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Remdesivir-associated survival outcomes among immunocompromised patients hospitalized for COVID-19: real-world evidence from the Omicron dominant era 因 COVID-19 而住院的免疫功能低下患者中雷米地韦相关的生存结果:来自 Omicron dominant 时代的真实证据
IF 11.8 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae510
Essy Mozaffari, Aastha Chandak, Robert L Gottlieb, Chidinma Chima-Melton, Mark Berry, Alpesh N Amin, Paul E Sax, Andre C Kalil
Background Patients with immunocompromising conditions are at an increased risk for coronavirus disease 2019 (COVID-19)-related hospitalizations and mortality. Randomized clinical trials provide limited enrollment, if any, to inform outcomes of such patients treated with remdesivir. Methods Using the US PINC AI Healthcare Database, we identified adult patients with immunocompromising conditions, hospitalized for COVID-19 between December 2021 and February 2024. Primary outcome was all-cause inpatient mortality examined in propensity score (PS) matched patients in remdesivir versus non-remdesivir groups. Subgroup analyses were performed for patients with cancer, hematologic malignancies, and solid organ/hematopoietic stem cell transplant recipients. Results Of 28,966 patients included in the study, 16,730 (58%) received remdesivir during first two days of hospitalization. After PS matching, 8,822 patients in remdesivir and 8,822 patients in non-remdesivir group were analyzed. Remdesivir was associated with a significantly lower mortality among patients with no supplemental oxygen (aHR [95% CI]: 14-day, 0.73 [0.62-0.86]; 28-day, 0.79 [0.68-0.91]) and among those with supplemental oxygen (14-day, 0.75 [0.67-0.85]; 28-day, 0.78 [0.70-0.86]). Remdesivir was also associated with lower mortality in subgroups of patients with cancer, hematological malignancies (including leukemia, lymphoma, and multiple myeloma), and solid organ/hematopoietic stem cell transplantation. Conclusions In this large cohort of patients with immunocompromising conditions hospitalized for COVID-19, remdesivir was associated with significant improvement in survival, including patients with varied underlying immunocompromising conditions. The integration of current real-world evidence into clinical guideline recommendations can inform clinical communities to optimize treatment decisions in the evolving COVID-19 era, extending beyond the conclusion of the public health emergency declaration.
背景 免疫功能低下的患者发生冠状病毒病2019(COVID-19)相关住院和死亡的风险增加。随机临床试验提供的入组人数有限(如果有的话),无法为此类患者接受雷米替韦治疗的结果提供信息。方法 利用美国 PINC AI 医疗保健数据库,我们确定了 2021 年 12 月至 2024 年 2 月期间因 COVID-19 而住院的免疫力低下成年患者。主要结果是倾向评分(PS)匹配的雷米地韦组与非雷米地韦组患者的全因住院死亡率。对癌症患者、血液系统恶性肿瘤患者和实体器官/造血干细胞移植受者进行了分组分析。结果 在纳入研究的 28966 名患者中,16730 人(58%)在住院头两天接受了雷米替韦治疗。经过PS配对后,对8822名雷米地韦组患者和8822名非雷米地韦组患者进行了分析。在没有补充氧气的患者中,雷米地韦可显著降低死亡率(aHR [95% CI]:14 天,0.73 [0.62-0.86];28 天,0.79 [0.68-0.91]),在有补充氧气的患者中,雷米地韦可显著降低死亡率(14 天,0.75 [0.67-0.85];28 天,0.78 [0.70-0.86])。在癌症、血液恶性肿瘤(包括白血病、淋巴瘤和多发性骨髓瘤)和实体器官/造血干细胞移植患者亚组中,雷米替韦也与较低的死亡率相关。结论 在这一大群因 COVID-19 而住院的免疫力低下患者中,雷米替韦能显著改善患者的生存状况,包括具有不同基础免疫力低下状况的患者。将当前真实世界的证据纳入临床指南建议可为临床社区提供信息,以便在不断发展的 COVID-19 时代优化治疗决策,使其延续到公共卫生紧急状态声明结束之后。
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引用次数: 0
Remdesivir Effectiveness in Reducing the Risk of 30-day Readmission in Vulnerable Patients Hospitalized for COVID-19: A Retrospective US Cohort Study Using Propensity Scores 雷米地韦能有效降低因 COVID-19 而住院的高危患者 30 天内再次入院的风险:使用倾向评分的美国队列回顾性研究
