Background Under standard therapies, the incidence of drug-induced liver injury (DILI) in patients with tuberculosis ranges from 2% to 28%. Numerous studies have identified the risk factors for antituberculosis DILI; however, none have been conducted in a multiethnic real-world setting. The primary outcome of the current study was to identify the risk factors that could be used as the best predictors

RSV vaccine clinical trials reported higher frequencies of atrial fibrillation in intervention groups compared to control. In this large, population-based, propensity-matched study, we found RSV vaccine was not associated with increased risk of new-onset or recurrent atrial fibrillation within 1-42 days compared to influenza or Tdap vaccines.

Background The long-acting injectable regimen of cabotegravir plus rilpivirine (CAB/RPV) emerged as an alternative to oral standard of care integrase strand transfer inhibitor (INSTI)-based regimens for individuals with adherence challenges or preference for reduced dosing schedules. Although oral INSTI regimens have a high barrier to emergent resistance, less is known about the potency and durability

BACKGROUND A MenABCWY vaccine containing 4CMenB and MenACWY-CRM vaccine components has been developed to protect against the five meningococcal serogroups that cause most invasive disease cases. METHODS In this phase 3 study (NCT04707391), healthy participants aged 15-25 years, who had received MenACWY vaccination ≥4 years previously, were randomized (1:1) to receive two MenABCWY doses six months apart

A distinction between infections of left ventricular assist devices (LVADs) and cardiac implantable electronic devices (CIEDs) is warranted as they differ markedly in incidence, microbiologic profiles, clinical presentations, and extraction feasibility. These differences necessitate tailored suppressive antibiotic therapy (SAT) strategies. This commentary highlights the need for device-specific SAT

Lyme disease is caused by Borrelia species that are transmitted by Ixodes ticks prevalent in parts of the United States and Europe. A Lyme vaccine containing the OspA antigens from the single Borrelia species most prevalent in the United States was marketed in the 1990s, but was withdrawn because of unproven concerns about safety, which led to insufficient sales. Since then, the incidence of Lyme disease

With no standard method to capture penicillin allergy de-labeling prevalence across populations, we developed and validated a simple penicillin allergy de-labeling prevalence measure from electronic health records that achieved perfect sensitivity (100.0%), high specificity (99.4%), and strong agreement with a comprehensive algorithm that included free-text manual review (Kappa=0.997).

Background Little is known about how symptoms or symptom clusters of Post-COVID Conditions (PCC) impact an individual’s return to pre-COVID health. Methods We used four state-level COVID-19 case reporting systems and patient-reported survey data to identify patients with PCC and associations with an individual’s return to pre-COVID health after laboratory-confirmed SARS-CoV-2 infection. Participants

Background Invasive pulmonary aspergillosis (IPA), once limited to immunocompromised patients, is now a severe complication in critically ill ICU patients without classic risk factors. Due to the difficulty of obtaining histological evidence, its diagnosis relies on poorly tested algorithms in real-world settings. Methods We conducted a retrospective multicenter (n=9) cohort study including 202 patients

Background Simplified approaches to HCV treatment delivery are needed to meet elimination goals. However, the impact of low-touch strategies on individuals at higher risk due to treatment failure or reinfection is unknown. We estimated HCV reinfection rates, and the impact of resistance associated substitutions (RASs) on response in the ACTG A5360 (MINMON) trial. Methods HCV RNA evaluations were scheduled

Risk and severity of congenital toxoplasmosis were estimated using data from 2,455 consecutive mother/child pairs. Clinical signs at 3 years were halved in the 177 children born since 2009 compared to 1996-2008 (OR=0.49; 95% Confidence interval 0.28-0.85). Maternofetal transmission rates remained stable from 1992 to 2021.

