Véronique Joly, Valentine M Ferré, Quentin Le Hingrat, Gilles Peytavin, Mélanie Cresta, Charlotte Charpentier, Marc Digumber, Florence Damond, Yazdan Yazdanpanah, Sophie Matheron, Diane Descamps, Jade Ghosn
This retrospective study evaluated Bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) in 24 persons with human immunodeficiency virus type 2 (HIV-2, PWHIV-2), 5 naive and 19 pretreated. After a median follow-up of 37.5 months, all PWHIV-2 had a plasma viral load <40 copies/mL. Median CD4 count increased significantly from 580 to 625 cells/mm3, suggesting the effectiveness of BIC/FTC/TAF to treat HIV-2 infection.
{"title":"Immuno-virological and Clinical Follow-up of Persons With HIV-2 (PWHIV-2) Receiving Bictegravir/Emtricitabine/Tenofovir Alafenamide Fumarate (BIC/FTC/TAF): A Retrospective Study.","authors":"Véronique Joly, Valentine M Ferré, Quentin Le Hingrat, Gilles Peytavin, Mélanie Cresta, Charlotte Charpentier, Marc Digumber, Florence Damond, Yazdan Yazdanpanah, Sophie Matheron, Diane Descamps, Jade Ghosn","doi":"10.1093/cid/ciae447","DOIUrl":"10.1093/cid/ciae447","url":null,"abstract":"<p><p>This retrospective study evaluated Bictegravir (BIC)/emtricitabine (FTC)/tenofovir alafenamide (TAF) in 24 persons with human immunodeficiency virus type 2 (HIV-2, PWHIV-2), 5 naive and 19 pretreated. After a median follow-up of 37.5 months, all PWHIV-2 had a plasma viral load <40 copies/mL. Median CD4 count increased significantly from 580 to 625 cells/mm3, suggesting the effectiveness of BIC/FTC/TAF to treat HIV-2 infection.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"618-620"},"PeriodicalIF":8.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142281453","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}
Rachel Abbott, Kirsten Landsiedel, Mucunguzi Atukunda, Sarah B Puryear, Gabriel Chamie, Judith A Hahn, Florence Mwangwa, Elijah Kakande, Maya L Petersen, Diane V Havlir, Edwin Charlebois, Laura B Balzer, Moses R Kamya, Carina Marquez
Data on alcohol use and incident tuberculosis (TB) infection are needed. In adults aged ≥15 in rural Uganda (N = 49 585), estimated risk of incident TB was 29.2% with alcohol use versus 19.2% without (RR: 1.49; 95%CI: 1.40-1.60). There is potential for interventions to interrupt transmission among people who drink alcohol.
{"title":"Incident Tuberculosis Infection Is Associated With Alcohol Use in Adults in Rural Uganda.","authors":"Rachel Abbott, Kirsten Landsiedel, Mucunguzi Atukunda, Sarah B Puryear, Gabriel Chamie, Judith A Hahn, Florence Mwangwa, Elijah Kakande, Maya L Petersen, Diane V Havlir, Edwin Charlebois, Laura B Balzer, Moses R Kamya, Carina Marquez","doi":"10.1093/cid/ciae304","DOIUrl":"10.1093/cid/ciae304","url":null,"abstract":"<p><p>Data on alcohol use and incident tuberculosis (TB) infection are needed. In adults aged ≥15 in rural Uganda (N = 49 585), estimated risk of incident TB was 29.2% with alcohol use versus 19.2% without (RR: 1.49; 95%CI: 1.40-1.60). There is potential for interventions to interrupt transmission among people who drink alcohol.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"562-565"},"PeriodicalIF":8.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141186136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ahizechukwu C Eke, Sean S Brummel, Muktar H Aliyu, Lynda Stranix-Chibanda, George U Eleje, Ifeanyichukwu U Ezebialu, Violet Korutaro, Deo Wabwire, Allen Matubu, Tapiwa Mbengeranwa, Nahida Chakhtoura, Lameck Chinula, Katie McCarthy, Kevin Knowles, Chelsea Krotje, Macrae F Linton, Kelly E Dooley, Paul E Sax, Todd Brown, Shahin Lockman
Background: Tenofovir alafenamide (TAF)-based antiretroviral therapy (ART) regimens have been associated with adverse changes in lipid and glucose profiles compared with tenofovir disoproxil fumarate (TDF)-based ART, but data in pregnancy are limited. We evaluated metabolic markers in pregnant women with human immunodeficiency virus (HIV) after starting TAF- versus TDF-based ART.
Methods: We analyzed data within the IMPAACT 2010/VESTED trial, which demonstrated better pregnancy outcomes in pregnant women randomized to initiate TAF/Emtricitabine/Dolutegravir (TAF/FTC + DTG; n = 217) or TDF/FTC + DTG (n = 215). We measured non-fasting plasma concentrations of glucose, total-cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), lipoprotein (a), and triglycerides from samples collected 8 weeks after enrollment. We employed linear regression models to estimate by-arm mean differences.
