Clinical Infectious Diseases Research Articles

Determinants of manifestations of the epidemic process of epidemic hemorrhagic fever in Primorsky Krai

BACKGROUND: The contribution of random and regular factors in the process of epidemic hemorrhagic fever is unknown, which necessitates the search for the reasons for the formation of severe and fatal cases.
 AIM: Based on the incidence of epidemic hemorrhagic fever in Primorsky Krai over a long period, we aimed to establish the role of the main determinants of the epidemic process and to demonstrate the causality of local manifestations in epidemic foci in patients with epidemic hemorrhagic fever.
 MATERIALS AND METHODS: In this comprehensive descriptive epidemiological and clinical study, we undertook the epidemiological analysis of the incidence of epidemic hemorrhagic fever and data from examinations of the foci of infection. We performed a clinical observation (case study) of a case of epidemic hemorrhagic fever with a fatal outcome at the Regional Clinical Infectious Diseases Hospital in March 2022. The object of the study is statistical data on officially registered cases of epidemic hemorrhagic fever in Primorsky Krai from 1995 to 2021.
 RESULTS: The proportion of random factors in the epidemic process of epidemic hemorrhagic fever in the period under review was 28.7% of the incidence, which formed deviations from the typical curve, but did not participate in the formation of cyclicity in the long-term dynamics. Variable factors that formed cyclicity and random deviations together determined 53.4% of the incidence. They were fully related to seasonal morbidity (67.8%). Moreover, the remaining 14.4% of seasonality was formed by constant factors for each month. Factors constant for all months of the year form a year-round form, that is, 32.2% of the incidence.
 In the clinical and epidemiological observation of a lethal case of epidemic hemorrhagic fever, infection was noted under conditions of dust formation, such as when restoring order in a closed room at a negative temperature (sweeping) and high titers of specific antibodies resulting from repeated encounters with the pathogen in residential and occupational types of morbidity and the accompanying illnesses.
 CONCLUSIONS: The study of the incidence of epidemic hemorrhagic fever demonstrated a high resolution of epidemiological analysis by using a binary method in zoonoses. The patterns and features of human morbidity were controlled by natural and social factors more strictly than by biological ones. The determinants of the socio-ecological system in epidemic hemorrhagic fever in Primorsky Krai make it possible to specify the tactics and strategy for the implementation of epidemiological surveillance.

The cascade of care for pregnant women with latent tuberculosis infection in a high-income country

Background Pregnant women have an increased risk of developing active tuberculosis (TB). The Public Health Agency of Sweden recommends screening of active TB and latent tuberculosis infection (LTBI) among pregnant women from countries with high TB incidence at Maternal Health Care (MHC) clinics. In Östergötland County, Sweden, a screening program has been active since 2013. The aim of this study was to evaluate this screening program and the cascade of care for LTBI among pregnant women in Östergötland county. Methods Data were obtained from pregnant women screened for TB at MHC clinics and subsequently referred to the pulmonary medicine clinic or the clinic of infectious diseases in Östergötland County between 2013 and 2018. The Public Health Agency of Sweden’s national database for active TB was used to analyse if any women developed active TB up to two years after the screening process. Results A total of 439 women were included. Nine cases of active TB were discovered during the screening process and two developed active TB afterward. 177 women were recommended LTBI treatment and variables significantly associated with a decreased likelihood of being recommended treatment were increasing age, time in Sweden, and parity. 137 women received and 112 (82%) completed treatment. 14 women discontinued treatment due to adverse effects. Conclusion Screening of pregnant women from countries with high TB incidence at MHC clinics led to the discovery of several cases of active TB. The completion rate of LTBI treatment was high and few discontinued due to adverse effects.

