Volume 11, Issue 3, March 2024

With the rapid advancement of artificial intelligence, the field of infectious diseases faces both innovation and disruption. We provide considerations for infectious diseases specialists to leverage this growing technology while mitigating its risks.

The top 13 publications of 2022 describing an actionable antimicrobial stewardship intervention were selected by a modified Delphi technique. This summary will serve as a resource for readers seeking to stay up to date on successful antimicrobial stewardship strategies.

Endemic mycoses may cause severe disease among SOT recipients, especially those with epidemiologic risk. Fever, disseminated disease, and cytopenia are common. Heightened suspicion for these mycoses is needed to facilitate early recognition and reduce morbidity and mortality rates in SOT recipients.

The Sankey approach provides a dynamic visual model to understand the changing risk of invasive aspergillosis from diagnosis of an underlying condition throughout the treatment journey. Future upgrades could include actionable links to references or bundles of pharmacologic or non-pharmacologic interventions.

Kidney, liver, heart, and lung transplant recipients who acquired hepatitis C from donor organs described positive experiences overall; however, some had concerns about hepatitis C transmission, treatment costs, and unexpected treatment delays, highlighting opportunities for improved education.

Our randomized clinical trial compared safety and efficacy of high-dose rifampicin (R25/R35) against conventional dose (R10). We found that R35 was more toxic than R10. R25 was equally safe and more efficacious than R10; hence, it may be implemented for treatment shortening of drug-susceptible pulmonary tuberculosis.

In this prospective multicenter cohort with 4,548 infective endocarditis cases, mycotic aneurysms (MA) developed in 2%, with half being intracranial. Rupture was common, correlating with poor prognosis. A notable portion of initially intact intracranial MA ruptured within the initial days.

The NIH disbursed more than $4 billion in funding to large consortiums and clinical trials to develop diagnostics, therapeutics, and vaccines. Approximately 8% of funding was used for R01 grants. Clinical trial sites were generally located in areas of high COVID-19 burden.

This study investigated the timing of β-lactam antibiotic dose adjustment in sepsis patients with acute kidney injury. The findings indicated that delaying antipseudomonal β-lactam antibiotic dose adjustment was associated with reduced in-hospital mortality.

One of 4 participants administered anti-PD-1 antibody exhibited increased HIV-1–specific T-cell responses and transiently increased HIV-1 expression. Significant immune-related adverse events after a single, low dose of anti-PD-1 antibody may limit translating the benefits of anti-PD-1 therapies from cancer to HIV.

Integrase strand transfer inhibitor–based antiretroviral therapy (ART) did not increase the risk of tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in the Reflate TB2 randomized controlled trial. Low CD4 counts and high HIV-RNA at ART initiation and extrapulmonary/disseminated TB were risk factors for TB-IRIS.

In a randomized controlled trial from Guinea-Bissau contrasting BCG-Japan and BCG-Russia, BCG strain was not associated with differences in all-cause morbidity and mortality by 6 weeks or 6 months of age. BCG-Japan produced more and larger BCG skin reactions.

Itraconazole is the mainstay therapy for endemic mycoses. Unfavorable pharmacokinetics lead to subtherapeutic levels and adverse effects. Super-bioavailability itraconazole is bioequivalent to conventional itraconazole, with similar clinical outcomes, but has fewer adverse events, possibly owing to lower drug-level variability.

We describe a novel population of urgent care clinic patients diagnosed and treated for community-acquired pneumonia. Variability in the use of chest imaging among patients diagnosed with pneumonia reveals opportunities for improving clinical decision-making support and antibiotic stewardship. Existing tools for predicting pneumonia severity which are based on ED and inpatient data overestimated the need for hospital admission.

Septic arthritis of the facet joint is a distinct clinical syndrome typically involving the lumbar spine, and frequently associated with bacteremia, posterior epidural abscesses, and paraspinal pyomyositis. Neurologic outcomes are usually good with medical management alone.

In a college population, an index-cluster sampling strategy in which clusters were established based on geographic proximity alone did not enrich for cases of respiratory viral transmission.

Timely identification of infants at highest risk of respiratory syncytial virus–related morbidity is key to prevention. We developed a personalized risk prediction tool using birth/postnatal data that may have applications in promoting immunoprophylaxis to prevent the most severe infant respiratory syncytial virus infections.

We found a high level of transmissibility of the SARS-CoV-2 BA.1* Omicron variant both within the community and households. Phylogenetic analysis suggests a diverse set of viruses were transmitted within the community and households, consistent with multiple introductions and high rates of incidence.

A systematic review (93 studies) and meta-analysis were conducted to assess the association between bacterial strains and complications, recurrence, and mortality in Clostridioides difficile infection. NAP1/BI/R027 was associated with unfavorable outcomes. Data on other strains were insufficient for significant conclusions.

Over half of adults with HIV initiated on a dolutegravir-based regimen developed hypertension, with a quarter of them developing it 6 months post–dolutegravir initiation. Incidence was higher in treatment-naive persons. Obesity and low high-density lipoprotein were risk factors for developing hypertension.

We identified 2 genetic polymorphisms associated with greatly increased risk of astrovirus diarrheal infections in the first year of life, the A allele of rs75437404 (odds ratio, 2.71) and the C allele of rs75935441 (odds ratio, 4.17).