Results: In total, 219 participants enrolled in the DTG arms in Zimbabwe and Uganda: 109 in the TAF/FTC + DTG and 110 in the TDF/FTC + DTG arms. At study entry, mean gestational age was 22.6 weeks, median HIV-1 RNA was 711 copies/mL, and mean age was 25.8 years. By 8 weeks, mean total cholesterol was 12 mg/dL higher in women randomized to TAF/ FTC + DTG versus TDF/FTC + DTG (95% confidence interval [CI]: 3.8, 21.1). Pregnant women in the TAF/FTC + DTG arm had higher mean LDL-C (7.1 mg/dL, 95% CI: .2, 14.0), triglycerides (12.3 mg/dL, 95% CI: 1.8, 22.7), lipoprotein (a) (7.3 mg/dL, 95% CI: 1.1, 13.6), and lower mean HDL-C (2.8 mg/dL, 95% CI: .1, 5.6) compared to the TDF/FTC + DTG arm.
Conclusions: Pregnant women randomized to start TAF/FTC + DTG had higher lipids than those randomized to TDF/FTC + DTG within 8 weeks of ART initiation. However, lipid levels were within normal reference ranges.
目的:与基于富马酸替诺福韦二吡呋酯(TDF)的抗逆转录病毒疗法(ART)相比,基于替诺福韦-阿拉非酰胺(TAF)的抗逆转录病毒疗法(ART)方案与血脂和血糖的不良变化有关,但孕期数据有限。我们评估了感染 HIV 的孕妇在开始接受 TAF 与 TDF 抗逆转录病毒疗法后的代谢指标:我们分析了 IMPAACT 2010/VESTED 试验的数据,该试验显示,随机接受 TAF/Emtricitabine/Dolutegravir (TAF/FTC+DTG; n=217) 或 TDF/FTC+DTG (n=215) 治疗的孕妇妊娠结局更好。我们从入组八周后采集的样本中测量了非空腹血浆中葡萄糖、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白(a)和甘油三酯的浓度。我们采用线性回归模型来估算各组的平均差异。结果:219 名参与者参加了津巴布韦和乌干达的 DTG 治疗组:109 人参加 TAF/FTC+DTG 治疗组,110 人参加 TDF/FTC+DTG 治疗组。研究开始时,平均胎龄为 22.6 周,HIV-1 RNA 中位数为 711 拷贝/毫升,平均年龄为 25.8 岁。到八周时,随机接受 TAF/FTC+DTG 与 TDF/FTC+DTG 治疗的妇女的平均总胆固醇比 TDF/FTC+DTG 高 12 mg/dL(95% CI 3.8,21.1)。与TDF/FTC+DTG组相比,TAF/FTC+DTG组孕妇的平均低密度脂蛋白胆固醇(7.1 mg/dL,95% CI 0.2,14.0)、甘油三酯(12.3 mg/dL,95% CI 1.8,22.7)、脂蛋白(a)(7.3 mg/dL,95% CI 1.1,13.6)较高,平均高密度脂蛋白胆固醇(2.8 mg/dL,95% CI 0.1,5.6)较低:结论:在开始接受抗逆转录病毒疗法的八周内,随机接受TAF/FTC+DTG治疗的孕妇的血脂高于随机接受TDF/FTC+DTG治疗的孕妇。但是,血脂水平在正常参考范围内。
{"title":"Lipid and Glucose Profiles in Pregnant Women With HIV on Tenofovir-based Antiretroviral Therapy.","authors":"Ahizechukwu C Eke, Sean S Brummel, Muktar H Aliyu, Lynda Stranix-Chibanda, George U Eleje, Ifeanyichukwu U Ezebialu, Violet Korutaro, Deo Wabwire, Allen Matubu, Tapiwa Mbengeranwa, Nahida Chakhtoura, Lameck Chinula, Katie McCarthy, Kevin Knowles, Chelsea Krotje, Macrae F Linton, Kelly E Dooley, Paul E Sax, Todd Brown, Shahin Lockman","doi":"10.1093/cid/ciae441","DOIUrl":"10.1093/cid/ciae441","url":null,"abstract":"<p><strong>Background: </strong>Tenofovir alafenamide (TAF)-based antiretroviral therapy (ART) regimens have been associated with adverse changes in lipid and glucose profiles compared with tenofovir disoproxil fumarate (TDF)-based ART, but data in pregnancy are limited. We evaluated metabolic markers in pregnant women with human immunodeficiency virus (HIV) after starting TAF- versus TDF-based ART.</p><p><strong>Methods: </strong>We analyzed data within the IMPAACT 2010/VESTED trial, which demonstrated better pregnancy outcomes in pregnant women randomized to initiate TAF/Emtricitabine/Dolutegravir (TAF/FTC + DTG; n = 217) or TDF/FTC + DTG (n = 215). We measured non-fasting plasma concentrations of glucose, total-cholesterol, low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), lipoprotein (a), and triglycerides from samples collected 8 weeks after enrollment. We employed linear regression models to estimate by-arm mean differences.