Background Endocarditis occurs in approximately 10-15% of patients with Staphylococcus aureus bacteremia. Short time to positivity (TTP) in blood culture flasks has been linked to endocarditis in smaller studies. This study evaluated the association between TTP and endocarditis in S. aureus bacteremia in a large cohort. Methods Adult patients with ≥1 S. aureus positive blood culture treated at a tertiary

BACKGROUND Given the known relationship between human immunodeficiency virus (HIV), antiretroviral therapies, and excess visceral adipose tissue (VAT), this review sought to characterize risk of negative health outcomes associated with excess VAT and increased waist circumference (WC) in people with HIV (PWH). METHODS Comprehensive targeted literature searches were conducted in Medline/Embase (27 June

Despite widespread adoption of "high-dose" glucocorticoid definitions across international immunisation guidelines (i.e., prednisone-equivalent dosing >20 mg/day, or >2 mg/kg/day in children), the rationale remains unclear. Literature searches were performed through academic databases for this narrative review to identify relevant evidence regarding glucocorticoid dosing on vaccine responses and safety

BACKGROUND World Health Organization (WHO) tuberculosis (TB) screening guidelines recommend computer-aided detection (CAD) software for chest radiograph (CXR) interpretation. However, studies evaluating their diagnostic and prognostic accuracy are limited. METHODS We conducted a prospective cohort study of household contacts of rifampicin-resistant TB in South Africa. Participants underwent baseline

Background Despite suppressive antiretroviral therapy (ART), 15%–30% of people with human immunodeficiency virus (HIV) experience a limited recovery of CD4 T cells. Although autoantibodies against the CD4 receptor have previously been identified in people with HIV (PWH), little is known about their longitudinal impact on CD4 T-cell reconstitution. Methods Anti-CD4 autoantibodies were evaluated by the

Background The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics during acute infection and the development of long coronavirus disease 2019 (COVID-19), or “long COVID,” is largely unknown. Methods Between October 2021 and February 2022, 7361 people not known to have COVID-19 self-collected nasal swab samples for SARS-CoV-2 reverse-transcription polymerase

Background Limited data exist regarding outcomes of cryptococcosis in patients without HIV with few studies having compared outcomes of Cryptococcus gattii, versus C. neoformans, infection. Methods We conducted a retrospective study in 46 Australian and New Zealand hospitals to determine the outcomes of cryptococcosis in patients without HIV diagnosed between 2015 and 2019, and compared outcomes of

Background Treatment of hepatitis C virus (HCV) during pregnancy can cure maternal HCV and prevent perinatal HCV transmission. The primary objective was to compare the pharmacokinetics (PK) of sofosbuvir/velpatasvir (SOF/VEL) in pregnant versus nonpregnant people. Methods Pregnant people with chronic HCV infection were enrolled between 23-25 weeks’ gestation and were provided SOF/VEL daily for 12 weeks

Background PAXLOVID consists of nirmatrelvir, an inhibitor of SARS-CoV-2 main protease (Mpro), copackaged with ritonavir, a pharmacokinetic enhancer. Nirmatrelvir/ritonavir received emergency use authorization in the United States in 2021 and was approved in 2023. However, there is limited published information on SARS-CoV-2 clinical resistance to nirmatrelvir/ritonavir. Methods To investigate SARS-CoV-2

Spinal implant infections are a serious complications of instrumented spinal fusion surgeries, carrying high morbidity and complex management challenges. Early postoperative infections may manifest with wound-healing issues, back pain, and fevers. Magnetic resonance imaging (MRI) is the preferred imaging modality, but can be limited by metal artifacts. For cases with stable implants, surgical debridement

Background Guidelines state that all hospitalized children with suspected or confirmed influenza receive prompt treatment with influenza-specific antivirals. We sought to determine the frequency of, and factors associated with, antiviral receipt among hospitalized children. Methods We conducted active surveillance of children presenting with fever or respiratory symptoms from 1 December 2016 to 31