A cost-utility analysis of two Clostridioides difficile infection guideline treatment pathways

ObjectivesTreatment guidelines are key drivers of prescribing practice in the management of Clostridioides difficile infection (CDI), but recommendations on best practice can vary. We conducted a cost-utility analysis to compare the treatment pathway recommended by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline with the pathway proposed by the National Institute for Health and Care Excellence (NICE) guideline, from the perspective of the UK National Health Service. MethodsA decision tree modelling approach was adopted to reflect the treatment pathway for CDI as outlined in ESCMID and NICE guidelines. Patients experiencing a CDI infection received up to three treatments per infection to achieve a response and could subsequently experience up to two recurrences. Data on patient demographics, treatment response, recurrence, utilities, CDI-related mortality, and costs were taken from published literature. ResultsThe ESCMID treatment pathway was cost-effective versus the NICE treatment pathway at a threshold of £20 000 per quality-adjusted life year gained, with an incremental cost-effectiveness ratio of £4931. Cost-effectiveness was driven by differences in index infection recommendations (ESCMID recommends fidaxomicin as first-line treatment whereas NICE recommends vancomycin). The model results were robust to variations in inputs investigated in scenarios and sensitivity analyses, and probabilistic sensitivity analysis demonstrated that the ESCMID guideline treatment strategy had a 100% likelihood of being cost-effective versus the NICE treatment strategy. DiscussionCompared with the NICE guideline, the ESCMID guideline recommendations for treating an index CDI represent the most cost-effective use of healthcare resources from the perspective of the UK National Health Service.

SARS-CoV-2 Antibody Replacement Therapy for Immunocompromised Patients.

Journal Article Accepted manuscript SARS-CoV-2 Antibody Replacement Therapy for Immunocompromised Patients Get access Jonathon W Senefeld, PhD, Jonathon W Senefeld, PhD Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MinnesotaDepartment of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota https://orcid.org/0000-0001-8116-3538 Search for other works by this author on: Oxford Academic PubMed Google Scholar Michael J Joyner, MD Michael J Joyner, MD Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MinnesotaDepartment of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota Correspondence: M. Joyner, MD, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA (joyner.michael@mayo.edu). https://orcid.org/0000-0002-7135-7643 Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, ciad367, https://doi.org/10.1093/cid/ciad367 Published: 20 June 2023 Article history Received: 23 May 2023 Editorial decision: 30 May 2023 Accepted: 17 June 2023 Published: 20 June 2023

Molecular Characteristics and Genetic Analysis of Extensively Drug-Resistant Isolates with different Tn3 Mobile Genetic Elements.

Extensively drug-resistant (XDR) bacteria are the main caues for causing clinical infectious diseases. Our aim was to distinguish the present molecular epidemiological situation of XDR Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli isolates recovered from local hospitals in Changzhou. Antibiotic susceptibility and phenotypic analysis, multilocus sequence typing and Pulsed Field Gel Electrophoresis were performed to trace these isolates. Resistant phenotype and gene analysis from 29 XDR strains demonstrated that they mainly included TEM, CTX-M-1/2, OXA-48, and KPC products. A. baumannii strains belonged to sequence type (ST) ST224, and carrying the blaCTX-M-2/TEM gene. The quinolone genes aac(6')-ib-cr and qnrB were carrying only in A. baumannii and E.coli. Three (2.3%) of these strains were found to contain the blaNDM-1 or blaNDM-5 gene. A new genotype of K. pneumoniae was found as ST2639. Epidemic characteristics of the XDR clones showed that antibiotic resistance genes distributed unevenly in different wards in Changzhou's local hospitals. With the sequencing of blaNDM carrying isolates, the plasmids often carrying a highly conservative Tn3-relavent mobile genetic element. The especially coupled insert sequence ISKox3 may be a distinctive resistance gene transfer loci. The genotypic diversity variation of XDRs suggested that tracking and isolating the sources of antibiotic resistance especially MBL-encoding genes such as blaNDM-will help manage the risk of infection by these XDRs.

Antibiotic Myths for the Infectious Diseases Clinician.

Antimicrobials are commonly prescribed and often misunderstood. With more than 50% of hospitalized patients receiving an antimicrobial agent at any point in time, judicious and optimal use of these drugs is paramount to advancing patient care. This narrative will focus on myths relevant to nuanced consultation from infectious diseases specialists, particularly surrounding specific considerations for a variety of antibiotics.

