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Impact of C-reactive protein point-of-care testing on antibiotic prescriptions for children and adults with suspected respiratory tract infections in primary care: author's response. C反应蛋白床旁检测对基层医疗机构为疑似呼吸道感染的儿童和成人开具抗生素处方的影响"--作者回复。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-05 DOI: 10.1016/j.cmi.2024.09.032
Camille Jung, Xavier Wang, Corinne Levy, Robert Cohen, Robert Touitou
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引用次数: 0
ESR and CRP: it is time to stop the zombie tests: author's response. ESR和CRP:是时候停止 "僵尸检验 "了》--作者回复。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-05 DOI: 10.1016/j.cmi.2024.09.029
Brad Spellberg, Bassam Ghanem, Tom Boyles, Todd C Lee, Emily G McDonald
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引用次数: 0
Steroids for viral meningitis: a foe or a friend? 治疗病毒性脑膜炎的类固醇:是敌还是友?
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-05 DOI: 10.1016/j.cmi.2024.09.030
Rodrigo Hasbun
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引用次数: 0
Introducing new antibiotics for multidrug-resistant bacteria: obstacles and the way forward. 针对耐多药细菌引进新抗生素:障碍与前进之路。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-05 DOI: 10.1016/j.cmi.2024.09.025
Thomas Tängdén, Elena Carrara, Mona Mustafa Hellou, Dafna Yahav, Mical Paul

Background: Following intense efforts to revive the dry antibiotic research and development pipeline, a few highly awaited antibiotics with activity against multidrug-resistant (MDR) bacteria were recently approved.

Objectives: We aim to highlight gaps in the evidence generated for new antibiotics by the time of their approval and to review the consequent limitations of treatment guidelines for priority MDR bacteria. We also report on the availability of the new antibiotics, reimbursement strategies allowing the use of these antibiotics in hospitals, and antibiotic stewardship efforts.

Sources: We searched PubMed for phase 3 randomized controlled trials, guidelines, and publications on access, usage, regulatory aspects and antimicrobial stewardship of antibiotics approved for use against MDR bacteria between 2013 and 2023. Other sources included governmental and professional documents regarding policies for reimbursement and use of the new antibiotics.

Content: Several gaps in the evidence available regarding the new antibiotics are described related to the trials' target populations, comparators, management algorithm within the trial, non-inferiority hypotheses, and assessment of resistance development within the studies. We highlight the risk of current guidelines to increase the usage of new antibiotics and consequently accelerate resistance development. Updated mapping of antibiotic availability reveals critical inequality in access to the new antibiotics. Finally, strategies used nationally in Europe to provide access to the new antibiotics are not sufficiently balanced by antibiotic stewardship efforts to calibrate the judicious use of the new antibiotics.

Implications: Antibiotic resistance is an immediate threat. The present review highlights areas where more systematic and uniform strategies across countries and geographical regions are warranted to improve evidence, availability, and use of new broad-spectrum antibiotics.

背景:在大力重振干抗生素研发管道之后,最近批准了几种备受期待的具有抗耐多药(MDR)细菌活性的抗生素:目的:我们旨在强调新抗生素在获得批准时所产生的证据方面的差距,并审查优先 MDR 细菌治疗指南因此而受到的限制。我们还报告了新抗生素的可用性、允许医院使用这些抗生素的报销策略以及抗生素监管工作:我们在 PubMed 上搜索了 2013-2023 年间获批用于抗 MDR 细菌的 3 期随机对照试验。其他来源包括有关新抗生素报销和使用政策的政府和专业文件:内容:本文介绍了有关新型抗生素的现有证据中存在的几个缺陷,涉及试验的目标人群、比较对象、试验中的管理算法、非劣效假设以及研究中的耐药性发展评估。我们强调了现行指南有可能会增加新抗生素的使用,从而加速耐药性的产生。对抗生素可用性的最新调查显示,在获得新抗生素方面存在严重的不平等。最后,欧洲各国为提供新抗生素而采取的策略没有得到抗生素监管工作的充分平衡,无法合理使用新抗生素:抗生素耐药性是一个迫在眉睫的威胁。本综述强调了需要在不同国家和地理区域采取更加系统和统一的策略,以改进新型广谱抗生素的证据、供应和使用的领域。
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引用次数: 0
Pitfalls in generating robust malaria molecular evidence for SP-resistance. 生成抗 SP 的可靠疟疾分子证据的陷阱。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-05 DOI: 10.1016/j.cmi.2024.09.026
Nimita Deora, Abhinav Sinha
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引用次数: 0
In vitro activity of cefepime-enmetazobactam on carbapenem-resistant gram negatives. 头孢吡肟-恩马唑巴坦对耐碳青霉烯类革兰氏阴性菌的体外活性。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-05 DOI: 10.1016/j.cmi.2024.09.031
Rémy A Bonnin, Katy Jeannot, Anne Santerre Henriksen, Juan Quevedo, Laurent Dortet

