The S3 Guideline provides evidence- and consensus-based recommendations for the structured follow-up care of adult patients after lung transplantation. Its goal is to standardize long-term management in order to optimize survival, functional status, and quality of life. The guideline is addressed to professionals in pulmonology, internal medicine, surgery, and general practice, as well as to transplant centers and inpatient institutions in the German-speaking countries of Germany, Austria, and Switzerland. The guideline is led by the Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP).Methodologically, it is based on systematic literature searches and GRADE-based evidence assessment, combined with the development of an interdisciplinary and multiprofessional consensus involving patient representatives.The guideline emphasizes lifelong, individualized follow-up care founded on close cooperation between transplant centers, community physicians, and patients. Core topics include immunosuppression - specifically the selection, combination, and monitoring of calcineurin inhibitors, antimetabolites, and mTOR inhibitors - as well as strategies to minimize adverse effects and nephrotoxicity.Additional key areas are the prevention and management of infections, including the prophylaxis of opportunistic infections (such as CMV, Aspergillus, and Pneumocystis jirovecii), and vaccination strategies. The guideline also provides recommendations for standardized patient monitoring through bronchoscopy, biopsy, and spirometry within structured follow-up intervals and preventive examinations.Further topics include acute cellular rejection, non-adherence, chronic graft dysfunction, and comorbidities such as diabetes, chronic kidney disease, osteoporosis, and tumor prevention.

Fracture-related infection (FRI) is a devastating complication of open fractures and remains common even with ideal open fracture care including prompt systemic antibiotics and thorough surgical debridement. There is growing interest in the use of adjuvant local antibiotics; however, traditional carriers like polymethylmethacrylate (PMMA) are limited by subtherapeutic elution, biofilm formation, and the need for secondary removal. We describe a technique of in vivo augmentation of intramedullary nailing with Cerament G, a resorbable gentamicin-eluting calcium sulfate/hydroxyapatite ceramic, delivered through the 2-CAN device for targeted antibiotic prophylaxis. Nine patients (mean age 44 years; 22% female) with Gustilo-Anderson Type II (n = 3), IIIA (n = 4), IIIB (n = 1), and IIIC (n = 1) open fractures of the tibia, femur, or humerus underwent this technique at a Level 1 trauma center by a single fellowship-trained orthopaedic traumatologist. Postoperative outcomes included FRI incidence, fracture union, complications, and functional recovery. At a mean follow-up of 9.1 months (2.6-17.1 months), all fractures achieved union with no cases of FRI. Two GA IIIB/C cases required flap coverage, including one flap failure successfully revised. Self-limiting serous drainage (n = 3) resolved within 1 week. No secondary procedures for infection, implant removal, or amputations occurred. Intramedullary nailing and intraoperative augmentation with Cerament G using the 2-CAN device offer a technically simple, time-efficient strategy for FRI prophylaxis in high-risk open fractures. The technique provides sustained local antibiotic delivery, avoids PMMA-related complications, and maximizes biomechanical stability by eliminating nail downsizing. Early results demonstrate promising infection prophylaxis, warranting further prospective trials to validate long-term efficacy and cost-effectiveness.

Voriconazole plays an important role in the treatment of invasive fungal infections (IFIs). Keeping voriconazole concentration at appropriate levels is crucial for drug effectiveness and safety. However, it remains unclear whether drug concentrations influence the clinical outcome of secondary prophylaxis in allogeneic hematopoietic stem cell transplantation (allo-HSCT). In this retrospective analysis, 83 patients receiving allo-HSCT with histories of IFIs responsive to voriconazole were enrolled. These patients continued voriconazole during and after allo-HSCT. Their characteristics, clinical outcomes, and plasma voriconazole concentrations at (1) Days -30 to -9, (2) Days -8 to -1, (3) Days 0 to 14, and (4) Days 15 to 30 of allo-HSCT were examined. Voriconazole trough concentrations significantly declined after transplantation and remained low for approximately 4 weeks post allo-HSCT, despite dose adjustment. This variation was observed across subgroups defined by age, sex, diagnosis, conditioning regimens, donor type, administration route, or documented drug interactions. The cumulative incidence of breakthrough IFI was 11.4% at 3 months and 18.6% at 1 year after transplantation. Transient decreases in voriconazole trough levels were not significantly associated with breakthrough IFIs. However, a trend toward a lower risk of proven or probable breakthrough IFIs at 12 months has been observed in patients having average voriconazole trough levels ≥ 1 mg/L after allo-HSCT. Transient fluctuations in voriconazole levels occur after allo-HSCT, independent of most clinical factors. These subtherapeutic exposures did not significantly affect the incidence of breakthrough IFIs in this cohort. Larger prospective studies are warranted to further investigate the clinical impact.

