Clinical Infectious Diseases最新文献

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Low CD4+ cell counts linked to mortality after sustained virological response: evaluating interaction with liver stiffness vs. FIB-4.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-15 DOI: 10.1093/cid/ciaf017

Anaïs Corma-Gómez, Jésica Martín-Carmona, Juan A Pineda, Juan Macías

引用次数: 0

Improving UTI Diagnostics in Oncology: Reliability of Reflex Urine Culture in Immunosuppressed Neutropenic and Non-neutropenic Cancer Patients 改进肿瘤学中的 UTI 诊断：免疫抑制的中性粒细胞和非中性粒细胞癌症患者的反射尿培养可靠性

IF 11.8 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-15 DOI: 10.1093/cid/ciaf018

Justin C Laracy, June L Chan, Rich Kodama, Judy Yan, Kevin M Raible, Kent Sepkowitz, Lauren McVoy, N Esther Babady, Mini Kamboj

Background Urinary tract infections are prone to overdiagnosis, and reflex urine culture protocols offer a valuable opportunity for diagnostic stewardship in this arena. However, there is no recommended standard testing approach. Cancer patients are often excluded from reflex urine culture protocols, especially if severely immunosuppressed or neutropenic. The aim of this study was to evaluate the performance characteristics of urine screening studies, including dipstick urinalysis for nitrite and leukocyte esterase and urine microscopy for white blood cell count, to detect significant pathogen growth. Methods A retrospective study of 58,098 urine cultures with a paired dipstick urinalysis with or without urine microscopy was performed at Memorial Sloan Kettering Cancer Center in New York City, evaluating data from January 1, 2018, to December 31, 2020. A dipstick urinalysis was considered negative only if leukocyte esterase and nitrite were undetected. Results A negative dipstick urinalysis had a negative predictive value (NPV) of 98% for clinically significant bacteriuria in voided urine, and 95% for catheterized urine. Notably, a negative urine dipstick test screen maintained a high NPV among patients with neutropenia and in those with antibiotic exposure before testing. Finally, the presence of pyuria ≥10 white blood cells per high power field on urine microscopy offered negligible incremental diagnostic benefit in samples with a negative dipstick urinalysis. Conclusions Reflex urine culture protocols contingent upon a screening dipstick urinalysis are a safe and effective platform for diagnostic stewardship in patients with cancer including those with neutropenia.

{"title":"Improving UTI Diagnostics in Oncology: Reliability of Reflex Urine Culture in Immunosuppressed Neutropenic and Non-neutropenic Cancer Patients","authors":"Justin C Laracy, June L Chan, Rich Kodama, Judy Yan, Kevin M Raible, Kent Sepkowitz, Lauren McVoy, N Esther Babady, Mini Kamboj","doi":"10.1093/cid/ciaf018","DOIUrl":"https://doi.org/10.1093/cid/ciaf018","url":null,"abstract":"Background Urinary tract infections are prone to overdiagnosis, and reflex urine culture protocols offer a valuable opportunity for diagnostic stewardship in this arena. However, there is no recommended standard testing approach. Cancer patients are often excluded from reflex urine culture protocols, especially if severely immunosuppressed or neutropenic. The aim of this study was to evaluate the performance characteristics of urine screening studies, including dipstick urinalysis for nitrite and leukocyte esterase and urine microscopy for white blood cell count, to detect significant pathogen growth. Methods A retrospective study of 58,098 urine cultures with a paired dipstick urinalysis with or without urine microscopy was performed at Memorial Sloan Kettering Cancer Center in New York City, evaluating data from January 1, 2018, to December 31, 2020. A dipstick urinalysis was considered negative only if leukocyte esterase and nitrite were undetected. Results A negative dipstick urinalysis had a negative predictive value (NPV) of 98% for clinically significant bacteriuria in voided urine, and 95% for catheterized urine. Notably, a negative urine dipstick test screen maintained a high NPV among patients with neutropenia and in those with antibiotic exposure before testing. Finally, the presence of pyuria ≥10 white blood cells per high power field on urine microscopy offered negligible incremental diagnostic benefit in samples with a negative dipstick urinalysis. Conclusions Reflex urine culture protocols contingent upon a screening dipstick urinalysis are a safe and effective platform for diagnostic stewardship in patients with cancer including those with neutropenia.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"74 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981514","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