Objectives: Cefepime-enmetazobactam is a new β-lactam/βlactamase inhibitor combination with broad-spectrum activity against multidrug-resistant Enterobacterales, including extended-spectrum β-lactamase producers. This study evaluated the in vitro activity of cefepime-enmetazobactam towards a collection of carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa and Acinetobacter baumannii compared to the other β-lactam/β-lactamase inhibitor combinations.

Methods: The MIC of cefepime, cefepime-enmetazobactam, ceftazidime, ceftazidime-avibactam, meropenem, meropenem-vaborbactam, imipenem, imipenem-relebactam, and ertapenem were determined by broth microdilution on 2212 CRE, including 2089 carbapenemase producers (1000 OXA-48-like, 49 KPC, 697 NDM, 180 VIM, 1 IMP, 9 IMI, and 158 multiple carbapenemases) and 123 CRE that do not produce carbapenemase received at the French National Reference Centre (from March 1, 2023 to August 31, 2023), 50 P. aeruginosa, and 30 A. baumannii. All strains were fully sequenced.

Results: We confirmed the absence of inhibitory activity of enmetazobactam towards metallo-β-lactamases. Cefepime-enmetazobactam and ceftazidime-avibactam exhibited a similar susceptibility (96.7% vs. 99.5%, respectively) on OXA-48-producers. Cefepime-enmetazobactam exhibited 66.9% and 63.3% susceptibility for CRE non-EPC and KPC, whereas those rates rose to 96.7%/95.9%, 93.4%/95.9%, and 95.9%/98.0% for ceftazidime-avibactam, imipenem-relebactam, and meropenem-vaborbactam, respectively. Low MICs (≤0.25 mg/L) were obtained for ceftazidime-avibactam-resistant KPC variants. Cefepime-enmetazobactam did not display a significant added value when compared with cefepime alone on Pseudomonas aeruginosa and Acinetobacter baumannii.

Discussion: OXA-48 producers displayed high susceptibility to cefepime-enmetazobactam, which is similar to ceftazidime-avibactam, including for OXA-48 producers that coproduce a ceftazidime hydrolyzing enzyme (extended-spectrum β-lactamases or AmpC). In vivo experiments have to be implemented to confirm if cefepime-enmetazobactam might be a relevant alternative to ceftazidime-avibactam for the treatment of infections caused by OXA-48 producers.

