Journal articles: 'OFID'

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Xu, Qianqian, and Duanzheng Yao. "Influences of Size and Relaxation Time on Optical Free Induction Decay in a Small Spherical CdSe/ZnS Quantum Dot Quantum Well." Zeitschrift für Naturforschung A 64, no. 12 (December 1, 2009): 837–43. http://dx.doi.org/10.1515/zna-2009-1210.

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The optical free induction decay (OFID) induced by the transition between 1s and 1p state in a small isolated spherical CdSe/ZnS quantum dot quantum well (QDQW) has been studied numerically under the framework of effective-mass approximation. The size and relaxation time-dependent properties of the OFID have been obtained and analyzed. It shows that the OFID-change mechanisms dependent on shell thickness and core size are different. Moreover, the OFID signal decays sharply in amplitude and life as the transverse relaxation time being reduced while the change is slight to the longitudinal relaxation time. By comparing these two factors, we infer that the size mainly influences the amplitude of the decay signal and the delay time is basically determined by the relaxation time

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Kälin, A. W., R. Kesselring, Cao Hongru, and F. K. Kneubühl. "Optical free induction decay (OFID) 10 μm co2 laser systems." Infrared Physics 33, no. 2 (January 1992): 73–112. http://dx.doi.org/10.1016/0020-0891(92)90001-a.

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George, Elizabeth, Sarah Aurit, Christopher Destache, and Renuga Vivekanandan. "1195. Where You Live Matters: United States Region as a Significant Predictor of Mortality for ESBL Infection Based on a Descriptive Study Using NIS Database." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S361—S362. http://dx.doi.org/10.1093/ofid/ofy210.1028.

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Abstract Background Extended-spectrum β-lactamase (ESBL) enzymes are produced by multidrug-resistant (MDR) pathogens and confer resistance to β-lactam antibiotics. Infections due to MDR organisms, particularly those ESBL producing pathogens, are of major concern worldwide and are associated with prolonged hospital stay and increased case-fatality rate. Carbapenems are the treatment of choice for severe infections however overuse of this class of antibiotics is leading Carbapenemase-producing pathogens. Variations have been observed in the prevalence of ESBL strains from different US regions; however, it is unclear whether morbidity and mortality follow a similar pattern. This study was conducted to explore the incidence of ESBL infections in the inpatient setting and factors that affect morbidity/mortality. Methods The National Inpatient Sample (NIS) was used to identify all hospitalizations during 2002 to 2014; all primary and secondary diagnoses were searched to identify-resistant infection that utilized the ICD-9 code “V091.” All hospitalizations were stratified based on the indication of resistant infection, and comparisons were made with the chi-square test and linear regression for categorical and continuous variables, respectively. A multivariable binary logistic regression model was used to examine survival for those with ESBL infection. All analyses were conducted with SAS version 9.4; P < 0.005 was considered significant. Results The analysis identified 320,888,511 hospitalizations with 17,732 identified with ESBL infection. Significant differences for those with and without an ESBL infection were found based on the US region with the pertinent results as follows; Northeast: 19.95% vs. 23.30%, Midwest: 14.71% vs. 16.81%, South: 25.14% vs. 40.53%, and West: 40.20% vs. 19.35%; P < 0.001. Results indicated the US region as a significant predictor of mortality for those with ESBL infection. Regions identified in Figure 1. Conclusion Notable findings from this study include a statistically significant variation in mortality risk between US regions. Comparatively lower risk of mortality as related to ESBL infection was noted in the Midwest region when compared with the West region. A greater understanding of the regional epidemiology of β-lactamases is needed to clarify why this disparity exists. Figure 1 Disclosures All authors: No reported disclosures.

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Kjerulf, Anne, Jette Holt, Anne Birgitte Jensen, Peter Poulsen, and Andreas Petersen. "1223. Increasing Incidence of Methicillin-Resistant Staphylococcus aureus in Greenland." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S371. http://dx.doi.org/10.1093/ofid/ofy210.1056.

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Abstract Background The first case of methicillin-resistant Staphylococcus aureus (MRSA) in Greenland was diagnosed in 2000 and led to the first guideline on screening and treatment for MRSA. Up to 2015 there were only 13 patients with MRSA but since then a nearly 4-fold increase in incidence has been seen. The objectives of this study were to analyze the reasons for this increase. Methods MRSA data were collected from the laboratory surveillance database at Dronning Ingrids Hospital, typing results from the Reference Laboratory for Antimicrobial Resistance and Staphylococci at SSI, and the patient records. Results From 2000 to 2017, 48 patients (15 children and 33 adults) have been diagnosed with MRSA. Thirty patients were colonized with MRSA, predominantly in the nose and throat. Eighteen patients had infections: conjunctivitis, middle ear infections, wounds, skin abscesses, mastitis, surgical site infections, for example. The increase since 2015 was mainly due to three large outbreaks in three different cities: Aasiaat in 2014/2015 (seven persons with MRSA; three children and four adults), the capital Nuuk in 2016 (six persons with MRSA; two children and four adults) and Tasiilaq in 2017 (13 persons with MRSA; three children and ten adults). The first two outbreaks were community-acquired with transmission in families and the last one was community-acquired or community-onset hospital acquired. Each outbreak was caused by a specific MRSA-type: t902 CC22 in Aasiaat (unknown epidemiology), t3979 CC5 in Nuuk (probably from Australia), and t304 CC6 in Tasiilaq (probably from Denmark). MRSA was mainly imported from Denmark or abroad due to admission to hospital or due to traveling to high-endemic countries like Australia, but in some cases the epidemiology was unknown. Transmission occurred mainly in families with close contact. Conclusion The increasing number of patients with MRSA in Greenland can be explained by factors such as import from Denmark or abroad due to admission to hospital or traveling, and transmission in Greenland. An ongoing surveillance, compliance to screening procedures (especially patients admitted to hospitals abroad) and guidelines for infection prevention and control are necessary in order to combat MRSA in Greenland in the future. Disclosures All authors: No reported disclosures.

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Lindsay, Julian, and Stuart Mudge. "1354. Novel Formulation SUBA-Itraconazole in Fed and Fasted Healthy Volunteers: Expanding the Clinical Utility of the Established Mold Active Agent." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S414—S415. http://dx.doi.org/10.1093/ofid/ofy210.1185.

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Abstract Background Itraconazole has been established as an effective mold active agent; however, wide interpatient variability in bioavailability and poor gastrointestinal tolerability have made using the agent challenging. A novel formulation, SUBA-Itraconazole (SUperBioAvailable) has been developed by Mayne Pharma to alleviate these negative properties. Methods An open-label, randomized, cross-over study of SUBA–Itraconazole capsules 65 mg (2 × 65 mg BID) in healthy adults under fasting and fed conditions was assessed for steady-state levels. Subjects (n = 20) were administered two capsules of SUBA–Itraconazole twice daily on Days 1–14 and once on the morning of Day 15, either on an empty stomach or with a meal. Safety was monitored by vital signs measurements, electrocardiogram measurements, clinical safety laboratory tests (liver and kidney function tests), and physical examination. Results Overall, SUBA–Itraconazole demonstrated similar concentrations at the end of the dosing interval (trough), with modestly lower total and peak exposure when administered under fed conditions compared with the fasted state (fed/fasted ratios of 78.09% for AUCtau [14,183.2 vs. 18,479.8] 73.05% for Cmax,ss [1,519.1 vs. 2,085.2] and 91.53% for Ctrough[1,071.5 vs. 1,218.5]); see Figures 1 and 2. The administration of SUBA–Itraconazole 65 mg capsules was well-tolerated by the healthy subjects participating in this study. Conclusion The results demonstrate a promising clinical utility for SUBA–Itraconazole in practice. Unlike the conventional capsule formulation which requires a high fat meal for absorption, or the oral solution formulation which requires a fasted administration, SUBA–Itraconazole reached a therapeutic steady state in both fasted and fed states. The similar trough level, however higher peak with fasted state, likely represents a more gradual absorption of drug in the fed state. The slightly higher bioavailability in a fasted state, without gastrointestinal intolerability, is particularly promising for the clinical use of SUBA–Itraconazole in patients unable to have a high fat content meal due to chemotherapy or post-surgery such as hematology patients and transplant recipients. Disclosures J. Lindsay, Mayne Pharma: Consultant, Consulting fee. S. Mudge, Mayne Pharma: Employee, Salary.

