Pub Date : 2024-12-01Epub Date: 2024-07-06DOI: 10.1016/j.cmi.2024.06.031
Mark H Ebell, Dan J Merenstein, Bruce Barrett, Michelle Bentivegna, Cassie Hulme, Caroline Hamer, Sarah Walters, Alea Sabry, Shari Barlow
Objectives: To describe the symptoms, duration, severity, and microbiology of lower respiratory tract infection (LRTI) in outpatients.
Methods: Prospective cohort study of adults in US primary or urgent care with a chief complaint of cough and symptoms consistent with LRTI. Baseline data included demographics, signs, symptoms, and PCR for 46 viruses and bacteria. The severity of symptoms reported for ≤28 days follow-up via diary and text message. The Bronchitis severity score assessed severity at baseline; overall severity was defined as the area under the symptom severity curve.
Results: Of 718 patients with complete baseline data, 618 had valid PCR results, and 443 were followed until symptoms resolved. Of those with valid PCR, 100 (16.2%) had 1+ viruses detected, 211 (34.1%) had 1+ bacteria, and 168 (27.2%) had both. Symptoms more likely with viral or mixed infection included feverishness (36.7-38.4% vs. 18.5%), chills or sweats (36.0-38.1% vs. 17.9%), being generally unwell (78.2-81.3% vs. 64.9%), and myalgias (42.7-48.2% vs. 28.6%). Coloured sputum (42.9% vs. 23.2-29.5%) was more common with a bacterial infection. The mean duration of cough was 14.7 days with viruses (95% CI: 13.2-16.2), 17.3 with bacteria (95% CI: 15.9-18.6), 16.9 with mixed infection (95% CI: 15.2-18.6), and 18.4 with no detection (95% CI: 16.1-20.8). Overall severity of cough was lower for viral infections (20.9 points, 95% CI: 18.6-23.3) than for other groups (range 24.2-26.3). The most common potential bacterial pathogens were Haemophilus influenza (28.0%), Moraxella catarrhalis (16.2%), and Streptococcus pneumoniae (10.2%), whereas the most common viral pathogens were rhinovirus (17.3%), influenza (12.8%), SARS-CoV-2 (11.5%), and seasonal coronaviruses (8.1%).
Discussion: The mean duration of cough was 16.4 days. Consistent with European studies, the type of infection or potential pathogen was not an important predictor of the duration or severity of LRTI.
目的描述门诊患者下呼吸道感染(LRTI)的症状、持续时间、严重程度和微生物学:方法:前瞻性队列研究,对象为在美国初级或紧急医疗机构就诊、主诉为咳嗽且症状符合 LRTI 的成人。基线数据包括人口统计学、体征、症状以及 46 种病毒和细菌的 PCR 检测。通过日记和短信报告长达 28 天的随访症状严重程度。支气管炎严重程度评分(BSS)评估基线时的严重程度;总体严重程度定义为症状严重程度曲线下的面积:在基线数据完整的 718 名患者中,618 人的 PCR 结果有效,443 人接受了随访,直至症状缓解。在 PCR 结果有效的患者中,100 人(16.2%)检测到 1+ 病毒,211 人(34.1%)检测到 1+ 细菌,168 人(27.2%)同时检测到病毒和细菌。病毒感染或混合感染更可能出现的症状包括发热(36.7% 至 38.4% vs 18.5%)、发冷或出汗(36.0% 至 38.1% vs 17.9%)、全身不适(78.2% 至 81.3% vs 64.9%)和肌痛(42.7% 至 48.2% vs 28.6%)。细菌感染时,痰液带色(42.9% 对 23.2% 至 29.5%)的情况更为常见。病毒感染者咳嗽的平均持续时间为 14.7 天(95% CI 13.2-16.2),细菌感染者为 17.3 天(95% CI 15.9-18.6),混合感染者为 16.9 天(95% CI 15.2-18.6),未检测到病毒者为 18.4 天(95% CI 16.1-20.8)。病毒感染者的总体咳嗽严重程度(20.9 分,95% CI 18.6-23.3)低于其他组别(范围 24.2-26.3)。最常见的潜在细菌病原体是流感嗜血杆菌(28.0%)、白喉摩拉菌(16.2%)和肺炎链球菌(10.2%),而最常见的病毒病原体是鼻病毒(17.3%)、流感(12.8%)、SARS-CoV-2(11.5%)和季节性冠状病毒(8.1%):结论:咳嗽的平均持续时间为 16.4 天。结论:咳嗽的平均持续时间为 16.4 天。与欧洲的研究结果一致,感染类型或潜在病原体并不是预测 LRTI 持续时间或严重程度的重要因素。
