Open Forum Infectious Diseases最新文献

英文中文

Every Crisis Is an Opportunity: Advancing Blood Culture Stewardship During a Blood Culture Bottle Shortage. 每一次危机都是一次机遇：在血培养瓶短缺期间推进血培养管理。

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-23 eCollection Date: 2024-09-01 DOI: 10.1093/ofid/ofae479

Jonathan H Ryder, Trevor C Van Schooneveld, Daniel J Diekema, Valeria Fabre

The current manufacturing disruption of BACTEC blood culture bottles has drawn attention to diagnostic stewardship around blood culture utilization. In this perspective, we offer strategies for implementing blood culture stewardship using a graded approach based on a hospital's blood culture bottle supply. These strategies should inform plans to mitigate the impact of the shortage on patient care and reinforce fundamental principles of blood culture stewardship.

目前 BACTEC 血培养瓶的生产中断引起了人们对血培养使用诊断管理的关注。在本文中，我们将根据医院的血培养瓶供应情况，采用分级方法提供实施血培养管理的策略。这些策略应能为减轻血培养瓶短缺对患者护理的影响和加强血培养管理的基本原则提供参考。

引用次数: 0

Correction to: The Presence of Hemoglobin in Cervicovaginal Lavage Is Not Associated With Genital Schistosomiasis in Zambian Women From the BILHIV Study. 更正：来自 BILHIV 研究的赞比亚妇女宫颈阴道洗液中的血红蛋白与生殖器血吸虫病无关。

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-22 eCollection Date: 2024-08-01 DOI: 10.1093/ofid/ofae472

[This corrects the article DOI: 10.1093/ofid/ofac586.].

[此处更正了文章 DOI：10.1093/ofid/ofac586]。

引用次数: 0

Epidemiology and Clinical Characteristics of Ocular Tuberculosis in the United States, 1993–2019 1993-2019 年美国眼结核病的流行病学和临床特征

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-22 DOI: 10.1093/ofid/ofae476

Thomas D Filardo, Aryn Andrzejewski, Michael Croix, Julie L Self, Henry S Fraimow, Sonal S Munsiff

Introduction Data regarding ocular tuberculosis (OTB) in the United States have not been previously reported. We evaluated trends of OTB compared with other extrapulmonary TB (EPTB). Methods We estimated the proportion of all EPTB cases (with or without concurrent pulmonary involvement) with OTB reported to the National Tuberculosis Surveillance System during 1993–2019. We compared demographics and clinical characteristics of people with OTB and other EPTB during 2010–2019. P-values were calculated by chi-square test for categorical variables and Kruskal-Wallis for continuous variables. Results During 1993–2019, 1,766 OTB cases were reported, representing 1.6% of 109,834 all EPTB cases: 200 (0.5% of 37,167) during 1993–1999, 395 (1.0% of 41,715) during 2000–2009, and 1,171 (3.8% of 30,952) during 2010–2019. In contrast to persons with other EPTB, persons with OTB were older (median: 48 vs 44 years, p<0.01), more likely to be U.S.-born (35% vs 28%, p<0.01) and to have diabetes (17% vs 13%, p<0.01), and less likely to have HIV (1% vs 8%, p<0.01). OTB was less likely to be laboratory confirmed (5% vs 75%, p<0.01) but patients were more likely to be tested by interferon gamma release assay (IGRA; 84% vs 56%, p<0.01) and IGRA positive (96% vs 80%, p<0.01). Conclusion Reported OTB increased during 1993–2019 despite decreasing TB, including EPTB; the largest increase occurred during 2010–2019. OTB was rarely laboratory confirmed and primarily diagnosed in conjunction with IGRA results. More research is needed to understand the epidemiology of OTB to inform clinical and diagnostic practices.