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Peterson, Marnie, Samuel Kilgore, and Patrick Schlievert. "1362. A Novel Intravesical Antimicrobial for CAUTIs." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S417. http://dx.doi.org/10.1093/ofid/ofy210.1193.

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Abstract Background As many as 1.5 million people reside in long-term care facilities in the United States. Nearly all of these patients will develop catheter-associated urinary tract infections (CAUTIs) within a month of catheterization. These infections collectively cost the healthcare system billions of dollars each year. In addition, the emergence of multi-drug-resistant ESKAPE (Enterobacter species, Staphylococcus aureus, Klebsiella species, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterococcus species) pathogens affects the severity of infections, increasing both morbidity and mortality. Our research group is exploring a novel, dual-acting, antimicrobial, glycerol monolaurate (GML)-containing gel to prevent and treat CAUTIs. Methods Pieces (7 mm in length) of RenaSil Silicone Tubing were placed in the bladders of BALB/c female mice (n = 5/group). Approximately 1 × 108 colony-forming units/mL ESKAPE pathogens (50 µL) were inoculated into the bladder, and animals were returned to cages for 18 hours. One hundred microliters of 2.5% GML Gel (50:50 mix of saline and human-approved glycols) or phosphate-buffered saline (placebo) was administered into the bladders. After 2 hours, animals were euthanized and colony-forming units in bladders and on catheters were determined, and histological analysis of bladders was performed. Results GML Gel was bactericidal against ESKAPE pathogens at 2 hours post-treatment. Subsequent histological analysis of bladders from infected and noninfected mice showed that GML Gel was not toxic to bladder tissue. Conclusion Our results in this murine catheter infection model indicate that the newly formulated GML Gel may be useful in prevention and treatment of CAUTIs. Disclosures M. Peterson, Hennepin Life Sciences: Board Member, Consulting fee. S. Kilgore, Hennepin Life Sciences: Employee, Salary. P. Schlievert, Hennepin Life Sciences: Board Member, Consulting fee.

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Ito, Akinobu, Merime Ota, Rio Nakamura, Masakatsu Tsuji, Takafumi Sato, and Yoshinori Yamano. "1366. In Vitro and In Vivo Activity of Cefiderocol against Stenotrophomonas maltophilia Clinical Isolates." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S418. http://dx.doi.org/10.1093/ofid/ofy210.1197.

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Abstract Background Cefiderocol (S-649266, CFDC) is a novel siderophore cephalosporin against Gram-negatives, including carbapenem (CR)-resistant strains. Its spectrum includes both the Enterobacteriaceae but also nonfermenters, including Stenotrophomonas maltophilia—an opportunistic pathogen with intrinsic resistance to carbapenem antibiotics. In this study, in vitro activity and in vivo efficacy of CFDC and comparators against S. maltophilia were determined. Methods MICs of CFDC and comparators (trimethoprim/sulfamethoxazole (TMP/SMX), minocycline (MINO), tigecycline (TGC), ciprofloxacin (CPFX), cefepime (CFPM), meropenem (MEPM), and colistin (CL)) were determined by broth microdilution method as recommended by CLSI. The MIC against CFDC was determined using iron-depleted cation-adjusted Mueller–Hinton broth. In vivo efficacy of CFDC, CFPM, ceftazidime–avibactam (CAZ/AVI), MEPM, and CL was evaluated using neutropenic murine systemic infection model caused by strain SR21970. The 50% effective doses (ED50s) were calculated by the logit method using the survival number at each dose 7 days after infection. Results MIC90 of CFDC and comparators against the 216 clinical isolates from global countries collected in SIDERO-CR 2014/2016 study are shown in the table. CFDC, TMP/SMX, MINO, and TGC showed good activity with MIC90 of 0.5, 0.25/4.75, 1, and 2 µg/mL, respectively. CFDC, MINO, and TGC inhibited growth of all tested strains at ≤1, ≤4, and ≤8 µg/mL although two strains showed resistance to TMP/SMX. MICs of CFPM, CAZ/AVI, MEPM, and CL were ≥32 µg/mL. The ED50 of CFDC against S. maltophilia SR21970 with MIC of 0.125 mg/mL was 1.17 mg/kg/dose. Conversely, MICs of CFPM, CAZ/AVI, MEPM/CS, and CL against SR21970 were 32 μg/mL or higher, and ED50s were >100 mg/kg/dose, showing that CFDC had potent in vivo efficacy against S. maltophilia strain which was resistant to other antibiotics. Conclusion CFDC showed potent in vitro activity against S. maltophilia, including TMP/SMX-resistant isolates. CFDC also showed potent in vivo efficacy reflecting in vitro activity against S. maltophilia in murine systemic infection model. Disclosures A. Ito, Shionogi & Co., Ltd.: Employee, Salary. M. Ota, Shionogi & Co., Ltd.: Employee, Salary. R. Nakamura, Shionogi & Co., Ltd.: Employee, Salary. M. Tsuji, Shionogi & Co., Ltd.: Employee, Salary. T. Sato, Shionogi & Co., Ltd.: Employee, Salary. Y. Yamano, Shionogi & Co., Ltd.: Employee, Salary.

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Pogorzelska-Maziarz, Monika, and Mary Lou Manning. "1862. The Role of Infection Preventionists in Antimicrobial Stewardship Programs in Acute Care Hospitals." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S532. http://dx.doi.org/10.1093/ofid/ofy210.1518.

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Noorbakhsh, Mir H. "1998. Urine Culture Incubation Time: One vs. 2 Days!" Open Forum Infectious Diseases 5, suppl_1 (November 2018): S581. http://dx.doi.org/10.1093/ofid/ofy210.1654.

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Josten, Monica Schwarz, and Susana Keeshin. "2345. Knowledge, Practices, and Attitudes of Youth Providers About STI, HIV Testing, and PrEP." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S697. http://dx.doi.org/10.1093/ofid/ofy210.1998.

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Mahmood, Syed Faisal. "2416. Risk Factors and Outcomes of Bacteremia Caused by Carbapenem-Resistant Enterobacteriaceae Compared With Carbapenem Susceptible Enterobacteriaceae." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S722. http://dx.doi.org/10.1093/ofid/ofy210.2069.

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Watkins, Emily, and Kristen Feemster. "2460. Factors Associated With Uptake of Meningococcus B Vaccination After an ACIP Category B Recommendation." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S737. http://dx.doi.org/10.1093/ofid/ofy210.2113.