In South African people with HIV, the presence of Vpr amino acid G41 showed significant associations with higher levels of soluble urokinase plasminogen activator receptor compared to other amino acids at these positions.

Dolutegravir combined with tenofovir alafenamide or tenofovir disoproxil fumarate had high potency and safety, with no resistance to dolutegravir after 192 weeks, but it sustained weight gain, especially among women, those with low initiation CD4 counts, and those taking tenofovir alafenamide.

Study findings indicate that acute-care costs for lower respiratory tract illness due to respiratory syncytial virus (RSV-LRTI) are high among US adults, and that attributable costs for RSV-LRTI remain high throughout the 1-year period following the acute phase of illness.

In a retrospective study of 3,507 renal transplant recipients (RTRs) the detection of an MDRO during the early post-transplant (EPT) period was associated with death-censored allograft loss. This suggests the need for increased strategies to optimize prevention of MDROs colonization and infection.

There are scarce epidemiologic data on febrile neutropenia infections in people with hematologic malignancies in Latin America. This retrospective and multicenter study offers updated knowledge regarding bloodstream infections, predominantly consisting of gram-negative rods with high rates of antibiotic resistance.

Acyclovir-resistant mucocutaneous herpes simplex virus (HSV) infection is a rare morbid illness typically treated with foscarnet. In this multicenter retrospective study of foscarnet therapy, half of 31 HSV episodes resolved during or after therapy; renal and electrolyte-related adverse events were common.

We interviewed 115 persons with mpox who did and did not receive tecovirimat, and performed a multivariable regression analysis. Initiating tecovirimat within 5 days of symptom onset appeared to be associated with faster improvement of symptoms in patients with severe mpox.

Syringe access program (SAP) clients report high rates of hepatitis C virus (HCV) infection but limited access to treatment. They reported being more likely to get treated for HCV at the SAP and are comfortable with telemedicine-based appointments.

We present the clinical characteristics, outcomes, and risk factors for coronavirus disease 2019 (COVID-19) in allogeneic hematopoietic stem cell transplantation recipients during the Omicron wave. The recipients exhibited a low COVID-19–related mortality rate and high moderate-to-severe and prolonged disease incidence.

An increase in the number of enteric fever cases was observed in South Africa between 2020 and 2022. The outbreak predominantly affected illegal gold miners, likely due to the consumption of contaminated water while underground.

Severe outcomes among pregnant women hospitalized with RSV infection were rare, and mild/asymptomatic infection was more frequently identified in pregnant women. In addition, more pregnant women delivered during their RSV-associated hospitalization during the COVID-19 pandemic vs before the pandemic.

In this retrospective analysis, seizures and behavioral disturbances occurred following carbapenem administration in 46.3% and 50.8% of encounters, respectively, in patients with valproate exposure. Clinicians should be aware of this drug interaction and consider alternative antimicrobials when clinically appropriate.

We describe 5 health care–associated neuroinvasive Bacillus cereus infections. No point source was identified, and isolates were unrelated. Enhancing environmental cleaning, laundry management, and the neutropenic diet, as well as modifying empiric treatment protocols for febrile neutropenia, aborted the cluster.

We performed a prospective observational study to evaluate contamination of N95 respirators and face shields with SARS-CoV-2 when worn by healthcare providers giving care for SARS-CoV-2–positive patients housed in a COVID-19 unit. SARS-CoV-2 contamination was minimal.

Thirty-three percent of unvaccinated adults with mild-to-moderate acute COVID-19 experienced long COVID symptoms; 8% still had not returned to their pre-COVID-19 health status 24 months postinfection. Long COVID symptoms peaked and quality of life nadired at 6–12 months postinfection.

Hospitalization due to Shigella gastroenteritis can strikingly increase the 5-year risk of developing irritable bowel syndrome. Clinical and background factors, such as education level, abdominal cramps, and prolonged diarrhea during hospitalization, can affect this risk.

The SEIMC-CEME-22 study in Spain investigated the mpox outbreak. Predominantly middle-aged, cisgender men with a high HIV prevalence were affected, primarily through sexual transmission. Prominent symptoms included rash (95.7%) and fever (48.2%). STI were concurrently diagnosed. Diverse treatments were administered.

This analysis evaluated observed-to-expected ratios for adverse events of special interest that were proposed in advance of COVID-19 vaccine use. Following administration of an estimated 772 908 958 doses of mRNA-1273, meaningful associations were found only for anaphylaxis, myocarditis, and pericarditis.

In a nationwide real-world study among nursing home residents, mRNA COVID-19 vaccines provided substantial protection against COVID-19–related death, even among prior COVID-19 survivors. Two-dose protection waned after 6 months. A third dose significantly boosted protection.

Infectious Diseases (ID) Training Program Directors have observed an increase in clinical volume and acuity. Specific goals and strategies to manage the volume and acuity while preserving quality education in both the inpatient and ambulatory settings are described

In this viewpoint, we discuss the consequences of the SCOTUS ruling ending race-conscious consideration for college admission, on diversifying the infectious disease workforce and combatting current and future pandemics. We provide strategies to mitigate this potential negative impact.