导言：有关美国眼结核病（OTB）的数据以前从未报道过。我们评估了 OTB 与其他肺外结核病（EPTB）相比的趋势。方法我们估算了 1993-2019 年期间向美国国家结核病监测系统报告的所有 EPTB 病例（无论是否并发肺部受累）中 OTB 的比例。我们比较了 2010-2019 年期间 OTB 患者和其他 EPTB 患者的人口统计学特征和临床特征。分类变量采用卡方检验，连续变量采用 Kruskal-Wallis 检验，计算 P 值。结果 1993-2019年期间，共报告了1 766例OTB病例，占所有EPTB病例109 834例的1.6%：1993-1999年期间为200例（占37 167例的0.5%），2000-2009年期间为395例（占41 715例的1.0%），2010-2019年期间为1 171例（占30 952例的3.8%）。与其他 EPTB 患者相比，OTB 患者年龄更大（中位数：48 岁 vs 44 岁，p<0.01），更有可能在美国出生（35% vs 28%，p<0.01）和患有糖尿病（17% vs 13%，p<0.01），感染 HIV 的可能性更小（1% vs 8%，p<0.01）。实验室确诊 OTB 的几率较低（5% vs 75%，p<0.01），但患者更有可能通过伽马干扰素释放测定（IGRA；84% vs 56%，p<0.01）进行检测，且 IGRA 呈阳性（96% vs 80%，p<0.01）。结论 1993-2019 年间，尽管结核病（包括 EPTB）有所减少，但报告的 OTB 却有所增加；2010-2019 年间增幅最大。OTB 很少得到实验室确诊，主要是结合 IGRA 结果进行诊断。需要开展更多研究来了解 OTB 的流行病学，为临床和诊断实践提供依据。

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引用次数: 0

High Rates of Nonsusceptibility to Common Oral Antibiotics in Streptococcus pneumoniae Clinical Isolates From the United States (2019-2021). 美国肺炎链球菌临床分离株对常用口服抗生素的高不敏感率（2019-2021 年）。

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-22 eCollection Date: 2024-09-01 DOI: 10.1093/ofid/ofae470

Lalitagauri M Deshpande, Michael D Huband, Sarah Charbon, Mariana Castanheira, Rodrigo E Mendes

Streptococcus pneumoniae isolates from the United States (n = 1038; 2019-2021) were susceptible to omadacycline (99.8%), levofloxacin (99.7%), and ceftriaxone (98.1%), whereas doxycycline (80.2%), oral penicillin (63.5%), cefpodoxime (76.8%), and azithromycin (54.4%) activity was limited. Tet(M) did not affect omadacycline activity but altered activity of older tetracyclines including doxycycline, suggesting omadacycline is an important option for treatment of community-acquired bacterial pneumonia.

来自美国的肺炎链球菌分离株（n = 1038；2019-2021年）对奥美拉唑（99.8%）、左氧氟沙星（99.7%）和头孢曲松（98.1%）敏感，而对强力霉素（80.2%）、口服青霉素（63.5%）、头孢泊肟（76.8%）和阿奇霉素（54.4%）的活性有限。Tet(M)不影响奥马大环素的活性，但会改变包括多西环素在内的老式四环素的活性，这表明奥马大环素是治疗社区获得性细菌性肺炎的一个重要选择。

引用次数: 0

Combination of a Rapid Diagnostic Assay and Antimicrobial Stewardship Intervention on Gram-negative Bacteremia 革兰氏阴性菌血症的快速诊断分析与抗菌药物管理干预相结合

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-22 DOI: 10.1093/ofid/ofae477

Julian Ventres, Michelle H Ting, Diane M Parente, Ralph Rogers, Ashlyn M Norris, Gregorio Benitez, Fadi Shehadeh, April M Bobenchik, Eleftherios Mylonakis, Kimberle C Chapin, Cheston B Cunha