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"OFID Development Loans." Africa Research Bulletin: Economic, Financial and Technical Series 55, no. 8 (October 2018): 22258A. http://dx.doi.org/10.1111/j.1467-6346.2018.08516.x.

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Sax, Paul E. "A Welcome to Open Forum Infectious Diseases (OFID)." Open Forum Infectious Diseases 1, no. 1 (2014). http://dx.doi.org/10.1093/ofid/ofu001.

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Darrow, Jonathan J., and Aaron S. Kesselheim. "Incentivizing Antibiotic Development: Why Isn’t the Generating Antibiotic Incentives Now (GAIN) Act Working?" Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa001.

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Abstract Antimicrobial resistance is of increasing global concern. To incentivize the creation of new treatments, the US Congress enacted the Generating Antibiotic Incentives Now Act (GAIN Act) of 2012, which provides benefits to manufacturers of Qualified Infectious Disease Products (QIDPs) including 5 years of additional nonpatent exclusivity. The results of this program have so far been disappointing, largely because QIDP eligibility criteria were not sufficiently targeted to unmet need. The time value of money also means that QIDP exclusivity disproportionately rewards modifications to existing drugs rather than the creation of new drugs. To improve the outlook, GAIN Act criteria should be limited to a more narrowly tailored list of qualifying pathogens to ensure that QIDPs offer clinical value not available from existing treatments. Additional options for improvement include greater reliance on animal data when determining QIDP eligibility and conditioning GAIN Act benefits on the availability of companion diagnostics.

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Liao, Siyun, Judith Rhodes, Roman Jandarov, Zachary DeVore, and Madhuri M. Sopirala. "Out of Sight—Out of Mind: Impact of Cascade Reporting on Antimicrobial Usage." Open Forum Infectious Diseases 7, no. 2 (January 8, 2020). http://dx.doi.org/10.1093/ofid/ofaa002.

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Abstract Background There is a paucity of data evaluating the strategy of suppressing broader-spectrum antibiotic susceptibilities on utilization. Cascade reporting (CR) is a strategy of reporting antimicrobial susceptibility test results in which secondary (eg, broader-spectrum, costlier) agents may only be reported if an organism is resistant to primary agents within a particular drug class. Our objective was to evaluate the impact of ceftriaxone-based cascade reporting on utilization of cefepime and clinical outcomes in patients with ceftriaxone-susceptible Escherichia and Klebsiella clinical cultures. Methods We compared post-CR (July 2014–June 2015) with baseline (July 2013–June 2014), evaluating utilization of cefepime, cefazolin, ceftriaxone, ampicillin derivatives, fluoroquinolones, piperacillin/tazobactam, ertapenem, and meropenem; new Clostridium difficile infection; and length of stay (LOS) after the positive culture, 30-day readmission, and in-hospital all-cause mortality. Results Mean days of therapy (DOT) among patients who received any antibiotic for cefepime decreased from 1.229 days during the baseline period to 0.813 days post-CR (adjusted relative risk, 0.668; P < .0001). Mean DOT of ceftriaxone increased from 0.864 days to 0.962 days, with an adjusted relative risk of 1.113 (P = .004). No significant differences were detected in other antibiotics including ertapenem and meropenem, demonstrating the direct association of the decrease in cefepime utilization with CR based on ceftriaxone susceptibility. Average LOS in the study population decreased from 14.139 days to 10.882 days from baseline to post-CR and was found to be statistically significant (P < .0001). Conclusions In conclusion, we demonstrated significant association of decreased cefepime utilization with the implementation of a CR based on ceftriaxone susceptibility. We demonstrated the safety of deescalation, with LOS being significantly lower during the post-CR period than in the baseline period, with no change in in-hospital mortality.

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Tande, Aaron J., Elie F. Berbari, Priya Ramar, Shiva P. Ponamgi, Umesh Sharma, Lindsey Philpot, and John C. O’Horo. "Association of a Remotely Offered Infectious Diseases eConsult Service With Improved Clinical Outcomes." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa003.

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Abstract We performed a case–control study to evaluate an electronic, asynchronous infectious diseases consultative service at 2 rural hospitals within our health system. Patients with consultation via this platform (n = 100) had a significantly decreased odds of death at 30 days compared with propensity-matched controls (n = 300; adjusted odds ratio, 0.3; 95% confidence interval, 0.2–0.7; P = .003).

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Wei, Shuo, Xin Su, Yun-hu Pan, Yuan-yuan Zheng, Xiao-wen Dong, Xiao-hua Hu, Fan Wu, and Yi Shi. "Postoperative Antifungal Treatment of Pulmonary Cryptococcosis in Non-HIV-Infected and Non-Transplant-Recipient Patients: A Report of 110 Cases and Literature Review." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa004.

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Abstract Background To explore the efficacy of postoperative antifungal treatment for preventing the recurrence of pulmonary cryptococcosis (PC) and occurrence of cryptococcal meningitis (CM), a retrospective study was conducted in 112 hospitalized PC patients with or without antifungal treatment following surgery. Methods The treatment failure rate, PC recurrence rate, and CM incidence were compared. Additionally, the effectiveness of postoperative antifungal therapy was assessed by gathering and analyzing the published literature. Results The failure rate (P = .054) and recurrence rate (P = .178) were similar in the 2 groups, but the incidence of CM was lower in the group that received postoperative antifungal treatment (P = .039). Conclusions This study did not show any difference in the PC recurrence rate or failure rate in the different treatment duration groups. Thus, a shorter antifungal treatment course of 2 months may be an optional treatment. In addition, upon review of the literature, no case of CM occurrence was reported among the 169 cases given postoperative antifungal treatment.

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Marra, Fawziah, Kamalpreet Parhar, Bill Huang, and Nirma Vadlamudi. "Risk Factors for Herpes Zoster Infection: A Meta-Analysis." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa005.

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Abstract Background The burden of herpes zoster (HZ) is significant worldwide, with millions affected and the incidence rising. Current literature has identified some risk factors for this disease; however, there is yet to be a comprehensive study that pools all evidence to provide estimates of risk. Therefore, the purpose of this study is to identify various risk factors, excluding immunosuppressive medication, that may predispose an individual to developing HZ. Methods The literature search was conducted in MEDLINE, EMBASE, and Cochrane Central, yielding case control, cohort, and cross-sectional studies that were pooled from January 1966 to September 2017. Search terms included the following: zoster OR herpe* OR postherpe* OR shingle* AND risk OR immunosupp* OR stress OR trauma OR gender OR ethnicity OR race OR age OR diabetes OR asthma OR chronic obstructive pulmonary disease OR diabetes. Risk ratios (RRs) for key risk factors were calculated via natural logarithms and pooled using random-effects modeling. Results From a total of 4417 identified studies, 88 were included in analysis (N = 3, 768 691 HZ cases). Immunosuppression through human immunodeficiency virus/acquired immune deficiency syndrome (RR = 3.22; 95% confidence interval [CI], 2.40–4.33) or malignancy (RR = 2.17; 95% CI, 1.86–2.53) significantly increased the risk of HZ compared with controls. Family history was also associated with a greater risk (RR = 2.48; 95% CI, 1.70–3.60), followed by physical trauma (RR = 2.01; 95% CI, 1.39–2.91) and older age (RR = 1.65; 95% CI, 1.37–1.97). A slightly smaller risk was seen those with psychological stress, females, and comorbidities such as diabetes, rheumatoid arthritis, cardiovascular diseases, renal disease, systemic lupus erythematosus, and inflammatory bowel disease compared with controls (RR range, 2.08–1.23). We found that black race had lower rates of HZ development (RR = 0.69; 95% CI, 0.56–0.85). Conclusions This study demonstrated a number of risk factors for development of HZ infection. However, many of these characteristics are known well in advance by the patient and clinician and may be used to guide discussions with patients for prevention by vaccination.