Impact of Fluconazole Resistance on the Outcomes of Patients With Candida parapsilosis Bloodstream Infections: A Retrospective Multicenter Study.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-15 DOI: 10.1093/cid/ciae603

Antonio Vena, Giusy Tiseo, Marco Falcone, Claudia Bartalucci, Cristina Marelli, Mario Cesaretti, Vincenzo Di Pilato, Pilar Escribano, Arianna Forniti, Daniele Roberto Giacobbe, Jesus Guinea, Alessandro Limongelli, Antonella Lupetti, Marina Machado, Malgorzata Mikulska, Jon Salmanton-García, Ana Soriano-Martin, Lucia Taramasso, Maricela Valerio, Emilio Bouza, Patricia Muñoz, Matteo Bassetti

Background: This study assesses the impact of fluconazole resistance on 30-day all-cause mortality and 1-year recurrence in patients with Candida parapsilosis bloodstream infections (BSI).

Methods: A multicenter retrospective study was performed at 3 hospitals in Italy and Spain between 2018 and 2022. Adult patients with positive blood cultures for C. parapsilosis who received appropriate targeted therapy with either echinocandins or fluconazole were included.

Results: Among 457 patients, 196 (42.9%) had fluconazole-resistant C. parapsilosis (FLZR-CP) BSI and 261 (57.1%) had fluconazole-susceptible C. parapsilosis (FLZS-CP) BSI. All FLZR-CP patients received targeted echinocandins, while FLZS-CP patients received either echinocandins (60.5%) or fluconazole (39.5%). Unadjusted 30-day all-cause mortality rates were 28.6% for FLZR-CP and 28.4% for FLZS-CP (log-rank test, P = .998). In multivariable analysis, increased mortality was associated with age (adjusted hazard ratio [aHR] 1.03 per year; 95% confidence interval [CI], 1.01-1.05; P = .0005), solid tumor (aHR 1.91; 95% CI, 1.06-3.46; P = .0302), previous antifungal treatment (aHR 1.84; 95% CI, 1.12-3.10; P = .0192), and septic shock (aHR 2.39; 95% CI, 1.42-4.06; P = .0010), but not fluconazole resistance (aHR 1.00; 95% CI, .62-1.63; P = .9864) nor the type of initial antifungal therapy (aHR 1.46; 95% CI, .69-3.06; P = .3202). Propensity score-matched analysis showed no 30-day all-cause mortality difference between echinocandin-treated FLZR-CP and fluconazole-treated FLZS-CP patients (HR 0.81; 95% CI, .37-1.75; P = .5915). However, a higher 1-year recurrence risk was observed in FLZR-CP patients (odds ratio, 7.37; 95% CI, 2.11-25.80; P = .0018).

Conclusions: Our results suggest that fluconazole resistance is not associated with a higher mortality risk in patients with C. parapsilosis BSI, though 1-year recurrence rates were higher in the FLZR-CP group.