Non-Tuberculous Mycobacterial Cervicofacial Lymphadenitis in Children-10-Year Experience in a Tertiary Pediatric Center.

Lymphadenitis is the most common manifestation of non-tuberculous mycobacteria (NTM) infection in children. We describe the epidemiology and clinical characteristics of NTM lymphadenitis, determine diagnostic yield from tissue sampling, and review management and outcomes. This was a 10-year retrospective review of children aged 0-16 years diagnosed with NTM cervicofacial lymphadenitis who were seen in a pediatric infectious disease clinic in a tertiary public hospital. Data relating to patient demographics, clinical features, surgical and antimicrobial treatment, complications, and outcomes were retrieved from patients' electronic medical records and analyzed. There were 48 episodes of NTM cervicofacial lymphadenitis in 45 children (17 males and 28 females). Of these episodes, 43.7% manifested as a unilateral single node, mostly parotid (39.6%) and submandibular (29.2%). All patients underwent diagnostic fine-needle aspiration or surgery. Surgical excision more frequently yielded positive histological findings (P = .016). NTM was identified in 22/48 episodes (45.8%) via culture or molecular sequencing. Mycobacterium abscessus was most commonly found (47.8%). Thirty-eight children (79.2%) received antibiotics. Outcomes in 43 episodes revealed full resolution in 69.8%, while 25.6% had de novo disease and 4.6% experienced recurrence at the same site. Overlying skin changes and multiple or bilateral nodal diseases were significantly associated with de novo disease or recurrence (P = .034 and .084, respectively). Complications occurred in 11/70 (15.7%) procedures. Antibiotic-associated adverse effects occurred in 14/38 (36.8%) episodes. NTM lymphadenitis remains a challenging condition. More aggressive management with surgical excision and antibiotics is recommended for those with overlying skin changes and extensive nodal disease.

Infectious diseases and biomarker use

Background: Biomarkers are used in diverse clinical fields, including oncological, cardiovascular, infectious, and rheumatoid diseases. In infectious diseases, biomarkers are widely used for identifying fever due to infection, evaluating the possibility of progression to sepsis, predicting prognosis, estimating treatment response, and determining the timing of discontinuation of antibiotic treatment. Thus, biomarkers are used as indicators that can inform clinical decisions.Current Concepts: Biomarkers for infectious diseases typically relate to inflammatory processes in, which are activated by external antigens. Historically, research has focused on acute phase reactants; however, more recently, various inflammatory response biomarkers have been investigated.Discussion and Conclusion: To date, no infallible biomarker has been identified for infectious diseases. The main reasons are the potential for these molecules to also be affected by non-infectious causes and the individual differences in the degree of change of the biomarker. Although diagnosis and clinical decisions cannot depend on biomarkers alone, these are undoubtedly essential tools in clinical contexts, if thoroughly and carefully characterized. Here, we review several substances used or showing significant potential as biomarkers for infectious diseases.

The microbiological diagnostic performance of metagenomic next-generation sequencing in patients with infectious diseases.

Metagenomic next-generation sequencing (mNGS) can be used to detect pathogens in clinical infectious diseases through the sequencing analysis of microbial and host nucleic acids in clinical samples. This study aimed to assess the diagnostic performance of mNGS in patients with infections. In this study, 641 patients with infectious diseases were enrolled. These patients simultaneously underwent pathogen detection by both mNGS and microbial culture. Through statistical analysis, we judged the diagnostic performance of mNGS and microbial culture on different pathogens. Among 641 patients, 276 cases of bacteria and 95 cases of fungi were detected by mNGS, whereas 108 cases of bacteria and 41 cases of fungi were detected by traditional cultures. Among all mixed infections, combined bacterial and viral infections were the highest (51%, 87/169), followed by combined bacterial with fungal infections (16.57%, 28/169) and mixed bacterial, fungal, and viral infections (13.61%, 23/169). Among all sample types, bronchoalveolar lavage fluid (BALF) samples had the highest positive rate (87.8%, 144/164), followed by sputum (85.4%, 76/89) and blood samples (61.2%, 158/258). For the culture method, sputum samples had the highest positive rate (47.2%, 42/89), followed by BALF (37.2%, 61/164). The positive rate of mNGS was 69.89% (448/641), which was significantly higher than that of traditional cultures (22.31% [143/641]) (P < .05). Our results show that mNGS is an effective tool for the rapid diagnosis of infectious diseases. Compared with traditional detection methods, mNGS also showed obvious advantages in mixed infections and infections with uncommon pathogens.

