Pub Date : 2026-02-17DOI: 10.1016/S1473-3099(26)00002-2
Victor Garcia-Bustos, Francesc Puchades, Fernando Alonso-Ecenarro, Marta Dafne Cabanero-Navalon, Alba Ruiz-Gaitán, Javier Pemán, Miguel Salavert, María Tasias, Eva Calabuig, Remedio Guna, Carolina Ferrer-Gómez, María Pilar Ortega-García, Vicente Abril
Background: Candidozyma auris is an emerging multidrug-resistant pathogen that frequently colonises hospitalised patients and can cause invasive disease. Traditional tools, such as the Candida score, perform poorly in this setting. We aimed to externally validate and refine a clinical prediction model for C auris candidaemia among colonised patients in the intensive care unit (ICU).
Methods: We performed a retrospective analysis of prospectively and systematically collected cohort data from ICUs in two tertiary-care hospitals in Valencia, Spain, to predict candidaemia among adult C auris-colonised patients during prolonged outbreaks (October, 2017, to March, 2020). A previously derived logistic regression-based prediction model was externally validated, then refined in a bicentric cohort using Elastic Net regression. Internal validation was performed by bootstrap resampling (n=5000). Model discrimination and calibration were assessed and compared with the Candida score.
Findings: In the external validation cohort, 216 C auris-colonised ICU patients were included, of whom 31 (14%) developed candidaemia. After pooling this cohort with the original derivation cohort, a bicentric dataset of 422 patients was obtained, with 68 (16%) candidaemia events. Four predictors were retained: total parenteral nutrition (TPN; p<0·0001), previous antifungal therapy (p=0·027), multifocal colonisation (p=0·0020), and urinary isolation (p=0·029). These formed a simplified four-variable model (AURIS score) with a validated area under the curve of 0·81, outperforming the Candida score (0·75; p=0·0003). A graphical nomogram and point-based score for bedside risk estimation was created. At a 28% threshold, sensitivity was 0·72, specificity 0·84, and negative predictive value 0·94.
Interpretation: The AURIS score provides a pragmatic tool for risk stratification among C auris-colonised ICU patients, with value in identifying those at low risk of candidaemia, reducing unnecessary empirical antifungal therapy. Its predictors highlight the risk in multi-colonised carriers, the relevance of urinary colonisation, the ecological advantage from previous antifungal exposure, and the strong association with TPN. Broader validation across diverse clades and epidemiological settings is warranted before widespread implementation.
Funding: None.
Translation: For the Spanish translation of the abstract see Supplementary Materials section.
{"title":"Development and validation of the AURIS score for predicting candidaemia in Candidozyma auris-colonised patients in the intensive care unit: a bicentric retrospective cohort study.","authors":"Victor Garcia-Bustos, Francesc Puchades, Fernando Alonso-Ecenarro, Marta Dafne Cabanero-Navalon, Alba Ruiz-Gaitán, Javier Pemán, Miguel Salavert, María Tasias, Eva Calabuig, Remedio Guna, Carolina Ferrer-Gómez, María Pilar Ortega-García, Vicente Abril","doi":"10.1016/S1473-3099(26)00002-2","DOIUrl":"https://doi.org/10.1016/S1473-3099(26)00002-2","url":null,"abstract":"<p><strong>Background: </strong>Candidozyma auris is an emerging multidrug-resistant pathogen that frequently colonises hospitalised patients and can cause invasive disease. Traditional tools, such as the Candida score, perform poorly in this setting. We aimed to externally validate and refine a clinical prediction model for C auris candidaemia among colonised patients in the intensive care unit (ICU).</p><p><strong>Methods: </strong>We performed a retrospective analysis of prospectively and systematically collected cohort data from ICUs in two tertiary-care hospitals in Valencia, Spain, to predict candidaemia among adult C auris-colonised patients during prolonged outbreaks (October, 2017, to March, 2020). A previously derived logistic regression-based prediction model was externally validated, then refined in a bicentric cohort using Elastic Net regression. Internal validation was performed by bootstrap resampling (n=5000). Model discrimination and calibration were assessed and compared with the Candida score.</p><p><strong>Findings: </strong>In the external validation cohort, 216 C auris-colonised ICU patients were included, of whom 31 (14%) developed candidaemia. After pooling this cohort with the original derivation cohort, a bicentric dataset of 422 patients was obtained, with 68 (16%) candidaemia events. Four predictors were retained: total parenteral nutrition (TPN; p<0·0001), previous antifungal therapy (p=0·027), multifocal colonisation (p=0·0020), and urinary isolation (p=0·029). These formed a simplified four-variable model (AURIS score) with a validated area under the curve of 0·81, outperforming the Candida score (0·75; p=0·0003). A graphical nomogram and point-based score for bedside risk estimation was created. At a 28% threshold, sensitivity was 0·72, specificity 0·84, and negative predictive value 0·94.</p><p><strong>Interpretation: </strong>The AURIS score provides a pragmatic tool for risk stratification among C auris-colonised ICU patients, with value in identifying those at low risk of candidaemia, reducing unnecessary empirical antifungal therapy. Its predictors highlight the risk in multi-colonised carriers, the relevance of urinary colonisation, the ecological advantage from previous antifungal exposure, and the strong association with TPN. Broader validation across diverse clades and epidemiological settings is warranted before widespread implementation.</p><p><strong>Funding: </strong>None.</p><p><strong>Translation: </strong>For the Spanish translation of the abstract see Supplementary Materials section.</p>","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":31.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146259789","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}