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Humphrey, John M., Philani Mpofu, April C. Pettit, Beverly Musick, E. Jane Carter, Eugène Messou, Olivier Marcy, et al. "Mortality Among People With HIV Treated for Tuberculosis Based on Positive, Negative, or No Bacteriologic Test Results for Tuberculosis: The IeDEA Consortium." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa006.

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Abstract Background In resource-constrained settings, many people with HIV (PWH) are treated for tuberculosis (TB) without bacteriologic testing. Their mortality compared with those with bacteriologic testing is uncertain. Methods We conducted an observational cohort study among PWH ≥15 years of age initiating TB treatment at sites affiliated with 4 International epidemiology Databases to Evaluate AIDS consortium regions from 2012 to 2014: Caribbean, Central and South America, and Central, East, and West Africa. The exposure of interest was the TB bacteriologic test status at TB treatment initiation: positive, negative, or no test result. The hazard of death in the 12 months after TB treatment initiation was estimated using a Cox proportional hazard model. Missing covariate values were multiply imputed. Results In 2091 PWH, median age 36 years, 53% had CD4 counts ≤200 cells/mm3, and 52% were on antiretroviral therapy (ART) at TB treatment initiation. The adjusted hazard of death was higher in patients with no test compared with those with positive test results (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.08–2.26). The hazard of death was also higher among those with negative compared with positive tests but was not statistically significant (HR, 1.28; 95% CI, 0.91–1.81). Being on ART, having a higher CD4 count, and tertiary facility level were associated with a lower hazard for death. Conclusions There was some evidence that PWH treated for TB with no bacteriologic test results were at higher risk of death than those with positive tests. Research is needed to understand the causes of death in PWH treated for TB without bacteriologic testing.

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Vaughn, Valerie M., Lindsay A. Petty, Scott A. Flanders, Anurag N. Malani, Twisha Patel, Steven J. Bernstein, Lama M. Hsaiky, et al. "A Deeper Dive Into Antibiotic Stewardship Needs: A Multihospital Survey." Open Forum Infectious Diseases 7, no. 3 (January 11, 2020). http://dx.doi.org/10.1093/ofid/ofaa007.

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Abstract In a 2016 survey of 46 Michigan hospitals, we identified four key needs for antibiotic stewardship: clinically-relevant antibiotic data, monitoring compliance, syndrome-specific interventions, and discharge stewardship. A stewardship initiative now addresses these needs within the Michigan Hospital Medicine Safety Consortium.

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Hamdi, Ahmed M., Madiha Fida, Omar M. Abu Saleh, and Elena Beam. "Stenotrophomonas Bacteremia Antibiotic Susceptibility and Prognostic Determinants: Mayo Clinic 10-Year Experience." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa008.

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Abstract Background Stenotrophomonas maltophilia is a gram-negative, opportunistic infection that is usually hospital-acquired and associated with high morbidity and mortality. The reported increase in S. maltophilia infections is presumed to be due to an increase in the population at risk. Methods We retrospectively reviewed 10-year data for S. maltophilia bacteremia in hospitalized adults at our institution to determine the population at risk, sources of infection, common complications, antimicrobial susceptibility profiles, and clinical outcome trends over the past decade. Results Among the 98 patients analyzed, the most common source of infection was catheter-related (62, 63.3%). Most isolates (61, 65%) were resistant to ceftazidime; fewer were resistant to trimethoprim-sulfamethoxazole (TMP-SMX; 2, 2.1%) and levofloxacin (22, 23.4%). All-cause in-hospital mortality was 29.6% (29 patients). The highest mortality, 53.8%, was observed in pulmonary sources of bacteremia. Conclusions Although TMP-SMX continues to have reliable activity in our cohort, we noted resistance to TMP-SMX in patients with recent TMP-SMX exposure, including a case with developing resistance to TMP-SMX while on therapy.

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Boyce, Ross M., Carly Speight, Jessica T. Lin, and Claire E. Farel. "Errors in Diagnostic Test Use and Interpretation Contribute to the High Number of Lyme Disease Referrals in a Low-Incidence State." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa009.

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Abstract Lyme disease accounted for more than two-thirds (56 of 81, 69.1%) of all tick-borne disease referrals to a large, academic infectious diseases clinic in a low-incidence state. Deviations from diagnostic testing guidelines and errors in test interpretation were common (23 of 35, 65.7%), suggesting that frontline providers need additional clinical support.

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Chesdachai, Supavit, Susan Kline, Derrek Helmin, and Radha Rajasingham. "The Effect of Infectious Diseases Consultation on Mortality in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus, Candida, and Pseudomonas Bloodstream Infections." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa010.

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Abstract We evaluated the association between infectious disease consultation and bloodstream infection outcomes, including methicillin-resistant Staphylococcus aureus, Candida, and Pseudomonas. No infectious diseases consultation was associated with over 4-fold increased hazard of death at 3 months and 6-fold increased hazard of death in hospital.

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Falcone, Marco, Giusy Tiseo, Alberto Antonelli, Cesira Giordano, Vincenzo Di Pilato, Pietro Bertolucci, Eva Maria Parisio, et al. "Clinical Features and Outcomes of Bloodstream Infections Caused by New Delhi Metallo-β-Lactamase–Producing Enterobacterales During a Regional Outbreak." Open Forum Infectious Diseases 7, no. 2 (January 21, 2020). http://dx.doi.org/10.1093/ofid/ofaa011.

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Abstract Limited data about New Delhi metallo-β-lactamase (NDM) bacteremia are available. Blood isolates from 40 patients with NDM bacteremia were studied for antibiotic susceptibility and whole-genomic sequencing. NDM bacteremia has high 30-day mortality. In most cases, aztreonam-avibactam is active in vitro. Ceftazidime-avibactam plus aztreonam may represent a feasible therapeutic option.

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Collingwood, Abigail, Freida Blostein, Anna M. Seekatz, Christiane E. Wobus, Robert J. Woods, Betsy Foxman, and Michael A. Bachman. "Epidemiological and Microbiome Associations Between Klebsiella pneumoniae and Vancomycin-Resistant Enterococcus Colonization in Intensive Care Unit Patients." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa012.