The Argentinian landscape of mycological diagnostic capacity and treatment accessibility.

Immunosuppressed patients, transplant recipients, and those with acute or chronic respiratory disease are at increased risk for invasive fungal infections in Argentina. Although the national public system guarantees universal access to health care for all citizens, little is known about the quality of available diagnostic and treatment armamentaria for invasive fungal infections in the country. Between June and August 2022, infectious disease clinicians from each of the 23 provinces and the Autonomous City of Buenos Aires were contacted to describe local access to fungal diagnostic tools and antifungal agents. The information collected included different aspects such as hospital characteristics, patients admitted and wards, access to diagnostic tools, estimated infection incidence, and treatment capacity. Thirty responses were collected from facilities throughout Argentina. Most institutions were governmental (77%). A mycology department was available in 83% of them. Histopathology was available in almost 93% of the sites, while automated methods and galactomannan tests were available in 57%, each; 53% of the sites had access to MALDI-TOF-MS through regional reference laboratories, and PCR was present in 20% of the sites. Susceptibility testing was available in 63% of the laboratories. Candida spp. (24%), Cryptococcus spp. (20%), Aspergillus spp. (18%), and Histoplasma spp. (16%) were described as the main pathogens. Fluconazole was the only antifungal agent available in all institutions. This was followed by amphotericin B deoxycholate (83%) and itraconazole (80%). If an antifungal agent was not available onsite, then 60% of the patients could receive adequate antifungal treatment within the first 48 h upon request. Although there are no significant differences in access to diagnostic and clinical management of invasive fungal infections among the Argentinean centres studied, national awareness-raising initiatives led by policymakers could help to improve their general availability.

Unraveling neonatal sepsis: sharper tools needed for unexpected organisms.

Journal Article Accepted manuscript Unraveling neonatal sepsis: sharper tools needed for unexpected organisms Get access Ian C Michelow, MD, MMed, FCPaed. DTM&H, Ian C Michelow, MD, MMed, FCPaed. DTM&H Professor of Pediatrics and Infectious Diseases, Connecticut Children’s Medical Center, University of Connecticut School of Medicine Search for other works by this author on: Oxford Academic PubMed Google Scholar Stephen K Obaro, MD, PhD Stephen K Obaro, MD, PhD Professor of Pediatrics and infectious Diseases, University of Nebraska Medical Center, Omaha. NE Corresponding author:stephen.obaro@unmc.edu https://orcid.org/0000-0002-7526-1075 Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, ciad338, https://doi.org/10.1093/cid/ciad338 Published: 05 June 2023 Article history Received: 22 April 2023 Revision received: 23 May 2023 Accepted: 31 May 2023 Published: 05 June 2023

Pneumonia panel results and antibiotic prescribing in COVID-19 patients in 2020 versus 2022