目的:头孢吡肟-恩美唑巴坦是一种新型β-内酰胺-β-内酰胺酶抑制剂(BL/BLI)复方制剂,对包括ESBL产生者在内的多重耐药肠杆菌科细菌具有广谱活性。本研究评估了头孢吡肟-恩马唑巴坦与其他 BL/BLI 组合相比,对一系列耐碳青霉烯类肠杆菌(CRE)、铜绿假单胞菌和鲍曼不动杆菌的体外活性:方法:采用肉汤微稀释法测定了头孢吡肟、头孢吡肟-恩马唑巴坦、头孢他啶、头孢他啶-阿维巴坦、美罗培南、美罗培南-瓦硼巴坦、亚胺培南、亚胺培南-雷巴坦和厄他培南对 2 212 种 CRE(包括 2、089 个碳青霉烯酶生产者(1000 个 OXA-48 样、49 个 KPC、697 个 NDM、180 个 VIM、1 个 IMP、9 个 IMI、158 个多重碳青霉烯酶)和 123 个非碳青霉烯酶生产者(CRE non-CPE)、50 个铜绿假单胞菌和 30 个甲氧苄氨嘧啶。铜绿假单胞菌(P. aeruginosa)和鲍曼不动杆菌(A. baumannii)各 30 株。所有菌株均已完成测序:结果:我们证实恩美唑巴坦对金属-β-内酰胺酶没有抑制活性。头孢吡肟-恩美唑巴坦和头孢唑肟-阿维巴坦对 OXA-48 产菌具有相似的敏感性(分别为 96.7% 和 99.5%)。头孢吡肟-恩马唑巴坦对 CRE 非EPC 和 KPC 的药敏率分别为 66.9% 和 63.3%,而对头孢唑肟-阿维巴坦、亚胺培南-雷巴坦和美罗培南-瓦巴坦的药敏率则分别升至 96.7%/95.9%、93.4%/95.9% 和 95.9%/98.0%。对头孢唑肟-阿维巴坦耐药的 KPC 变体的 MIC 较低(≤0.25 mg/L)。与单独使用头孢吡肟相比,头孢吡肟-恩马唑巴坦对铜绿假单胞菌和鲍曼不动杆菌没有明显的增效作用:结论:OXA-48生产者对头孢吡肟-恩美唑巴坦的敏感性很高,这与头孢他啶-阿维巴坦相似,包括对同时产生头孢他啶水解酶(ESBL或AmpC)的OXA-48生产者。要确定头孢吡肟-烯酰巴坦是否可以替代头孢他啶-阿维巴坦治疗由 OXA-48 生产者引起的感染,还需要进行体内实验。
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引用次数: 0
'Quantifying the long-term effects of measles infection': author's response. 量化麻疹感染的长期影响"--作者回复。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-27 DOI: 10.1016/j.cmi.2024.09.021
Ella Dor, Ronen Fluss, Ariel Israel, Amit Huppert
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引用次数: 0
Which trials do we need? Fidaxomicin plus either intravenous metronidazole or tigecycline versus vancomycin plus either intravenous metronidazole or tigecycline for fulminant Clostridioides difficile infection. 我们需要哪些试验?菲达霉素加静脉注射甲硝唑或替加环素治疗难辨梭状芽孢杆菌感染与万古霉素加静脉注射甲硝唑或替加环素治疗难辨梭状芽孢杆菌感染的比较。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-27 DOI: 10.1016/j.cmi.2024.09.017
Giuseppe Pipitone, Chiara Iaria, Guido Granata, Antonio Cascio, Alberto Enrico Maraolo
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引用次数: 0
Measurement of circulating viral antigens post-SARS-CoV-2 infection in a multicohort study. 在一项多队列研究中测量 SARS-CoV-2 感染后的循环病毒抗原。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-27 DOI: 10.1016/j.cmi.2024.09.001
Zoe Swank, Ella Borberg, Yulu Chen, Yasmeen Senussi, Sujata Chalise, Zachary Manickas-Hill, Xu G Yu, Jonathan Z Li, Galit Alter, Timothy J Henrich, J Daniel Kelly, Rebecca Hoh, Sarah A Goldberg, Steven G Deeks, Jeffrey N Martin, Michael J Peluso, Aarthi Talla, Xiaojun Li, Peter Skene, Thomas F Bumol, Troy R Torgerson, Julie L Czartoski, M Juliana McElrath, Elizabeth W Karlson, David R Walt

Objectives: To determine the proportion of individuals with detectable antigen in plasma or serum after SARS-CoV-2 infection and the association of antigen detection with postacute sequelae of COVID-19 (PASC) symptoms.

Methods: Plasma and serum samples were collected from adults participating in four independent studies at different time points, ranging from several days up to 14 months post-SARS-CoV-2 infection. The primary outcome measure was to quantify SARS-CoV-2 antigens, including the S1 subunit of spike, full-length spike, and nucleocapsid, in participant samples. The presence of 34 commonly reported PASC symptoms during the postacute period was determined from participant surveys or chart reviews of electronic health records.

Results: Of the 1569 samples analysed from 706 individuals infected with SARS-CoV-2, 21% (95% CI, 18-24%) were positive for either S1, spike, or nucleocapsid. Spike was predominantly detected, and the highest proportion of samples was spike positive (20%; 95% CI, 18-22%) between 4 and 7 months postinfection. In total, 578 participants (82%) reported at least one of the 34 PASC symptoms included in our analysis ≥1 month postinfection. Cardiopulmonary, musculoskeletal, and neurologic symptoms had the highest reported prevalence in over half of all participants, and among those participants, 43% (95% CI, 40-45%) on average were antigen-positive. Among the participants who reported no ongoing symptoms (128, 18%), antigen was detected in 28 participants (21%). The presence of antigen was associated with the presence of one or more PASC symptoms, adjusting for sex, age, time postinfection, and cohort (OR, 1.8; 95% CI, 1.4-2.2).