To describe a series of doxycycline-induced fixed drug eruptions (FDE) observed in sexual health clinics, in a context of increasing doxycycline use for sexually transmitted infection (STI) management and prophylaxis in France. We conducted a retrospective case series, combined with a doxycycline prescription audit and a sexual health clinician survey. Thirteen male patients (mean age: 32.5 years) were diagnosed with doxycycline-induced FDE. Most were MSM (men who have sex with men, 84.6%) and received doxycycline for STI treatment (92.3%). Lesions were mainly genital (85%) and often misdiagnosed as ulcerative STIs. Doxycycline prescriptions increased by 345% between 2018 and 2024. When performed, allergy workups confirmed the diagnosis in 60% of cases. The sharp rise in doxycycline use for STI prophylaxis coincides with the identification of multiple FDE cases. Enhanced dermatological awareness is needed within antimicrobial stewardship programs to ensure safer implementation of doxycycline-based prevention strategies.

Dental implants are widely used to replace missing teeth, providing a long-term solution for patients seeking functional and esthetic restoration. Concerns about implant failure and post-surgical complications, however,can arise, particularly in patients with known penicillin allergies. Because penicillin is often the first-line antibiotic used for infection prophylaxis in dental procedures, alternative antibiotics such as clindamycin are commonly prescribed for these patients. Penicillin allergy is associated with a higher risk of dental implant failure than in non-allergic patients, particularly when clindamycin is used as an alternative prophylactic antibiotic. Further research is needed to explore the optimal antibiotic regimen and minimize the risks of implant failure and infection in this patient population. This article reviews the clinical implications when caring for patients with selfreported penicillin allergies receiving dental implant therapy.

An underlying allergic diathesis is a risk factor for acquiring COVID-19; however, some have found it attenuates outcomes of hospitalization/death. To examine the effect of background allergic conditions on COVID-19 outcomes in patients with and without COVID-19 treated with casirivimab plus imdevimab (CAS+IMD). This analysis included 4057 outpatients with COVID-19 and ≥1 risk factor. Supplementary analyses involved 2652 patients without COVID-19, investigating prevention in home or community settings. Participants were equally randomized to CAS+IMD 1.2 g, 2.4 g, or placebo. Patients with allergic conditions were identified by medical history of atopic dermatitis, asthma, allergic rhinitis, or anaphylaxis, categorized as: any allergy; allergy excluding asthma; and asthma excluding other allergies. Assessments included duration from CAS+IMD to hospitalization/death. The adjusted risk of hospitalization/death in patients receiving placebo was 2.37 times higher for patients with asthma vs those without allergy (hazard ratio [HR] [95% CI], 2.366 [1.006-5.563]; nominal P = .048). The HR for hospitalization/death for CAS+IMD vs placebo was 0.276 for patients without allergies (95% CI, 0.175-0.437; nominal P < .001). In prevention studies, those with allergies excluding asthma exhibited >2-fold increase in the rate of contracting COVID-19 vs those without allergies (HR [95% CI], 2.16, [1.202-3.912); nominal P = .009). In outpatients with COVID-19, a history of allergic disease was associated with heightened susceptibility to infection but better clinical outcomes (hospitalization/death). CAS+IMD improved clinical outcomes in those with established infection and prevented infection in both allergic and non-allergic participants.

