Use Of Prophylaxis Research Articles

Comparative Analysis of Outcomes in Adult Spinal Deformity Patients with Proximal Junctional Kyphosis or Failure Initially Fused to Upper Versus Lower Thoracic Spine

Background: Patients with proximal junctional kyphosis (PJK) or failure (PJF) may demonstrate disparate outcomes and recovery when fused to the upper (UT) versus lower (LT) thoracic spine. Few studies have distinguished the reoperation and recovery abilities of patients with PJK or PJF when fused to the upper (UT) versus lower (LT) thoracic spine. Methods: Adult spine deformity patients ≥ 18 yrs with preoperative and 5-year (5Y) data fused to the sacrum/pelvis were included. The rates of PJK, PJK revision, and radiographic PJF were compared between patients with upper instrumented vertebra (UIV) in the upper thoracic spine (UT; T1-T7) and lower thoracic spine (LT; T8-L1). Mean differences were assessed via analyses of covariance, factoring in any differences between cohorts at baseline and any use of PJF prophylaxis. Backstep logistic regressions assessed predictors of achieving Smith et al.’s Best Clinical Outcomes (BCOs) and complications, controlling for similar covariates. Results: A total of 232 ASD patients were included (64.2 ± 10.2 years, 78% female); 36.3% were UT and 63.7% were LT. Postoperatively, the rates of PJK for UT were lower than LT at 1Y (34.6 vs. 50.4%, p = 0.024), 2Y (29.5 vs. 49.6% (p = 0.003), and 5Y (48.7 vs. 62.8%, p = 0.048), with comparable rates of PJF. In total, 4.0% of UT patients underwent subsequent reoperation, compared to 13.0% of LT patients (p = 0.025). A total of 6.0% of patients had recurrent PJK, and 3.9% had recurrent PJF (both p > 0.05). After reoperation, UT patients reported higher rates of improvement in the minimum clinically important difference for ODI by 2Y (p = 0.007) and last follow-up (p < 0.001). While adjusted regression revealed that, for UT patients, the minimization of construct extension was predictive of achieving BCOs by last follow-up (model p < 0.001), no such relationship was identified in LT patients. Conclusions: Patients initially fused to the lower thoracic spine demonstrate an increased incidence of PJK and lower rates of disability improvement, but are at a lessened risk of neurologic complications if reoperation is required.

Antibiotic prophylaxis in oral implant surgery in Germany: a cross-sectional study

PurposeProphylactic antibiotics are used in dental implants to reduce infection risk and implant failure, especially benefiting patients with risk factors. However, evidence suggests that using clindamycin or extending antibiotics postoperatively has an unfavorable risk–benefit ratio.MethodsThis national cross-sectional study analyzed antibiotic prophylaxis during implant insertion across Germany. Dentists from the German Society for Oral Implantology (DGOI) provided demographic information and data on the next 10 consecutive implant patients, including age, sex, risk factors, type of implantation, and antibiotic details.Results103 dentists participated, providing data on 1040 patients. Most dentists were male and aged 30–64. Patients were evenly split between genders, with an average age of 51 years. Antibiotics were administered in 87.6% of all cases, more frequently for patients undergoing bone augmentation (OR 7.01, p < 0.0001), immediate (OR 3.11, p = 0.002) or delayed (OR 5.30, p < 0.0001) implant insertion, and those with cardiovascular disease (OR 3.24, p = 0.009). 74.8% of implantologists tended to use antibiotic prophylaxis routinely, while the remaining implantologists decided on a case-by-case basis. Implantologists primarily used aminopenicillins for 63.8% of prescriptions and clindamycin for the remaining 35.6%. Additionally, 78.8% of patients with prophylaxis received postoperative, multi-day treatments.ConclusionsThe study reveals extensive antibiotic use for perioperative prophylaxis in implant surgery, often not justified by current recommendations, particularly concerning the choice of antibiotic (e.g., clindamycin) and duration (e.g., postoperative use). Specialized clinical guidelines and targeted training for dentists on antibiotic prophylaxis are needed.Graphical