Background: Antibiotics are frequently prescribed in patients with COVID-19 infections to treat secondary bacterial pneumonia. The pneumonia panel (PNP) is a molecular diagnostic tool that rapidly detects 33 bacterial and viral targets. The utility of this panel in COVID-19 patients and how it may direct antibiotic use is unknown. We sought to understand the utilization of PNP in patients with COVID-19 pneumonia over time by comparing clinical parameters, microbiologic results, and antibiotic use between May–December 2020 and January–July 2022. Methods: We implemented the PNP in May 2020 with antimicrobial stewardship guidance, provider education, and order restriction to critical care and infectious disease clinicians. From February–July 2021 prescribers received regular structured antimicrobial stewardship feedback regarding PNP results; from August 2021 to January 2022, no antimicrobial stewardship feedback was provided; from February to July 2022, intermittent feedback was provided. We compared PNP and culture results from sputum or bronchoalveolar lavage samples and antibiotic use and modification within 24 hours of PNP result from patients with confirmed COVID-19 pneumonia between May–December 2020 and January–July 2022. Clinical data and antibiotic use were abstracted through chart review. We excluded patients who died within 72 hours of PNP, those who had concurrent nonpulmonary infections, and those whose COVID-19 test was &gt;30 days prior. Results: We included 114 patients in 2020 and 71 patients in 2022. The overall median age was 61 years, 71% were male, and 66% were mechanically ventilated without statistical differences between the cohorts, including their comorbidities. Acute or worsening hypoxia remained the predominant indication for PNP (77% in 2020 vs 75% in 2022, NS). The median number of days between admission and PNP was 4 (IQR, 1–8) in 2020 versus 3 (IQR, 1–7), and the difference was not significant. PNP and culture results in Table 1 show that Staphylococcus aureus and Hemophilus influenzae were the pathogens most commonly identified. Table 2 describes empiric prescribing and modifications for commonly prescribed antibiotics. Prescribers used empiric cefepime and ceftriaxone more in 2020 and vancomycin more in the 2022 group; however, these were not statistically significant. Cefepime de-escalation was more common in 2022 (53% vs 28%; P = .03). Antibiotic modifications within 24 hours of PNP remained similar in 2020 vs 2022. Although vancomycin cessation was more common in 2020 (78%) versus 2022 (57%), the difference was not statistically significant. Conclusions: With ASP guidance, PNP may be a useful tool to stop or target antibiotics for secondary bacterial pneumonia in COVID-19 pneumonia. Early vancomycin cessation (prior to culture results) may be an enduring consequence of PNP implementation.Disclosures: None

Using telehealth to support antimicrobial stewardship at four rural VA medical centers: Interim analysis

Background: Healthcare settings without access to infectious diseases experts may struggle to implement effective antibiotic stewardship programs. We previously described a successful pilot project using the Veterans Affairs (VA) telehealth system to form a Videoconference Antimicrobial Stewardship Team (VAST) that connected multidisciplinary teams from rural VA medical centers (VAMCs) with infectious diseases experts at geographically distant locations. VASTs discussed patients from the rural VAMC, with the overarching goal of supporting antibiotic stewardship. This project is currently ongoing. Here, we describe preliminary outcomes describing the cases discussed, recommendations made, and acceptance of those recommendations among 4 VASTs. Methods: Cases discussed at any of the 4 participating intervention sites were independently reviewed by study staff, noting the infectious disease diagnoses, recommendations made by infectious diseases experts and, when applicable, acceptance of those recommendations at the rural VAMC within 1 week. Discrepancies between independent reviewers were discussed and, when consensus could not be reached, discrepancies were discussed with an infectious diseases clinician. Results: The VASTs serving 4 different rural VAMCs discussed 96 cases involving 92 patients. Overall, infection of the respiratory tract was the most common syndrome discussed by VASTs (Fig. 1). The most common specific diagnoses among discussed cases were cellulitis (n = 11), acute cystitis (n = 11), wounds (n = 11), and osteomyelitis (n = 10). Of 172 recommendations, 41 (24%) related to diagnostic imaging or laboratory results and 38 (22%) were to change the antibiotic agent, dose, or duration (Fig. 2). Of the 151 recommendations that could be assessed via chart review, 122 (81%) were accepted within 1 week. Conclusions: These findings indicate successful implementation of telehealth to connect clinicians at rural VAMCs with an offsite infectious diseases expert. The cases represented an array of common infectious syndromes. The most frequent recommendations pertained to getting additional diagnostic information and to adjusting, but not stopping, antibiotic therapy. These results suggest that many of the cases discussed warrant antibiotics and that VASTs may use the results of diagnostic studies to tailor that therapy. The high rate of acceptance suggests that the VASTs are affecting patient care. Future work will describe VAST implementation at 4 additional VAMCs, and we will assess whether using telehealth to disseminate infectious diseases expertise to rural VAMCs supports changes in antibiotic use that align with principles of antimicrobial stewardship.Disclosures: None