Pub Date : 2026-02-16DOI: 10.1016/s1473-3099(26)00003-4
Pauline Howell MD, Jonathan Stillo PhD, Anja Reuter MBChB, Tendai Nkomo MPH, Prof Carole D Mitnick ScD, Lorenzo Guglielmetti MD, Kelly Curran MHS, Prof Richard E Chaisson MD, Jennifer Furin MD
Drug-resistant tuberculosis is entering a new and dangerous phase. Bedaquiline and other newer drugs have transformed drug-resistant tuberculosis treatment, yet resistance to these agents is now being reported across high-burden settings. In some regions, baseline bedaquiline resistance is substantial, treatment outcomes for extensively drug-resistant tuberculosis remain poor and mortality is unacceptably high. At the same time, the tuberculosis drug pipeline is stronger than it has been in decades, with several promising investigational compounds advancing to late-stage trials. However, regulatory approval remains years away, leaving people with few or no effective treatment options to wait—and often die—while drugs with potential benefit remain inaccessible. Here, we argue that the central barrier to addressing complex drug-resistant tuberculosis is not scientific, but moral and organisational. Drawing on lessons from earlier pre-approval access programmes for bedaquiline and delamanid, we propose the establishment of compassionate-use support platforms (CUSPs): coordinated, global mechanisms to facilitate equitable access to investigational tuberculosis drugs before formal approval. Well designed CUSPs could balance urgency with safety, share responsibility across stakeholders, strengthen diagnostic and pharmacovigilance capacity, and ensure that people with the most difficult-to-treat tuberculosis are not excluded from scientific progress.
{"title":"The looming crisis of bedaquiline-resistant tuberculosis and a promising way forward","authors":"Pauline Howell MD, Jonathan Stillo PhD, Anja Reuter MBChB, Tendai Nkomo MPH, Prof Carole D Mitnick ScD, Lorenzo Guglielmetti MD, Kelly Curran MHS, Prof Richard E Chaisson MD, Jennifer Furin MD","doi":"10.1016/s1473-3099(26)00003-4","DOIUrl":"https://doi.org/10.1016/s1473-3099(26)00003-4","url":null,"abstract":"Drug-resistant tuberculosis is entering a new and dangerous phase. Bedaquiline and other newer drugs have transformed drug-resistant tuberculosis treatment, yet resistance to these agents is now being reported across high-burden settings. In some regions, baseline bedaquiline resistance is substantial, treatment outcomes for extensively drug-resistant tuberculosis remain poor and mortality is unacceptably high. At the same time, the tuberculosis drug pipeline is stronger than it has been in decades, with several promising investigational compounds advancing to late-stage trials. However, regulatory approval remains years away, leaving people with few or no effective treatment options to wait—and often die—while drugs with potential benefit remain inaccessible. Here, we argue that the central barrier to addressing complex drug-resistant tuberculosis is not scientific, but moral and organisational. Drawing on lessons from earlier pre-approval access programmes for bedaquiline and delamanid, we propose the establishment of compassionate-use support platforms (CUSPs): coordinated, global mechanisms to facilitate equitable access to investigational tuberculosis drugs before formal approval. Well designed CUSPs could balance urgency with safety, share responsibility across stakeholders, strengthen diagnostic and pharmacovigilance capacity, and ensure that people with the most difficult-to-treat tuberculosis are not excluded from scientific progress.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"35 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146209761","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}
Pub Date : 2026-02-16DOI: 10.1016/s1473-3099(25)00774-1
M Jahangir Hossain MBBS, Fatou Secka MBChB, Lady C Sanyang MSc, Raifu Taiwo MBChB, Emmanuel C Okoh MBBS, Olubunmi A Olubiyi MBBS, Mbemba Drammeh MBBS, Emmanuel U Richard MBBS, Ahmed D Balami MBBS, Mama Drammeh MSc, Samba Juma Jallow BSc, Bakary Sonko BSc, Paticia Ezedimbu-Michael BPharm, Jacinta Obiaduo MSc, Ousman Secka PhD, Joanna Kaim MSc, Björn Sjöstrand MBA, Agneta Lissmats BSc, Nils Carlin PhD, Prof Umberto D'Alessandro PhD, Prof Ann-Mari Svennerholm MD, Prof Thomas F Wierzba PhD
Enterotoxigenic Escherichia coli (ETEC) causes 75 million diarrhoea episodes with up to 42 000 deaths annually in children. To prevent ETEC in children, we aimed to evaluate the safety, immunogenicity, and efficacy of ETVAX, an oral, inactivated, whole-cell ETEC vaccine with toxoid and double-mutant heat-labile toxin adjuvant.