Use of HIV pre-exposure prophylaxis among men who have sex with men: low uptake and retention despite high-risk indications

ABSTRACT HIV PrEP is over 99% effective in preventing HIV when medication adherence is high. Despite this, uptake and retention in PrEP care remains less than optimal. We investigated whether gbMSM with objective risk factors for HIV who were automatically offered PrEP would have higher uptake and retention in PrEP care. For this, gbMSM with clinical evidence of HIV risk received a reflexive offer for PrEP from a nurse. The number of offers, referral acceptance, presentation to the first appointment, initiation and retention at 6 months were examined. Of 1181 gbMSM with objective HIV risk factors who were offered PrEP, only 50% accepted, 28% initiated and 16% remained on PrEP at 6 months. Loss across the cascade was more pronounced for youth. We found a notable disconnect between recent STI diagnosis and acceptance, initiation and retention in PrEP. This notwithstanding, 137 at-risk individuals were retained on PrEP because of an active offer. PrEP delivered by nurses was as effective as that delivered by infectious disease physicians. While active offer PrEP successfully brought at-risk individuals into care, more work is required to understand the perceptions of risk, the benefits and challenges of PrEP use, and how stigma and structural barriers affect retention among diverse groups affected by HIV.

Knowledge, uptake and intention to use antibiotic post-exposure prophylaxis and meningococcal B vaccine (4CMenB) for gonorrhoea among a large, online community sample of men and gender-diverse individuals who have sex with men in the UK.

Novel STI prevention interventions, including doxycycline post-exposure prophylaxis (doxyPEP) and meningococcal B vaccination (4CMenB) against gonorrhoea, have been increasingly examined as tools to aid STI control. There is evidence of the efficacy of doxyPEP in preventing bacterial STIs; however, limited data exist on the extent of use in the UK. We examined self-reported knowledge and use of antibiotic post-exposure prophylaxis (PEP), and intention to use (ITU) doxyPEP and 4CMenB among a large, community sample of men and gender-diverse individuals who have sex with men in the UK. Using data collected by the RiiSH survey (November/December 2023), part of a series of online surveys of men and other gender-diverse individuals in the UK, we describe (%, [95% CI]) self-reported knowledge and use of antibiotic PEP (including doxyPEP) and doxyPEP and 4CMenB ITU. Using bivariate and multivariable logistic regression, we examined correlates of ever using antibiotic PEP, doxyPEP ITU, and 4CMenB ITU, respectively, adjusting for sociodemographic characteristics and a composite marker of sexual risk defined as reporting (in the last three months): ≥5 condomless anal sex partners, bacterial STI diagnosis, chemsex, and/or meeting partners at sex-on-premises venues, sex parties, or cruising locations. Of 1,106 participants (median age: 44 years [IQR: 34-54]), 34% (30%-37%) knew of antibiotic PEP; 8% (6%-10%) ever reported antibiotic PEP use. Among those who did, most reported use in the last year (84%, 73/87) and exclusively used doxycycline (69%, 60/87). Over half of participants reported doxyPEP ITU (51% [95% CI: 47%-56%], 568/1,106) while over two-thirds (64% [95% CI: 60%-69%], 713/1,106) reported 4CMenB ITU. Participants with markers of sexual risk and with uptake of other preventative interventions were more likely to report ever using antibiotic PEP as well as doxyPEP and 4CMenB ITU, respectively. HIV-PrEP users and people living with HIV (PLWHIV) were more likely to report antibiotic PEP use and doxyPEP and 4CMenB vaccination ITU than HIV-negative participants not reporting recent HIV-PrEP use. Findings demonstrate considerable interest in the use of novel STI prevention interventions, more so for 4CMenB vaccination relative to doxyPEP. Fewer than one in ten participants had reported ever using antibiotic PEP, with most using appropriate, evidence-based antibiotics. The use of antibiotic PEP and the report of doxyPEP ITU and 4CMenB ITU was more common among those at greater risk of STIs.

A Pharmacoeconomic Study of Post-Exposure Prophylaxis Strategies for Influenza Virus Infections in Japan.

