Volume 78, Issue 6, 15 June 2024

We describe the validity, reliability, feasibility, and usability of 2 safety measures for hospitalized medicine patients: inappropriate diagnosis of urinary tract infection and inappropriate diagnosis of community-acquired pneumonia. These highly reliable, valid measures can be used to improve patient care.

In this mixed-methods study, hospitals with low antibiotic overuse had 4 distinguishing characteristics: robust knowledge of antibiotic stewardship, quality clinical pharmacist–physician relationships, tools and infrastructure to support stewardship, and highly engaged infectious diseases physicians who advocated for stewardship principles.

• 40% of the time between blood taking and appropriate treatment administration is postanalytical time.

• Current health information systems serve as bottleneck and rigid framework to focus on.

• Because of complex process, next-generation health information systems should be codesigned with healthcare workers.

People who inject drugs (PWID) were heavily overrepresented among patients with Staphylococcus aureus bacteremia nationally. PWID had lower odds of death in the absence of endocarditis and lower odds of readmission within 90 days compared to non-PWID patients.

Central nervous system anthrax treatment requires effective antimicrobial concentrations at sites of Bacillus anthracis growth in cerebrospinal fluid, brain parenchyma, and areas of abscess and hemorrhage. Using population pharmacokinetics, we identified antimicrobial dosages predicted to achieve effective cerebrospinal fluid concentrations.

Patients with persistent gram-negative bloodstream infections (ie, ongoing positive blood cultures) were at increased risk of recurrent gram-negative bloodstream infection (ie, initial clearance of infection followed by later return of infection) with the same bacterial species and strain.

In this phase 3 superiority study, ridinilazole, bactericidal bis-benzimidazole against C. difficile, versus vancomycin reduced recurrent disease by 53%, preserved microbiota diversity, increased secondary bile acids, did not increase resistome, but did not meet superiority in initial clinical response.

Exebacase in addition to standard-of-care antibiotics was well-tolerated but failed to improve clinical response at day 14 in patients with Staphylococcus aureus bacteremia/endocarditis. This trial provides lessons for future superiority design studies in Staphylococcus aureus bacteremia/endocarditis.

The win ratio is a method for assessing trial outcome using a hierarchical composite endpoint. Using its application post hoc to the MERINO trial provided further detail on clinically important outcomes, demonstrating its potential utility in infectious diseases trials.

COVID-19 mortality risk of virus, host factors.

We evaluated the SARS-CoV-2 viral load changes over the course of illness in children. The median time to presumably non-infectious viral load was 5 days after symptom onset, with 60–90% of children meeting the threshold of non-infectiousness on the day after symptom resolution.

In 245 immunocompromised patients treated with anti–SARS-CoV-2, mortality remained substantial when treatment was initiated after hospital admission. Viral sequencing showed that spike protein mutations occurred more frequently after treatment with a single antibody compared with dual therapy.

Household contacts of SARS-CoV-2 test-positive asymptomatic children were 5 times more likely to develop symptomatic illness within 2 weeks compared with household contacts of test-negative asymptomatic children. Post-COVID condition was reported by 8% of initially asymptomatic SARS-CoV-2–infected children.

Five years of the LEAP Fellowship program, sponsored by the Centers for Disease Control and Prevention, demonstrates a successful model for establishing effective partnerships between early-career infectious diseases physicians and public health while fitting into the current fellowship training framework.

The overall 14-day mortality rate among 861 episodes of streptococcal bacteremia was 8%. Interventions performed within 48 hours of bacteremia onset, such as infectious diseases consultation, appropriate antimicrobial treatment, and source control were associated with improved outcome.

Public health officials are investigating a multistate fungal meningitis outbreak affecting US residents who received epidural anesthesia at 2 clinics in Matamoros, Mexico, from 1 January to 13 May 2023. We summarize current epidemiology, clinical characteristics, interim treatment recommendations, and ongoing challenges.

To address challenges with the development of inhaled antifungal therapies, the US Food and Drug Administration convened a workshop on 25 September 2020 to discuss clinical trial designs for both prophylaxis and treatment and strategies to streamline product development.

80.1% of Veterans with hepatitis C viremia initiated treatment, with sustained virologic response in 91.6%. Younger age, stimulant use, and unstable housing were negatively associated with each step of the hepatitis C care continuum, indicating where resources should be targeted.

6-year hepatitis B viral and liver outcomes of ART-treated HBVHIV coinfection were reassuring in Zambia. HBV DNA non-suppression and alanine aminotransferase ALT elevation persisted in some patients. High hepatitis B surface antigen clearance rates should motivate additional research in this population.