PurposeChildren with acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and allogeneic haemopoietic stem cell transplantation (HSCT) are at high risk of invasive fungal infection (IFI), which contributes to morbidity and mortality. The purpose of this study was to describe fungal prophylaxis and IFI for children at our hospital.MethodsThe primary objective was to describe fungal prophylaxis for children with AML, relapsed ALL, and HSCT. Secondary objectives included describing prevalence of proven, probable, or possible fungal infections; type of fungal infection; and prevalence and type of adverse effects of fungal prophylaxis. This was a retrospective cohort study of children admitted to our hospital with AML, relapsed ALL, and HSCT between January 2015 and June 2019.ResultsWe included 105 patients with 263 inpatient visits. Eighty-three patients (79%) had fungal prophylaxis at all visits. Fungal prophylaxis was present at 91 (95%) inpatient visits for AML, 15 (21%) for relapsed ALL, and 87 (99%) for HSCT. Caspofungin was the most prescribed antifungal (86%). There were 4 patients each with proven and possible IFI and 11 patients with probable IFI, representing a prevalence of 18.1%. There were 10 patients with fungal infection in the lungs, 2 patients each in the liver and spleen, and 1 patient with disseminated fungal infection. There was a total of 283 adverse events in 79 (40.1%) patients.ConclusionThe prevalence of IFI in this population is within range of what is reported from other countries. Choice of fungal prophylaxis was consistent with published guideline recommendations.

Anti-CD20 monoclonal antibodies (mAbs), which act as B-cell-depleting therapies, are now regarded as important treatments for a range of paediatric kidney diseases. Despite their effectiveness in achieving B-cell depletion and consequent disease remission, concerns remain regarding their side effect profile. These include infusion reactions, hypogammaglobulinaemia, and neutropenia, as well as infections. At present, the evidence supporting preventive measures such as intravenous immunoglobulin (IVIG) replacement and antibiotic prophylaxis remains inconclusive. In this review, we summarise the existing data on infection-related risks following anti-CD20 therapy and propose practical strategies to mitigate infection risk tailored to this group of children.

Antiretroviral stewardship programs have been recommended by several organizations, including the Infectious Diseases Society of America, to minimize medication errors that may adversely affect people living with human immunodeficiency virus (HIV). To date, the role of antiretroviral stewardship has largely been studied in tertiary or quaternary care medical centers with dedicated infectious diseases pharmacists, complex patient populations, and robust clinical laboratory services. Thus, limited data are available in lower-acuity community hospital settings. The purpose of this study was to evaluate the impact of pharmacist-led antiretroviral stewardship on antiretroviral therapy (ART)-related medication error rates in community hospital settings. This was a multicenter retrospective chart review of patients receiving ART during admission to 6 community hospitals of a large health system between May and July 2024. ART-related medication errors were defined as incomplete ART regimens, inappropriate or absent opportunistic infection (OI) prophylaxis, incorrect dose adjustments due to renal function, or unaddressed drug-drug interactions (DDIs). Patients were excluded if they were receiving ART for pregnancy, neonates, hepatitis B, pre-exposure prophylaxis, or post-exposure prophylaxis, had a length of stay under 48 hours, or died within 48 hours of admission. Of 247 patients who received ART during the study period, 94 were excluded based on the predefined criteria, with 153 patients included in the final analysis. The mean age was 52 years, and 68% (n = 104) of patients were male. CD4+ T cell counts below 200 cells/mm³ were observed in 37% (n = 57) of patients, and 77% (n = 118) were on a single-pill regimen. Pharmacist interventions occurred in 67 patients (44%), with OI prophylaxis (n = 10) being the most frequent intervention. The rate of ART-related medication errors was significantly lower in the pharmacist intervention group (7.5%, n = 5) than in the nonintervention group (23%, n = 20; P = 0.009). In the pharmacist intervention group, unaddressed DDIs (n = 3) were the most common error, whereas in the nonintervention group errors most frequently included inappropriate or absent OI prophylaxis (n = 9), incomplete ART optimization (n = 6), unaddressed DDIs (n = 5), and incorrect renal dose adjustment (n = 2). In community hospital settings, ART-related medication error rates were significantly lower among patients who received pharmacist-led intervention, supporting the role of antiretroviral stewardship in improving medication safety in hospitalized persons with HIV.

