Open Forum Infectious Diseases最新文献

Background: Oseltamivir is recommended for the treatment of adults hospitalized with influenza, but adherence is often suboptimal. This may be due to doubts about the reliability of the evidence supporting its benefits, particularly when initiation is delayed. We aimed to assess the effectiveness of oseltamivir in reducing mortality in older adults hospitalized with influenza, with a focus on the timing of initiation.

Methods: The CIRN-SOS Network gathered data on severe respiratory illnesses across 5 Canadian provinces during the influenza seasons 2012-2019. Individuals aged ≥65 years with confirmed influenza and available antiviral prescription data were included. We compared the 30-day survival rates of hospitalized patients based on oseltamivir prescription status. Kaplan-Meier estimated survival probability and inverse probability of treatment (IPT)-weighted Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. The analyses considered the time to antiviral initiation (>48 vs ≤48 hours).

Results: Among the 8135 influenza patients studied, 2126 did not receive antiviral treatment, whereas 6009 were treated with oseltamivir. A total of 395 patients were hospitalized for >30 days. The overall mortality rate was 8.32 per 1000 person-days, with 53.9% of the deaths occurring within the first week. Oseltamivir recipients had a 18% lower risk of 30-day mortality (IPT-weighted HR, 0.82 [95% CI, .69-.98]). The benefit was significant for influenza A (IPT-weighted HR, 0.74 [95% CI, .61-.91]) but not for influenza B (IPT-weighted HR, 1.12 [95% CI, .81-1.56]). Oseltamivir remained effective even when initiated after 48 hours (IPT-weighted HR, 0.66 [95% CI, .49-.90]). Influenza vaccination did not mediate the effectiveness of oseltamivir in reducing mortality.

Conclusions: Oseltamivir significantly reduces mortality risk in older adults hospitalized with influenza, even when administered after 48 hours, independent of vaccination status. Clinical Trials Registration. NCT01517191.

[This corrects the article DOI: 10.1093/ofid/ofae746.].

Appropriate, protocol-adherent, doxycycline postexposure prophylaxis prescribing occurred for 70% of prescriptions from our clinic. Most of the nonadherent prescribing was due to missed sexually transmitted infection screenings (89%). As utilization of doxycycline postexposure prophylaxis continues to increase, it is necessary to ensure appropriate follow-up and monitoring.

Background: Doxycycline postexposure prophylaxis (doxy-PEP) effectively prevents bacterial sexually transmitted infections (STIs) but may increase antibiotic pressure. Little is known about longitudinal antibiotic use among men who have sex with men (MSM), a key population for doxy-PEP.

Methods: We analyzed data from a prospective cohort of MSM in Seattle, Washington, from 2016 to 2018, prior to the introduction of doxy-PEP. Antibiotic use and reason for prescription were self-reported in weekly surveys and extracted from medical records. We characterized antibiotic use across 49 weeks of follow-up, stratified by specific antibiotics of interest and reasons for prescription. Incidence rates (IRs) were calculated for the number of incident events of antibiotic initiation per 100 person-years (PY) at risk. We assessed factors associated with antibiotic initiation using negative binomial regression to estimate adjusted incidence rate ratios (IRRs).

Results: Among 140 participants, 68.6% (n = 96) received at least 1 antibiotic during follow-up, resulting in an overall IR of 264.5 events of antibiotic initiation per 100 PY and 1696 total days of antibiotic use. STI treatment was the most common reason for antibiotic initiation (IR, 153.5 events per 100 PY; 462 days); however, treatment for other conditions contributed most to overall days of antibiotic use (IR, 42.6 events per 100 PY; 947 days). An age of 25-39 years (IRR, 1.54 [95% confidence interval {CI}, 1.02-2.32]) and a history of bacterial STIs <12 months prior to enrollment (IRR, 1.81 [95% CI, 1.12-2.93]) were significantly associated with higher incidence of antibiotic initiation.

Conclusions: Antibiotic consumption among this population was very high. Our analysis provides a necessary foundation for assessing the potential impacts of doxy-PEP.

Introduction: Classification of patients with Staphylococcus aureus bacteremia as complicated versus uncomplicated is based on a combination of clinical and microbiologic variables. Whether daily body temperature and common laboratory tests such as C-reactive protein (CRP) and white blood cell (WBC) can improve risk stratification algorithms is unclear.

Methods: We conducted a post hoc secondary analysis of the CAMERA2 trial, which enrolled hospitalized adult patients with methicillin-resistant S aureus bacteremia and prospectively collected daily body temperature and peripheral blood WBC and CRP. We evaluated the prognostic relevance of each parameter by calculating crude and adjusted odds ratios for 90-day all-cause mortality comparing patients with the abnormal parameter of interest versus those with normal parameters on each day of illness.

Results: A total of 345 patients were included in this analysis, of whom 63 (18.3%) died within 90 days. Fever (body temperature ≥38.0 °C) was associated with increased odds of 90-day mortality from day 4 and onwards. Fever later in the illness course was associated with higher adjusted odds of mortality (8.78; 95% confidence interval, 2.78-27.7 on day 7 vs adjusted odds ratio 3.70; 95% CI, 1.58-8.67 on day 4). In contrast, CRP and abnormal WBC count did not demonstrate a consistent or temporal association with mortality.

Conclusions: Persistent fever after 72 hours is associated with increased mortality in patients with methicillin-resistant S aureus bacteremia, supporting recommendations that this should be kept as a criterion for classifying patients as either "high-risk" or "complicated." Within this dataset, there was limited additional predictive value in WBC or CRP.