Background Traditional blood cultures for gram-negative bacteremia can take up to 72 hours or more to return results, prolonging the duration of empiric broad-spectrum intravenous antibiotics. The Accelerate Pheno® system provides rapid identification and susceptibilities for blood cultures in gram-negative bacteremia. Current data on its clinical utility is mixed overall and requires further research. Methods A multi-center, retrospective quasi-experimental study was conducted comparing the Accelerate Pheno® rapid diagnostic system with antimicrobial stewardship intervention and traditional blood cultures alone. Results A total of 264 patients with blood cultures with gram-negative bacteria growth were included in the final analysis (102 pre-intervention, 162 post-intervention). The antimicrobial stewardship team made 364 recommendations in 152/162 (93.8%) patients in the post-group. Duration of intravenous therapy was shorter (p<0.001) for the post-intervention group (median 4.0 days) compared to the pre-intervention group (median 7.5 days). Hospital length of stay was also shorter (p<0.001) for the post-intervention group (median 5.1 days) compared to the pre-intervention group (median 7.0 days). Readmission rates within 30 days were reduced (p=0.042) post-intervention (13.0%) compared to pre-intervention (22.6%). In the post-intervention group, a larger proportion of patients were transitioned to oral therapy at any point (126/162, 77.8%) compared to pre-intervention (62/102, 60.8%) (p<0.001). Conclusions These results suggest that the Accelerate Pheno® with active review and intervention by a multidisciplinary antimicrobial stewardship team is a useful tool in improving both patient-centric and antimicrobial stewardship outcomes.

背景传统的革兰氏阴性菌血症血液培养需要 72 小时或更长时间才能得出结果，从而延长了静脉注射广谱抗生素的时间。Accelerate Pheno® 系统可对革兰氏阴性菌血症的血液培养物进行快速鉴定和药敏试验。目前有关该系统临床实用性的数据不一，需要进一步研究。方法进行了一项多中心、回顾性准实验研究，比较了加速 Pheno® 快速诊断系统与抗菌药物管理干预和传统的单纯血培养。结果共有 264 名血液培养结果显示有革兰氏阴性菌生长的患者被纳入最终分析（干预前 102 人，干预后 162 人）。抗菌药物管理团队对干预后组的 152/162 名患者（93.8%）提出了 364 项建议。与干预前（中位数为 7.5 天）相比，干预后组（中位数为 4.0 天）的静脉治疗时间更短（p<0.001）。干预后组的住院时间（中位数为 5.1 天）也比干预前组（中位数为 7.0 天）短（p<0.001）。干预后（13.0%）与干预前（22.6%）相比，30 天内再入院率有所降低（p=0.042）。与干预前（62/102，60.8%）相比，干预后组中有更大比例的患者在任何时候都转为口服治疗（126/162，77.8%）（p<0.001）。结论这些结果表明，在多学科抗菌药物管理团队的积极审查和干预下，加速 Pheno® 是改善以患者为中心和抗菌药物管理结果的有效工具。

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引用次数: 0

Therapeutic Drug Monitoring of Long Acting Rilpivirine and Cabotegravir for Treatment of HIV-1 Infection – A Case Series of Five Patients with One Virologic Failure after Development of Two-Class Resistance 用于治疗 HIV-1 感染的长效利匹韦林和卡博替拉韦的治疗药物监测 - 五名患者在出现两类抗药性后出现一次病毒学失败的病例系列研究

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-22 DOI: 10.1093/ofid/ofae480

Jacob Gerstenberg, Hartwig Klinker, Michael Baier, Amrei von Braun, Ulrich Seybold, Carlotta Helbig, Martin Däumer, Klaus Korn, Christoph Stephan, Benjamin T Schleenvoigt

Virologic failure of long-acting rilpivirine/cabotegravir is rare but may result in severely limited treatment options. Known risk factors cannot predict all cases. Therapeutic drug monitoring (TDM) may help identify patients-at-risk, but reliable thresholds are missing. We report retrospective TDM in a cohort of five patients, including one virological failure.

长效利匹韦林/卡博替拉韦的病毒学失败非常罕见，但可能导致治疗方案严重受限。已知的风险因素无法预测所有病例。治疗药物监测（TDM）可帮助识别高危患者，但缺乏可靠的阈值。我们报告了一组五名患者的回顾性 TDM，其中包括一名病毒学失败患者。

引用次数: 0

Population-Based Influenza Vaccine Effectiveness Against Laboratory-Confirmed Influenza Infection in Southern China, 2023-2024 Season. 2023-2024 年流感季节中国南方人群接种流感疫苗预防实验室确诊流感感染的效果。

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-21 eCollection Date: 2024-09-01 DOI: 10.1093/ofid/ofae456

Xīn Gào, Yexiang Sun, Peng Shen, Jinxin Guo, Yunpeng Chen, Yueqi Yin, Zhike Liu, Siyan Zhan

Background: In China, the 2022-2023 influenza season began earlier and was characterized by higher levels of influenza activity and co-circulation of various respiratory pathogens compared with seasons before the coronavirus disease 2019 (COVID-19) pandemic. Timely and precise estimates of influenza vaccine effectiveness (IVE) against infections can be used to guide public health measures.