Vaccines can prevent influenza (flu) infections and are cost-effective for society and healthcare. However, the cost-effectiveness of post-exposure prophylaxis as a follow-up strategy is unclear. This study aims to evaluate the cost utility of post-exposure prophylaxis and treatment strategies with neuraminidase inhibitors and a cap-dependent endonuclease inhibitor for flu infections from the perspective of healthcare costs in Japan. A base-case analysis was used to compare oseltamivir, zanamivir, and laninamivir for neuraminidase inhibitors and baloxavir marboxil for the endonuclease inhibitor. The costs of the first visit to a physician and pharmacy were excluded because of the policy on out-of-pocket expenses for post-exposure prophylaxis in Japan. Direct medical costs include the second physician visit, pharmacy and hospital admission expenses, and drug prices, based on the 2020 Japanese Medical Fee Index. The EuroQol-5Dimention-5Level was utilized to measure healthy participants' quality of life scores, with a time horizon of 14days. Deterministic and probabilistic sensitivity analyses were conducted. We have found baloxavir marboxil as the post-exposure prophylaxis agent and laninamivir as the treatment agent to be the most cost-effective strategy in Japan, followed by oseltamivir as the post-exposure prophylaxis agent and zanamivir as the treatment agent. Baloxavir marboxil and oseltamivir are cost-effective prophylactic agents for flu from the perspective of healthcare costs in Japan. This strategy to select baloxavir marboxil or oseltamivir would be helpful to manage a formulary for post-exposure prophylaxis in Japan.

Prevalence of Dirofilaria immitis in dogs in Jamaica.

Dirofilaria immitis is a zoonotic vector-borne parasite that causes heartworm disease most commonly in canines. Although present in the Caribbean, no published work exists from Jamaica. Therefore, the aim of our study was to evaluate the prevalence of D. immitis in Jamaica. From June to December 2022, whole blood samples from 1000 dogs were collected from all parishes and tested using the Bionote Canine Heartworm Antigen Test Kit 2.0. Dogs that were at least 6months old, privately owned, residing in shelters, working in the security sector, or strays were recruited into the study. Details on the breed, known or approximate age, sex, use of heartworm prophylaxis, and other medications and location of animals were provided by owners/authorizing agents and recorded. Test results were available for 986 dogs of which 184 tested positive, with an overall prevalence of 18.7% (95% CI, 16.28 to 21.24). Mature adults (2-6years) comprised most of our sampled population (46.7%), followed by early seniors (7-9years) (20.1%) and young adults (13-24months) (9.9%). Prevalence for those age groups was 21.9%, 19.5%, and 7.1%, respectively. A seropositivity of 25.1% was seen in dogs not on heartwormpreventative medication compared to 5.5% of dogs on heartwormpreventative medication. Our study highlights a higher seroprevalence of D. immitis infections in older dogs and provides evidence supporting the use of preventive medication in the country.

Training Social Network-Central Fishermen in Western Kenya to Distribute HIV Self-Test Kits and Health Facility Referral Vouchers

Low HIV testing among men, particularly highly mobile fishermen, is a persistent challenge. The Owete study (NCT#04772469) used social network-central men (Promoters) to promote testing and linkage to HIV services among social networks of fishermen in western Kenya. The Promoters and fishermen networks were randomised to intervention or control arms. We describe Owete’s interactive training approach and Promoters’ training experiences for implementation insights. The 146 Promoters trained (balanced across arms) were highly engaged, eager learners, and supportive of targeted health training sessions for men. Promoters felt the knowledge gained improved their understanding of health matters and elevated their social status. Promoters felt empowered knowing how to interpret self-testing results and how to address pre-exposure prophylaxis use questions and correct misconceptions. Offering capacity building for social network-central men to spearhead campaigns on health issues affecting fishermen can leverage established relationships and trust, expand knowledge, and help increase health-seeking practices among underserved, highly mobile men.