Sex representation of editors, editorial boards, and authors of infectious diseases and healthcare epidemiology journals

Background: Academic publishing is not exempt from potential structural disparities. We assessed the sex representation among the editors and on editorial boards by their level of influence in the decision of a manuscript of the leading journals focused on infectious diseases and healthcare epidemiology. We also explored whether the sex of the first or last author correlates with the sex of the editors in a convenience sample of these journals. Methods: In a cross-sectional study, the 40 top infectious disease journals (Scimago Journal and Country Rank) and 4 healthcare epidemiology journals were selected. The names and positions of the editorial members were extracted from the journal’s website, and a decision-making level was assigned (ie, editor-in-chief as level 1, board members as level 3). Next, the first and corresponding authors’ names of all 2019 research articles published in a convenience sample of 15 of these journals were retrieved for the second aim. A digital gallery was used to assign one of the binary denominations of woman or man based on the probability that a name was culturally given to a woman or man. Differences were determined by χ2 and linear regression. Results: Overall, 2,416 names were retrieved from the editorial boards of 44 journals; 799 (33%) were assigned as women and 1,617 (67%) as men. The decision-making level showed 70 (3%) at the editor-in-chief level, 756 (31%) at the associate editor level, and 1,600 (66%) as editorial board members. The frequency distribution of assigned gender by decision-making level showed 21 (30%) women and 49 (70%) men at the editor-in-chief level; 263 (35%) women and 493 (65%) men at the associate editor level; 515 (32%) women and 1,075 (68%) men at the editorial board level. Some journals showed an even sex distribution, such as Clinical Infectious Disease or Microbiology Spectrum. However, others were significantly unbalanced. We retrieved 2,725 articles from the convenience sample of infectious disease–focused journals. Women were the first authors in 1,373 (50%) and the last authors in 974 (35%). Editorial board sex composition and sex of authors showed no significant correlation. Trends between infectious disease–focused and healthcare epidemiology–focused journals were similar. Conclusions: Although the data showed uneven sex representation on the editorial boards of infectious disease–focused and healthcare epidemiology–focused journals, there is no apparent vertical segregation or influence on publishing by sex. A generational transition seems to be occurring in editorship and authorship in the field.Disclosures: None

Editorial introductions.

Editorial introductions.

КЛИНИКО-ЛАБОРАТОРНАЯ ХАРАКТЕРИСТИКА ПОРАЖЕНИЙ ПЕЧЕНИ ПРИ COVID-19

Background. Having its multisystemic effect СOVID-19 leads to liver disfunction. Objective. To assess the functional state of the liver in patients with COVID-19 during the periods of circulation of different SARS-CoV 2 strains. Material and methods. The object of the study was 180 patients with COVID-19 who were hospitalized at Grodno Regional Infectious Diseases Clinical Hospital. The patients were divided into two groups: the 1st group (n=51) - those examined during the circulation of the Omicron strain (2022), the 2nd (n=129) – the patients who were treated over 2020-2021 (during the circulation of previous strains). The laboratory analysis included the assessment of biochemical and sonographic parameters. Results. In the first group, dyspeptic syndrome, hyperbilirubinemia and hypoalbuminemia were more often recorded. The patients of the second group had more pronounced manifestations of severe respiratory failure alongside with significantly more pronounced hyperenzymemia according to aspartate aminotransferase (AST) level. Conclusions. Hyperbilirubinemia and hypoalbuminemia, being significantly more common during the circulation of the Omicron strain, may be regarded as a manifestation of acute mixed-etiology reactive hepatitis. The predominance of hyperenzymemia due to AST during the circulation of other strains may be accounted for by the cytopathic effect of the virus and drug-induced liver damage.