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Abstract Background Prior colonization by Klebsiella pneumoniae and vancomycin-resistant Enterococci (VRE) is associated with subsequent infection, particularly in intensive care unit (ICU) populations. Screening for VRE colonization, but not K. pneumoniae, is routinely performed in some health care systems. Identification of patient factors associated with K. pneumoniae colonization could enable infection prevention. Methods ICU patients were screened for VRE and K. pneumoniae by rectal swab culture over 2 time periods: July–October 2014 (n = 1209) and January–May 2016 (n = 1243). Patient demographics, baseline laboratory data, comorbidities, and outcomes were analyzed. 16S rRNA gene-based analysis was performed on a subset of patients (n = 248) to identify microbiota characteristics associated with VRE and K. pneumoniae colonization. Results K. pneumoniae colonization (17.3% of patients in the 2014 cohort, 7.3% in 2016) was significantly associated with VRE colonization in multivariable analysis (P = .03 in 2016; P = .08 in 2014). VRE colonization was associated with poor underlying health, whereas K. pneumoniae colonization was associated with advanced age. The most prevalent operational taxonomic units were Escherichia coli/Shigella spp., Klebsiella, and Enterococcus, consistent with high rates of detectable K. pneumoniae and VRE by culture. Microbial community structure in noncolonized patients was significantly different from those with VRE, K. pneumoniae, or both, attributable to differences in the relative abundance of Klebsiella and Enterococcus. Conclusions K. pneumoniae co-colonizes with VRE and is a predominant taxon in ICU patients, but colonization was not associated with significant comorbidities. Screening for K. pneumoniae and VRE simultaneously could be an efficient approach for novel infection prevention strategies.

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Carvajal, Horacio G., Anoop K. Brar, and Pirooz Eghtesady. "Maternal Gut Virome in Pregestational Diabetes—Possible Cause of Congenital Heart Disease?" Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa013.

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Jones, Bruce M., Kathryn Huelfer, and Christopher M. Bland. "Clinical and Safety Evaluation of Continuously Infused Ceftolozane/Tazobactam in the Outpatient Setting." Open Forum Infectious Diseases 7, no. 2 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa014.

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Abstract Background Ceftolozane/tazobactam (C/T) is a novel cephalosporin/β-lactamase inhibitor currently dosed by 8-hour intervals to treat complicated and multidrug-resistant Pseudomonas aeruginosa infections in inpatients. This dosing strategy limits the ability to transition patients to outpatient antimicrobial therapy. There are limited data in the literature to support continuous infusion (CI) dosing. Methods This study is a retrospective chart review of patients who received CI C/T at an infusion center part of a community health system. Patients were evaluated from August 2016 through January 2018. Patients were included in the study if they were ≥18 years old and received their entire course of C/T as a CI in the outpatient setting. Patients were excluded if they received any part of their therapy as an inpatient. Results The primary outcome evaluated was symptom resolution. Secondary outcomes evaluated were microbiologic resolution as well as patient satisfaction. Seven patients received either 4.5 or 9 grams of continuous infusion C/T every 24 hours in the outpatient setting over the study period. For the primary outcome, 6 of 7 patients had symptom resolution. For the secondary outcomes, 3 of 3 patients had microbiologic resolution, and patient satisfaction scores were overall positive among respondents. Conclusions Ceftolozane/tazobactam delivered as a continuous infusion may be a safe, effective, and convenient way to treat infections caused by P aeruginosa. This novel treatment regimen can be an option for patients to avoid hospital admission or discharge to complete therapy as an outpatient.

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Wada, Paul Y., Christian Lee-Rodriguez, Yun-Yi Hung, and Jacek Skarbinski. "Burden of Active Tuberculosis in an Integrated Health Care System, 1997–2016: Incidence, Mortality, and Excess Health Care Utilization." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa015.

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Abstract Active tuberculosis (TB) is preventable. To quantify the potential value of prevention, we assessed active TB burden in a large health system from 1997 to 2016. Compared with a matched non-TB cohort, patients with active TB had higher mortality (8.4% vs 1.3%), mean number of hospitalizations (0.55 vs 0.10), emergency department visits (0.78 vs 0.28), and outpatient visits (14.6 vs 5.9) in the first year. TB-associated hospital use (mean number of hospitalizations and total length of stay) increased from 1997–2000 compared with 2013–2016 despite decreasing active TB incidence. Active TB is associated with high mortality and health care utilization and has remained stable or increased over time.

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Rauseo, Adriana M., Ariella Coler-Reilly, Lindsey Larson, and Andrej Spec. "Hope on the Horizon: Novel Fungal Treatments in Development." Open Forum Infectious Diseases 7, no. 2 (January 12, 2020). http://dx.doi.org/10.1093/ofid/ofaa016.

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Abstract The treatment of invasive fungal infections remains challenging due to limitations in currently available antifungal therapies including toxicity, interactions, restricted routes of administration, and drug resistance. This review focuses on novel therapies in clinical development, including drugs and a device. These drugs have novel mechanisms of action to overcome resistance, and some offer new formulations providing distinct advantages over current therapies to improve safety profiles and reduce interactions. Among agents that target the cell wall, 2 glucan synthesis inhibitors are discussed (rezafungin and ibrexafungerp), as well as fosmanogepix and nikkomycin Z. Agents that target the cell membrane include 3 fourth-generation azoles, oral encochleated amphotericin B, and aureobasidin A. Among agents with intracellular targets, we will review olorofim, VL-2397, T-2307, AR-12, and MGCD290. In addition, we will describe neurapheresis, a device used as adjunctive therapy for cryptococcosis. With a field full of novel treatments for fungal infections, the future looks promising.

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Gouel-Cheron, Aurelie, Martha Nason, Adam Rupert, Virginia Sheikh, Greg Robby, Gary A. Fahle, and Irini Sereti. "Cardiovascular Biomarker Profile on Antiretroviral Therapy Is Not Influenced by History of an IRIS Event in People With HIV and Suppressed Viremia." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa017.

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Abstract Immune reconstitution inflammatory syndrome (IRIS) is characterized by release of proinflammatory cytokines and tissue inflammation occurring early after antiretroviral therapy (ART) initiation. The role of previous IRIS events in persistent chronic inflammation in people with HIV is currently unclear. In this retrospective analysis of 143 participants who maintained suppression of HIV viremia, we compared biomarkers related to inflammation, coagulation, and cardiovascular risk after 3 years on ART in participants with and without a history of IRIS. There was no evidence of higher levels of persistent chronic inflammation in people with HIV who had a history of an IRIS event. ClinicalTrials.gov Identifier . NCT00286767.

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Flerlage, Tim, Jessica N. Brazelton de Cardenas, Cherilyn D. Garner, Nur A. Hasan, Hiren Karathia, Amr Qudeimat, Gabriela Maron, and Randall Hayden. "Multiple NDM-5-Expressing Escherichia Coli Isolates From an Immunocompromised Pediatric Host." Open Forum Infectious Diseases 7, no. 2 (January 12, 2020). http://dx.doi.org/10.1093/ofid/ofaa018.

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Abstract Background Genes conferring carbapenem resistance have disseminated worldwide among Gram-negative bacteria. Here we present longitudinal changes in clinically obtained Escherichia coli isolates from 1 immunocompromised pediatric patient. This report demonstrates potential for antibiotic resistance genes and plasmids to emerge over time in clinical isolates from patients receiving intensive anticancer chemotherapy and broad-spectrum antibiotics. Methods Thirty-three isolates obtained over 7 months from 1 patient were included. Clinical data were abstracted from the medical record. For each isolate, studies included phenotypic antibacterial resistance patterns, sequence typing, bacterial isolate sequencing, plasmid identification, and antibiotic resistance gene identification. Results Sites of isolation included blood, wound culture, and culture for surveillance purposes from the perianal area. Isolates were of 5 sequence types (STs). All were resistant to multiple classes of antibiotics; 23 (69.6%) were phenotypically resistant to all carbapenems. The blaNDM-5 gene was identified in 22 (67%) isolates, all of ST-167 and ST-940, and appeared to coincide with the presence of the IncFII and IncX3 plasmid. Conclusions We present unique microbiologic data from 33 multidrug-resistant E. coli isolates obtained over the course of 7 months from an individual patient in the United States. Two E. coli sequence types causing invasive infection in the same patient and harboring the blaNDM-5 gene, encoded on the IncX3 plasmid and the IncFII plasmid, were identified. This study highlights the emergence of multidrug-resistant bacteria on antibiotic therapy and the necessity of adequate neutrophil number and function in the clearance of bacteremia.