IF 11.8 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae511
Essy Mozaffari, Aastha Chandak, Robert L Gottlieb, Andre C Kalil, Heng Jiang, Thomas Oppelt, Mark Berry, Chidinma Chima-Melton, Alpesh N Amin
Background Reducing hospital readmission offer potential benefits for patients, providers, payers, and policymakers to improve quality of healthcare, reduce cost, and improve patient experience. We investigated effectiveness of remdesivir in reducing 30-day COVID-19-related readmission during the Omicron era, including older adults and those with underlying immunocompromising conditions. Methods This retrospective study utilized the US PINC AI Healthcare Database to identify adult patients discharged alive from an index COVID-19 hospitalization between December 01, 2021 and February 29, 2024. Odds of 30-day COVID-19-related readmission to the same hospital were compared between patients who received remdesivir vs those not, after balancing characteristics of two groups using inverse probability of treatment weighting (IPTW). Analyses were stratified by maximum supplemental oxygen requirement during index hospitalization. Results Of 326,033 patients hospitalized for COVID-19 during study period, 210,586 patients met the eligibility criteria. Of these, 109,551 (52%) patients were treated with remdesivir. After IPTW, lower odds of 30-day COVID-19-related readmission were observed in patients who received remdesivir vs those who did not, in the overall population (3.3% vs 4.2%, respectively; odds ratio [95% confidence interval]: 0.78 [0.75–0.80]), elderly population (3.7% vs 4.7%, respectively; 0.78 [0.75–0.81]), and those with underlying immunocompromising conditions (5.3% vs 6.2%, respectively; 0.86 [0.80–0.92]). These results were consistent irrespective of supplemental oxygen requirements. Conclusions Treating patients hospitalized for COVID-19 with remdesivir was associated with a significantly lower likelihood of 30-day COVID-19-related readmission across all patients discharged alive from the initial COVID-19 hospitalization, including older adults and those with underlying immunocompromising conditions.
背景 降低再入院率可为患者、医疗服务提供者、支付者和政策制定者带来潜在的益处,从而提高医疗质量、降低成本并改善患者体验。我们调查了在 Omicron 时代雷米替韦在减少 30 天 COVID-19 相关再入院方面的有效性,包括老年人和有潜在免疫力低下情况的患者。方法 这项回顾性研究利用美国 PINC AI 医疗保健数据库来识别 2021 年 12 月 1 日至 2024 年 2 月 29 日期间从 COVID-19 指征住院治疗中存活出院的成年患者。使用反向治疗概率加权法(IPTW)平衡两组患者的特征后,比较了接受雷米替韦治疗与未接受雷米替韦治疗的患者在 30 天内再次入院接受 COVID-19 相关治疗的几率。分析按住院期间最大补氧需求进行分层。结果 在研究期间因 COVID-19 住院的 326,033 名患者中,有 210,586 名患者符合资格标准。其中,109551 名患者(52%)接受了雷米替韦治疗。IPTW治疗后,在总体人群中,接受雷米替韦治疗的患者与未接受雷米替韦治疗的患者相比,30天内COVID-19相关再入院的几率更低(分别为3.3% vs 4.2%;几率比[95%置信区间]:0.78 [0.75-0.75] [0.78-0.75]):0.78[0.75-0.80])、老年人群(分别为 3.7% vs 4.7%;0.78[0.75-0.81])和有潜在免疫力低下症状的人群(分别为 5.3% vs 6.2%;0.86[0.80-0.92])。无论是否需要补充氧气,这些结果都是一致的。结论 对因COVID-19住院的患者使用雷米替韦治疗与COVID-19相关的30天再入院的可能性显著降低。
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引用次数: 0
Safety and Effectiveness of 3 Novel All-Oral Shortened Regimens for Rifampicin- or Multidrug-Resistant Tuberculosis in Kazakhstan. 哈萨克斯坦治疗耐利福平或耐多药结核病的三种新型全口服缩短疗法的安全性和有效性。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae305
Makhmujan Rashitov, Molly F Franke, Letizia Trevisi, Gulzhanat Bekbolatova, Julia Shalimova, Gafurzhan Eshmetov, Sagit Bektasov, Allison LaHood, Nataliya Arlyapova, Elna Osso, Askar Yedilbayev, Oleksandr Korotych, Anisoara Ciobanu, Alena Skrahina, Carole D Mitnick, Kwonjune J Seung, Yerkebulan Algozhin, Michael L Rich