Marine ecosystems have yielded a remarkable diversity of bioactive metabolites with relevance for antiviral drug discovery. This article reviews recent advances in marine-derived compounds investigated as anti-HIV agents. Metabolites, such as sulfated polysaccharides, lectins, alkaloids, and terpenoids, display inhibitory activity across multiple stages of the HIV life cycle, including viral entry, reverse transcription, integration, and maturation. From sponge-inspired development of AZT to the application of Griffithin in clinical trials for the prophylaxis of the HIV infection, recent discoveries showcase the chemical diversity of marine ecosystems and validate their utility as hit and compound sources in drug discovery. We highlight possible mechanisms of action, as well as translational hurdles from research to clinical trials. Overall, marine biodiversity represents a valuable and underexploited reservoir for the development of novel HIV therapeutics.

Plasma cell dyscrasia (PCD) is a rare but important cause of end stage kidney disease (ESKD). Kidney transplant is the treatment of choice in patients with ESKD. However, the complexity of PCD care and risk of disease recurrence poses challenges to kidney transplant candidacy and outcomes. We examined the current clinical practice patterns of clinicians who care for patients with PCD and identified barriers to kidney transplantation for patients with PCD. A web-based survey was developed and distributed from January to July 2024 to kidney transplant clinicians (American Society of Transplant (AST) members), hematologists (PCD experts), and onco-nephrologists. Seventy clinicians (50 transplant nephrologists, 18 hematologists, and two surgeons) from 42 transplant centers in the US participated in the survey. Clinical practice patterns pre and post kidney transplant for patients with PCD are highly variable among institutions, and only 36% reported having a protocol for pre- and post-transplant management for patients with PCD. Particularly, the requirement for pre-transplant hematologic remission criteria, induction and maintenance immunosuppression regimens and protocols for prophylaxis and screening for opportunistic infection are areas of future study. Clinicians listed lack of data and practice guidance as well as communication challenges among multiple specialties especially hematology and kidney transplant clinicians as notable barriers. Our study identified the highly variable current practice patterns when evaluating and managing patients with PCD for kidney transplant. Our findings emphasize the need for collecting and sharing clinical data to support standardized practices and serve as a basis for the upcoming multi-societal management recommendation for kidney transplant for patients with PCD.

Introduction: Proton beam therapy (PBT) is widely used in pediatric oncology to reduce radiation exposure to normal tissues and mitigate late adverse effects. In Japan, the limited availability of centers that can provide pediatric PBT with sedation and/or concurrent chemotherapy often necessitates inter-facility travel. However, the safety of daily inter-facility travel for PBT during chemotherapy-induced myelosuppression has not been well evaluated. We assessed the feasibility and safety of this model in Nagano Prefecture.Methods: We conducted a retrospective cohort study using data from three hospitals in Nagano Prefecture (Nagano Children’s Hospital, Shinshu University Hospital, and Aizawa Hospital) from June 2011 to August 2021. Patients who underwent PBT at a proton center with daily inter-facility travel during chemotherapy-induced myelosuppression were compared with patients who received conventional X-ray therapy (XRT) without transfer. Myelosuppression was defined as an absolute neutrophil count <500/µL. We extracted data on infection prophylaxis, febrile neutropenia (FN), documented infections, radiotherapy interruptions, and other adverse events, including events related to inter-facility travel or sedation.Results: Among 166 pediatric patients who received radiotherapy, 55 underwent PBT and 111 underwent XRT. Of these, 20 patients in the PBT group and 18 in the XRT group developed myelosuppression during concurrent chemoradiotherapy and were included in the analysis. Treatment interruptions were more frequent in the PBT group, but most lasted one to two days. FN was the most common immediate reason for interruption. There were no significant differences between groups in the incidence of FN or documented infections, and no adverse events were clearly attributable to inter-facility travel or sedation in the PBT group.Conclusions: In this cohort, daily inter-facility travel for pediatric PBT during chemotherapy-induced myelosuppression was feasible. Although brief treatment interruptions were more frequent in the PBT group, infectious outcomes were comparable to those of patients receiving XRT without transfer, and no travel- or sedation-related adverse events were identified. Coordinated multidisciplinary protocols may help minimize avoidable interruptions while maintaining safety.