{"title":"Acute cough in outpatients: what causes it, how long does it last, and how severe is it for different viruses and bacteria?","authors":"Mark H Ebell, Dan J Merenstein, Bruce Barrett, Michelle Bentivegna, Cassie Hulme, Caroline Hamer, Sarah Walters, Alea Sabry, Shari Barlow","doi":"10.1016/j.cmi.2024.06.031","DOIUrl":"10.1016/j.cmi.2024.06.031","url":null,"abstract":"<p><strong>Objectives: </strong>To describe the symptoms, duration, severity, and microbiology of lower respiratory tract infection (LRTI) in outpatients.</p><p><strong>Methods: </strong>Prospective cohort study of adults in US primary or urgent care with a chief complaint of cough and symptoms consistent with LRTI. Baseline data included demographics, signs, symptoms, and PCR for 46 viruses and bacteria. The severity of symptoms reported for ≤28 days follow-up via diary and text message. The Bronchitis severity score assessed severity at baseline; overall severity was defined as the area under the symptom severity curve.</p><p><strong>Results: </strong>Of 718 patients with complete baseline data, 618 had valid PCR results, and 443 were followed until symptoms resolved. Of those with valid PCR, 100 (16.2%) had 1+ viruses detected, 211 (34.1%) had 1+ bacteria, and 168 (27.2%) had both. Symptoms more likely with viral or mixed infection included feverishness (36.7-38.4% vs. 18.5%), chills or sweats (36.0-38.1% vs. 17.9%), being generally unwell (78.2-81.3% vs. 64.9%), and myalgias (42.7-48.2% vs. 28.6%). Coloured sputum (42.9% vs. 23.2-29.5%) was more common with a bacterial infection. The mean duration of cough was 14.7 days with viruses (95% CI: 13.2-16.2), 17.3 with bacteria (95% CI: 15.9-18.6), 16.9 with mixed infection (95% CI: 15.2-18.6), and 18.4 with no detection (95% CI: 16.1-20.8). Overall severity of cough was lower for viral infections (20.9 points, 95% CI: 18.6-23.3) than for other groups (range 24.2-26.3). The most common potential bacterial pathogens were Haemophilus influenza (28.0%), Moraxella catarrhalis (16.2%), and Streptococcus pneumoniae (10.2%), whereas the most common viral pathogens were rhinovirus (17.3%), influenza (12.8%), SARS-CoV-2 (11.5%), and seasonal coronaviruses (8.1%).</p><p><strong>Discussion: </strong>The mean duration of cough was 16.4 days. Consistent with European studies, the type of infection or potential pathogen was not an important predictor of the duration or severity of LRTI.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1569-1575"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141558270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-07-26DOI: 10.1016/j.cmi.2024.07.014
Camille Jung, Corinne Levy, Stéphane Béchet, Philippe Aegerter, Robert Cohen, Robert Touitou
Objectives: The value of C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescriptions in adults has previously been emphasized. The aim of this study was to assess the impact of CRP POCT on antibiotic prescriptions by general practitioners (GPs) for suspected lower respiratory tract infections in children ≥3 years old and in adults.
Methods: This was an open-label randomized trial (NCT03540706) conducted in 26 GPs in France between October 2019 and March 2023. Of the 404 participating patients, 207 (51.2%) were randomized to the CRP POCT group and 197 (48.8%) to the control group (i.e. no CRP POCT). During consultations, GPs measured CRP levels in patients randomized to the CRP POCT group. The primary endpoint was the proportion of patients in each group who were prescribed antibiotics by their GP during the consultation. Z-tests were used for comparisons.
Results: The overall proportion of patients treated with antibiotics was similar in the CRP POCT (n = 89/207, 43% CI: 36.2, 50.0) and in the control group (n = 94/197, 47.7% CI: 40.6, 54.9), difference: -4.7 CI: -14.4, 5.0; p 0.3. Overall, 75% of the GPs followed CRP-based antibiotic prescription recommendations in the CRP POCT group.
Discussion: CRP POCT did not reduce antibiotic prescriptions in this trial.