Background: In 2019, the World Health Organization called for operational research on all-oral shortened regimens for multidrug- and rifampicin-resistant tuberculosis (MDR/RR-TB). We report safety and effectiveness of three 9-month all-oral regimens containing bedaquiline (Bdq), linezolid (Lzd), and levofloxacin (Lfx) and reinforced with cycloserine (Cs) and clofazimine (Cfz), delamanid (Dlm) and pyrazinamide (Z), or Dlm and Cfz.

Methods: We conducted a prospective cohort study of patients initiating treatment for pulmonary MDR/RR-TB under operational research conditions at public health facilities in Kazakhstan. Participants were screened monthly for adverse events. Participants with baseline resistance were excluded from the study and treated with a longer regimen. We analyzed clinically relevant adverse events of special interest in all participants and sputum culture conversion and end-of-treatment outcomes among individuals who were not excluded.

Results: Of 510 participants, 41% were women, the median age was 37 years (25th-75th percentile: 28-49), 18% had a body mass index <18.5 kg/m2, and 51% had cavitary disease. A total of 399 (78%) initiated Bdq-Lzd-Lfx-Cs-Cfz, 83 (16%) started Bdq-Lzd-Lfx-Dlm-Z, and 28 (5%) initiated Bdq-Lzd-Lfx-Dlm-Cfz. Fifty-eight individuals (11%) were excluded from the study, most commonly due to identification of baseline drug resistance (n = 52; 90%). Among the remaining 452 participants, treatment success frequencies were 92% (95% CI: 89-95%), 89% (95% CI: 80-94%), and 100% (95% CI: 86-100%) for regimens with Cs/Cfz, Dlm/Z, and Dlm/Cfz, respectively. Clinically relevant adverse events of special interest were uncommon.

Conclusions: All regimens demonstrated excellent safety and effectiveness, expanding the potential treatment options for patients, providers, and programs.

背景:2019年,世界卫生组织呼吁开展针对耐多药和耐利福平结核病(MDR/RR-TB)的全口服缩短疗程方案的业务研究。我们报告了包含贝达喹啉(Bdq)、利奈唑胺(Lzd)和左氧氟沙星(Lfx),并用环丝氨酸(Cs)和氯法齐明(Cfz)、地拉那米(Dlm)和吡嗪酰胺(Z)或Dlm和Cfz加强治疗的三种为期9个月的全口服治疗方案的安全性和有效性:我们在哈萨克斯坦的公共卫生机构开展了一项前瞻性队列研究,研究对象是在业务研究条件下开始接受肺部 MDR/RR-TB 治疗的患者。每月对参与者进行不良事件筛查。基线耐药性患者被排除在研究之外,并接受更长疗程的治疗。我们分析了所有参与者中与临床相关的特殊不良事件,以及未被排除者的痰培养转换和治疗结束结果:在 510 名参与者中,41% 为女性,年龄中位数为 37 岁(四分位间范围:28-49 岁),18% 的参与者体重指数为结论:所有治疗方案都显示出卓越的安全性和有效性,为患者、医疗服务提供者和项目提供了更多潜在的治疗选择。
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引用次数: 0
Factors Associated With Unfavorable Treatment Outcomes Among Persons With Pulmonary Tuberculosis: A Multicentric Prospective Cohort Study From India. 肺结核患者治疗效果不佳的相关因素:印度的一项多中心前瞻性队列研究。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae367
Senbagavalli Prakash Babu, Komala Ezhumalai, Kalaivani Raghupathy, Meagan Karoly, Palanivel Chinnakali, Nikhil Gupte, Mandar Paradkar, Arutselvi Devarajan, Mythili Dhanasekaran, Kannan Thiruvengadam, Madolyn Rose Dauphinais, Akshay N Gupte, Shrivijay Balayogendra Shivakumar, Balamugesh Thangakunam, Devasahayam Jesudas Christopher, Vijay Viswanathan, Vidya Mave, Sanjay Gaikwad, Aarti Kinikar, Hardy Kornfeld, C Robert Horsburgh, Padmapriyadarsini Chandrasekaran, Natasha S Hochberg, Padmini Salgame, Amita Gupta, Gautam Roy, Jerrold Ellner, Pranay Sinha, Sonali Sarkar

In this prospective cohort of 2006 individuals with drug-susceptible tuberculosis in India, 18% had unfavorable treatment outcomes (4.7% treatment failure, 2.5% recurrent infection, 4.1% death, 6.8% loss to follow-up) over a median 12-month follow-up period. Age, male sex, low education, nutritional status, and alcohol use were predictors of unfavorable outcomes.

