Clinical Infectious Diseases

BACKGROUND: Studies estimate that 30-50% of antibiotics prescribed for hospitalized patients are inappropriate, but pediatric data are limited. Characterization of inappropriate prescribing practices for children are needed to guide pediatric antimicrobial stewardship. METHODS: Cross-sectional analysis of antibiotic prescribing at 32 US children's hospitals. Subjects included hospitalized children with ≥1 antibiotic order at 0800 on one day per calendar quarter, over six quarters (Quarter 3 2016 - Quarter 4 2017)...

BACKGROUND: Drug-drug interactions (DDI) between feminizing hormone therapy (FHT) and antiretroviral therapy (ART) is a major concern among transgender women (TGW) that may lead to sub-optimal ART adherence and inappropriate FHT dosage. To evaluate potential DDI between FHT and ART, we measured intensive pharmacokinetic parameters (PK) of blood tenofovir (TFV), efavirenz (EFV), and estradiol (E2). METHODS: Twenty newly-diagnosed HIV-positive TGW were enrolled. FHT (estradiol valerate 2 mg and cyproterone acetate 25 mg) were prescribed at baseline until week 5 and restarted at week 8...

BACKGROUND: Daily oral preexposure prophylaxis (PrEP) is highly effective in preventing HIV infection if used adherently throughout periods of HIV risk. We estimated PrEP persistence among cohorts of persons with commercial or Medicaid insurance. METHODS: We analyzed data from the IBM MarketScan Research Database to identify persons aged 18-64 years who initiated PrEP between 2012-2017. We assessed PrEP persistence by calculating the time period that each person continued filling PrEP prescriptions until there was a gap in prescription fills >30 days...

Guidance regarding indications for initial or follow-up (FU) blood cultures (BCx) is limited. We conducted a scoping review of articles published between 1/2004-6/2019 that reported the yield of BCx and/or their impact in the clinical management of fever and common infectious syndromes in non-neutropenic adult inpatients. 2,893 articles were screened; 51 were included. Based on the reported incidence of bacteremia, syndromes were categorized into low, moderate and high pre-test probability of bacteremia. Routine BCx are recommended in syndromes with a high likelihood of bacteremia (e...

No abstract text is available yet for this article.

BACKGROUND: Metagenomic next-generation sequencing (mNGS) of plasma cell-free DNA has emerged as an attractive diagnostic modality allowing broad-range pathogen detection, noninvasive sampling, and earlier diagnosis. However, little is known about its real-world clinical impact as used in routine practice. METHODS: We performed a retrospective cohort study of all patients for whom plasma mNGS (Karius test) was performed for all indications at 5 U.S. institutions over 1...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

In hematopoietic stem cell transplant recipients, the incidence of tuberculosis in positive interferon-gamma-releasing-assay (IGRA) without isoniazid prophylaxis (3.58/100 person-years) was higher than in negative-or-indeterminate IGRA (1.15/100 person-years)(P=.01) and in positive IGRA with isoniazid prophylaxis (0/100 person-years)(P=.09). The number needed to treat was 22 (95% CI 12-99) with positive IGRA results.

Reports of antibiotic stewardship (AS) integration into the >1000 U.S. internal medicine and family practice residency core curricula are scarce, but residents value such training. To help address this gap, and the projected shortage of physicians with training for establishing and leading an AS program (ASP), we describe the rationale for, and the output and shortcomings of, a dedicated AS rotation. Residents critically review, in real-time, inpatient antibiotic orders, provide feedback to the prescribers, learn the mechanics and requirements of an ASP, and complete a preliminary quality improvement project...

BACKGROUND: Susceptibility to metabolic diseases may be influenced by mitochondrial genetic variability among people living with HIV (PLWH), but remains unexplored in African-ancestry populations. We investigated the association between mitochondrial DNA (mtDNA) haplogroups and β-cell function (HOMA-B), insulin resistance (HOMA-IR), and incident diabetes mellitus (DM) among black women with or at risk for HIV. METHODS: Women without DM who had fasting glucose (FG) and insulin (FI) data for ≥2 visits were included...

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BACKGROUND: Early antiretroviral treatment (ART) is recommended for HIV-infected infants. However, few antiretroviral options are available for neonates. METHODS: The Early Infant Treatment Study in Botswana tested HIV-exposed infants using DNA PCR within 96 hours of birth, and HIV-infected infants started nevirapine (NVP) 6mg/kg BID, zidovudine (ZDV), and lamivudine (3TC) at age <7 days. Nevirapine trough concentrations were tested at 1 and 2 weeks. NVP was switched to lopinavir-ritonavir (LPV-r) at week 2, 3, 4, or 5 according to delivery gestational age (≥38, 37, 36, 35 weeks)...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Infection is a major complication during circulatory support with a left ventricular assist device (VAD). Changes in device characteristics and treatment practices in the last decade can affect the epidemiology of infection. The International Society for Heart and Lung Transplantation (ISHLT) has published recommendations on the prevention and management of VAD infections, but data to support these recommendations remains sparse. METHODS: We performed a retrospective review of 455 patients who underwent VAD placement from 2009 to 2015...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: Necrotizing soft-tissue infections (NSTI) are life-threatening conditions often caused by β-hemolytic streptococci, group A streptococcus (GAS) in particular. Optimal treatment is contentious. The INFECT cohort includes the largest set of prospectively enrolled streptococcal NSTI cases to date. METHODS:  From the INFECT cohort of 409 adults admitted with NSTI to five clinical centers in Scandinavia, patients culture-positive for GAS or Streptococcus dysgalactiae (SD) were selected...

BACKGROUND: In September 2009, a live attenuated herpes zoster vaccine (ZVL) became available in Canada. Beginning in September 2016, ZVL was made available to all Ontario residents aged 65 to 70 through a publicly funded immunization program. We assessed the impact of ZVL availability and its subsequent public funding on herpes zoster burden in this population. METHODS: We conducted a population-based study of Ontario residents aged 65 to 70 between January 2005 and September 2018...