Discussion: The findings of this multicohort study indicate that SARS-CoV-2 antigens can be detected in the blood of a substantial proportion of individuals up to 14 months after infection. While approximately one in five asymptomatic individuals was antigen-positive, roughly half of all individuals reporting ongoing cardiopulmonary, musculoskeletal, and neurologic symptoms were antigen-positive.

目的确定感染 SARS-CoV-2 后血浆或血清中可检测到抗原的人数比例,以及抗原检测与 COVID-19 后遗症(PASC)症状的关联:参与四项独立研究的成人在感染 SARS-CoV-2 后几天到 14 个月的不同时间点采集了血浆和血清样本。主要结果是对参与者样本中的 SARS-CoV-2 抗原(包括尖头 S1 亚基、全长尖头和核壳)进行量化。根据参与者调查或电子健康记录的病历审查,确定参与者在急性期后是否出现 34 种常见的 PASC 症状:结果:在分析的来自 706 名 SARS-CoV-2 感染者的 1569 份样本中,21%(95% CI,18%-24%)的 S1、尖头或核头状病毒呈阳性。在感染后 4 至 7 个月期间,主要检测到尖峰病毒,尖峰病毒阳性样本比例最高(20%;95% CI,18-22%)。共有 578 名参与者(82%)在感染后≥1 个月时报告了 34 种 PASC 症状中的至少一种。心肺、肌肉骨骼和神经系统症状的报告发病率最高,占所有参与者的一半以上,在这些参与者中,平均有 43% (95% CI,40-45%)的人抗原阳性。在报告没有持续症状的参与者中(128 人,18%),有 28 人(21%)检测到抗原。在对性别、年龄、感染后时间和队列进行调整后,抗原的存在与一种或多种 PASC 症状的存在相关(OR,1.8;95% CI,1.4-2.2):讨论:这项多队列研究的结果表明,在感染后 14 个月内,相当一部分人的血液中可以检测到 SARS-CoV-2 抗原。大约五分之一无症状的人抗原呈阳性,而在所有报告有持续心肺、肌肉骨骼和神经症状的人中,大约有一半人抗原呈阳性。
{"title":"Measurement of circulating viral antigens post-SARS-CoV-2 infection in a multicohort study.","authors":"Zoe Swank, Ella Borberg, Yulu Chen, Yasmeen Senussi, Sujata Chalise, Zachary Manickas-Hill, Xu G Yu, Jonathan Z Li, Galit Alter, Timothy J Henrich, J Daniel Kelly, Rebecca Hoh, Sarah A Goldberg, Steven G Deeks, Jeffrey N Martin, Michael J Peluso, Aarthi Talla, Xiaojun Li, Peter Skene, Thomas F Bumol, Troy R Torgerson, Julie L Czartoski, M Juliana McElrath, Elizabeth W Karlson, David R Walt","doi":"10.1016/j.cmi.2024.09.001","DOIUrl":"10.1016/j.cmi.2024.09.001","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the proportion of individuals with detectable antigen in plasma or serum after SARS-CoV-2 infection and the association of antigen detection with postacute sequelae of COVID-19 (PASC) symptoms.</p><p><strong>Methods: </strong>Plasma and serum samples were collected from adults participating in four independent studies at different time points, ranging from several days up to 14 months post-SARS-CoV-2 infection. The primary outcome measure was to quantify SARS-CoV-2 antigens, including the S1 subunit of spike, full-length spike, and nucleocapsid, in participant samples. The presence of 34 commonly reported PASC symptoms during the postacute period was determined from participant surveys or chart reviews of electronic health records.</p><p><strong>Results: </strong>Of the 1569 samples analysed from 706 individuals infected with SARS-CoV-2, 21% (95% CI, 18-24%) were positive for either S1, spike, or nucleocapsid. Spike was predominantly detected, and the highest proportion of samples was spike positive (20%; 95% CI, 18-22%) between 4 and 7 months postinfection. In total, 578 participants (82%) reported at least one of the 34 PASC symptoms included in our analysis ≥1 month postinfection. Cardiopulmonary, musculoskeletal, and neurologic symptoms had the highest reported prevalence in over half of all participants, and among those participants, 43% (95% CI, 40-45%) on average were antigen-positive. Among the participants who reported no ongoing symptoms (128, 18%), antigen was detected in 28 participants (21%). The presence of antigen was associated with the presence of one or more PASC symptoms, adjusting for sex, age, time postinfection, and cohort (OR, 1.8; 95% CI, 1.4-2.2).</p><p><strong>Discussion: </strong>The findings of this multicohort study indicate that SARS-CoV-2 antigens can be detected in the blood of a substantial proportion of individuals up to 14 months after infection. While approximately one in five asymptomatic individuals was antigen-positive, roughly half of all individuals reporting ongoing cardiopulmonary, musculoskeletal, and neurologic symptoms were antigen-positive.</p>","PeriodicalId":10444,"journal":{"name":"Clinical Microbiology and Infection","volume":null,"pages":null},"PeriodicalIF":10.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142399606","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}
引用次数: 0
Effectiveness of the enterovirus A71 vaccine on hand, foot, and mouth disease: a real-world study in China. 肠道病毒 A71 疫苗对手足口病的疗效:中国的一项实际研究。
IF 10.9 1区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-09-27 DOI: 10.1016/j.cmi.2024.09.020
Yuanhua Liu, Yang Song, Fengfeng Liu, Yue Chen, Yang Liu, Jin Shi, Ke Li, Yun Yin, Qingqing Liang, Na Liu, Ming Ming, Lei Hua, Qian Shi, Jiayao Xu, Rui Yuan, Shuting Li, Lele Zhang, Yu Zhao, Na Wang, Jidan Zhang, Yanping Zhang, Zhaorui Chang, Zhijie Zhang