该前瞻性队列由印度的 2,006 名非 MDR 肺结核患者组成,在中位 12 个月的随访期间,18% 的患者出现了不利的治疗结果(4.7% 治疗失败、2.5% 复发感染、4.1% 死亡、6.8% 失去随访)。年龄、男性、教育程度低、营养状况和酗酒是预测不良后果的因素。
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引用次数: 0
Safety and Immunogenicity of Respiratory Syncytial Virus Prefusion F Protein Vaccine when Co-administered with Adjuvanted Seasonal Quadrivalent Influenza Vaccine in Older Adults: A Phase 3 Randomized Trial. 呼吸道合胞病毒预融合 F 蛋白疫苗与添加佐剂的季节性四价流感疫苗合用的安全性和免疫原性:3期随机试验。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae365
Rebecca Clark, Sam Davies, Jorge Labrador, Paul Loubet, Silvina Natalini Martínez, Helena Moza Moríñigo, Jean-François Nicolas, Mercè Pérez Vera, Mika Rämet, Maria Henar Rebollo-Rodrigo, Iván Sanz-Muñoz, Nancy Dezutter, Sophie Germain, Marie-Pierre David, Amulya Jayadev, Hiwot Amare Hailemariam, Shady Kotb, Nadia Meyer

Background: We evaluated co-administration of adjuvanted seasonal quadrivalent influenza vaccine (FLU-aQIV) and respiratory syncytial virus (RSV) prefusion F protein-based vaccine (RSVPreF3 OA) in ≥65-year-olds.

Methods: This phase 3, open-label trial randomized ≥65-year-olds to receive FLU-aQIV and RSVPreF3 OA concomitantly (Co-Ad) or sequentially, 1 month apart (Control). Primary objectives were to demonstrate the non-inferiority of FLU-aQIV and RSVPreF3 OA co-administration versus sequential administration in terms of hemagglutination inhibition (HI) titers for each FLU-aQIV strain and RSV-A and RSV-B neutralization titers, 1 month post-vaccination. Reactogenicity and safety were also assessed.

Results: Overall, 1045 participants were vaccinated (Co-Ad: 523; Control: 522). Non-inferiority of FLU-aQIV and RSVPreF3 OA co-administration versus sequential administration was demonstrated in terms of HI titers for the A/Victoria(H1N1), B/Victoria, and B/Yamagata influenza strains and RSV-A neutralization titers (upper limits [ULs] of 95% confidence intervals [CIs] for adjusted geometric mean titer [GMT] ratios [Control/Co-Ad] ≤1.50) but not for A/Darwin(H3N2) HI titers (95% CI UL = 1.53). The immune response to A/Darwin(H3N2) was further assessed post-hoc using a microneutralization assay; the post-vaccination adjusted GMT ratio (Control/Co-Ad) was 1.23 (95% CI: 1.06-1.42, ie, UL ≤1.50), suggesting an adequate immune response to A/Darwin(H3N2) following co-administration. RSV-B neutralization titers were comparable between groups (95% CI UL for adjusted GMT ratio ≤1.50). Solicited adverse events were mostly mild or moderate and transient; unsolicited and serious adverse event rates were balanced between groups.

Conclusions: Adjuvanted FLU-aQIV and RSVPreF3 OA had acceptable reactogenicity/safety profiles when co-administered in ≥65-year-olds, without clinically relevant interference with the immune responses to either vaccine.

Clinical trials registration: NCT05568797.