</p><p><strong>Results: </strong>In total, 219 participants enrolled in the DTG arms in Zimbabwe and Uganda: 109 in the TAF/FTC + DTG and 110 in the TDF/FTC + DTG arms. At study entry, mean gestational age was 22.6 weeks, median HIV-1 RNA was 711 copies/mL, and mean age was 25.8 years. By 8 weeks, mean total cholesterol was 12 mg/dL higher in women randomized to TAF/ FTC + DTG versus TDF/FTC + DTG (95% confidence interval [CI]: 3.8, 21.1). Pregnant women in the TAF/FTC + DTG arm had higher mean LDL-C (7.1 mg/dL, 95% CI: .2, 14.0), triglycerides (12.3 mg/dL, 95% CI: 1.8, 22.7), lipoprotein (a) (7.3 mg/dL, 95% CI: 1.1, 13.6), and lower mean HDL-C (2.8 mg/dL, 95% CI: .1, 5.6) compared to the TDF/FTC + DTG arm.</p><p><strong>Conclusions: </strong>Pregnant women randomized to start TAF/FTC + DTG had higher lipids than those randomized to TDF/FTC + DTG within 8 weeks of ART initiation. However, lipid levels were within normal reference ranges.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"594-601"},"PeriodicalIF":8.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Annette K Regan, Stacey L Rowe, Sheena G Sullivan, Matthew M Coates, Flor M Muñoz, Onyebuchi A Arah
Background: Pregnant people are at risk of severe coronavirus disease 2019 (COVID-19) and associated complications. While withholding treatment from pregnant patients is not recommended, little is known about the frequency of antiviral medication use during pregnancy.
Methods: Using Medicaid and commercial insurance databases, we constructed a national claims-based cohort study of pregnant, recently pregnant, and nonpregnant female patients 18-49 years old with an outpatient diagnosis of COVID-19 between 21 December 2021 and 30 September 2022. Outpatient treatment with a recommended antiviral medication was identified within 5 days of diagnosis, using national drug codes in outpatient prescription drug claims. Propensity score-matched prevalence ratios (PRs) were used to compare antiviral treatment by pregnancy status.
Results: A total of 412 755 publicly and privately insured patients with COVID-19 were identified, including 33 855 currently pregnant, 2460 recently pregnant, and 376 440 nonpregnant female patients; 6.8% had a record of antiviral medication use, including 1.3% of pregnant, 5.4% of recently pregnant, and 7.3% of nonpregnant women. Most commonly ritonavir-boosted nirmatrelvir was administered. The prevalence of antiviral medication use was 67% lower among pregnant patients compared with nonpregnant patients (PR, 0.33 [95% confidence interval, .30-.36]), even among patients with ≥1 high-risk medical condition (0.29 [.25-.33]). Antiviral medication use was slightly lower among recently pregnant women with ≥1 high-risk medical condition than among nonpregnant women with similar conditions (PR, 0.57; [95% confidence interval, .44-.72]).
Conclusions: Despite US clinical guidelines, we observed low rates of outpatient treatment for COVID-19 among pregnant patients, indicating possible missed opportunities to treat COVID-19 illness during pregnancy and lactation.