{"title":"Impact of Fluconazole Resistance on the Outcomes of Patients With Candida parapsilosis Bloodstream Infections: A Retrospective Multicenter Study.","authors":"Antonio Vena, Giusy Tiseo, Marco Falcone, Claudia Bartalucci, Cristina Marelli, Mario Cesaretti, Vincenzo Di Pilato, Pilar Escribano, Arianna Forniti, Daniele Roberto Giacobbe, Jesus Guinea, Alessandro Limongelli, Antonella Lupetti, Marina Machado, Malgorzata Mikulska, Jon Salmanton-García, Ana Soriano-Martin, Lucia Taramasso, Maricela Valerio, Emilio Bouza, Patricia Muñoz, Matteo Bassetti","doi":"10.1093/cid/ciae603","DOIUrl":"https://doi.org/10.1093/cid/ciae603","url":null,"abstract":"Background: This study assesses the impact of fluconazole resistance on 30-day all-cause mortality and 1-year recurrence in patients with Candida parapsilosis bloodstream infections (BSI).Methods: A multicenter retrospective study was performed at 3 hospitals in Italy and Spain between 2018 and 2022. Adult patients with positive blood cultures for C. parapsilosis who received appropriate targeted therapy with either echinocandins or fluconazole were included.Results: Among 457 patients, 196 (42.9%) had fluconazole-resistant C. parapsilosis (FLZR-CP) BSI and 261 (57.1%) had fluconazole-susceptible C. parapsilosis (FLZS-CP) BSI. All FLZR-CP patients received targeted echinocandins, while FLZS-CP patients received either echinocandins (60.5%) or fluconazole (39.5%). Unadjusted 30-day all-cause mortality rates were 28.6% for FLZR-CP and 28.4% for FLZS-CP (log-rank test, P = .998). In multivariable analysis, increased mortality was associated with age (adjusted hazard ratio [aHR] 1.03 per year; 95% confidence interval [CI], 1.01-1.05; P = .0005), solid tumor (aHR 1.91; 95% CI, 1.06-3.46; P = .0302), previous antifungal treatment (aHR 1.84; 95% CI, 1.12-3.10; P = .0192), and septic shock (aHR 2.39; 95% CI, 1.42-4.06; P = .0010), but not fluconazole resistance (aHR 1.00; 95% CI, .62-1.63; P = .9864) nor the type of initial antifungal therapy (aHR 1.46; 95% CI, .69-3.06; P = .3202). Propensity score-matched analysis showed no 30-day all-cause mortality difference between echinocandin-treated FLZR-CP and fluconazole-treated FLZS-CP patients (HR 0.81; 95% CI, .37-1.75; P = .5915). However, a higher 1-year recurrence risk was observed in FLZR-CP patients (odds ratio, 7.37; 95% CI, 2.11-25.80; P = .0018).Conclusions: Our results suggest that fluconazole resistance is not associated with a higher mortality risk in patients with C. parapsilosis BSI, though 1-year recurrence rates were higher in the FLZR-CP group.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982841","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

Correction to: Unpasteurized Milk: A Continued Public Health Threat.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-15 DOI: 10.1093/cid/ciaf012

引用次数: 0

Low CD4 cell count is associated with post-hepatitis C virus cure mortality in people living with HIV (ANRS CO13 HEPAVIH cohort).

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-15 DOI: 10.1093/cid/ciaf016

Tangui Barré, Clémence Ramier, Linda Wittkop, Philippe Sogni, David Zucman, Raphaëlle Tardieu, Patrizia Carrieri, Fabienne Marcellin

引用次数: 0

Correction to: Incidence of Tetanus and Diphtheria in Relation to Adult Vaccination Schedules.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-15 DOI: 10.1093/cid/ciaf014

引用次数: 0

Predicting the risk of intensive care unit admission in patients with COVID-19 presenting in the emergency room: Development and evaluation of the CROSS score

IF 11.8 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-10 DOI: 10.1093/cid/ciaf006

Weiwei Xiang, Fridolin Steinbeis, Kiret Dhindsa, Florian Kurth, Tilman Lingscheid, Charlotte Thibeault, Hans-Jakob Meyer, Norbert Suttorp, Mirja Mittermaier, Melanie Stecher, Margarete Scherer, Marina Hagen, Lazar Mitrov, Ramsia Geisler, Katharina S Appel, Sina M Hopff, Carolin Koll, Susana M Nunes de Miranda, Christina Weismantel, Jens-Peter Reese, Peter Heuschmann, Olga Miljukov, Carolin Nürnberger, Leif-Erik Sander, Jörg Janne Vehreschild, Martin Witzenrath, Maarten van Smeden, Thomas Zoller