Methods: A test-negative study was conducted to estimate IVE against laboratory-confirmed influenza using data from the CHinese Electronic health Records Research in Yinzhou (CHERRY) study that prospectively integrated laboratory, vaccination, and health administrative data in Yinzhou, southern China. We included patients who presented influenza-like illness and received nucleic acid tests and/or antigen tests between October 2023 and March 2024. Estimates of IVE were adjusted for age, gender, month of specimen submitted, chronic comorbidities, and hospitalization status.

Results: A total of 205 028 participants, including 96 298 influenza cases (7.6% vaccinated) and 108 730 influenza-negative controls (13.4% vaccinated), were eligible for this analysis. The estimates of IVE were 49.4% (95% CI, 47.8%-50.9%), 41.9% (95% CI, 39.8%-44.0%), and 59.9% (95% CI, 57.9%-61.9%) against overall influenza, influenza A, and influenza B, respectively. A lower IVE was observed for individuals aged 7-17 years (38.6%), vs 45.8% for 6 months-6 years, 46.7% for 18-64 years, and 46.1% for ≥65 years. Vaccination reduced the risk of infection by 44.4% among patients with chronic comorbidities. IVEs varied by epidemic weeks with the changes in influenza activity levels and the switch of dominant influenza strains.

Conclusions: Influenza vaccination in the 2023-2024 season was protective against infection for the entire population.

背景：与2019年冠状病毒病（COVID-19）大流行前相比，中国2022-2023年流感季节开始较早，流感活动水平较高，各种呼吸道病原体共流行。及时、准确地估计流感疫苗对感染的有效性（IVE）可用于指导公共卫生措施：方法：我们利用鄞州中国电子健康记录研究（CHERRY）的数据开展了一项检测阴性的研究，以估算针对实验室确诊流感的 IVE，该研究前瞻性地整合了中国南方鄞州的实验室、疫苗接种和卫生管理数据。我们纳入了 2023 年 10 月至 2024 年 3 月期间出现流感样病症并接受核酸检测和/或抗原检测的患者。IVE的估计值根据年龄、性别、提交标本的月份、慢性合并症和住院情况进行了调整：共有 205 028 名参与者符合分析条件，其中包括 96 298 例流感病例（7.6% 已接种疫苗）和 108 730 例流感阴性对照组（13.4% 已接种疫苗）。针对整体流感、甲型流感和乙型流感的 IVE 估计值分别为 49.4%（95% CI，47.8%-50.9%）、41.9%（95% CI，39.8%-44.0%）和 59.9%（95% CI，57.9%-61.9%）。7-17岁人群的IVE较低（38.6%），6个月-6岁人群为45.8%，18-64岁人群为46.7%，≥65岁人群为46.1%。接种疫苗可将慢性合并症患者的感染风险降低 44.4%。随着流感活动水平的变化和主要流感病毒株的切换，IVEs随流行周而变化：结论：在2023-2024年流感季节接种流感疫苗对整个人群的感染具有保护作用。

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引用次数: 0

Defining the Landscape of Educational Experiences in Transplant Infectious Diseases: A National Survey of Infectious Diseases Fellows in the United States. 确定移植传染病教育经历的格局：美国传染病研究员全国调查。

IF 4.2 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-20 DOI: 10.1093/ofid/ofae473

Varun K Phadke,Saman Nematollahi,Julie M Steinbrink,Rachel Bartash,Megan K Morales,Scott C Roberts,Monica I Ardura,Nicole M Theodoropoulos