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Roth, Jan A., Fabian C. Franzeck, Suraj Balakrishna, Stephan Lautenschlager, Maria Christine Thurnheer, Laurence Toutous Trellu, Matthias Cavassini, et al. "Repeated Syphilis Episodes in HIV-Infected Men Who Have Sex With Men: A Multicenter Prospective Cohort Study on Risk Factors and the Potential Role of Syphilis Immunity." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa019.

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Abstract Background Syphilis is re-emerging globally in general and HIV-infected populations, and repeated syphilis episodes may play a central role in syphilis transmission among core groups. Besides sexual behavioral factors, little is known about determinants of repeated syphilis episodes in HIV-infected individuals—including the potential impact of preceding syphilis episodes on subsequent syphilis risk. Methods In the prospective Swiss HIV cohort study, with routine syphilis testing since 2004, we analyzed HIV-infected men who have sex with men (MSM). Our primary outcome was first and repeated syphilis episodes. We used univariable and multivariable Andersen-Gill models to evaluate risk factors for first and repeated incident syphilis episodes. Results Within the 14-year observation period, we included 2513 HIV-infected MSM with an initially negative syphilis test. In the univariable and multivariable analysis, the number of prior syphilis episodes (adjusted hazard ratio [aHR] per 1-episode increase, 1.15; 95% confidence interval [CI], 1.01–1.31), having occasional sexual partners with or without condomless anal sex (aHR, 4.99; 95% CI, 4.08–6.11; and aHR, 2.54; 95% CI, 2.10–3.07), and being currently on antiretroviral therapy (aHR, 1.62; 95% CI, 1.21–2.16) were associated with incident syphilis. Conclusions In HIV-infected MSM, we observed no indication of decreased syphilis risk with repeated syphilis episodes. The extent of sexual risk behavior over time was the strongest risk factor for repeated syphilis episodes. The observed association of antiretroviral therapy with repeated syphilis episodes warrants further immunological and epidemiological investigation.

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Phan, My V. T., Mariana Mendonca Melo, Els van Nood, Georgina Aron, Jolanda J. C. Kreeft-Voermans, Marion P. G. Koopmans, Chantal Reusken, Corine H. GeurtsvanKessel, and Matthew Cotten. "Shedding of Yellow Fever Virus From an Imported Case in the Netherlands After Travel to Brazil." Open Forum Infectious Diseases 7, no. 2 (January 13, 2020). http://dx.doi.org/10.1093/ofid/ofaa020.

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Abstract We report yellow fever infection in a Dutch traveler returning from Brazil. Yellow fever virus (YFV) was identified in serum and urine samples over a period of 1 month. Yellow fever virus genome sequences from the patient clustered with recent Brazilian YFV and showed with limited nucleotide changes during the resolving infection.

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Ishimaru, Kai, Mari Sasaki, Hiroshi Narimatsu, Yoko Arimizu, Yasuhiro Gotoh, Keiji Nakamura, Tetsuya Hayashi, and Yoshitoshi Ogura. "Escherichia coli O8:H8 Carrying a Novel Variant of the Heat-Labile Enterotoxin LT2 Gene Caused Outbreaks of Diarrhea." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa021.

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Abstract No outbreaks caused by Escherichia coli–producing heat-labile enterotoxin LT2 have been reported to date. Here, we revealed that the E. coli O8:H8 strains isolated from patients in 2 independent diarrhea outbreaks were negative for any known virulence determinants in routine microbiological tests, were very closely related, and carried a prophage-encoded gene for a novel LT2 variant (LT2d) and the genes for colonization factor antigen III. We also showed that LT2d has a cytotonic activity similar to LT1. These data indicate the importance of E. coli strains producing LT2d as a human pathogen.

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Davis, J. S., M. Young, C. Marshall, J. Tate-Baker, M. Madison, S. Sharma, C. Silva, T. Jones, and J. Davies. "Minimal Compared With Standard Monitoring During Sofosbuvir-Based Hepatitis C Treatment: A Randomized Controlled Trial." Open Forum Infectious Diseases 7, no. 2 (January 19, 2020). http://dx.doi.org/10.1093/ofid/ofaa022.

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Abstract Background Oral direct-acting antiviral agents (DAAs) for hepatitis C virus (HCV) became government subsidized in Australia in March 2016, bringing the interferon era to a close. The ideal monitoring schedule for patients receiving DAAs is unclear. Methods This study is a randomized controlled trial comparing standard with minimal monitoring in adults receiving sofosbuvir-based therapy for HCV genotypes 1 or 3. Exclusion criteria were cirrhosis or predicted poor adherence. Standard monitoring included blood tests and face-to-face clinic visits at treatment weeks 4 and 12 and 12 weeks after treatment completion. Minimal monitoring included a phone call at weeks 4 and 12 and one set of blood tests plus a clinic visit 12 weeks after treatment completion. The coprimary outcomes were as follows: (1) proportion of participants with sustained virological response; (2) staff time spent on patient support; and (3) patient satisfaction on a 10-point Likert scale. Results Thirty-six patients were randomized to standard monitoring and 38 to minimal monitoring. Sustained virological response at 12 weeks after the end of treatment was documented in 32 of 36 (89%) in the standard versus 37 of 38 (97%) in the minimal monitoring group. Staff time was nonsignificantly longer in the standard group (median 69 [interquartile range {IQR}, 54–80] versus 52 [IQR, 40–75] minutes). Patient satisfaction scores were not different (mean 9.8 of 10 standard versus 9.6 of 10 minimal group). There was no difference in adverse events or unplanned hospital visits; mean per-patient blood test costs were higher in the standard monitoring group ($432 versus $123, P < .001). Conclusions On-treatment monitoring with blood tests and clinic visits may not be necessary during sofosbuvir-based HCV treatment in selected patients.

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"A good meme is worth a thousand words." Open Forum Infectious Diseases 7, no. 1 (January 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa023.

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Chaillon, Antoine, Martin Hoenigl, Lorri Freitas, Haruna Feldman, Winston Tilghman, Lawrence Wang, Davey Smith, Susan Little, and Sanjay R. Mehta. "Optimizing Screening for HIV." Open Forum Infectious Diseases, January 19, 2020. http://dx.doi.org/10.1093/ofid/ofaa024.