{"title":"Impact of C-reactive protein point-of-care testing on antibiotic prescriptions for children and adults with suspected respiratory tract infections in primary care: a French patient-level randomized controlled superiority trial.","authors":"Camille Jung, Corinne Levy, Stéphane Béchet, Philippe Aegerter, Robert Cohen, Robert Touitou","doi":"10.1016/j.cmi.2024.07.014","DOIUrl":"10.1016/j.cmi.2024.07.014","url":null,"abstract":"<p><strong>Objectives: </strong>The value of C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescriptions in adults has previously been emphasized. The aim of this study was to assess the impact of CRP POCT on antibiotic prescriptions by general practitioners (GPs) for suspected lower respiratory tract infections in children ≥3 years old and in adults.</p><p><strong>Methods: </strong>This was an open-label randomized trial (NCT03540706) conducted in 26 GPs in France between October 2019 and March 2023. Of the 404 participating patients, 207 (51.2%) were randomized to the CRP POCT group and 197 (48.8%) to the control group (i.e. no CRP POCT). During consultations, GPs measured CRP levels in patients randomized to the CRP POCT group. The primary endpoint was the proportion of patients in each group who were prescribed antibiotics by their GP during the consultation. Z-tests were used for comparisons.</p><p><strong>Results: </strong>The overall proportion of patients treated with antibiotics was similar in the CRP POCT (n = 89/207, 43% CI: 36.2, 50.0) and in the control group (n = 94/197, 47.7% CI: 40.6, 54.9), difference: -4.7 CI: -14.4, 5.0; p 0.3. Overall, 75% of the GPs followed CRP-based antibiotic prescription recommendations in the CRP POCT group.</p><p><strong>Discussion: </strong>CRP POCT did not reduce antibiotic prescriptions in this trial.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1553-1558"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-30DOI: 10.1016/j.cmi.2024.08.022
Tommaso Matucci, Giacomo Pozza, Angelo Roberto Raccagni, Alberto Borghetti, Silvia Nozza, Andrea Giacomelli, Niccolò Riccardi
Background: Advanced HIV disease (AHD) is increasing, with late presentation accounting for half of newly diagnosed people with HIV (PWH) in Europe. Mortality in late-presenting PWH remains high, and Mycobacterium avium complex (MAC) disease, among other opportunistic infections, presents several diagnostic and treatment challenges that lead, ultimately, to a poor clinical outcome.
Objectives: We aimed to provide guidance on the diagnosis and treatment of disseminated MAC disease (dMACd) in PWH.
Sources: We performed a review of original articles, meta-analyses, and systematic reviews retrieved from PubMed.
Content: We reviewed and discussed the most challenging steps in the management of PWH with AHD and dMACd: the current epidemiology in the era of effective antiretroviral treatment; clinical presentation and interpretation of symptoms in the context of other opportunistic infections and immune reconstitution; diagnosis, sampling, and timing to reach a definitive diagnosis; prophylaxis, treatment options, and indications for discontinuing MAC treatment; future perspectives; and the role of rifamycins in the treatment of dMACd.
Implications: Despite the widespread availability of effective antiretroviral treatment, dMACd still represents a major cause of morbidity and mortality in PWH with AHD. Residual challenges are mainly related to the difficulties and timing required to reach a definitive diagnosis, and the discussion regarding the role of rifamycins in the treatment of dMACd is still open.