{"title":"COVID-19 Antiviral Medication Use Among Pregnant and Recently Pregnant US Outpatients.","authors":"Annette K Regan, Stacey L Rowe, Sheena G Sullivan, Matthew M Coates, Flor M Muñoz, Onyebuchi A Arah","doi":"10.1093/cid/ciae580","DOIUrl":"10.1093/cid/ciae580","url":null,"abstract":"<p><strong>Background: </strong>Pregnant people are at risk of severe coronavirus disease 2019 (COVID-19) and associated complications. While withholding treatment from pregnant patients is not recommended, little is known about the frequency of antiviral medication use during pregnancy.</p><p><strong>Methods: </strong>Using Medicaid and commercial insurance databases, we constructed a national claims-based cohort study of pregnant, recently pregnant, and nonpregnant female patients 18-49 years old with an outpatient diagnosis of COVID-19 between 21 December 2021 and 30 September 2022. Outpatient treatment with a recommended antiviral medication was identified within 5 days of diagnosis, using national drug codes in outpatient prescription drug claims. Propensity score-matched prevalence ratios (PRs) were used to compare antiviral treatment by pregnancy status.</p><p><strong>Results: </strong>A total of 412 755 publicly and privately insured patients with COVID-19 were identified, including 33 855 currently pregnant, 2460 recently pregnant, and 376 440 nonpregnant female patients; 6.8% had a record of antiviral medication use, including 1.3% of pregnant, 5.4% of recently pregnant, and 7.3% of nonpregnant women. Most commonly ritonavir-boosted nirmatrelvir was administered. The prevalence of antiviral medication use was 67% lower among pregnant patients compared with nonpregnant patients (PR, 0.33 [95% confidence interval, .30-.36]), even among patients with ≥1 high-risk medical condition (0.29 [.25-.33]). Antiviral medication use was slightly lower among recently pregnant women with ≥1 high-risk medical condition than among nonpregnant women with similar conditions (PR, 0.57; [95% confidence interval, .44-.72]).</p><p><strong>Conclusions: </strong>Despite US clinical guidelines, we observed low rates of outpatient treatment for COVID-19 among pregnant patients, indicating possible missed opportunities to treat COVID-19 illness during pregnancy and lactation.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":"512-519"},"PeriodicalIF":8.2,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11912976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sonali D Advani, Joshua T Thaden, Reinaldo Perez, Sabrina L Stair, Una J Lee, Nazema Y Siddiqui
Over 50% of adult women experience at least 1 urinary tract infection (UTI) in their lifetime, and almost one-quarter of them will experience a recurrent UTI (rUTI). Recurrent UTI is defined as ≥2 UTIs in a 6-month period or ≥3 UTIs in 12 months (at least 1 of these episodes should be culture-proven to confirm infectious etiology). In this narrative review, we discuss the epidemiology, pathogenesis, diagnosis, and treatment considerations for recurrent uncomplicated cystitis in the adult female population. We provide a focused overview of the comprehensive management of these patients, with input from infectious disease physicians, urogynecologists, and urologists with expertise in rUTI, highlighting updated recommendations by the Infectious Diseases Society of America, American Urologic Association, Canadian Urologic Association, and American Urogynecologic Society. Finally, given the variety of prevention strategies, different treatment goals, and the need for “preference sensitive” decisions, we highlight the need for shared decision-making with patients.
{"title":"State-of-the-Art Review: Recurrent Uncomplicated Urinary Tract Infections in Women","authors":"Sonali D Advani, Joshua T Thaden, Reinaldo Perez, Sabrina L Stair, Una J Lee, Nazema Y Siddiqui","doi":"10.1093/cid/ciae653","DOIUrl":"https://doi.org/10.1093/cid/ciae653","url":null,"abstract":"Over 50% of adult women experience at least 1 urinary tract infection (UTI) in their lifetime, and almost one-quarter of them will experience a recurrent UTI (rUTI). Recurrent UTI is defined as ≥2 UTIs in a 6-month period or ≥3 UTIs in 12 months (at least 1 of these episodes should be culture-proven to confirm infectious etiology). In this narrative review, we discuss the epidemiology, pathogenesis, diagnosis, and treatment considerations for recurrent uncomplicated cystitis in the adult female population. We provide a focused overview of the comprehensive management of these patients, with input from infectious disease physicians, urogynecologists, and urologists with expertise in rUTI, highlighting updated recommendations by the Infectious Diseases Society of America, American Urologic Association, Canadian Urologic Association, and American Urogynecologic Society. Finally, given the variety of prevention strategies, different treatment goals, and the need for “preference sensitive” decisions, we highlight the need for shared decision-making with patients.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"16 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143641077","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}
Giulia Jole Burastero, Emmanuel Q Wey, Veronica Guidetti, Samuele Cantergiani, Valentina Menozzi, Davide Lo Porto, Andrea Cona, Amreen Khan, Valentina Serra, Giacomo Assirati, Giovanni Guaraldi, Giovanni Dolci, Marianna Meschiari, Adriana Cervo, Martina Tosi, Salvatore Gruttadauria, Joerg-Matthias Pollok, Fabrizio Di Benedetto, Alessandra Mularoni, Cristina Mussini, Erica Franceschini
Background: Data regarding the effectiveness of vancomycin resistant Enterococci (VRE) active prophylaxis for preventing early post-liver transplant (LT) VRE infections in VRE-colonized patients are scarce.
Methods: One-hundred-thirty-one pre-LT VRE colonized patients who underwent liver transplantation were enrolled in a retrospective, observational, multicenter study. The incidence of early-onset VRE infections was compared between patients who received active prophylaxis for VRE and those who did not.