{"title":"Efficacy of ETVAX, a vaccine against enterotoxigenic Escherichia coli-positive diarrhoea in Gambian children: a double-blind, randomised, placebo-controlled, phase 2b trial","authors":"M Jahangir Hossain MBBS, Fatou Secka MBChB, Lady C Sanyang MSc, Raifu Taiwo MBChB, Emmanuel C Okoh MBBS, Olubunmi A Olubiyi MBBS, Mbemba Drammeh MBBS, Emmanuel U Richard MBBS, Ahmed D Balami MBBS, Mama Drammeh MSc, Samba Juma Jallow BSc, Bakary Sonko BSc, Paticia Ezedimbu-Michael BPharm, Jacinta Obiaduo MSc, Ousman Secka PhD, Joanna Kaim MSc, Björn Sjöstrand MBA, Agneta Lissmats BSc, Nils Carlin PhD, Prof Umberto D'Alessandro PhD, Prof Ann-Mari Svennerholm MD, Prof Thomas F Wierzba PhD","doi":"10.1016/s1473-3099(25)00774-1","DOIUrl":"https://doi.org/10.1016/s1473-3099(25)00774-1","url":null,"abstract":"Enterotoxigenic <ce:italic>Escherichia coli</ce:italic> (ETEC) causes 75 million diarrhoea episodes with up to 42 000 deaths annually in children. To prevent ETEC in children, we aimed to evaluate the safety, immunogenicity, and efficacy of ETVAX, an oral, inactivated, whole-cell ETEC vaccine with toxoid and double-mutant heat-labile toxin adjuvant.","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"106 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146209833","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}
Pub Date : 2026-02-13DOI: 10.1016/s1473-3099(26)00069-1
Krutika Kuppalli
No Abstract
没有抽象的
{"title":"I worked at WHO: the USA leaving will not make America healthier","authors":"Krutika Kuppalli","doi":"10.1016/s1473-3099(26)00069-1","DOIUrl":"https://doi.org/10.1016/s1473-3099(26)00069-1","url":null,"abstract":"No Abstract","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"126 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146205112","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}
Pub Date : 2026-02-13DOI: 10.1016/S1473-3099(26)00083-6
{"title":"Correction to Lancet Infect Dis 2025; published online Nov 27. https://doi.org/10.1016/S1473-3099(25)00605-X.","authors":"","doi":"10.1016/S1473-3099(26)00083-6","DOIUrl":"https://doi.org/10.1016/S1473-3099(26)00083-6","url":null,"abstract":"","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":31.0,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208482","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}
Pub Date : 2026-02-05DOI: 10.1016/s1473-3099(26)00054-x
Seth D Judson, Claude Kwe Yinda, Franziska K Kaiser, Daniel S Chertow, Emmie de Wit, James O Lloyd-Smith, Vincent J Munster
{"title":"Circulation of clade Ib mpox outside of Africa—are we prepared?","authors":"Seth D Judson, Claude Kwe Yinda, Franziska K Kaiser, Daniel S Chertow, Emmie de Wit, James O Lloyd-Smith, Vincent J Munster","doi":"10.1016/s1473-3099(26)00054-x","DOIUrl":"https://doi.org/10.1016/s1473-3099(26)00054-x","url":null,"abstract":"","PeriodicalId":49923,"journal":{"name":"Lancet Infectious Diseases","volume":"126 1","pages":""},"PeriodicalIF":56.3,"publicationDate":"2026-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146134179","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}
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