背景:晚期艾滋病毒疾病(AHD)正在增加,在欧洲,新确诊的艾滋病毒感染者(PWH)中有一半是晚期患者。晚期艾滋病病毒感染者的死亡率仍然很高,而复合分枝杆菌病(MAC)与其他机会性感染一样,给诊断和治疗带来了诸多挑战,最终导致不良的临床结果:我们旨在为诊断和治疗 PWH 中的播散性 MAC 病(dMACd)提供指导:我们对从 PubMed 上检索到的原创文章、荟萃分析和系统综述进行了综述:内容:我们回顾并讨论了对患有AHD和dMACd的PWH进行管理的最具挑战性的步骤:在有效的抗逆转录病毒治疗(ART)时代的当前流行病学;临床表现以及在其他机会性感染和免疫重建背景下对症状的解释;诊断、取样和达到明确诊断的时机;预防、治疗选择以及停止MAC治疗的指征;未来展望以及利福霉素在治疗dMACd中的作用:意义:尽管有效的抗逆转录病毒疗法已得到广泛应用,但在患有艾滋病的残疾人中,麦角疯仍是发病和死亡的主要原因。余下的挑战主要与明确诊断所需的困难和时间有关,而关于利福霉素在治疗dMACd中的作用的讨论仍未结束。
{"title":"How do I manage disseminated Mycobacterium avium complex disease in people with HIV?","authors":"Tommaso Matucci, Giacomo Pozza, Angelo Roberto Raccagni, Alberto Borghetti, Silvia Nozza, Andrea Giacomelli, Niccolò Riccardi","doi":"10.1016/j.cmi.2024.08.022","DOIUrl":"10.1016/j.cmi.2024.08.022","url":null,"abstract":"<p><strong>Background: </strong>Advanced HIV disease (AHD) is increasing, with late presentation accounting for half of newly diagnosed people with HIV (PWH) in Europe. Mortality in late-presenting PWH remains high, and Mycobacterium avium complex (MAC) disease, among other opportunistic infections, presents several diagnostic and treatment challenges that lead, ultimately, to a poor clinical outcome.</p><p><strong>Objectives: </strong>We aimed to provide guidance on the diagnosis and treatment of disseminated MAC disease (dMACd) in PWH.</p><p><strong>Sources: </strong>We performed a review of original articles, meta-analyses, and systematic reviews retrieved from PubMed.</p><p><strong>Content: </strong>We reviewed and discussed the most challenging steps in the management of PWH with AHD and dMACd: the current epidemiology in the era of effective antiretroviral treatment; clinical presentation and interpretation of symptoms in the context of other opportunistic infections and immune reconstitution; diagnosis, sampling, and timing to reach a definitive diagnosis; prophylaxis, treatment options, and indications for discontinuing MAC treatment; future perspectives; and the role of rifamycins in the treatment of dMACd.</p><p><strong>Implications: </strong>Despite the widespread availability of effective antiretroviral treatment, dMACd still represents a major cause of morbidity and mortality in PWH with AHD. Residual challenges are mainly related to the difficulties and timing required to reach a definitive diagnosis, and the discussion regarding the role of rifamycins in the treatment of dMACd is still open.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1529-1536"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-06DOI: 10.1016/j.cmi.2024.07.023
Gangqiang Sun, Ke Lin, Jingwen Ai, Wenhong Zhang
{"title":"'The efficacy of antivirals, corticosteroids, and mAbs as acute COVID treatments in reducing the incidence of long COVID' - Author's reply.","authors":"Gangqiang Sun, Ke Lin, Jingwen Ai, Wenhong Zhang","doi":"10.1016/j.cmi.2024.07.023","DOIUrl":"10.1016/j.cmi.2024.07.023","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1618-1619"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-07-26DOI: 10.1016/j.cmi.2024.07.020
Massimo Franchini, Mario Cruciani, Carlo Mengoli, Arturo Casadevall, Claudia Glingani, Michael J Joyner, Liise-Anne Pirofski, Jonathon W Senefeld, Shmuel Shoham, David J Sullivan, Matteo Zani, Daniele Focosi
Background: Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients.
Objectives: To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect.
Data sources: Electronic databases were searched for studies published from January 2020 to January 2024.
Study eligibility criteria: Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19.
Participants: Hospitalized patients with COVID-19.
Interventions: CCP versus no CCP.
Assessment of risk of bias: Cochrane risk of bias tool for RCTs.
Methods of data synthesis: The random-effects model was used to calculate the pooled risk ratio (RR) with 95% CI for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence.
Results: Twenty-seven RCTs were included, representing 18,877 hospitalized patients with COVID-19. When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61-0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90-1.06). The certainty of the evidence was graded as moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity.
Conclusions: In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit.