Arthritic progression after high tibial osteotomy (HTO) can require total knee arthroplasty (TKA). While primary TKA results are reliably favorable, there remains uncertainty regarding outcomes of TKA after HTO. We aimed to compare perioperative complication and revision rates for patients who converted to TKA after HTO (HTO-TKA) vs patients who underwent primary TKA. Retrospective deidentified data were obtained from the PearlDiver Mariner Database from 2010 to 2022. Patients who underwent TKA following HTO were matched in a 1:3 ratio based on age, gender, and Charlson Comorbidity index to patients who underwent primary TKA. The incidence of revision surgery and postoperative complications were compared. After matching, 786 patients who underwent converted HTO-TKA were compared to 2356 patients who underwent primary TKA. Patients with TKA after HTO had nearly 4-fold increased incidence of postoperative infection (2.9% vs 0.64%, odds ratio (OR) = 4.7, 95% confidence interval [CI] 2.4-9.1, P < .0001) and wound disruption (6.0% vs 1.7%, OR = 3.7, 95% CI 2.4-5.7, P < .0001) compared to primary TKA patients. There was an increased incidence of aseptic loosening (1.8% vs 0.76%, OR = 2.4, 95% CI 1.2-4.8, P = .024). History of prior HTO was also associated with a 3-fold increase in incidence of revision TKA within 2 years (6.2% vs 2.3%, OR = 2.8, 95% CI 1.9-4.2, P < .0001). Patients who undergo HTO before TKA have a higher incidence of perioperative complications and revision surgery compared to primary TKA patients. These data can be useful when counseling patients; however, further research should investigate whether recent advances in surgical techniques and contemporary changes in infection prophylaxis may enhance outcomes of TKA following HTO.

To assess the effect of the timing of antibiotic prophylaxis on the incidence of surgical site infections in patients undergoing caesarean section in a public-sector tertiary care setting. The prospective study was conducted at Gynaecology Unit 2 of the Dr Ruth KM Pfau Civil Hospital, Karachi, from November 2023 to April 2024, and comprised adult inpatients aged 18-45 years who had elective or emergency caesarean section. The patients were divided into four groups based on the timing of antibiotic administration; group A <30 minutes, group B 30-60 minutes, group C 60-120 minutes, and group D >120 minutes. All the patients received a single dose of prophylactic antibiotic in the shape pf 2g injection of ceftriaxone. Following hospital discharge, the patients were monitored for wound infection for 30 days. Data was analysed using SPSS 21. Of the 323 patients with mean age 33.88±6.61 years, 81(25.07%) were in group A with mean age 34.58±6.22 years, 81(25.07%) were in group B with mean age 33.50±6.81 years, 81(25.07%) were in group C with mean age 33.09±6.85 years, and 80(24.76%) were in group D with mean age 35.32±6.33 years. Overall, 36(11.1%) patients developed wound infection; 4(11.1%), 5(13.9%), 12(33.3%) and 15(41.7%) in group A, B, C and D, respectively (p=0.010). The timing of prophylactic antibiotic administration was found to have significantly affected the occurrence of surgical site infections.