Background Existing risk evaluation tools underperform in predicting intensive care unit (ICU) admission for patients with the Coronavirus Disease 2019 (COVID-19). This study aimed to develop and evaluate an accurate and calculator-free clinical tool for predicting ICU admission at emergency room (ER) presentation. Methods Data from patients with COVID-19 in a nationwide German cohort (March 2020-January 2023) were analyzed. Candidate predictors were selected based on literature and clinical expertise. A risk score, predicting ICU admission within seven days of ER presentation, was developed using elastic net logistic regression on a northern German cohort (derivation cohort), evaluated on a southern German cohort (evaluation cohort) and externally validated on a Colombian cohort. Performance was evaluated through discrimination, calibration, and clinical utility against existing tools. Results ICU admission rates within seven days were 30.8% (derivation cohort, n=1295, median age 60, 38.1% female), 28.1% (evaluation cohort, n=1123, median age 58, 36.9% female), and 30.3% (Colombian cohort, n=780, median age 57, 38.8% female). The 11-point CROSS score, based on Confusion, Respiratory rate, Oxygen Saturation (with or without concurrent supplemental oxygen), and oxygen Supplementation, demonstrated good discrimination (area under the curve (AUC): 0.77 in the evaluation cohort; 0.69 in the Colombian cohort), good calibration, and superior clinical utility compared to existing tools. Mortality-predicting tools performed poorly in predicting ICU admission risk for patients with COVID-19. Conclusions The calculator-free CROSS score effectively predicts ICU admission for patients with COVID-19 in the ER. Further studies are needed to assess its generalizability in other settings. Mortality-predicting tools are not recommended for ICU admission prediction.

{"title":"Predicting the risk of intensive care unit admission in patients with COVID-19 presenting in the emergency room: Development and evaluation of the CROSS score","authors":"Weiwei Xiang, Fridolin Steinbeis, Kiret Dhindsa, Florian Kurth, Tilman Lingscheid, Charlotte Thibeault, Hans-Jakob Meyer, Norbert Suttorp, Mirja Mittermaier, Melanie Stecher, Margarete Scherer, Marina Hagen, Lazar Mitrov, Ramsia Geisler, Katharina S Appel, Sina M Hopff, Carolin Koll, Susana M Nunes de Miranda, Christina Weismantel, Jens-Peter Reese, Peter Heuschmann, Olga Miljukov, Carolin Nürnberger, Leif-Erik Sander, Jörg Janne Vehreschild, Martin Witzenrath, Maarten van Smeden, Thomas Zoller","doi":"10.1093/cid/ciaf006","DOIUrl":"https://doi.org/10.1093/cid/ciaf006","url":null,"abstract":"Background Existing risk evaluation tools underperform in predicting intensive care unit (ICU) admission for patients with the Coronavirus Disease 2019 (COVID-19). This study aimed to develop and evaluate an accurate and calculator-free clinical tool for predicting ICU admission at emergency room (ER) presentation. Methods Data from patients with COVID-19 in a nationwide German cohort (March 2020-January 2023) were analyzed. Candidate predictors were selected based on literature and clinical expertise. A risk score, predicting ICU admission within seven days of ER presentation, was developed using elastic net logistic regression on a northern German cohort (derivation cohort), evaluated on a southern German cohort (evaluation cohort) and externally validated on a Colombian cohort. Performance was evaluated through discrimination, calibration, and clinical utility against existing tools. Results ICU admission rates within seven days were 30.8% (derivation cohort, n=1295, median age 60, 38.1% female), 28.1% (evaluation cohort, n=1123, median age 58, 36.9% female), and 30.3% (Colombian cohort, n=780, median age 57, 38.8% female). The 11-point CROSS score, based on Confusion, Respiratory rate, Oxygen Saturation (with or without concurrent supplemental oxygen), and oxygen Supplementation, demonstrated good discrimination (area under the curve (AUC): 0.77 in the evaluation cohort; 0.69 in the Colombian cohort), good calibration, and superior clinical utility compared to existing tools. Mortality-predicting tools performed poorly in predicting ICU admission risk for patients with COVID-19. Conclusions The calculator-free CROSS score effectively predicts ICU admission for patients with COVID-19 in the ER. Further studies are needed to assess its generalizability in other settings. Mortality-predicting tools are not recommended for ICU admission prediction.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"74 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961615","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

Safety, Efficacy and Pharmacokinetics of daily optimised doses of Rifampicin for the Treatment of Tuberculosis: A Systematic Review and Bayesian Network Meta-Analysis.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-10 DOI: 10.1093/cid/ciaf003

Juan Espinosa-Pereiro, Ana Aguiar, Eva Nara, Angelica Medina, Gladys Molinas, Margarida Tavares, Teresa Tortola, Samiksha Ghimire, Jan-Willem C Alfenaar, Marieke G G Sturkenboom, Cecile Magis-Escurra, Adrián Sánchez-Montalva, Henrique Barros, Raquel Duarte

Background: Higher than standard doses of rifampicin could improve the treatment outcome of drug-susceptible tuberculosis without compromising the safety of patients.