Results: Sixty-nine (52.7%) and 62 (47.3%) patients were enrolled in the VRE-active and non-VRE-active prophylaxis group. Tigecycline was the most common drug prescribed as VRE-active for prophylaxis (55/69, 79.7%). There was no significant difference in the number of patients who developed early-onset VRE infections in the VRE-active vs non-VRE-active groups at 7 [0 (0.0 %) vs 2 (3.2 %), p=0.222], 14 [4 (5.7 %) vs 4 (6.4%), p=1.000] and 30 [6 (8.7%) vs. 8 (12.9%), p=0.621] days post-LT respectively. Risk of early-onset VRE infection within 30 days was not lower in the VRE-active group (log-rank p=0.16 at Kaplan-Meier analysis; OR 0.643, 95% CI 0.210-1.969, p=0.439 at univariate analysis). Conversely, early infections caused by any pathogen were significantly lower in the VRE-active prophylaxis group compared to the control group [11 (15.9%) vs. 20 (32.2%), p=0.047]. Tigecycline prophylaxis was associated with a lower risk of early-onset infections at multivariate analysis (OR 0.106, 95% CI 0.015-0.745, p=0.024) and after adjusting for propensity score (aOR 0.146, 95% CI 0.031-0.708, p=0.017).
Conclusions: VRE-active prophylaxis at LT did not reduce the incidence of early post-LT VRE infections and should not be recommended.
背景:有关耐万古霉素肠球菌(VRE)的积极预防措施对预防肝移植(LT)后VRE定植患者早期VRE感染的有效性的数据很少:一项回顾性、观察性、多中心研究共纳入了 131 名接受肝移植手术的 LT 前 VRE 定植患者。结果:69 例(52.7%)肝移植前 VRE 定植患者感染了 VRE:69名(52.7%)和62名(47.3%)患者分别加入了VRE主动预防组和非VRE主动预防组。替加环素是最常见的VRE活性预防药物(55/69,79.7%)。在 LT 后 7 天 [0 (0.0 %) vs 2 (3.2 %),p=0.222]、14 天 [4 (5.7 %) vs 4 (6.4 %),p=1.000]和 30 天 [6 (8.7 %) vs. 8 (12.9 %),p=0.621],VRE 活性组和非 VRE 活性组发生早发 VRE 感染的患者人数无明显差异。VRE活跃组在30天内发生早期VRE感染的风险并不低(卡普兰-梅耶分析的对数秩p=0.16;单变量分析的OR为0.643,95% CI为0.210-1.969,p=0.439)。相反,与对照组相比,VRE 活性预防组中由任何病原体引起的早期感染显著减少 [11 (15.9%) vs. 20 (32.2%),p=0.047]。在多变量分析(OR 0.106,95% CI 0.015-0.745,p=0.024)和倾向评分调整后(aOR 0.146,95% CI 0.031-0.708,p=0.017),替加环素预防与较低的早发感染风险相关:结论:在LT时进行VRE活性预防并不能降低LT后早期VRE感染的发生率,因此不应推荐使用。
{"title":"Impact of VRE-active perioperative prophylaxis in liver transplant patients colonized by Vancomycin-Resistant Enterococci.","authors":"Giulia Jole Burastero, Emmanuel Q Wey, Veronica Guidetti, Samuele Cantergiani, Valentina Menozzi, Davide Lo Porto, Andrea Cona, Amreen Khan, Valentina Serra, Giacomo Assirati, Giovanni Guaraldi, Giovanni Dolci, Marianna Meschiari, Adriana Cervo, Martina Tosi, Salvatore Gruttadauria, Joerg-Matthias Pollok, Fabrizio Di Benedetto, Alessandra Mularoni, Cristina Mussini, Erica Franceschini","doi":"10.1093/cid/ciaf121","DOIUrl":"https://doi.org/10.1093/cid/ciaf121","url":null,"abstract":"<p><strong>Background: </strong>Data regarding the effectiveness of vancomycin resistant Enterococci (VRE) active prophylaxis for preventing early post-liver transplant (LT) VRE infections in VRE-colonized patients are scarce.</p><p><strong>Methods: </strong>One-hundred-thirty-one pre-LT VRE colonized patients who underwent liver transplantation were enrolled in a retrospective, observational, multicenter study. The incidence of early-onset VRE infections was compared between patients who received active prophylaxis for VRE and those who did not.</p><p><strong>Results: </strong>Sixty-nine (52.7%) and 62 (47.3%) patients were enrolled in the VRE-active and non-VRE-active prophylaxis group. Tigecycline was the most common drug prescribed as VRE-active for prophylaxis (55/69, 79.7%). There was no significant difference in the number of patients who developed early-onset VRE infections in the VRE-active vs non-VRE-active groups at 7 [0 (0.0 %) vs 2 (3.2 %), p=0.222], 14 [4 (5.7 %) vs 4 (6.4%), p=1.000] and 30 [6 (8.7%) vs. 8 (12.9%), p=0.621] days post-LT respectively. Risk of early-onset VRE infection within 30 days was not lower in the VRE-active group (log-rank p=0.16 at Kaplan-Meier analysis; OR 0.643, 95% CI 0.210-1.969, p=0.439 at univariate analysis). Conversely, early infections caused by any pathogen were significantly lower in the VRE-active prophylaxis group compared to the control group [11 (15.9%) vs. 20 (32.2%), p=0.047]. Tigecycline prophylaxis was associated with a lower risk of early-onset infections at multivariate analysis (OR 0.106, 95% CI 0.015-0.745, p=0.024) and after adjusting for propensity score (aOR 0.146, 95% CI 0.031-0.708, p=0.017).</p><p><strong>Conclusions: </strong>VRE-active prophylaxis at LT did not reduce the incidence of early post-LT VRE infections and should not be recommended.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630181","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}
J Daniel Kelly, Katherine J Hoggatt, Nathan C Lo, Samuel Leonard, W John Boscardin, Hye Sun Kim, Emily N Lum, Charles C Austin, Amy L Byers, Phyllis C Tien, Peter C Austin, Dawn M Bravata, Salomeh Keyhani
Background: Current U.S. COVID-19 vaccine recommendations provide guidance for adults to receive at least annual variant-targeted vaccination. We sought to estimate the strength and durability of protection from annual variant-targeted vaccination against severe COVID-19 illness in individuals with vaccine-derived and hybrid immunity.