Urinary tract infections (UTIs) are one of the most important infectious complications in kidney transplant recipients; hence, antibiotic prophylaxis is warranted. Due to limited information for selection of an appropriate antibiotic for prophylaxis, as well as the varying reports concerning increasing resistance of Escherichia coli as the common related pathogen, this systematic review and meta-analysis assess the effect of a combined regimen including fluoroquinolone + co-trimoxazole as prophylaxis in high-risk group patients. PubMed, Cochrane Library, Embase, and Web of Science were used as electronic databases to perform a systematic literature between 2010 and December 2024. A commercially available software program (EndNote X9) was used for electronic title management. Searches were performed with keywords, (“Urinary Tract Infections” OR “urinary tract infection” OR “UTI”) AND (“Kidney Transplantation” OR “renal transplant*” OR “kidney transplant*”) AND (“Co-Trimoxazole” OR “co-trimoxazole” OR “trimethoprim sulfamethoxazole” OR “TMP-SMX”) AND (“Fluoroquinolones” OR “fluoroquinolone*” OR “ciprofloxacin” OR “levofloxacin”). A total of 454 potentially relevant titles and abstracts were found during the electronic and manual search, finally two studies were included. Heterogeneity showed a higher percentage of patients in Group I suffered from urinary infection, compared to Group II. Addition of ciprofloxacin to the standard regimen, co-trimoxazole, was related to a reduced risk of UTI in kidney transplant recipients.

Chimeric antigen receptor (CAR)-T cell therapy has revolutionized outcomes in relapsed/refractory lymphomas, yet nonrelapse mortality (NRM) has emerged as a notable concern, with older age and infections identified as major determinants of NRM in real-life studies. The aim of the present study was to describe the rate and causes of NRM after CAR-T cells and identify risk factors. Within the framework of the prospective, multicenter, observational CART‑SIE study, we analyzed causes and determinants of NRM in a large real-world cohort of lymphoma patients receiving CAR‑T cells from 2019 to 2025. Associations between NRM and clinical or biological factors were assessed using Fine and Gray subdistribution hazard models. From 2019 to 2025, 1132 patients were enrolled in the CART-SIE Study; among those, 932 were evaluable for outcomes, with a median follow-up of 17.8 months (IQR 6.3-25.4). In this cohort, 305 deaths were observed, mainly occurring after disease progression (n = 258); overall, 47 deaths were solely attributable to NRM (5%), either early (≤28 days, 40.4%), late (29-90 days, 23.4%) or very late (>90 days, 36.2%). The 1- and 2-year cumulative incidence of NRM were 5.5% and 8.8%. Infections were the leading cause (51%), followed by CAR-T acute toxicities (CRS, ICANS, and HLH/MAS; 30%), and secondary malignancies (11%). In univariable analysis, age > 60 gt; 60 years, diabetes, atrial fibrillation, high CAR-HEMATOTOX score, elevated ferritin, baseline cytopenias, CRS grade ≥3, any-grade or grade ≥3 ICANS and infectious events were risk factors for NRM. Multivariable models revealed that, among pre-infusion factors, only high ferritin levels (HR 3.23, 95% CI: 1.37-7.62, P = .007) and diabetes (HR 3.93, 95% CI: 1.28-12.1, P = .017) independently predicted NRM, while only severe CRS, ICANS, and infections remained strong post-infusion predictors. These findings emphasize the role of host-related factors and inflammation in shaping CAR-T outcomes. Optimized patient selection, rigorous management of acute toxicities, tailored infectious prophylaxis and long-term oncologic surveillance are essential components of long-term survivorship care, aiming to mitigate NRM and sustain long-term benefits of CAR-T cells. Clinical trial registration ClinicalTrials.gov ID: NCT06339255.

Sex-based differences in human immunity are well-described in the general population, cumulatively favoring a more hyperinflammatory immune response among females in different scenarios. It is imperative to understand how this applies in the setting of transplantation, where dynamic immune function determines key clinical outcomes, including graft rejection and responses to infection. Sex differences unique to transplant immunity begin at the chromosomal level and are influenced by steroid hormones and sex-specific factors ranging from pre-existing pregnancy-induced alloimmunization to differential metabolism of routine immunosuppressive medications. Given active efforts for greater sex and gender equity in transplantation, and with increasing transplantation of older candidates, the unique immunological considerations at the cross-roads of biological sex and age are also critical to consider. Age is an important modifier of the relationship between sex and immune-related outcomes asyoung females appear to have a greater risk for poor outcomes related to alloimmunity compared to similarly-aged male counterparts, particularly when receiving an organ from a male donor. However, this risk does not endure in post-menopausal age categories and there are some limiteddata to suggest, in fact, that post-menopausal women may have a greater risk for transplant-related infection. Greater efforts to incorporate sex as a biological variable into transplant research will lead to a more tailored strategy for immunosuppressive management, rejection surveillance, infection prophylaxis and other considerations for optimization of transplant outcomes.