背景:我们评估了在≥65岁的老年人中同时接种佐剂季节性四价流感疫苗(FLU-aQIV)和基于F蛋白的呼吸道合胞病毒(RSV)预融合疫苗(RSVPreF3 OA)的情况:这项 3 期开放标签试验随机分配年龄≥65 岁的患者同时接种 FLU-aQIV 和 RSVPreF3 OA(联合接种),或相隔 1 个月依次接种(对照组)。主要目的是证明FLU-aQIV和RSVPreF3 OA同时接种与顺序接种相比,在疫苗接种后1个月,各株FLU-aQIV的血凝抑制(HI)滴度以及RSV-A和RSV-B的中和滴度方面无劣效。此外,还对反应原性和安全性进行了评估:共有 1045 人接种了疫苗(联合免疫:523 人;对照组:522 人)。在甲型/乙型/Victoria(H1N1)、乙型/Victoria和乙型/Yamagata流感菌株的HI滴度和RSV-A中和滴度方面,FLU-aQIV和RSVPreF3 OA联合给药与连续给药相比无劣效(调整后几何平均滴度[GMT]比[对照组/联合给药组]≤1.50的95%置信区间[CI]上限[UL]),但在甲型/乙型/Victoria(H1N1)、乙型/Victoria和乙型/Yamagata流感菌株的HI滴度和RSV-A中和滴度方面无劣效。50),但对 A/Darwin(H3N2) HI 滴度的影响不大(95% CI UL = 1.53)。接种后调整的 GMT 比值(对照组/联合用药组)为 1.23(95% CI:1.06-1.42,即 UL ≤1.50),表明联合用药后对 A/Darwin(H3N2)产生了充分的免疫反应。各组之间的RSV-B中和滴度相当(调整后GMT比值的95% CI UL≤1.50)。主动发生的不良反应大多为轻度或中度,且为一过性;主动发生的不良反应和严重不良反应的发生率在各组之间保持平衡:临床试验注册:临床试验注册:NCT05568797。
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引用次数: 0
Application of Diagnostic Stewardship to Fungal Polymerase Chain Reaction: Low Yield of Follow-up Testing on Plasma and Bronchoalveolar Lavage After a Negative Result. 真菌聚合酶链反应的诊断管理应用:结果阴性后对血浆和支气管肺泡灌洗液进行后续检测的低产率。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae382
Tong Wang, Bosung Park, Gavin Anderson, Brian Shaller, Indre Budvytiene, Niaz Banaei

Background: Early diagnosis of invasive fungal disease is essential for optimizing management. Although the clinical utility of fungal polymerase chain reaction (PCR) testing on plasma and bronchoalveolar lavage (BAL) has been established, the role of follow-up testing remains unclear.

Methods: This was a retrospective single-center study. The yield of follow-up PCR for Aspergillus species, Mucorales agents, Fusarium species, Scedosporium species, dimorphic fungi, Pneumocystis jirovecii, and Candida species on plasma and/or BAL was measured at intervals of 1, 2, 3, and 4 weeks following a negative result.

Results: A total of 1389 follow-up tests on 406 plasma specimens from 264 patients and 983 BAL specimens from 431 patients were evaluated. Overall, the positivity rate at 1, 2, 3, and 4 weeks was 2.7% (4/148), 3.3% (4/123), 5.1% (4/78), and 3.5% (2/57), respectively, on plasma, and 0% (0/333), 0.3% (1/288), 0.4% (1/228), and 0.7% (1/134), respectively, on BAL. Conversions occurred with Aspergillus species, Mucorales agents, and Fusarium species PCR on plasma and Aspergillus species and P jirovecii PCR on BAL. All patients who converted were immunocompromised. Within 1 week of a prior negative test, 2 Aspergillus and 2 Mucorales PCRs were positive on plasma, and zero tests were positive on BAL. In week 1, only 1 Aspergillus species that was positive on day 7 was classified as probable fungal disease.

Conclusions: Fungal PCR follow-up testing on plasma and BAL within 4 weeks of a prior negative result was of low yield and rarely generated a positive result considered clinically significant in the first week.