In a population-based sample of persons living with human immunodeficiency virus on antiretroviral therapy in southern Uganda, facility switching was ubiquitous and associated with a 2-fold rate increase in loss of viral suppression, or viral rebound.

In a sub-study of a community cluster-randomized trial in rural Uganda, a universal human immunodeficiency virus (HIV)-test-and-treat intervention reduced incident tuberculosis (TB) infection, a marker of population-level TB transmission. Investments in community-level HIV interventions have direct impacts on HIV and broader population-level benefits.

Polypharmacy is prevalent among PWH. Slow gait speed and recurrent falls, both predictors of poor outcomes, are exacerbated in PWH with polypharmacy, even after accounting for other contributing factors.

Antepartum weight gain among women receiving dolutegravir was associated with less insufficient weight gain and lower risk of adverse pregnancy outcomes; however, women receiving dolutegravir were more likely to have postpartum body mass index in the overweight or obese range.

Undetectable HIV in maternal plasma does not translate to untransmissible while breastfeeding Guidance as to monitoring of mothers during lactation, type, and length of prophylaxis for infants is needed. The goal is to drive transmission to zero during breastfeeding.

Central line–associated bloodstream infections (CLABSIs) outside acute care are understudied and overlooked. This study underscores the need for CLABSI prevention initiatives targeted outside acute care.

The data supports only two preventive measures for reducing peripheral intravenous catheter-associated complications: wearing gloves during insertion and adhering to defined schedules for catheter removal. Our systematic review emphasizes the pressing need for additional high-quality studies addressing this essential topic.

Low-value, uncompensated work in academic infectious diseases is a threat to our well-being and success. Deliberate strategies can maximize higher-value job functions and minimize low-value tasks to maintain focus on both individual and group goals.

The scientific, historical, and political contexts of 5 frescoes painted by Diego Rivera, the widely acclaimed 20th-century Mexican artist, that depict the application of microbiological discoveries to the prevention and treatment of infectious diseases are briefly examined and explored.

We conducted 3 rounds of mass tuberculosis screening in heavily crowded, high-burden prisons in Brazil. We found extraordinarily high prevalence of tuberculosis, ranging from 3700 to 4000 cases per 100 000 persons.

Flat-dosing of rifampicin at 600 mg daily provided similar plasma exposure to conventional weight-banded dosing for drug-susceptible tuberculosis. This dosing strategy may be a reasonable alternative to weight-banded dosing in the 6-month standard-of-care regimen for drug-susceptible tuberculosis.

After 6 months of antibiotic treatment for nontuberculous mycobacterial pulmonary disease, health-related quality of life improved in almost one-third of patients, particularly in patients with severe initial symptoms, regardless of culture conversion.

The effectiveness of a 9-month regimen containing linezolid for treating multidrug-resistant tuberculosis was evaluated against the previously recommended regimen containing ethionamide. In a cohort of 5061 patients, no significant differences in treatment success and survival were observed between regimens.

After the initial phase of the COVID-19 pandemic, hospitals reported an increase in RSV cases. We examined encounters at US pediatric hospitals and found that increased testing is likely driving the observed increase in case volume.

Supervised exercise training during admission may not further reduce the already short admission length in patients with community-acquired pneumonia. However, exercise training during admission might have the potential to reduce the risk of readmission and the number of readmission days.

The 2020 Council of State and Territorial Epidemiologists (CSTE) case definition change for pertussis resulted in additional case reporting compared with the previous case definition despite a substantial decrease in reported pertussis cases in the setting of coronavirus disease 2019 (COVID-19).

One RSVPreF3 OA dose was efficacious against respiratory syncytial virus (RSV)–related lower respiratory tract disease during at least 2 RSV seasons in ≥60-year-olds. RSVPreF3 OA revaccination 1 year post–dose 1 did not seem to provide additional efficacy benefit. Optimal timing of revaccination remains to be determined.

The next-generation rabies vaccine PVRV-NG2, demonstrated immunogenic non-inferiority versus standard-of-care vaccines and a favorable safety profile when co-administered with human rabies immunoglobulin or as a stand-alone vaccine in a simulated post-exposure prophylaxis, phase 3 trial in healthy adults.

The 2013 and 2017 A(H7N9) inactivated influenza vaccines were well tolerated and no new safety concerns were identified. Administering AS03 adjuvant with the second H7N9 inactivated influenza vaccine dose and extending the boost interval to 4 months resulted in higher peak antibody responses.