Volume 78, Issue 1, 15 January 2024

Individualized antibiotic plans are a well-received tool that support antimicrobial stewardship principles in medically complex patients. We used this novel resource to decrease carbapenem use in pediatric patients receiving hematopoietic cell transplant without overall increase in bloodstream infection or mortality.

In a cohort of patients with Klebsiella pneumonia bacteremia, most infections were caused by strains that lacked canonical features associated with invasion. Patients given an ineffective first antibiotic were more likely to die, highlighting the need to rapidly identify resistance.

This meta-analysis showed that adjunctive rifampin therapy may be associated with lower risk of Staphylococcus aureus native vertebral osteomyelitis treatment failure. A randomized trial is necessary to corroborate these findings, given the very low certainty of evidence.

In this randomized-controlled trial, solid-organ transplant recipients receiving the MF59-adjuvanted and the high-dose influenza vaccines had higher antibody responses than patients receiving the standard influenza vaccine. All 3 vaccines were well tolerated. Rates of breakthrough influenza were similar between groups.

In the base case analysis, asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective. The cost-effectiveness depends mainly on the test-positive rate, the frequency of postoperative pulmonary complications, and screening costs.

The efficacy of arrival severe acute respiratory syndrome coronavirus 2 surveillance screening to prevent case clusters of coronavirus disease 2019 among training groups was not different when comparing nucleic acid amplification with rapid antigen detection test.

In the 300 days following infection, SARS-CoV-2–infected individuals exhibited increased risk of new-incident cardiovascular and cerebrovascular complications compared with test-negative controls. Risks decreased with vaccination and boosting. Conversely, risks increased for hospitalized and severe COVID-19 cases, compared to nonhospitalized cases.

This large retrospective case series (2013–2022) included 16 patients with neuroinvasive Powassan virus who presented with rhombencephalitis, isolated meningitis, meningoencephalitis, meningoencephalomyelitis, and/or opsoclonus myoclonus syndrome. The 90-day mortality rate was 18.8%, with neurologic deficits seen in 72.7% of survivors.

Antiretroviral dose adjustment is not required a priori in obese people with HIV (PWH). Despite a 20% reduction in antiretroviral exposure and trough concentrations below target thresholds for etravirine and rilpivirine, virological response was similar between obese and nonobese PWH.

Among 16 864 people diagnosed with HIV between 1 January 2009 and 31 December 2019, we describe considerable improvement in time from diagnosis to controlled viral load, from 254 [127–745] to 73 days [48–132] during the study period.

Among immigrant women seeking Swedish antenatal care, tuberculosis infection was independently associated with stillbirth, severe preeclampsia, low birthweight, and emergency cesarean section, suggesting that tuberculosis infection may be involved in the pathogenesis of pregnancy-related disorders.

This modeling analysis translates forthcoming clinical trial estimates of the efficacy of drug-resistant tuberculosis preventive therapy into longer-term and population-wide effects. The full impact and cost-effectiveness of this intervention are likely to be several times greater than trials directly measure.

Active case-finding might reduce the tuberculosis (TB) diagnostic gap. We estimate that screening tests could meaningfully improve these active case-finding efforts, but only if they are highly sensitive, specific (approximately 70%–95%), and available at low costs (approaching $4.5/test all-inclusive).

Quantifying recurrence risk following successful treatment for multidrug-resistant tuberculosis, crucial to regimen evaluation, is complicated when patients die or become lost during post-treatment follow-up. We examine multiple approaches for addressing these issues and provide guidance for researchers conducting similar analyses.

Invasive pneumococcal disease incidence increased among Alaska adults during 2011–2020, driven by increases among Alaska Native adults and adults experiencing homelessness. A substantial proportion of cases were potentially preventable by new pneumococcal conjugate vaccines.

This study compared infective endocarditis (IE) after surgical aortic valve replacement and transcatheter aortic valve replacement; 1688 patients with IE affecting the aortic valve prosthesis were included. Clinical presentation, complications, and treatment were different, but 1-year mortality rates were similar.

Limited data suggest suppressive antibiotic therapy (SAT) may reduce treatment failure following debridement and implant retention (DAIR) for prosthetic joint infection. We propose a structured approach to selecting patients for SAT following DAIR incorporating known DAIR treatment failure risk factors.

The risk of intussusception following rotavirus vaccination may vary by vaccine type and socioeconomic status. In a pooled analysis of data from 5 countries in Africa, RotaTeq vaccination was not associated with an increased risk of intussusception.

In pediatric hematopoietic cell transplant (HCT) recipients, 2 doses of high-dose trivalent influenza vaccine were more immunogenic than 2 doses of standard-dose quadrivalent influenza vaccine, especially when administered ≥6 months post-HCT. Influenza-specific titers remained higher than baseline for all antigens.

Persistent enterococcal bacteremia is a commonly encountered and morbid syndrome without a strong evidence base for optimal management practices. Here we highlight reports on the epidemiology of enterococcal bacteremia to better describe and define persistent enterococcal bacteremia, discuss factors specific to Enterococcus species that may contribute to persistent infections, and describe a measured approach to diagnostic and therapeutic strategies for patients with these frequently complicated infections. The diagnosis of persistent enterococcal bacteremia is typically clinically evident in the setting of repeatedly positive blood culture results; instead, the challenge is to determine in an accurate, cost-effective, and minimally invasive manner whether any underlying nidus of infection (eg, endocarditis or undrained abscess) is present and contributing to the persistent bacteremia. Clinical outcomes for patients with persistent enterococcal bacteremia remain suboptimal. Beyond addressing host immune status if relevant and pursuing source control for all patients, management decisions primarily involve the selection of the proper antimicrobial agent(s). Options for antimicrobial therapy are often limited in the setting of intrinsic and acquired antimicrobial resistance among enterococcal clinical isolates. The synergistic benefit of combination antimicrobial therapy has been demonstrated for enterococcal endocarditis, but it is not clear at present whether a similar approach will provide any clinical benefit to some or all patients with persistent enterococcal bacteremia.