背景:侵袭性真菌病的早期诊断对于优化治疗至关重要。虽然对血浆和支气管肺泡灌洗液(BAL)进行真菌聚合酶链反应(PCR)检测的临床实用性已得到证实,但后续检测的作用仍不明确:这是一项回顾性单中心研究。方法:这是一项回顾性的单中心研究,在阴性结果出现后的 1、2、3 和 4 周对血浆和/或 BAL 上的曲霉菌、粘菌、镰刀菌、头孢菌、二态真菌、肺孢子菌和念珠菌的 PCR 随访结果进行了测定:共对 264 名患者的 406 份血浆标本和 431 名患者的 983 份 BAL 标本进行了 1389 次跟踪检测。总体而言,血浆在 1、2、3 和 4 周的阳性率分别为 2.7% (4/148)、3.3% (4/123)、5.1% (4/78) 和 3.5% (2/57),BAL 的阳性率分别为 0% (0/333)、0.3% (1/288)、0.4% (1/228) 和 0.7% (1/134)。血浆中的曲霉菌、黏菌剂和镰刀菌 PCR 以及 BAL 中的曲霉菌和嗜肺曲霉菌 PCR 均可导致转阴。所有转阴患者均为免疫力低下者。在之前检测结果为阴性的 1 周内,血浆中有 2 例曲霉菌和 2 例粘菌 PCR 检测结果呈阳性,BAL 检测结果呈阳性的患者为零。在第 1 周,只有 1 种曲霉菌在第 7 天呈阳性,被归类为可能的真菌病:结论:在之前检测结果为阴性的 4 周内对血浆和 BAL 进行真菌 PCR 后续检测的结果较低,而且在第一周内很少出现具有临床意义的阳性结果。
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引用次数: 0
Correction to: Immunogenicity and Safety of a Purified Vero Rabies Vaccine-Serum Free, Compared With 2 Licensed Vaccines, in a Simulated Rabies Post-Exposure Regimen in Healthy Adults in France: A Randomized, Controlled, Phase 3 Trial. 更正:在法国健康成人狂犬病暴露后模拟治疗中,纯化的无狂犬病病毒疫苗血清与两种许可疫苗的免疫原性和安全性比较:一项随机对照 3 期试验。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae390
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引用次数: 0
Reply to Tannous et al. 葡萄球菌感染中的达托霉素药代动力学/药效学目标。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae018
Romain Garreau, Truong-Thanh Pham, Laurent Bourguignon, Aurélien Millet, François Parant, David Bussy, Marine Desevre, Victor Franchi, Tristan Ferry, Sylvain Goutelle
{"title":"Reply to Tannous et al.","authors":"Romain Garreau, Truong-Thanh Pham, Laurent Bourguignon, Aurélien Millet, François Parant, David Bussy, Marine Desevre, Victor Franchi, Tristan Ferry, Sylvain Goutelle","doi":"10.1093/cid/ciae018","DOIUrl":"10.1093/cid/ciae018","url":null,"abstract":"","PeriodicalId":10463,"journal":{"name":"Clinical Infectious Diseases","volume":null,"pages":null},"PeriodicalIF":8.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139485290","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
The Use of Long-term Antibiotics for Suppression of Bacterial Infections. 长期使用抗生素抑制细菌感染。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae302
Molly Horne, Ian Woolley, Jillian S Y Lau

Suppressive antibiotic therapy is prescribed when a patient has an infection that is presumed to be incurable by a defined course of therapy or source control. The cohort receiving suppressive antibiotic therapy is typically highly comorbid and the infections often involve retained prosthetic material. In part due to a lack of clear guidelines regarding the use of suppressive antibiotics, and in part due to the complex nature of the infections in question, patients are often prescribed suppressive antibiotics for extremely long, if not indefinite, courses. The risks of prolonged antibiotic exposure in this context are not fully characterized, but they include adverse drug effects ranging from mild to severe, the development of antibiotic-resistant organisms, and perturbations of the gastrointestinal microbiome. In this narrative review we present the available evidence for the use of suppressive antibiotic therapy in 4 common indications, examine the gaps in the current literature, and explore the known and potential risks of this therapy. We also make suggestions for improving the quality of evidence in future studies, particularly by highlighting the need for a standardized term to describe the use of long courses of antibiotics to suppress hard-to-treat infections.