Methods: We performed a systematic review of prospective clinical studies including adults with pulmonary and extrapulmonary TB receiving rifampicin doses above 10mg/kg/day. We extracted the data on overall adverse events (AE), hepatic AE, sputum culture conversion (SCC) at week 8, recurrence, mortality, and pharmacokinetics. We performed a Bayesian network meta-analysis (NMA) using a random-effects model.

Results: In 19 studies, 2033 out of 3654 participants received rifampicin doses higher than 10mg/kg/day. The NMA showed an increased risk of overall and hepatic AE for the 40mg/kg/day dose (RR 4.8, 95% CrI 1.1; 25, and 15.00, 95% CrI 1.1; 58.0, respectively), but no other doses, including 50mg/kg/day showed such an increase. Increasing doses improved sputum culture conversion at week 8 (RR 1.3, 95% CrI 1.1; 1.7 for SCC with 35mg/kg/day).

Conclusion: Optimal doses of rifampicin may be between 25 and 35mg/kg/day, but should be tailored at the individual or, at least, at the population level.

{"title":"Safety, Efficacy and Pharmacokinetics of daily optimised doses of Rifampicin for the Treatment of Tuberculosis: A Systematic Review and Bayesian Network Meta-Analysis.","authors":"Juan Espinosa-Pereiro, Ana Aguiar, Eva Nara, Angelica Medina, Gladys Molinas, Margarida Tavares, Teresa Tortola, Samiksha Ghimire, Jan-Willem C Alfenaar, Marieke G G Sturkenboom, Cecile Magis-Escurra, Adrián Sánchez-Montalva, Henrique Barros, Raquel Duarte","doi":"10.1093/cid/ciaf003","DOIUrl":"https://doi.org/10.1093/cid/ciaf003","url":null,"abstract":"Background: Higher than standard doses of rifampicin could improve the treatment outcome of drug-susceptible tuberculosis without compromising the safety of patients.Methods: We performed a systematic review of prospective clinical studies including adults with pulmonary and extrapulmonary TB receiving rifampicin doses above 10mg/kg/day. We extracted the data on overall adverse events (AE), hepatic AE, sputum culture conversion (SCC) at week 8, recurrence, mortality, and pharmacokinetics. We performed a Bayesian network meta-analysis (NMA) using a random-effects model.Results: In 19 studies, 2033 out of 3654 participants received rifampicin doses higher than 10mg/kg/day. The NMA showed an increased risk of overall and hepatic AE for the 40mg/kg/day dose (RR 4.8, 95% CrI 1.1; 25, and 15.00, 95% CrI 1.1; 58.0, respectively), but no other doses, including 50mg/kg/day showed such an increase. Increasing doses improved sputum culture conversion at week 8 (RR 1.3, 95% CrI 1.1; 1.7 for SCC with 35mg/kg/day).Conclusion: Optimal doses of rifampicin may be between 25 and 35mg/kg/day, but should be tailored at the individual or, at least, at the population level.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962063","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

High Time for Higher Dose Rifampin.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-10 DOI: 10.1093/cid/ciaf005

Nicole F Maranchick, Charles Peloquin

引用次数: 0

Consistently higher seroresponse to benzathine penicillin G (BPG) combined with doxycycline versus BPG alone for early syphilis.

IF 8.2 1区医学 Q1 IMMUNOLOGY

Clinical Infectious Diseases

Pub Date : 2025-01-09 DOI: 10.1093/cid/ciae660

Kai-Hsiang Chen, Kuan-Yin Lin, Chien-Ching Hung

引用次数: 0

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