was common among men presenting with urethritis symptoms to 6 U.S. sexually transmitted disease clinics; macrolide-associated mutation prevalence was high among men with MG. Persistent symptoms following treatment were frequent among men with and without MG.

Studies show intraseasonal decreases in measured vaccine effectiveness (VE) of influenza vaccine. Our simulations suggest that only some of this decline could occur if vaccine effect is leaky (partially protective). Studies to understand and strategies to overcome VE decline are needed.

Using a combination of whole-genome sequencing, patient transfer, and clinical data, we discerned the dissemination of 4 high-priority antibiotic-resistant organisms (AROs) in the regional healthcare network, and epidemiolocal drivers underlying the high ARO importation rate into regional nursing facilities.

We observed a reduction in 90-day readmission rates in PWID with invasive infections who left AMA who were prescribed oral antibiotic therapy, compared with those who were not. Readmission rates among those who received outpatient oral antibiotics were similar to those who completed inpatient IV antibiotic therapy.

MMV390048 is a promising new antimalarial compound in clinical development. We characterized the safety, pharmacokinetics, and antimalarial activity of MMV390048 in healthy adults. The results support the development of MMV390048 as a partner drug of a single-dose combination malaria therapy.

In a retrospective cohort study, relative effectiveness of the cell-derived quadrivalent influenza vaccine was significantly greater than egg-derived quadrivalent vaccines in preventing influenza-like illness during the 2017–2018 influenza season.

Youth living with perinatally acquired human immunodeficiency virus (HIV) appear to be at increased risk of endothelial dysfunction compared with age- and sex-matched youth without HIV in South Africa, suggesting that HIV plays a role in the progression of vascular disease and future atherosclerosis in youth living with perinatally acquired human immunodeficiency virus.

In this cluster-randomized quality improvement study of 26 inpatient units across 5 hospitals, introduction of electronic monitoring of hand hygiene resulted in a near-doubling of hand hygiene adherence associated with a trend toward reduced healthcare-associated transmission of methicillin-resistant Staphylococcus aureus.

Through analyses of publicly available human serological data, we identified a previously unrecognized persistence of Toxoplasma gondii sporozoite–specific antibodies. We discuss how sporozoite-specific serology can elucidate the transmission dynamics of T. gondii and help quantify the importance of transmission routes to inform public health initiatives.

Nonalcoholic fatty liver disease (NAFLD) can occur in lean patients. Lean NAFLD affects 13.9% of patients living with human immunodeficiency virus, particularly if dyslipidemic or with high alanine aminotransferase, and can lead to liver fibrosis.

This article describes 2017 baseline adult and pediatric Standardized Antimicrobial Administration Ratio predictive models, which were developed using antimicrobial use (AU) data submitted to the National Healthcare Safety Network AU Option from eligible patient-care locations in calendar year 2017.