Methods: We emulated a target trial using an electronic health record-based, propensity-score matched (1:1) cohort of U.S. Veterans. Booster vaccinated adults were eligible for a variant-targeted mRNA booster starting September 1, 2022. Matched sets of those who did and did not receive the variant-targeted booster dose were identified on a weekly basis, and the cohort was followed until August 31, 2023. Outcomes were hospitalization due to COVID-19 pneumonia, and in-hospital severe illness. We fit Cox models, overall and stratified by last documented SARS-CoV-2 infection (pre-Omicron, Omicron), to estimate relative vaccine effectiveness (VE).
Results: The propensity-score matched cohort consisted of 1,576,626 COVID-19 booster vaccinated adults. Estimates of relative vaccine effectiveness (rVE) from variant-targeted mRNA booster against hospitalization due to COVID-19 pneumonia were significant and similar in the cohort with vaccine-derived immunity (rVE: 29%; 95%CI: 25%, 34%) and cohort with hybrid immunity (rVE: 38%; 95%CI: 27%, 47%). These protective gains were significant from 0-6 but not 6-12 months after vaccination and during pre-XBB and XBB variant eras. Findings were similar for in-hospital severe illness.
Conclusion: In cohorts with vaccine-derived and hybrid immunity, modest but significant gains in protection against hospitalization and severe COVID-19 illness were conferred by the annual variant-targeted booster dose but not sustained beyond 6 months.
{"title":"Annual variant-targeted vaccination to prevent severe COVID-19 disease in cohorts with vaccine-derived and hybrid immunity.","authors":"J Daniel Kelly, Katherine J Hoggatt, Nathan C Lo, Samuel Leonard, W John Boscardin, Hye Sun Kim, Emily N Lum, Charles C Austin, Amy L Byers, Phyllis C Tien, Peter C Austin, Dawn M Bravata, Salomeh Keyhani","doi":"10.1093/cid/ciaf124","DOIUrl":"https://doi.org/10.1093/cid/ciaf124","url":null,"abstract":"<p><strong>Background: </strong>Current U.S. COVID-19 vaccine recommendations provide guidance for adults to receive at least annual variant-targeted vaccination. We sought to estimate the strength and durability of protection from annual variant-targeted vaccination against severe COVID-19 illness in individuals with vaccine-derived and hybrid immunity.</p><p><strong>Methods: </strong>We emulated a target trial using an electronic health record-based, propensity-score matched (1:1) cohort of U.S. Veterans. Booster vaccinated adults were eligible for a variant-targeted mRNA booster starting September 1, 2022. Matched sets of those who did and did not receive the variant-targeted booster dose were identified on a weekly basis, and the cohort was followed until August 31, 2023. Outcomes were hospitalization due to COVID-19 pneumonia, and in-hospital severe illness. We fit Cox models, overall and stratified by last documented SARS-CoV-2 infection (pre-Omicron, Omicron), to estimate relative vaccine effectiveness (VE).</p><p><strong>Results: </strong>The propensity-score matched cohort consisted of 1,576,626 COVID-19 booster vaccinated adults. Estimates of relative vaccine effectiveness (rVE) from variant-targeted mRNA booster against hospitalization due to COVID-19 pneumonia were significant and similar in the cohort with vaccine-derived immunity (rVE: 29%; 95%CI: 25%, 34%) and cohort with hybrid immunity (rVE: 38%; 95%CI: 27%, 47%). These protective gains were significant from 0-6 but not 6-12 months after vaccination and during pre-XBB and XBB variant eras. Findings were similar for in-hospital severe illness.</p><p><strong>Conclusion: </strong>In cohorts with vaccine-derived and hybrid immunity, modest but significant gains in protection against hospitalization and severe COVID-19 illness were conferred by the annual variant-targeted booster dose but not sustained beyond 6 months.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623871","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}
Sarah N Cox, Pavitra Roychoudhury, Collrane Frivold, Zack Acker, Tara M Babu, Cassandra L Boisvert, Marco Carone, Brenna Ehmen, Janet A Englund, Leora R Feldstein, Luis Gamboa, Sally Grindstaff, Hanna M Grioni, Peter D Han, Katherine L Hoffman, Hyeong Geon Kim, Jennifer L Kuntz, Natalie K Lo, Christina M Lockwood, Kathryn McCaffrey, Richard A Mularski, Tara L Hatchie, Sacha L Reich, Mark A Schmidt, Ning Smith, Lea M Starita, Alexandra Varga, Neil Yetz, Allison L Naleway, Ana A Weil, Helen Y Chu
Background: Household transmission of respiratory viruses may drive community spread. Few recent studies have examined household respiratory syncytial virus (RSV) transmission in the United States.