{"title":"Convalescent plasma and predictors of mortality among hospitalized patients with COVID-19: a systematic review and meta-analysis.","authors":"Massimo Franchini, Mario Cruciani, Carlo Mengoli, Arturo Casadevall, Claudia Glingani, Michael J Joyner, Liise-Anne Pirofski, Jonathon W Senefeld, Shmuel Shoham, David J Sullivan, Matteo Zani, Daniele Focosi","doi":"10.1016/j.cmi.2024.07.020","DOIUrl":"10.1016/j.cmi.2024.07.020","url":null,"abstract":"<p><strong>Background: </strong>Plasma collected from recovered patients with COVID-19 (COVID-19 convalescent plasma [CCP]) was the first antibody-based therapy employed to fight the COVID-19 pandemic. While the therapeutic effect of early administration of CCP in COVID-19 outpatients has been recognized, conflicting data exist regarding the efficacy of CCP administration in hospitalized patients.</p><p><strong>Objectives: </strong>To examine the effect of CCP compared to placebo or standard treatment, and to evaluate whether time from onset of symptoms to treatment initiation influenced the effect.</p><p><strong>Data sources: </strong>Electronic databases were searched for studies published from January 2020 to January 2024.</p><p><strong>Study eligibility criteria: </strong>Randomized clinical trials (RCTs) investigating the effect of CCP on COVID-19 mortality in hospitalized patients with COVID-19.</p><p><strong>Participants: </strong>Hospitalized patients with COVID-19.</p><p><strong>Interventions: </strong>CCP versus no CCP.</p><p><strong>Assessment of risk of bias: </strong>Cochrane risk of bias tool for RCTs.</p><p><strong>Methods of data synthesis: </strong>The random-effects model was used to calculate the pooled risk ratio (RR) with 95% CI for the pooled effect estimates of CCP treatment. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the certainty of evidence.</p><p><strong>Results: </strong>Twenty-seven RCTs were included, representing 18,877 hospitalized patients with COVID-19. When transfused within 7 days from symptom onset, CCP significantly reduced the risk of death compared to standard therapy or placebo (RR, 0.76; 95% CI, 0.61-0.95), while later CCP administration was not associated with a mortality benefit (RR, 0.98; 95% CI, 0.90-1.06). The certainty of the evidence was graded as moderate. Meta-regression analysis demonstrated increasing mortality effects for longer interval to transfusion or worse initial clinical severity.</p><p><strong>Conclusions: </strong>In-hospital transfusion of CCP within 7 days from symptom onset conferred a mortality benefit.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1514-1522"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-07-26DOI: 10.1016/j.cmi.2024.07.019
Jiaxin Cao, Pan Pan, Dan Feng, Mingyang Wang, Yawei Zheng, Nan Yang, Xin Chen, Weihua Zhai, Rongli Zhang, Qiaoling Ma, Jialin Wei, Donglin Yang, Yi He, Xiaodan Wang, Sizhou Feng, Mingzhe Han, Erlie Jiang, Aiming Pang
Objectives: To evaluate posaconazole (POS) gastro-resistant tablets for preventing invasive fungal disease (IFD) in haematopoietic stem cell transplantation (HSCT) patients and analyse POS plasma concentrations.
Methods: A single-arm trial was designed with a historical cohort as a control. Patients aged 13 years and older undergoing HSCT at the HSCT Center of Blood Diseases Hospital, Chinese Academy of Medical Sciences between December 2020 and May 2022 were enrolled, prospectively taking POS gastro-resistant tablets orally from day 1 to day 90 post-transplant and monitoring plasma concentrations. We also identified a retrospective cohort treated with alternative antifungal prophylaxis between January 2018 and December 2020, matched using propensity score methods. The primary outcome was the cumulative incidence of IFD at day 90 post-transplant.
Results: The prospective study involved 144 patients receiving POS gastro-resistant tablets for IFD prevention, contrasting with 287 patients receiving non-POS tablets. By day 90 post-transplant, the POS tablet group exhibited a significantly lower cumulative incidence of IFD (2.81%; 95% CI, 0.09-5.50% vs. 7.69%; 95% CI, 4.60-10.78%; p 0.044). Adverse events were comparable between the groups with liver changes in 33/144 (22.92%) vs. 84/287 (29.27%) (p 0.162), and renal injuries in 15/144 (10.41%) vs. 37/287 (12.89%) (p 0.457). Mean POS plasma concentrations on days 4, 8, 15, and 22 post-administration were 930.97 ng/mL, 1143.97 ng/mL, 1569.8 ng/mL, and 1652.57 ng/mL, respectively.
Discussion: Patients administered POS gastro-resistant tablets for antifungal prophylaxis experienced a lower cumulative incidence of IFD. POS plasma concentrations in HSCT patients stabilized by day 15 of medication.