Introduction We hypothesized that response to infant pneumococcal conjugate vaccines (PCVs), administered during peak respiratory viral seasons could be blunted, particularly to higher carrier-load PCVs. Methods We did a post-hoc analysis of a large, double-blind, randomized study comparing 13-valent vs. 7-valent PCVs (PCV13; PCV7) administered to infants (at 2, 4, 6, and 12 months). We defined respiratory

Background Drug susceptibility testing (DST) is essential for starting people on effective tuberculosis (TB) regimens. No published data exists for the high-throughput LiquidArray MTB-XDR (LA-XDR) test, which detects Mycobacterium tuberculosis complex (MTBC) and fluoroquinolone, amikacin, ethambutol, and linezolid susceptibility (latter two have no rapid DSTs available). Methods We enrolled people

Background This study (China Assessment of Antifungal Therapy in Hematological Diseases, CAESAR 2.0) aimed to provide updated epidemiological data on invasive fungal disease (IFD) in patients undergoing allogeneic stem cell transplantation (allo-HSCT). Methods This multicenter, real-world, observational study was conducted at 12 allo-HSCT centers in China between January 2021 and December 2021. Consecutive

Objectives This study aimed to determine whether collecting a lower respiratory tract sample (LRTS) for bacterial microscopy, culture, and resistance (MCR) testing affects outcomes in patients with CAP. Methods A cohort study including adults admitted to hospital with CAP. The primary outcome was the duration of narrow-spectrum antibiotic treatment. Secondary outcomes included intravenous and total

Background Alterations in brain function and structure, such as depression and neurocognitive impairment, continue to occur in people with human immunodeficiency virus (HIV, PWH) taking suppressive antiretroviral therapy (ART). The lifespan of PWH has improved but the healthspan remains worse than people without HIV, in part because of aging-related diseases. As a result, polypharmacy is common and

We reviewed prominent national and international guidelines to compare recommendations for laboratory monitoring for persons on antiretroviral therapy. The United States Department of Health and Human Services guidelines recommend more frequent CD4 count, viral load, hematologic, renal, and liver tests than other guidelines. To evaluate the evidence base for these recommendations, we reviewed phase

Background The 2022 WHO guidelines on multi-drug/rifampicin resistant tuberculosis (MDR/RR-TB) recommend six months of bedaquiline (Bdq) in the all-oral 9-month shorter regimen and six months or longer for Bdq and delamanid (Dlm) in the 18-20-month longer regimen. However, lack of evidence on extended treatment using Bdq or Dlm has limited their use to six months. We examine the frequency and incidence

Background Nirsevimab is an extended half-life, highly potent neutralizing monoclonal antibody against the respiratory syncytial virus (RSV) fusion protein, with efficacy in preventing RSV-associated medically attended (MA) lower respiratory tract infection (LRTI) in infants and medically vulnerable children (aged ≤24 months). This post-hoc exploratory analysis examined the incidence of LRTI from RSV

Background The 2023-2024 influenza season had predominant influenza A(H1N1)pdm09 virus activity, but A(H3N2) and B viruses co-circulated. Seasonal influenza vaccine strains were well-matched to these viruses. Methods Using health care encounters data from health systems in 8 states, we evaluated influenza vaccine effectiveness (VE) against influenza-associated medical encounters from October 2023-April

Background Vaccination has been shown to attenuate the risk of post-acute sequelae following SARS-CoV-2 infection. However, no prior population-based studies have evaluated if updated bivalent boosters reduce risk of post-acute sequelae following Omicron-variant infection, versus ancestral vaccines. Methods National databases were utilised to construct a population-based cohort of adult individuals

Background Little is known about the frequency, hospital-level variation, predictors, and clinical outcomes of antibiotic de-escalation in suspected sepsis. Methods We retrospectively analyzed all adults admitted to 236 US hospitals between 2017-2021 with suspected sepsis (defined by a blood culture draw, lactate measurement, and intravenous antibiotic administration) who were initially treated with