Objectives: For the prevention of hand, foot, and mouth disease (HFMD), enterovirus A71 (EV-A71) vaccines have been used in China since 2016. To better inform vaccination strategies, we assess the real-world effectiveness of EV-A71 vaccination in China.

Methods: The analysis was based on surveillance data of HFMD caused by EV-A71 in children under the age of 5 in China, along with meteorological and demographic data. The seasonal autoregressive integrated moving average model and the interrupted time series analysis were used to estimate the effectiveness of the EV-A71 vaccination on the EV-A71 HFMD incidence and to predict the counterfactual cases with no EV-A71 vaccine.

Results: Between 2010 and 2018, 6 712 613 cases of HFMD caused by EV-A71 were reported in children under 5 years old in 260 Chinese cities. During 2017-2018, the EV-A71 vaccination was associated with a reduction in EV-A71 HFMD incidence, with a relative risk of 0.83 (95% CI, 0.81-0.86), and an estimated reduction of 297 946 (95% CI, 250 534-346 658) cases. However, this association varied across cities (I2 = 85.6%, p < 0.001) and the effectiveness of the EV-A71 vaccination decreased as population density increased. Higher vaccination coverage was associated with greater effectiveness of the EV-A71 vaccination and an earlier point in EV-A71 case reduction. Specifically, when the vaccination coverage exceeded ∼20%, the relative risk was rapidly reduced to below 0.71 (95% CI, 0.69-0.72).

Discussion: Our study demonstrated that the EV-A71 vaccination was associated with a reduction in the incidence of EV-A71 HFMD, but the association varied with regions and was influenced by vaccination coverage and population density. To optimize EV-A71 HFMD prevention, increasing vaccination coverage (>20%) is recommended for children under 5 years old.

目的:为预防手足口病(HFMD),中国自2016年起开始使用肠道病毒A71(EV-A71)疫苗。为了更好地指导疫苗接种策略,我们评估了中国接种 EV-A71 疫苗的实际效果:分析基于中国五岁以下儿童中由 EV-A71 引起的手足口病的监测数据以及气象和人口数据。采用季节自回归综合移动平均模型和间断时间序列分析方法,估计接种EV-A71疫苗对EV-A71手足口病发病率的影响,并预测未接种EV-A71疫苗的反事实病例:2010年至2018年,中国260个城市共报告6 712 613例5岁以下儿童由EV-A71引起的手足口病。2017-2018年期间,接种EV-A71疫苗与EV-A71手足口病发病率下降有关,相对风险为0.83(95%置信区间(CI):0.81-0.86),估计减少297946(95% CI:250534-346658)例。然而,这种关联在不同城市之间存在差异(I2=85.6%,PConclusions:我们的研究表明,EV-A71 疫苗接种与 EV-A71 手足口病发病率的降低有关,但这种关联因地区而异,并受疫苗接种覆盖率和人口密度的影响。为了更好地预防 EV-A71 手足口病,建议提高五岁以下儿童的疫苗接种率(超过 20%)。
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引用次数: 0
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Clinical Microbiology and Infection
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