Clostridioides difficile Infection: Targeting an Unwelcome and Persistent Threat

An integrated symposium, with an esteemed panel of experts, discussed the burden and treatment approaches for Clostridioides difficile infection (CDI). The session took place on 17th April 2023 as part of the 33rd European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) 2023 in Copenhagen, Denmark. The session was co-chaired by Mark Wilcox, Head of Microbiology Research &amp; Development and Infection Lead at Leeds Teaching Hospitals NHS Trust, UK, and Professor of Medical Microbiology at the University of Leeds, UK; and Anne Gonzales-Luna, Assistant Professor at the University of Houston College of Pharmacy, Texas, USA. Sarah Tschudin-Sutter, Professor and Head Division of Hospital Epidemiology at the University Hospital Basel, Switzerland, explored the changing landscape for CDI, including the epidemiology and surveillance of infection, and approaches to diagnosis. John Coia, Professor Emeritus at the Institute of Regional Health Research, University of South Denmark, and Honorary Research Fellow at Glasgow University, UK; and Esther Calbo, Professor and Head of Infectious Disease at the Hospital Universitari Mútua de Terrassa, Spain, gave an overview of the burden of recurrent CDI, dysbiosis in CDI, and the role in recurrent CDI, mortality risk, and the importance of targeting recurrence. Calbo also presented an interactive case study that allowed audience members to engage and review the patient case presented. The faculty panel explored with the audience how to approach assessment and treatment to achieve the best outcome for the patient case. Benoît Guery, Associate Professor Infectious Disease at the Centre Hospitalier Universitaire Vaudois, Switzerland, presented data from the EXTEND study, which explored extended-pulse dosing regimens of antibiotics (fidaxomicin) in CDI.

Providing Expert Consultation in a World Living with COVID-19

After a welcome by Paolo Antonio Grossi, the appointed chair by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Department of Medicine &amp; Surgery, University of Insubria, Varese, Italy; Ann-Brit Eg Hansen, Department of Infectious Diseases, Copenhagen University Hospital – Amager and Hvidovre, Denmark and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, summarised the objectives of the meeting and introduced the speakers. In their opening presentation, Tobias Welte, Department of Pulmonary and Infectious Diseases, Hannover University School of Medicine, Germany, described how the COVID-19 pandemic has evolved, in terms of variants, mortality rates, vaccinations, immunity, and antivirals. Welte then presented a hypothetical case study to illustrate how older patients with comorbidities can initially have mild symptoms, but may then deteriorate and require hospitalisation. Stephen Thomas, State University of New York Upstate Medical University, Syracuse, USA, then described the efficacy and potential side effects of the BNT162b2 (Pfizer–BioNTech, New York City, USA, and Mainz, Germany, respectively) vaccine, and the need for, and benefits of, booster doses. Thomas also described the added benefits of the newer bivalent vaccines in a world where COVID-19 is constantly mutating. Marta Boffito, HIV, Sexual and Gender Health, Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, Imperial College London, UK, then outlined various factors that increase the risk of progression to severe COVID-19 disease, including older age, immunocompromised status, and underlying health conditions (e.g., obesity, hypertension, heart disease, and chronic kidney disease [CKD]). Such patients can benefit from antiviral medications such as nirmatrelvir/ritonavir, although potential drug–drug interactions must be considered. Roger Paredes, Department of Infectious Diseases and IrsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain, and Center for Global Health and Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA, revisited the case study to highlight the importance of early COVID-19 diagnosis among high-risk patients to enable the use of nirmatrelvir/ritonavir, which is only approved within 5 days of symptom onset for non-hospitalised adults at increased risk of progression to severe COVID-19. Paredes went on to discuss antiviral treatments in more detail, describing a randomised controlled trial (EPIC-HR) and two large real-world studies that showed that nirmatrelvir/ritonavir could significantly reduce the risk of hospitalisation and death due to COVID-19 among high-risk patients. To conclude, Hansen highlighted the importance of regular updates to COVID-19 management guidelines, given the ongoing and evolving nature of COVID-19, as well as the importance of identifying high-risk patients early in their disease course to enable the use of nirmatrelvir/ritonavir.