BackgroundTransplant infectious diseases (TID) is a growing area of expertise within infectious diseases (ID), but TID training is not standardized. Previous surveys of fellows identified opportunities to improve TID education resources but did not explore didactic, clinical, and nonclinical experiences comprehensively.MethodsThe American Society of Transplantation ID Community of Practice surveyed adult and pediatric fellows in US-based general ID or dedicated TID training programs to explore their didactic exposure, clinical experiences, and non-direct patient care activities in TID.ResultsA total of 234 fellows initiated the survey, and 195 (83%) (190 general ID and 19 TID fellows, including 125 adult, 76 pediatric, and 8 combined adult-pediatric fellows) completed the entire survey. More than half of the fellows described receiving no formal curricular content on most foundational topics in transplant medicine. Almost all respondents (>90%) had some inpatient TID experience, but for >60% of fellows this was <12 weeks annually. Clinical exposure varied by fellow and patient type-in an average month rotating on an inpatient TID service, more than half of adult fellows had evaluated ≥10 kidney, liver, or hematopoietic stem cell transplant recipients but <10 heart, lung, pancreas, or intestinal recipients; pediatric fellows saw <10 of all patient types. Nearly half (46%) of general ID fellows had not spent any time in the dedicated TID clinic at their program. Few fellows had participated in protocol development, organ selection meetings, or donor evaluations.ConclusionsThis survey highlights important gaps in TID training. Given the increasing need for TID specialists, updated curricula and educational resources are needed.

背景移植感染性疾病（TID）是感染性疾病（ID）中一个不断发展的专业领域，但TID培训并不规范。方法美国移植 ID 实践社区学会对美国普通 ID 或专门 TID 培训项目的成人和儿科研究员进行了调查，以了解他们在 TID 方面的教学接触、临床经验和非直接患者护理活动。结果共有234名研究员发起了调查，195人（83%）（190名普通内科研究员和19名TID研究员，包括125名成人研究员、76名儿科研究员和8名成人-儿科联合研究员）完成了整个调查。超过半数的研究员表示没有接受过有关移植医学大多数基础主题的正式课程内容。几乎所有受访者（超过 90%）都有过一些 TID 住院经验，但超过 60% 的研究员每年的住院时间少于 12 周。临床接触因研究员和患者类型而异--在TID住院服务轮转的平均一个月中，一半以上的成人研究员评估过≥10名肾脏、肝脏或造血干细胞移植受者，但评估过＜10名心脏、肺脏、胰腺或肠道受者；儿科研究员见过＜10名所有类型的患者。近一半（46%）的普通ID研究员在其项目中没有在专门的TID诊所工作过。很少有研究员参与过方案制定、器官选择会议或捐赠者评估。鉴于对 TID 专家的需求不断增加，需要更新课程和教育资源。

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引用次数: 0

The Role of the Gut, Urine, and Vaginal Microbiomes in the Pathogenesis of Urinary Tract Infection in Women and Consideration of Microbiome Therapeutics. 肠道、尿液和阴道微生物组在女性尿路感染发病机制中的作用以及对微生物组疗法的考虑。

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-19 eCollection Date: 2024-09-01 DOI: 10.1093/ofid/ofae471

Amal Naji, Drew Siskin, Michael H Woodworth, John R Lee, Colleen S Kraft, Nirja Mehta

The gut, urine, and vaginal microbiomes play significant roles in the pathogenesis of recurrent urinary tract infections (rUTIs). Analysis of these microbiota has shown distinct associations with urinary tract infections. Encouraging data indicate that rUTIs may be responsive to microbiome treatments such as fecal microbiota transplantation, expanding potential treatments beyond antibiotics, hydration, and behavioral interventions. If successful, these nonantibiotic therapies have the potential to increase time between rUTI episodes and reduce the prevalence of multidrug-resistant organisms. In this review, we discuss the role of the 3 microbiomes in the pathogenesis of rUTI and utilization of live biotherapeutic products as therapy for rUTI.