当患者的感染被假定为无法通过确定的疗程或病源控制治愈时,就会处方抑制性抗生素疗法。接受抑制性抗生素治疗的人群通常合并症较多,感染通常涉及残留的假体材料。部分由于缺乏明确的抑制性抗生素使用指南,部分由于相关感染的复杂性,患者通常会被处以极长甚至无限期的抑制性抗生素治疗。在这种情况下,长期接触抗生素的风险尚未完全定性,但其中包括轻微到严重的药物不良反应、耐抗生素生物的发展以及胃肠道微生物群的扰乱。在这篇叙述性综述中,我们介绍了在四种常见适应症中使用抑制性抗生素疗法的现有证据,研究了现有文献中的不足之处,并探讨了这种疗法的已知和潜在风险。我们还就如何提高未来研究的证据质量提出了建议,特别是强调需要一个标准化术语来描述使用长疗程抗生素抑制难治性感染的情况。
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引用次数: 0
Hospital-Acquired and Ventilator-Associated Pneumonia Early After Lung Transplantation: A Prospective Study on Incidence, Pathogen Origin, and Outcome. 肺移植术后早期的医院和呼吸机相关肺炎:关于发病率、病原体来源和结果的前瞻性研究。
IF 8.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-10-15 DOI: 10.1093/cid/ciae399
Laura N Walti, Chun Fai Ng, Qasim Mohiuddin, Roni Bitterman, Mohammed Alsaeed, William Klement, Tereza Martinu, Aman Sidhu, Tony Mazzulli, Laura Donahoe, Shaf Keshavjee, Lorenzo Del Sorbo, Shahid Husain

Background: Hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) are important complications early (<30 days) after lung transplantation (LT). However, current incidence, associated factors, and outcomes are not well reported.

Methods: LT recipients transplanted at our institution (July 2019-January 2020 and October 2021-November 2022) were prospectively included. We assessed incidence and presentation of pneumonia and evaluated the impact of associated factors using regression models. We also evaluated molecular relatedness of respiratory pathogens collected peri-transplant and at pneumonia occurrence using pulsed-field gel electrophoresis (PFGE).

Results: In the first 30 days post-LT, 25/270 (9.3%) recipients were diagnosed with pneumonia (68% [17/25] VAP; 32% [8/25] HAP). Median time to pneumonia was 11 days (IQR, 7-13); 49% (132/270) of donor and 16% (44/270) of recipient respiratory peri-transplant cultures were positive. However, pathogens associated with pneumonia were not genetically related to either donor or recipient cultures at transplant, as determined by PFGE. Diagnosed pulmonary hypertension (HR, 4.42; 95% CI, 1.62-12.08) and immunosuppression use (HR, 2.87; 95% CI, 1.30-6.56) were pre-transplant factors associated with pneumonia. Pneumonia occurrence was associated with longer hospital stay (HR, 5.44; 95% CI, 2.22-13.37) and VAP with longer ICU stay (HR, 4.31; 95% CI, 1.73-10.75) within the first 30 days post-transplantation; 30- and 90-day mortality were similar.

Conclusions: Prospectively assessed early pneumonia incidence occurred in ∼10% of LT. Populations at increased risk for pneumonia occurrence include LT with pre-transplant pulmonary hypertension and pre-transplant immunosuppression. Pneumonia was associated with increased healthcare use, highlighting the need for further improvements by preferentially targeting higher-risk patients.

背景:医院相关肺炎(HAP)和呼吸机相关肺炎(VAP)是早期重要的并发症:前瞻性地纳入了在我院接受移植的LT受者(2010年7月至2020年1月和2021年10月至2022年11月)。我们评估了肺炎的发病率和表现形式,并使用回归模型评估了相关因素的影响。此外,我们还使用脉冲-场效应凝胶电泳(PFGE)评估了移植前和肺炎发生时收集的呼吸道病原体的分子相关性:结果:在移植后的前 30 天,25/270(9.3%)名受者被诊断为肺炎(68% [17/25] VAP;32% [8/25] HAP)。肺炎的中位时间为 11 天(IQR 7-13)。49%(132/270)的供体和 16%(44/270)的受体呼吸道移植周围培养呈阳性。然而,根据 PFGE 测定,与肺炎相关的病原体与移植时供体或受体培养物的基因无关。在移植后的前30天内,肺炎的发生与较长的住院时间有关(HR 5.44,95% CI 2.22-13.37),VAP与较长的ICU住院时间有关(HR 4.31,95% CI:1.73-10.75);30天和90天的死亡率相似:通过前瞻性评估发现,约10%的LT患者会发生早期肺炎。肺炎发生风险增加的人群包括移植前肺动脉高压和移植前免疫抑制的LT患者。肺炎与医疗服务使用量的增加有关,因此需要通过优先选择高危患者来进一步改善医疗服务。
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Clinical Infectious Diseases
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