The efficacy of cladribine in treating pulmonary Langerhans cell histiocytosis (PLCH) has been suggested in select case reports. Treatment-related malignancies remain a concern. In this phase 2 trial, the efficacy and safety of cladribine was evaluated in symptomatic PLCH patients with airflow obstruction and/or a decrease in lung function within the previous year. Cladribine was administered for 4 monthly cycles combined with infectious prophylaxis. Patients were followed up every 3 months during the first year to assess efficacy and then until 48 months. The primary endpoint was the cumulative incidence of response to treatment at 6 months, defined as ≥10% improvement in forced vital capacity (FVC) and/or forced expiratory volume in 1 s (FEV1), with an increase of at least 200 mL in the absolute value of FEV1. The study was registered with www. gov: NCT01473797. Ten patients (6 men; median age, 37 years; IQR [33; 47.5]; 6 current smokers) were included. The cumulative incidence of response to treatment at 6 months was 70% (CI, 28.4-90.4). The response to cladribine was associated with a median decrease of 14.9 points (IQR [10.5; 23.5]) in the Saint George's Respiratory Questionnaire score. At 12 months, 5 patients were still responders. The duration of infection prophylaxis was 11.8 months [IQR 11.7; 29]. One patient died before the 12-month visit. The remaining patients were alive at 48 months. No, malignancies were detected. Cladribine improved lung function in half of the patients at one year of follow-up and was well tolerated overall.

Micafungin and other echinocandins are commonly used for the prophylaxis and empirical treatment of invasive fungal infections in neutropenic patients due to their broad-spectrum activity and favorable safety profile. Drug-induced hemolytic anemia (DIHA) is a rare condition, and micafungin-related cases are exceptionally uncommon. We describe a fatal case of intravascular hemolysis triggered by re-administration of micafungin in a patient receiving chemotherapy for peripheral T cell lymphoma. The patient experienced convulsions and shock within minutes of infusion of the drug, followed by severe hemolysis and disseminated intravascular coagulation. Subsequently, hemolytic mechanisms were evaluated using drug-adsorption and immune complex models. Additionally, we had sera from eight patients treated with micafungin between January 2019 and December 2022, including our index case, tested for anti-micafungin antibodies. Immune complex-mediated hemolysis was confirmed in the index case, supported by positive indirect antiglobulin tests and in vitro hemolysis. Anti-micafungin antibodies were only detected in this single patient, indicating an extremely rare immunologic reaction. Although rare, micafungin-induced DIHA can be life-threatening. Clinicians should remain vigilant, particularly when resuming or continuing administration of micafungin.

In this article, we identify and summarise articles describing 10 current, impactful topics related to paediatric healthcare overuse for articles published between 2023 and 2024. Articles were identified using a manual table of contents review of high-impact journals and a PubMed search strategy and then scored using an established three-score rubric based on strength of methods, magnitude of potential harm and number of patients harmed. Afterwards, the most impactful articles were selected by author consensus and summarised in this review. We identified 212 articles related to paediatric healthcare overuse between the manual and PubMed search strategies. Twelve articles describing 10 topics were selected by author consensus in the following areas: harms of proton pump inhibitors, constraints of lipid screening, early discharge for patients with febrile neutropenia, oral antibiotics for bone and joint infections, ultrasound evaluation of fractures, opioid stewardship for neonatal opioid withdrawal syndrome and reduced treatment duration, imaging and prophylaxis for urinary tract infections. Our review identifies and highlights impactful articles that build on a previous body of literature and introduces more recent areas of paediatric healthcare overuse.