Methods: We conducted a prospective community-based cohort study from 1 June 2022 to 31 May 2023. Participants had blood samples collected and completed nasal swabs and surveys at least weekly, irrespective of symptoms. We tested serum for RSV antibody, nasal swabs by quantitative reverse transcription polymerase chain reaction (RT-qPCR), and performed whole genome sequencing. We evaluated secondary RSV transmission and associated risk factors based on a log-linear Poisson regression model.
Results: RSV was detected among 310 (10%) participants within 200 (20%) households. Most (94%) index cases were symptomatic. We identified 37 cases of potential secondary transmission within 14 days of a distinct index case (10%, 95% confidence interval [CI]: 7%, 14%); median age of index and secondary cases were 6 (interquartile range [IQR]: 3-10) and 35 (7-41) years, respectively, with 89% (24/27) of index cases aged 6 months to 12 years. Factors associated with increased risk of RSV transmission included index case viral detection ≥1 week and contact age ≤12 years. Of 120 sequenced specimens, the main lineages represented were A.d.5.2 (n = 37) and A.d.1 (n = 30). Sequenced viruses from households with ≥2 RSV infections were similar when occurring within ≤14 days (mean pairwise difference 4 [range 0-13], n = 17 households), compared to those >14 days (137 [37-236], n = 2).
Conclusions: Most RSV household transmission occurs from infants and young children to adults. Viral genome sequencing demonstrated that multiple household infections within a 14-day period are likely due to within-household transmission.
{"title":"Household Transmission and Genomic Diversity of Respiratory Syncytial Virus (RSV) in the United States, 2022-2023.","authors":"Sarah N Cox, Pavitra Roychoudhury, Collrane Frivold, Zack Acker, Tara M Babu, Cassandra L Boisvert, Marco Carone, Brenna Ehmen, Janet A Englund, Leora R Feldstein, Luis Gamboa, Sally Grindstaff, Hanna M Grioni, Peter D Han, Katherine L Hoffman, Hyeong Geon Kim, Jennifer L Kuntz, Natalie K Lo, Christina M Lockwood, Kathryn McCaffrey, Richard A Mularski, Tara L Hatchie, Sacha L Reich, Mark A Schmidt, Ning Smith, Lea M Starita, Alexandra Varga, Neil Yetz, Allison L Naleway, Ana A Weil, Helen Y Chu","doi":"10.1093/cid/ciaf048","DOIUrl":"https://doi.org/10.1093/cid/ciaf048","url":null,"abstract":"<p><strong>Background: </strong>Household transmission of respiratory viruses may drive community spread. Few recent studies have examined household respiratory syncytial virus (RSV) transmission in the United States.</p><p><strong>Methods: </strong>We conducted a prospective community-based cohort study from 1 June 2022 to 31 May 2023. Participants had blood samples collected and completed nasal swabs and surveys at least weekly, irrespective of symptoms. We tested serum for RSV antibody, nasal swabs by quantitative reverse transcription polymerase chain reaction (RT-qPCR), and performed whole genome sequencing. We evaluated secondary RSV transmission and associated risk factors based on a log-linear Poisson regression model.</p><p><strong>Results: </strong>RSV was detected among 310 (10%) participants within 200 (20%) households. Most (94%) index cases were symptomatic. We identified 37 cases of potential secondary transmission within 14 days of a distinct index case (10%, 95% confidence interval [CI]: 7%, 14%); median age of index and secondary cases were 6 (interquartile range [IQR]: 3-10) and 35 (7-41) years, respectively, with 89% (24/27) of index cases aged 6 months to 12 years. Factors associated with increased risk of RSV transmission included index case viral detection ≥1 week and contact age ≤12 years. Of 120 sequenced specimens, the main lineages represented were A.d.5.2 (n = 37) and A.d.1 (n = 30). Sequenced viruses from households with ≥2 RSV infections were similar when occurring within ≤14 days (mean pairwise difference 4 [range 0-13], n = 17 households), compared to those >14 days (137 [37-236], n = 2).</p><p><strong>Conclusions: </strong>Most RSV household transmission occurs from infants and young children to adults. Viral genome sequencing demonstrated that multiple household infections within a 14-day period are likely due to within-household transmission.</p>","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623876","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}
