Clinical Infectious Diseases

BACKGROUND: Treatment uptake for hepatitis C virus (HCV) infection in people who inject drugs (PWID) and patients on opioid substitution therapy (OST) is still low despite treatment guidelines that advocate the use of direct-acting antivirals (DAAs) in all patients. Our aim in this review was to investigate treatment outcomes among PWID and patients on OST in comparison to control cohorts. METHODS: A search of Embase, Medline, PubMed, and Web of Science (from October 2010 to March 2018) was conducted to assess sustained virologic response (SVR), discontinuation rates, adherence, and HCV reinfection in PWID and patients on OST...

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BACKGROUND: Polymyxins are antimicrobials of last resort for the treatment of carbapenem-resistant Enterobacteriaceae, but resistance in 5% to >40% isolates has been reported. We conducted a genomic survey of clinical polymyxin-resistant (PR) Klebsiella pneumoniae to determine the molecular mechanisms of PR and the role of polymyxin exposure versus transmission in PR emergence. METHODS: We included 88 patients with PR K. pneumoniae from 2011-2018 and collected demographic, antimicrobial exposure, and infection data...

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No abstract text is available yet for this article.

The San Diego Early Test (SDET) score is a simple risk-assessment tool for acute and early HIV-infection. Validation in a prospective cohort of Amsterdam men who have sex with men showed fair prediction of HIV seroconversion (AUC 0.701). Use of this score can help prioritise and target HIV prevention strategies.

BACKGROUND: HIV pre-exposure prophylaxis (PrEP) has great potential to reduce HIV incidence among young black men who have sex with men (YBMSM) but initiation and persistence for this group remain low. We sought to understand the patterns and predictors of PrEP uptake and discontinuation among YBMSM in Atlanta, Georgia. METHODS: PrEP was offered to all participants in a prospective cohort of HIV-negative YBMSM aged 18-29. For initiators, time on and off PrEP was recorded...

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BACKGROUND: Data on antimicrobial stewardship programs (ASPs) facilitated via telehealth in the community hospital setting are limited. METHODS: A telehealth-based ASP was implemented in two community hospitals (285 and 176 beds). Local pharmacists without residency or prior antimicrobial stewardship training were trained to conduct prospective audit and feedback. For approximately 60 minutes three times weekly at the 285-bed hospital and two times weekly at the 176-bed hospital, ID physicians remotely reviewed patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft tissue infections with local pharmacists...

BACKGROUND: Patients with HIV and low CD4 counts starting antiretroviral therapy (ART) are at high risk for immune reconstitution inflammatory syndrome (IRIS) and death. METHODS: To investigate the clinical impact of IRIS in adults with HIV and CD4 counts below 100 cells/µL starting ART, we designed an international, prospective, observational study in United States, Thailand, and Kenya. An independent review committee adjudicated IRIS events. We used Cox models to investigate associations between baseline biomarkers, IRIS, immune recovery at week 48, and death by week 48...

BACKGROUND: Effective contraception is critical to young women with HIV-associated tuberculosis (TB), as unintended pregnancy is associated with increased perinatal morbidity and mortality. The effects of co-administration of efavirenz and rifampicin on the pharmacokinetics of depot medroxyprogesterone acetate (DMPA) are unknown. We hypothesized that clearance of medroxyprogesterone acetate (MPA) would increase when given with rifampicin and efavirenz, thus increasing risk of ovulation...

BACKGROUND: The clinical role of sputum Gram stain (SGS) in community-acquired pneumonia (CAP) diagnosis remains controversial. A 1996 meta-analysis of the diagnostic accuracy of SGS reported heterogeneous results. To update the available evidence, we performed a systematic review and a Bayesian standard and latent-class model meta-analysis. METHODS: We searched MEDLINE, Embase, and Cochrane Central by August 23, 2018 to identify studies reporting on the diagnostic accuracy, yield (percentage of patients with any pathogen(s) correctly identified by SGS), and clinical outcomes of SGS in adult patients with CAP...

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No abstract text is available yet for this article.

BACKGROUND: The efficacy of screening programs to prevent anal cancer in HIV-1-infected subjects is unclear. AIM: To examine the impact of a screening program to detect anal cancer precursors on the incidence of cases of invasive-anal-squamous-cell-carcinoma (IASCC) in HIV-1-infected subjects. PATIENTS AND METHODS: Single-center, retrospective analysis of a prospective cohort of HIV-1-infected outpatients attending a reference HIV Unit from January 2005 onward...

BACKGROUND: Patients with hematological malignancies hospitalized for myelosuppressive chemotherapy are at high risk of life-threatening healthcare-associated infections, despite the use of oral prophylactic antibiotics. Chlorhexidine (CHG) bathing decreases incidence of bloodstream infections at intensive care units, but its effect has been understudied in patients with hematological malignancies at non-critical-care units. METHODS: Adults with hematological malignancies hospitalized for cytotoxic chemotherapy at non-critical-care units were offered daily 2% CHG bathing...

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BACKGROUND: Vancomycin is now a preferred treatment for all cases of C. difficile infection (CDI), regardless of disease severity. Concerns remain that a large-scale shift to oral vancomycin may increase selection pressure for vancomycin-resistant Enterococci (VRE). We evaluated the risk of VRE following oral vancomycin or metronidazole treatment among patients with CDI. METHODS: We conducted a retrospective cohort study of patients with CDI in the US Department of Veterans Affairs health system between January 1, 2006 and December 31, 2016...

BACKGROUND: Previous studies of outcomes in people who inject drugs (PWID) with infective endocarditis (IE) have often been retrospective, had a small sample size, the duration of follow-up has been short and limited to patients who were operated on. METHODS: PWID treated for IE between 01/01/2006 and 31/12/2016 were identified from a prospectively collected database. PWID hospitalised with other infections acted as a novel comparison group. Outcomes were all-cause mortality, cause of death, relapse, recurrence and re-operation...

INTRODUCTION: Self-reported neurocognitive impairment (srni) in people living with human immunodeficiency virus-1 (HIV-1) infection are frequent. We use longitudinal information on srni in the Swiss HIV Cohort Study (SHCS) to identify and characterize groups of patients with persisting srni over time. METHODS: We included all SHCS patients who were assessed for srni during at least 5 visits spanning at least 2.5 years in 2013-2017. We first compared patients with srni to those without srni over the whole study period...