Long-term Effectiveness of Amoxicillin Prophylaxis for Children with Primary Vesicoureteral Reflux

Aim: The use of antibiotic prophylaxis in the conservative treatment of vesicoureteral reflux (VUR) has a long historical precedent. In this study, we investigated the long-term efficacy of amoxicillin as antibiotic prophylaxis. Materials and Methods: A retrospective investigation was conducted to examine the clinical characteristics and follow-up results of patients with VUR who received amoxicillin prophylaxis for at least of six months. Results: A total of 44 patients were included in the study, comprising 13 girls (29.5%) and 31 boys (70.5%), with a mean age of 2.9±1.3 months. During a mean follow-up period of 27.4±19.4 months, nine patients (20.5%) experienced one urinary tract infection (UTI), while two patients (4.5%) had a febrile UTI. Antibiotic revision was performed in a total of four patients (9%), including two patients with a febrile UTI and two patients with gastrointestinal side effects. Conclusion: The long-term follow-up of patients with VUR who have been treated with amoxicillin prophylaxis has demonstrated that this is an effective and safe treatment option.

The (T) thrombosis (I) in patients with (L) lower (L) limb (I) injuries (R) requiring (I) immobilisation (TILLIRI) Study

BackgroundPatients requiring lower limb immobilisation after injury have an increased venous thromboembolism (VTE) risk. The extent of this risk in published studies varies. The TRiP(cast) model quantifies VTE risk using clinical parameters. Delineating low from high-risk patients remains challenging. AimsDetermine the 90-day incidence of symptomatic VTE following temporary lower limb immobilisation after injury in an unselected cohort. Prospectively collect data on risk factors, including those incorporated in TRiP(cast) model, to calculate TRiP(cast) scores. MethodsTILLIRI is a multi-centre, pragmatic observational cohort study including 10 sites within the Irish Network for VTE Research. Patients≥18 years with an immobilised injured lower limb were included. Twenty-one clinical variables were collected at presentation. Thromboprophylaxis was prescribed according to clinical gestalt. Patients were followed up at 90-days to determine if VTE occurred. ResultsBetween November 2018 and February 2023, 1242 patients were recruited. Follow-up was complete for 1199 patients(96.5%).43 patients(3.5%) were lost to follow-up.44(3.6%) patients and 125(10%) patients were prescribed anticoagulation and aspirin respectively. 21 patients receiving regular anticoagulation removed from final analysis. VTE incidence at 90-day follow-up was 6/1179(0.51%; CI 0.1%-0.92%). TRiP(cast) scores were calculated for 1176/1221 patients. 846 patients(71.9%) had TRiP(cast) Score< 7, received no prophylaxis and had no VTE. ConclusionTILLIRI indicates a low VTE incidence in an unselected cohort following lower limb immobilization with low rates of prophylaxis use. The proportion of patients with low TRiP(cast) scores and no symptomatic VTE suggests that thromboprophylaxis may be avoided in patients with TRiP(cast)scores< 7, with a low 90-day VTE risk.

Long-term perioperative antibiotic prophylaxis after urethral reconstruction does not improve clinical outcomes and increases incidence of MDR organisms

PurposeTo analyze the impact of long-term postoperative antibiotic prophylaxis following urethral reconstruction on perioperative outcomes, postoperative urine cultures, and the emergence of multidrug-resistant bacteria.MethodsIn this retrospective review of patients undergoing urethral reconstruction with a single surgeon from 2019 to 2023, patients either received long-term prophylactic postoperative antibiotics for 3–4 weeks while indwelling catheters were in place or they did not receive prophylactic antibiotics. Preoperative and postoperative urine cultures were obtained on all patients. The primary outcome measure was the association of prophylactic antibiotics with the presence of multidrug-resistant bacteria in postoperative urine cultures. Secondary outcomes included differences in perioperative outcomes.ResultsOf 166 patients undergoing urethral reconstruction, 147 met all inclusion criteria. Of these, 84 received antibiotic prophylaxis and 63 did not. The number of multidrug-resistant organisms in postoperative urine cultures was significantly different between cohorts indicating a harmful effect of antibiotic prophylaxis (P <.01). There were no significant differences in perioperative outcomes including positive urine cultures, clinical urinary tract infections, wound complications, or recurrence.ConclusionThese data show that the administration of postoperative prophylactic antibiotics does not influence perioperative outcomes but does heighten the risk of encountering multidrug-resistant bacteria. This novel finding should discourage the routine use of antibiotic prophylaxis in patients undergoing urethral reconstruction.