Background Bedaquiline (BDQ) resistance presents a critical challenge in the fight against tuberculosis (TB), particularly multidrug-resistant (MDR) strains. The emergence of resistance to BDQ, a key drug in treating MDR-TB, poses significant threats to TB treatment effectiveness. Methods The National Institute of Tuberculosis and Respiratory Diseases in Delhi and the Médecins Sans Frontières clinic in Mumbai provide BDQ, delamanid, and carbapenem-based regimens for patients with suspected or confirmed treatment failure. BDQ phenotypic drug-susceptibility testing (DST) was performed for all BDQ-exposed patients. Treatment regimens were individualized based on exposure history, comorbidities, drug interactions, prior adverse drug reactions, and DST results. Results Of 117 BDQ-exposed patients from December 2020–December 2022, 42 (36%) exhibited a BDQ-resistant strain. Median (IQR) age was 24 (22–32) years, with 63 (54%) females and 94% with pulmonary TB. Patients with a BDQ-resistant strain were older (median age: 27 vs 23 years; P = .04), more likely to have lung cavities (risk ratio [RR]: 1.8; 95%-CI: 1.1–3.1; P = .02), and be resistant to clofazimine (RR: 2.3; 95%-CI: 1.5–3.6; P = .001). Overall, 102 patients initiated treatment. Patients with BDQ-resistance had higher risk of unfavorable outcomes compared with BDQ-susceptible patients (RR:2.1; 95%-CI: 1.5–2.8; P < .001). Overall, 87% (33/38) of patients with BDQ-resistance experienced unfavorable treatment outcomes: 15 (40%) died, 15 (40%) had treatment failure, and 3 (8%) were lost-to-follow-up. Conclusions The study highlights a concerning rate of BDQ-resistance among previously treated patients, resulting in poor treatment outcomes. To prevent treatment failure, we recommend implementing BDQ-DST, developing affordable and accurate rapid tests for BDQ-resistance, and intensifying research and development efforts for newer TB drugs.
{"title":"Bedaquiline Resistance and Treatment Outcomes Among Patients With Tuberculosis Previously Exposed to Bedaquiline in India: A Multicentric Retrospective Cohort Study","authors":"Rupak Singla, Samsuddin Khan, Arunima Silsarma, Vijay Chavan, Raman Mahajan, Homa Mansoor, Ravindra Kumar Devan, Neeta Singla, Manpreet Bhalla, Gavish Kumar, Pramila Singh, Aparna Iyer, Mabel Morales, Satish Chandra Devkota, Alpa Dalal, Hannah Spencer, Petros Isaakidis","doi":"10.1093/cid/ciaf068","DOIUrl":"https://doi.org/10.1093/cid/ciaf068","url":null,"abstract":"Background Bedaquiline (BDQ) resistance presents a critical challenge in the fight against tuberculosis (TB), particularly multidrug-resistant (MDR) strains. The emergence of resistance to BDQ, a key drug in treating MDR-TB, poses significant threats to TB treatment effectiveness. Methods The National Institute of Tuberculosis and Respiratory Diseases in Delhi and the Médecins Sans Frontières clinic in Mumbai provide BDQ, delamanid, and carbapenem-based regimens for patients with suspected or confirmed treatment failure. BDQ phenotypic drug-susceptibility testing (DST) was performed for all BDQ-exposed patients. Treatment regimens were individualized based on exposure history, comorbidities, drug interactions, prior adverse drug reactions, and DST results. Results Of 117 BDQ-exposed patients from December 2020–December 2022, 42 (36%) exhibited a BDQ-resistant strain. Median (IQR) age was 24 (22–32) years, with 63 (54%) females and 94% with pulmonary TB. Patients with a BDQ-resistant strain were older (median age: 27 vs 23 years; P = .04), more likely to have lung cavities (risk ratio [RR]: 1.8; 95%-CI: 1.1–3.1; P = .02), and be resistant to clofazimine (RR: 2.3; 95%-CI: 1.5–3.6; P = .001). Overall, 102 patients initiated treatment. Patients with BDQ-resistance had higher risk of unfavorable outcomes compared with BDQ-susceptible patients (RR:2.1; 95%-CI: 1.5–2.8; P &lt; .001). Overall, 87% (33/38) of patients with BDQ-resistance experienced unfavorable treatment outcomes: 15 (40%) died, 15 (40%) had treatment failure, and 3 (8%) were lost-to-follow-up. Conclusions The study highlights a concerning rate of BDQ-resistance among previously treated patients, resulting in poor treatment outcomes. To prevent treatment failure, we recommend implementing BDQ-DST, developing affordable and accurate rapid tests for BDQ-resistance, and intensifying research and development efforts for newer TB drugs.","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":"87 1","pages":""},"PeriodicalIF":11.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618338","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}