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Abstract Background The HIV epidemic is unevenly distributed throughout the United States, even within neighborhoods. This study evaluated how effectively current testing approaches reached persons at risk for HIV infection across San Diego (SD) County, California. Methods HIV case and testing data, sexually transmitted infection (STI) and socio-demographic data for SD County were collected from the SD Health and Human Services Agency and the ‘Early Test’ community-based HIV screening program between 1998 and 2016. Relationships between HIV diagnoses, HIV prevalence, and STI diagnoses with screening at zip code level were evaluated. Results Overall, 379,074 HIV tests were performed. The numbers of HIV tests performed on persons residing in a zip code or region overall strongly correlated with prevalent HIV cases (R2=0.714), new HIV diagnoses (R2=0.798), and STI diagnoses (R2=0.768 [chlamydia],0.836 [gonorrhea], 0.655 [syphilis]) in those regions. Zip codes with the highest HIV prevalence had the highest number of tests per resident and fewest number of tests per diagnosis. Even though most screening tests occurred at fixed venues located in high prevalence areas, screening of residents from lower prevalence areas was mostly proportional to the prevalence of HIV and rates of new HIV and STI diagnoses in those locales. Conclusion This study supported the ability of a small number of standalone testing centers to reach at-risk populations dispersed across SD County. These methods can also be used to highlight geographic areas, or demographic segments that may benefit from more intensive screening.

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Crothers, Jessica W., Liangge Hsu, and Francisco M. Marty. "Fulminant Acanthamoeba castellanii Encephalitis in an Ibrutinib-Treated Patient." Open Forum Infectious Diseases 7, no. 2 (January 20, 2020). http://dx.doi.org/10.1093/ofid/ofaa025.

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Abstract We report a case of fulminant Acanthamoeba castellanii encephalitis in a patient with chronic lymphocytic leukemia treated with ibrutinib. The unusually rapid neurologic decline and fatal outcome observed are probably related to alterations in immunologic function associated with inhibition of Bruton tyrosine kinase.

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Baker, Jason V., Julian Wolfson, Tess Peterson, Micah Mooberry, Matthew Gissel, Harry Mystakelis, Michael W. Henderson, et al. "Factor Xa Inhibition Reduces Coagulation Activity but Not Inflammation Among People With HIV: A Randomized Clinical Trial." Open Forum Infectious Diseases 7, no. 2 (February 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa026.

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Abstract Background Coagulation activity among persons with HIV is associated with end-organ disease risk, but the pathogenesis is not well characterized. We tested a hypothesis that hypercoagulation contributes to disease risk, in part, via upregulation of inflammation. Methods Treatment effects of edoxaban (30 mg), a direct factor Xa inhibitor, vs placebo were investigated in a randomized, double-blind crossover trial among participants with HIV and viral suppression and D-dimer levels ≥100 ng/mL. During each 4-month crossover period, blood measures of coagulation, inflammation, and immune activation were assessed. Analyses of change on edoxaban vs change on placebo used linear mixed models. Results Forty-four participants were randomized, and 40 completed at least 1 visit during each study period. The mean age was 49 years, and the CD4+ count was 739 cells/mm3. Edoxaban treatment led to declines in D-dimer (44%) and thrombin-antithrombin complex (26%) but did not lower inflammatory or immune activation measures. More bruising or bleeding events occurred during edoxaban (n = 28) than during placebo or no drug periods (n = 15). Conclusions The direct factor Xa inhibitor edoxaban led to a substantial reduction in coagulation but no effect on inflammation or immune activation. These results do not support that hypercoagulation contributes to ongoing inflammation during chronic antiretroviral therapy–treated HIV disease.

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Stahl, Klaus, Benjamin Seeliger, Markus Busch, Olaf Wiesner, Tobias Welte, Matthias Eder, Andreas Schäfer, et al. "Corrigendum to: Maintenance Immunosuppression Is Associated With Better Outcome in the 2017/2018 Influenza Epidemic." Open Forum Infectious Diseases 7, no. 2 (February 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa027.

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Tran, Paul, Elaine Dowell, Stacey Hamilton, Susan A. Dolan, Kevin Messacar, Samuel R. Dominguez, and James Todd. "Two Blood Cultures With Age-Appropriate Volume Enhance Suspected Sepsis Decision-Making." Open Forum Infectious Diseases 7, no. 2 (January 27, 2020). http://dx.doi.org/10.1093/ofid/ofaa028.

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Abstract Background Multiple blood cultures have been shown to improve pathogen yield and antimicrobial stewardship for adult patients with suspected serious bacterial infection (SBI). For children, the use of multiple blood cultures is less common and volume recommendations are more complicated, often resulting in single cultures with low volume. Methods In 2010, Children’s Hospital Colorado instituted electronic medical record (EMR) decision support to recommend collection of 2 blood cultures before administration of antibiotics for suspected SBI. Recommended blood culture volumes were calculated by age rather than weight. We evaluated all children admitted to inpatient units between 2008 and 2009 (pre-intervention) and 2011 and 2013 (postintervention) who received antibiotics in the hospital after having blood cultures drawn in the emergency department, excluding those with a length of stay >8 days. We compared blood culture yield, isolate classification (pathogen vs contaminant), and antimicrobial modifications before and after the interventions. Results A total of 3948 children were included in the study. EMR guidelines were associated with a significantly higher number of children with multiple blood cultures drawn before antibiotic administration (88.0% vs 12.3%; P < .001) and an increased percentage of blood cultures with the recommended volume (74.3% vs 15.2%; P < .001), resulting in a significantly higher pathogen isolation rate and improved antimicrobial decisions. Multiple cultures helped define the role of common contaminants in the clinical decision process. Conclusions Multiple blood cultures with age-based volumes taken before starting antibiotics increase pathogen isolation rates and appropriate modification of antimicrobial treatment in children.

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Granok, Alexander B. "Successful Treatment of Malassezia furfur Endocarditis." Open Forum Infectious Diseases 7, no. 8 (January 27, 2020). http://dx.doi.org/10.1093/ofid/ofaa029.

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Abstract The first reported case of Malassezia furfur endocarditis in an adult patient is presented. The unique microbiological aspects of this organism, as well as the difficulties inherent in its antifungal susceptibility testing, are discussed.

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Libby, Tanya, Paula Clogher, Elisha Wilson, Nadine Oosmanally, Michelle Boyle, Dana Eikmeier, Cynthia Nicholson, et al. "Disparities in Shigellosis Incidence by Census Tract Poverty, Crowding, and Race/Ethnicity in the United States, FoodNet, 2004–2014." Open Forum Infectious Diseases 7, no. 2 (January 31, 2020). http://dx.doi.org/10.1093/ofid/ofaa030.

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Abstract Background Shigella causes an estimated 500 000 enteric illnesses in the United States annually, but the association with socioeconomic factors is unclear. Methods We examined possible epidemiologic associations between shigellosis and poverty using 2004–2014 Foodborne Diseases Active Surveillance Network (FoodNet) data. Shigella cases (n = 21 246) were geocoded, linked to Census tract data from the American Community Survey, and categorized into 4 poverty and 4 crowding strata. For each stratum, we calculated incidence by sex, age, race/ethnicity, and FoodNet site. Using negative binomial regression, we estimated incidence rate ratios (IRRs) comparing the highest to lowest stratum. Results Annual FoodNet Shigella incidence per 100 000 population was higher among children <5 years old (19.0), blacks (7.2), and Hispanics (5.6) and was associated with Census tract poverty (incidence rate ratio [IRR], 3.6; 95% confidence interval [CI], 3.5–3.8) and household crowding (IRR, 1.8; 95% CI, 1.7–1.9). The association with poverty was strongest among children and persisted regardless of sex, race/ethnicity, or geographic location. After controlling for demographic variables, the association between shigellosis and poverty remained significant (IRR, 2.3; 95% CI, 2.0–2.6). Conclusions In the United States, Shigella infections are epidemiologically associated with poverty, and increased incidence rates are observed among young children, blacks, and Hispanics.