{"title":"Posaconazole gastro-resistant tablets for preventing invasive fungal disease after haematopoietic stem cell transplantation: a propensity-matched cohort study.","authors":"Jiaxin Cao, Pan Pan, Dan Feng, Mingyang Wang, Yawei Zheng, Nan Yang, Xin Chen, Weihua Zhai, Rongli Zhang, Qiaoling Ma, Jialin Wei, Donglin Yang, Yi He, Xiaodan Wang, Sizhou Feng, Mingzhe Han, Erlie Jiang, Aiming Pang","doi":"10.1016/j.cmi.2024.07.019","DOIUrl":"10.1016/j.cmi.2024.07.019","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate posaconazole (POS) gastro-resistant tablets for preventing invasive fungal disease (IFD) in haematopoietic stem cell transplantation (HSCT) patients and analyse POS plasma concentrations.</p><p><strong>Methods: </strong>A single-arm trial was designed with a historical cohort as a control. Patients aged 13 years and older undergoing HSCT at the HSCT Center of Blood Diseases Hospital, Chinese Academy of Medical Sciences between December 2020 and May 2022 were enrolled, prospectively taking POS gastro-resistant tablets orally from day 1 to day 90 post-transplant and monitoring plasma concentrations. We also identified a retrospective cohort treated with alternative antifungal prophylaxis between January 2018 and December 2020, matched using propensity score methods. The primary outcome was the cumulative incidence of IFD at day 90 post-transplant.</p><p><strong>Results: </strong>The prospective study involved 144 patients receiving POS gastro-resistant tablets for IFD prevention, contrasting with 287 patients receiving non-POS tablets. By day 90 post-transplant, the POS tablet group exhibited a significantly lower cumulative incidence of IFD (2.81%; 95% CI, 0.09-5.50% vs. 7.69%; 95% CI, 4.60-10.78%; p 0.044). Adverse events were comparable between the groups with liver changes in 33/144 (22.92%) vs. 84/287 (29.27%) (p 0.162), and renal injuries in 15/144 (10.41%) vs. 37/287 (12.89%) (p 0.457). Mean POS plasma concentrations on days 4, 8, 15, and 22 post-administration were 930.97 ng/mL, 1143.97 ng/mL, 1569.8 ng/mL, and 1652.57 ng/mL, respectively.</p><p><strong>Discussion: </strong>Patients administered POS gastro-resistant tablets for antifungal prophylaxis experienced a lower cumulative incidence of IFD. POS plasma concentrations in HSCT patients stabilized by day 15 of medication.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1585-1591"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-07-26DOI: 10.1016/j.cmi.2024.07.016
Hui Li, Xia Wang, Guangting Zeng
{"title":"Re: 'The efficacy of antivirals, corticosteroids, and monoclonal antibodies as acute COVID-19 treatments in reducing the incidence of long COVID-19' by Sun et al.","authors":"Hui Li, Xia Wang, Guangting Zeng","doi":"10.1016/j.cmi.2024.07.016","DOIUrl":"10.1016/j.cmi.2024.07.016","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1616-1617"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-08DOI: 10.1016/j.cmi.2024.08.002
Guido Granata, Nicola Petrosillo, Eskild Petersen
{"title":"The impact of armed conflict on the development and global spread of antibiotic resistance: author's response.","authors":"Guido Granata, Nicola Petrosillo, Eskild Petersen","doi":"10.1016/j.cmi.2024.08.002","DOIUrl":"10.1016/j.cmi.2024.08.002","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1622-1623"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141912062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-08-24DOI: 10.1016/j.cmi.2024.08.012
Hélène Bricout, Marie-Cécile Levant, Nada Assi, Pascal Crépey, Alexandre Descamps, Karine Mari, Jacques Gaillat, Gaétan Gavazzi, Benjamin Grenier, Odile Launay, Anne Mosnier, Fanny Raguideau, Laurence Watier, Rebecca C Harris, Ayman Chit
Objectives: High-dose quadrivalent influenza vaccine (HD-QIV) was introduced during the 2021/2022 influenza season in France for adults aged ≥65 years as an alternative to standard-dose quadrivalent influenza vaccine (SD-QIV). The aim of this study is to estimate the relative vaccine effectiveness of HD-QIV vs. SD-QIV against influenza-related hospitalizations in France.