Nosocomial ventriculitis can be an extremely difficult infectious disease process to diagnose, thereby exposing patients to increased morbidity and unwarranted aggressive antibiotics. Thus, novel ventriculitis diagnostics are drastically needed. In this study, we demonstrate excellent sensitivity and specificity of cerebral spinal fluid α-defensins to aid in diagnosing ventriculitis.

Background: Long COVID is a common complication of infection with severe acute respiratory syndrome coronavirus 2, but the prevalence and predictors of the condition remain poorly characterized.

Methods: We prospectively studied adults (≥18 years) with acute coronavirus disease 2019 (COVID-19) presenting to an urban safety net hospital and associated clinics between July 2020 and December 2022. Logistic regression models were used to evaluate the association between baseline demographic, clinical, and laboratory characteristics with long COVID status, defined as symptoms persisting at least 9 months after acute disease. Among unrecovered participants, we describe the prevalence of individual symptoms.

Results: We enrolled 222 participants, 162 (73%) of whom had known recovery status by 9 months. Median age was 54 years, half (55%) were female, and the majority of participants (78%) had at least 1 comorbidity at the time of COVID-19 diagnosis. Based on acute illness characteristics, the adjusted odds ratio for long COVID was 3.0 (95% confidence interval [CI], 1.1-8.0) among those with detectable nucleocapsid antigen and 3.6 (95% CI, 1.2-11) for those who required supplemental oxygen. Of the 41% of participants with symptoms persisting at least 9 months, central nervous system and psychological symptoms were most commonly reported, with 57% reporting functional limitations due to their persistent symptoms.

Conclusions: The strong association with initial disease suggests a decreasing prevalence of long COVID as acute illnesses become milder. However, many contemporary patients still experience high viral burden with extended viral replication, even after vaccination. Our findings highlight the importance of properly characterizing long COVID as viral evolution shifts acute disease presentation.

Background: Whether and how sex plays differential roles in aging-related multimorbidity among people with HIV (PWH) is poorly characterized.

Methods: We included 2479 PWH and 5376 people without HIV from the baseline assessment of the CHART cohort (Comparative HIV and Aging Research in Taizhou). Ten non-AIDS comorbidities were investigated. Multiple logistic regression was used to assess the correlates of multimorbidity, defined as the coexistence of ≥2 non-AIDS comorbidities. Multimorbidity patterns were identified through hierarchical cluster analysis.

Results: The prevalence of multimorbidity was higher in PWH than in people without HIV (74.6% vs 66.9%, P < .001). This difference was particularly pronounced in women in each age group from 18 through 59 years and among men in each age group from 18 through 49 years. A significant interaction between sex and HIV on multimorbidity was identified (P < .001), with the strength of the association between HIV infection and multimorbidity being stronger in women than in men. Women with HIV presented a unique aggregation pattern of multimorbidity, where neuropsychiatric disorders (depression, neurocognitive impairment) clustered with cardiometabolic diseases. In contrast, all men and women without HIV manifested a similar multimorbidity pattern, where depression and neurocognitive impairment were clustered with hematologic abnormalities but not with cardiometabolic diseases.

Conclusions: Earlier onset and higher burden of multimorbidity in PWH, as well as disproportionate vulnerability to and a unique multimorbidity pattern among women with HIV, underscore the urgent need for early and sexually oriented integrative interventions and health services targeting multimorbidity in PWH.

Background: HIV coinfection worsens health outcomes for persons with chronic hepatitis C virus (HCV) infection; however, access to comprehensive Ryan White (RW) HIV care may improve the health of persons with HIV and HCV.

Methods: In a retrospective cohort study, we used surveillance data from Philadelphia's hepatitis and HIV registries for newly reported HCV infections from November 2015 to October 2021. We plotted Kaplan-Meier curves and performed Cox regressions on time to HCV clearance by HIV coinfection status, adjusting for demographic characteristics and HCV report year.

Results: A total of 10 251 persons with newly reported HCV infection were included, of whom 9898 (96.6%) had HCV monoinfection and 353 (3.4%) had HIV coinfection. HCV reports were mostly among residents who were non-Hispanic/Latine White (n = 3609, 35.2%) and non-Hispanic/Latine Black (n = 3221, 31.4%) and assigned male sex at birth (n = 6931, 67.8%). At every month of follow-up, having HIV was associated with a higher likelihood of HCV clearance as compared with HCV monoinfection (adjusted hazard ratio, 1.2; 95% CI, 1.1-1.4; P < .05). For persons with HIV coinfection, participation in RW support services 2 to 6 times monthly was associated with an increased likelihood (adjusted hazard ratio, 1.7-3.1) of HCV clearance at every month of follow-up as compared with persons without RW participation (P < .05).

Conclusions: Among newly reported HCV infections, the likelihood of HCV clearance was higher among persons with HIV coinfection who participated in RW support services. Frequent receipt of supportive services, such as those provided by the national, federally funded RW system, is crucial for HCV elimination.

Pneumococcus is a major cause of serious infections, especially among vulnerable populations. While pneumococcal conjugate vaccines (PCVs) provide effective protection against disease caused by the included serotypes, a substantial burden of disease remains. Several new PCVs are under development or were recently recommended for use to counteract the remaining disease burden. This had led to complicated policy deliberations on their optimal use in different populations. We discuss how key factors should be considered in any policy decision: serotype coverage of a new PCV, prevalence of the untargeted remaining serotypes, strength of the immune response to the serotypes in a new PCV, potential for PCV evasion, PCV costs, and optimal simultaneous use of PCVs in children and adults. We also suggest the need for robust analyses of available surveillance data and continual monitoring of changes in the pneumococcal serotypes that are responsible for disease and colonization to help decision makers make optimal recommendations.