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Swaminathan, Priya, and Sankar Swaminathan. "Nail Findings in Chikungunya Infection." Open Forum Infectious Diseases 7, no. 2 (February 1, 2020). http://dx.doi.org/10.1093/ofid/ofaa031.

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Havens, Joshua P., Kimberly K. Scarsi, Harlan Sayles, Donald G. Klepser, Susan Swindells, and Sara H. Bares. "Response to Dong et al." Open Forum Infectious Diseases 7, no. 2 (January 27, 2020). http://dx.doi.org/10.1093/ofid/ofaa032.

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Hoel, Hedda, Thor Ueland, Malene Hove-Skovsgaard, Hans Jakob Hartling, Marco Gelpi, Thomas Benfield, Henrik Ullum, et al. "Soluble T-Cell Immunoglobulin Mucin Domain-3 Is Associated With Hepatitis C Virus Coinfection and Low-Grade Inflammation During Chronic Human Immunodeficiency Virus Infection." Open Forum Infectious Diseases 7, no. 2 (January 29, 2020). http://dx.doi.org/10.1093/ofid/ofaa033.

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Abstract Background In well treated human immunodeficiency virus infection (HIV), there is a residual immune activation and immune exhaustion that may contribute to increased risk of comorbidities. T-cell immunoglobulin mucin domain-3 (Tim-3) is an inhibitory molecule involved in HIV-associated T-cell dysfunction. The Tim-3 can be cleaved to soluble Tim-3 (sTim-3) that may serve as a soluble marker of immune exhaustion. Methods We measured sTim-3 with enzyme-linked immunosorbent assay DuoSets in a cross-sectional cohort of 1010 people with HIV (PWH) on antiretroviral therapy (ART), and 76 controls from the Copenhagen Co-Morbidity in HIV Infection (COCOMO) study, and in a longitudinal cohort of 60 PWH before and during ART. Results In the cross-sectional cohort, levels of sTim-3 were elevated in PWH on ART compared with controls, especially in hepatitis C virus (HCV)-coinfected individuals, and were associated with HCV viremia and inflammation. In the longitudinal cohort, pretreatment sTim-3 correlated with HIV viral load and decreased after ART initiation. Pretreatment sTim-3 correlated inversely with CD4 counts, but it did not predict immunological response in multivariable analyses. Conclusions Levels of sTim-3 decreased after ART initiation. In a cross-sectional cohort, levels of sTIM-3 were higher in PWH than in controls and were independently associated with HCV coinfection and high-sensitivity C-reactive protein, representing a potential link between immune exhaustion, inflammation, and risk of comorbidities.

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Derington, Catherine G., Nancy Benavides, Thomas Delate, and Douglas N. Fish. "Multiple-Dose Oral Fosfomycin for Treatment of Complicated Urinary Tract Infections in the Outpatient Setting." Open Forum Infectious Diseases 7, no. 2 (January 29, 2020). http://dx.doi.org/10.1093/ofid/ofaa034.

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Abstract Background Few published studies exist to describe the off-label use of multiple-dose fosfomycin for outpatient treatment of complicated urinary tract infections (UTI). The purpose of this study was to characterize the patients, infections, drug susceptibilities, and outcomes of multiple-dose fosfomycin episodes for outpatient UTI treatment. Methods This retrospective study evaluated patients who received an outpatient prescription for multiple-dose fosfomycin between July 1999 and June 2018. Multiple-dose fosfomycin prescriptions dispensed for UTI prophylaxis were excluded. The primary outcome was clinical resolution (complete resolution of signs and symptoms) of infection within 30 days. Secondary outcomes included descriptions of antibiotics and cultures before and after treatment, 30-day bacteriologic resolution (posttreatment urine culture <103 colony-forming units of the original pathogen), and 90-day healthcare utilizations for UTI or pyelonephritis. Data were analyzed using descriptive statistics. Results Of 171 multiple-dose fosfomycin treatment episodes, the most common regimen was 1 dose every 3 days, mean duration of 6.1 days. Clinical resolution occurred in 115 of 171 (67.3%) episodes, and bacteriologic resolution occurred in 37 of 76 (48.7%) episodes with posttreatment cultures. Most patients used antibiotics or had urine cultures before treatment (81.9% and 97.7%, respectively). Additional antibiotic use, urine cultures, and healthcare utilizations within 90 days posttreatment occurred in 51.5%, 66.1%, and 24.6% of patients, respectively. Conclusions For treating complicated UTI with multiple-dose fosfomycin, clinical resolution occurred in 2 of 3 treatment episodes and bacteriologic resolution occurred in one-half of treatment episodes. Future research is necessary to determine the relative efficacy and safety and optimal dosing regimen, duration, and population for UTI treatment with multiple-dose fosfomycin.

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Laisuan, Wannada, Prapaporn Pisitkun, Pintip Ngamjanyaporn, Thanitta Suangtamai, and Porpon Rotjanapan. "Prospective Pilot Study of Cyclophosphamide as an Adjunct Treatment in Patients With Adult-Onset Immunodeficiency Associated With Anti-interferon-γ Autoantibodies." Open Forum Infectious Diseases 7, no. 2 (January 31, 2020). http://dx.doi.org/10.1093/ofid/ofaa035.

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Abstract Background Adult-onset immunodeficiency associated with interferon-γ autoantibody (IGA) is an emerging disease. The majority of patients require both antimicrobial and immunosuppressive treatments. However, anti-CD20 therapy is not fully accessible in a resource-limited setting to date. Background The objectives of this work were to study the efficacy of cyclophosphamide treatment and the role of laboratory biomarkers for disease progression monitoring. Methods A prospective pilot cohort study was conducted among patients with anti-interferon-γ autoantibodies (IGA) who had recurrent infections and required long-term antimicrobial therapy between 2015 and 2018. The patients were categorized into 2 groups: receipt of intravenous cyclophosphamide (IVCY) and receipt of anti-CD20 therapy (RTX). Clinical and laboratory data were determined. Results A total of 17 IGA patients were enrolled. Prolonged fever was the most common manifestation, and the most common infection identified was nontuberculous mycobacterial infections. Both were found in 88.24% of all patients. After completion of IVCY, 9/11 patients achieved complete remission and tended to reach remission faster compared with individuals in the RTX group. The median duration from treatment initiation to remission (interquartile range) was 84 (42–154) days in the IVCY group and 99 (51–202) days in the RTX group. In remission patients, the biomarkers of interest had normalized after treatment, except interferon γ autoantibody titers. There were no differences in adverse events among the 2 groups. Conclusion IVCY may be considered as alternative therapy in this population, especially in resource-limited countries. A comparable clinical outcome to RTX may support its use on a larger scale. However, further study is encouraged.

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Chen, Jing, Kusuma Gopala, Akarsh Puthatta, Frank Struyf, and Dominique Rosillon. "Erratum to: Prevalence and Incidence of Human Papillomavirus (HPV) Infection Before and After Pregnancy: Pooled Analysis of the Control Arms of Efficacy Trials of HPV-16/18 AS04-Adjuvanted Vaccine." Open Forum Infectious Diseases 7, no. 3 (February 28, 2020). http://dx.doi.org/10.1093/ofid/ofaa036.

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Journal articles on the topic 'OFID'

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