Methods: Community-dwelling individuals aged ≥65 years with reimbursed influenza vaccine claims during the 2021/2022 influenza season were included in the French national health insurance database. Individuals were followed up from vaccination day to 30 June 2022, nursing home admission or death date. Baseline socio-demographic and health characteristics were identified from medical records over the five previous years. Hospitalizations for influenza and other causes were recorded from 14 days after vaccination until the end of follow-up. HD-QIV and SD-QIV vaccinees were matched using 1:4 propensity score matching with an exact constraint on age group, sex, week of vaccination, and region. Incidence rate ratios were estimated using zero-inflated Poisson or zero-inflated negative binomial regression models.
Results: We matched 405 385 HD-QIV to 1 621 540 SD-QIV vaccinees. HD-QIV was associated with a 23.3% (95% CI, 8.4-35.8) lower rate of influenza hospitalizations compared with SD-QIV (69.5/100 000 person years vs. 90.5/100 000 person years). Post-matching, we observed higher rates in the HD-QIV group for hospitalizations non-specific to influenza and negative control outcomes, suggesting residual confounding by indication.
Discussion: HD-QIV was associated with lower influenza-related hospitalization rates vs. SD-QIV, consistent with existing evidence, in the context of high SARS-CoV-2 circulation in France and likely prioritization of HD-QIV for older/more comorbid individuals.
{"title":"The relative effectiveness of a high-dose quadrivalent influenza vaccine versus standard-dose quadrivalent influenza vaccines in older adults in France: a retrospective cohort study during the 2021-2022 influenza season.","authors":"Hélène Bricout, Marie-Cécile Levant, Nada Assi, Pascal Crépey, Alexandre Descamps, Karine Mari, Jacques Gaillat, Gaétan Gavazzi, Benjamin Grenier, Odile Launay, Anne Mosnier, Fanny Raguideau, Laurence Watier, Rebecca C Harris, Ayman Chit","doi":"10.1016/j.cmi.2024.08.012","DOIUrl":"10.1016/j.cmi.2024.08.012","url":null,"abstract":"<p><strong>Objectives: </strong>High-dose quadrivalent influenza vaccine (HD-QIV) was introduced during the 2021/2022 influenza season in France for adults aged ≥65 years as an alternative to standard-dose quadrivalent influenza vaccine (SD-QIV). The aim of this study is to estimate the relative vaccine effectiveness of HD-QIV vs. SD-QIV against influenza-related hospitalizations in France.</p><p><strong>Methods: </strong>Community-dwelling individuals aged ≥65 years with reimbursed influenza vaccine claims during the 2021/2022 influenza season were included in the French national health insurance database. Individuals were followed up from vaccination day to 30 June 2022, nursing home admission or death date. Baseline socio-demographic and health characteristics were identified from medical records over the five previous years. Hospitalizations for influenza and other causes were recorded from 14 days after vaccination until the end of follow-up. HD-QIV and SD-QIV vaccinees were matched using 1:4 propensity score matching with an exact constraint on age group, sex, week of vaccination, and region. Incidence rate ratios were estimated using zero-inflated Poisson or zero-inflated negative binomial regression models.</p><p><strong>Results: </strong>We matched 405 385 HD-QIV to 1 621 540 SD-QIV vaccinees. HD-QIV was associated with a 23.3% (95% CI, 8.4-35.8) lower rate of influenza hospitalizations compared with SD-QIV (69.5/100 000 person years vs. 90.5/100 000 person years). Post-matching, we observed higher rates in the HD-QIV group for hospitalizations non-specific to influenza and negative control outcomes, suggesting residual confounding by indication.</p><p><strong>Discussion: </strong>HD-QIV was associated with lower influenza-related hospitalization rates vs. SD-QIV, consistent with existing evidence, in the context of high SARS-CoV-2 circulation in France and likely prioritization of HD-QIV for older/more comorbid individuals.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1592-1598"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-12-01Epub Date: 2024-09-07DOI: 10.1016/j.cmi.2024.09.003
Alice Raffetin, Joppe W R Hovius, Benoît Jaulhac, Anna J Henningsson, Pierre Tattevin
{"title":"Early and better diagnosis for Lyme neuroborreliosis.","authors":"Alice Raffetin, Joppe W R Hovius, Benoît Jaulhac, Anna J Henningsson, Pierre Tattevin","doi":"10.1016/j.cmi.2024.09.003","DOIUrl":"10.1016/j.cmi.2024.09.003","url":null,"abstract":"","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":" ","pages":"1500-1502"},"PeriodicalIF":10.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}