A Retrospective Comparison of HIV Pre-exposure Prophylaxis (PrEP) Outcomes Between a Pharmacist-led Telehealth Clinic and In-person Clinic in a Veteran Population.

Pre-exposure prophylaxis (PrEP) reduces human immunodeficiency virus (HIV) transmission through sexual contact by at least 90% when taken as prescribed. This retrospective cohort study evaluated differences in adherence to PrEP medication and monitoring between the physician- and nurse practitioner (NP)-led in-person setting and the pharmacist-led telehealth setting among patients followed by the infectious diseases clinic at the VA Eastern Colorado Health Care System from July 2012 to February 2021. The primary outcomes were PrEP tablets filled per person-year, serum creatinine (SCr) tests per person-year, and HIV screens per person-year. Secondary outcomes included sexually transmitted infection (STI) screens per person-year and patients lost to follow-up.149 patients were included in the study, with 167 person-years in the in-person cohort and 153 person-years in the telehealth cohort. Adherence to PrEP medications and monitoring was similar between in-person and telehealth clinics. PrEP tablets filled per person-year was 324 in the in-person cohort and 321 in the telehealth cohort (RR = 0.99; 95% CI, 0.98-1.00). SCr screens per person-year was 3.51 in the in-person cohort and 3.37 in the telehealth cohort (RR = 0.96; 95% CI, 0.85-1.07). HIV screens per person-year was 3.55 in the in-person cohort and 3.38 in the telehealth cohort (RR = 0.95; 95% CI, 0.85-1.07). There were no new HIV infections. Additionally, patients were less likely to be lost to follow-up when followed via telehealth (11.9% vs. 30.0%), Χ2 (1, N = 149) = 6.85, p = 0.009. These findings indicate that pharmacist-driven delivery of PrEP via telehealth can be used to increase access to PrEP without sacrificing quality of care.

Clinical and laboratory differences between healthy and COVID-19 positive pregnant women and the negative effects of COVID-19 on pregnancy

Introduction: Depending on pregnancy; physiological changes in the immune system, respiratory and circulatory systems may cause a more severe course of infection with respiratory viruses. The aim of this study is to examine the clinical and laboratory findings of our pregnant patients with and without COVID-19 and to determine whether COVID-19 disease has a negative effect on late pregnancy. Methods: This study was conducted with a total of 60 pregnant patients followed in the Infectious Diseases and Clinical Microbiology Clinic and Gynecology and Obstetrics Clinic of a Training and Research Hospital. Demographic characteristics and laboratory findings of pregnant women and their fetuses were obtained from the hospital management information system. Results: The mean age of the COVID-19 positive pregnant women (n:30) included in the study was 28.87±1.38 years, the mean hospitalization time was 6.33±0.35 days, and it was significantly different from the COVID-19 negative group (n:30) (p&amp;lt;0.001). The most common symptom observed in COVID-19 positive pregnant women at presentation was fever (73.3%), followed by cough (53.3%) and headache (43.3%). C-reactive protein (25.53±5.79, p: 0.005), ferritin (83.97±10.51, p: 0.005) and erythrocyte sedimentation rate (30.97± 4.59, p: 0.011) were found to be higher in COVID-19 positive pregnant women. Conclusion: In conclusion; CRP, ferritin and ESR levels were found to be higher in pregnant women with COVID-19. It is important for healthcare providers to know the clinical course of COVID-19, maternofetal or obstetric outcomes in the pregnant population. Mode and timing of delivery should be individualized according to disease severity, pre-existing maternal comorbidities, obstetric history, gestational age, and fetal conditions. Keywords: COVID-19, C-reactive protein, cough, pregnancy