肠道、尿液和阴道微生物群在复发性尿路感染（rUTIs）的发病机制中发挥着重要作用。对这些微生物群的分析表明，它们与尿路感染有着不同的关联。令人鼓舞的数据表明，复发性尿路感染可能会对粪便微生物群移植等微生物群治疗产生反应，从而扩大了抗生素、水合作用和行为干预之外的潜在治疗方法。如果成功，这些非抗生素疗法有可能延长 rUTI 发作的间隔时间并降低耐多药生物的流行率。在这篇综述中，我们将讨论 3 种微生物组在 rUTI 发病机制中的作用，以及利用活生物治疗产品治疗 rUTI 的情况。

引用次数: 0

Preclinical Evidence for the Protective Capacity of Antibodies Induced by Lyme Vaccine Candidate VLA15 in People. 莱姆病候选疫苗 VLA15 在人体内诱导抗体保护能力的临床前证据。

IF 3.8 4区医学 Q2 IMMUNOLOGY

Open Forum Infectious Diseases

Pub Date : 2024-08-17 eCollection Date: 2024-09-01 DOI: 10.1093/ofid/ofae467

Urban Lundberg, Romana Hochreiter, Yekaterina Timofoyeva, Isis Kanevsky, Andreas Meinke, Annaliesa S Anderson, Raphael Simon

Background: Vaccine candidate VLA15 is designed to protect against the dominant Borrelia genospecies-causing Lyme disease in North America and Europe. Active immunization with VLA15 has protected in the mouse model of tick challenge. VLA15 is currently under evaluation in clinical studies for the prevention of Lyme borreliosis.

Methods: Mice were passively administered sera from clinical trial participants vaccinated with VLA15, or normal human serum from unvaccinated individuals as control. Posttransfer serum anti-outer surface protein A (OspA) immunoglobulin G titers were assessed by enzyme-linked immunosorbent assay. Following passive transfer, mice were challenged with Ixodes ticks colonized with Borrelia burgdorferi (OspA serotype 1) or Borrelia afzelii (OspA serotype 2) and infection was determined by serology for VlsE C6 or by polymerase chain reaction and culture to assess the presence of Borrelia bacteria.

Results: Passive transfer of immune sera prevented transmission of Borrelia from the tick vector and protected mice against challenge. Posttransfer protective threshold immunoglobulin G antibody titers were observed in this animal model of 131 U/mL for B burgdorferi (OspA serotype 1) and 352 U/mL for B afzelii (serotype 2).

Conclusions: Passive transfer of sera from trial participants immunized with VLA15 protected mice from borreliosis in a tick challenge model. This indicates that VLA15 induces functional immune responses in people that can be linked to efficacy in a stringent preclinical model.

背景：候选疫苗VLA15旨在预防在北美和欧洲引起莱姆病的主要鲍瑞氏菌基因种。用 VLA15 进行主动免疫可在小鼠蜱虫挑战模型中起到保护作用。VLA15 目前正在用于预防莱姆病的临床研究评估中：方法：给小鼠被动注射接种了 VLA15 疫苗的临床试验参与者的血清或未接种者的正常人血清作为对照。通过酶联免疫吸附试验评估转移后血清中的抗外周表面蛋白 A（OspA）免疫球蛋白 G 滴度。被动转移后，小鼠受到布氏包柔氏包虫（OspA血清型1）或阿夫泽氏包柔氏包虫（OspA血清型2）定殖的伊科蜱的挑战，感染情况通过血清学检测VlsE C6或聚合酶链反应和培养来评估包柔氏细菌的存在：结果：免疫血清的被动转移阻止了鲍瑞氏菌从蜱媒的传播，并保护小鼠免受挑战。在该动物模型中观察到，转移后保护性阈值免疫球蛋白 G 抗体滴度对 B burgdorferi（OspA 血清型 1）为 131 U/mL，对 B afzelii（血清型 2）为 352 U/mL：结论：在蜱虫挑战模型中，被动转移试验参与者免疫 VLA15 的血清可保护小鼠免受包虫病感染。这表明 VLA15 可诱导人体内的功能性免疫反应，并可与严格的临床前模型中的疗效联系起来。

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引用次数: 0

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