Background Studies on late community-acquired respiratory virus (CARV) infections in long-term allogeneic hematopoietic stem cell transplantation (allo-HCT) survivors are scarce, creating knowledge gaps on the epidemiology, risk of progression to lower respiratory tract disease (LRTD), and conditions linked to poor outcomes. Patients and Methods We included consecutive CARV infection episodes occurring

Background Cefepime and piperacillin-tazobactam are commonly used broad-spectrum antibiotics used to treat patients with potential gram-negative bacterial sepsis. Piperacillin-tazobactam has been shown to be associated with acute kidney injury (AKI). However, it has not been compared to cefepime in patients with septic shock. We compared cefepime and piperacillin-tazobactam on the incidence of severe

Background This systematic review evaluates the effect of audit and feedback (A&F) interventions targeting antibiotic prescribing in primary care and examines factors that may explain the variation in effectiveness. Methods Randomized controlled trials (RCTs) involving A&F interventions targeting antibiotic prescribing in primary care were included in the systematic review. Cochrane Central Register

Background Timely antibiotic initiation is critical to sepsis management, but there are limited data on the impact of giving β-lactams first vs vancomycin first amongst patients prescribed both agents. Methods We retrospectively analyzed all adults admitted to 5 US hospitals from 2015-2022 with suspected sepsis (blood culture collected, antibiotics administered, and organ dysfunction) treated with

Background Feedback reports summarizing clinician performance are effective tools for improving antibiotic use in the ambulatory setting, but the effectiveness of feedback reports in the hospital setting is unknown. Methods Quasi-experimental study conducted between December 2021 and November 2023 within a pediatric health system measuring the impact of clinician feedback reports delivered by email

BACKGROUND clinical guidelines recommend initiation of antiviral therapy as soon as possible for patients hospitalized with confirmed or suspected influenza. METHODS A multicenter US observational sentinel surveillance network prospectively enrolled adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza at 24 hospitals during October 1, 2022-July 21, 2023. A multivariable proportional

Background The first long-acting injectable antiretroviral, cabotegravir/rilpivirine (LA-CAB/RPV), was FDA approved in January 2021 for persons with HIV suppressed on their current regimen. Body mass index (BMI) ≥30 kg/m2 has been identified as a risk factor for virologic failure, however data is limited due to small sample sizes. The aim of this study was to evaluate the impact of BMI on the efficacy

Background The epidemiology of infective endocarditis (IE) is evolving, driven by an aging population and increased use of endovascular devices, and is associated with significant morbidity and mortality. This study aims to evaluate changes in microbiological trends and clinical outcomes in patients with IE over the past decade in Switzerland. Methods This nationwide cohort study analyzed in-hospital

Background Hepatitis C virus (HCV) elimination requires treating people who use drugs (PWUD), yet fewer than 10% of PWUD in the United States access HCV treatment and access is especially limited in rural communities. Methods We randomized PWUD with HCV viremia and past 90-day injection drug or non-prescribed opioid use in seven rural Oregon counties to peer-assisted telemedicine HCV treatment (TeleHCV)

Background Fever is common in infective endocarditis (IE), yet little is known about fever duration in such patients. We aim to identify predictors of persistent fever in patients with suspected IE. Methods This study was conducted at the Lausanne University Hospital, Switzerland, from January 2014 to June 2023. All patients with suspected IE being febrile upon presentation were included. Fever (>38°C)

The global experiences with the HIV/AIDS and COVID-19 pandemics hold important lessons for preparing for, and responding to, future outbreaks of emerging or re-emerging infectious diseases. Scores of infectious diseases have emerged or re-emerged over the past four decades, and future outbreaks are inevitable. The next emerging pathogen likely will again come from unanticipated sources and pose puzzles

Background COVID-19 booster vaccinations mitigate transmission and reduce the morbidity and mortality associated with infection. However, the optimal date for booster administration remains uncertain. Geographic variation in infection rates throughout the year makes it challenging to intuit the best yearly booster administration date to effectively prevent infection, and also challenging to provide