Mitigating and managing infection risk in adults treated with CAR T-cell therapy.

Chimeric antigen receptor T-cell therapy (CAR-T) has transformed the treatment paradigm of relapsed/refractory B-cell malignancies. Yet, this therapy is not without toxicities. While the early inflammation-mediated toxicities are now better understood, delayed hematopoietic recovery and infections result in morbidity and mortality risks that persist for months following CAR-T. The predisposition to infections is a consequence of immunosuppression from the underlying disease, prior therapies, lymphodepletion chemotherapy, delayed hematopoietic recovery, B-cell aplasia, and delayed T-cell immune reconstitution. These risks and epidemiology can vary over a post-CAR-T timeline of early (<30 days), prolonged (30-90 days), or late (>90 days) follow-up. Antibacterial, antiviral, and antifungal prophylaxis; growth factors and stem cell boost to expedite count recovery; immunoglobulin replacement therapy; and possibly revaccination programs are important prevention strategies to consider for infection mitigation. Assessment of risk factors, evaluation, and treatment for pathogen(s) prevalent in a particular time frame post-CAR-T are important clinical considerations in patients presenting with clinical features suggestive of infectious pathology. As more data emerge on the topic, personalized risk assessments to inform the type and duration of prophylaxis use and planning interventions will continue to emerge. Herein, we review our current approach toward infection mitigation while recognizing that this continues to evolve and that there are differences among practices stemming from data availability limitations.

Effect of metronidazole on concentrations of vaginal bacteria associated with risk of HIV acquisition.

Several bacterial vaginosis (BV)-associated bacteria have been associated with elevated risk of human immunodeficiency virus (HIV) acquisition; however, susceptibility of these bacteria to antibiotics is poorly understood. Vaginal samples were collected from 22 persons daily for 2 weeks following BV diagnosis. Metronidazole treatment was prescribed for 5-7 days. Changes in bacterial concentrations were measured with taxon-specific 16S rRNA gene quantitative PCR (qPCR) assays. A culture-based antimicrobial assay confirmed presence of antibiotics in vaginal swab samples. Bacterial DNA concentrations decreased during antibiotic administration for all 13 bacterial taxa tested. Comparison of bacterial DNA concentrations in samples before administration of antibiotics to samples taken on the last day of antimicrobial assay-confirmed antibiotic presence showed a 2.25-4.78 log10-fold decrease across all taxa. Concentrations were frequently reduced to the qPCR assay's limit of detection, suggesting eradication of bacteria. Mean clearance time varied across taxa (1.2-7.9 days), with several bacteria (e.g., Sneathia spp., Vaginal TM7, and Eggerthella-like sp.) taking >7 days to suppress. Metronidazole reduces quantities of bacterial taxa associated with increased HIV acquisition risk.IMPORTANCEHuman immunodeficiency virus (HIV) transmission through sex remains a major public health challenge despite efforts at risk reduction and use of anti-retroviral pre-exposure prophylaxis. Many bacterial vaginosis (BV)-associated vaginal bacteria have been associated with increased HIV infection risk among women. If these bacteria help mediate HIV infection risk, then eradication of these bacteria is one potential strategy to reduce this risk. However, the best approach to eradicate HIV-high risk bacteria from the vagina is not known. We analyzed vaginal swabs collected daily from women with BV to determine the impact of metronidazole treatment on 13 vaginal bacterial taxa linked to elevated risk of HIV infection through use of taxon-directed quantitative PCR assays. We conclude that eradication of high-risk vaginal bacteria using metronidazole is one promising avenue for reducing HIV acquisition risk, and we provide evidence that a 5-7-day treatment course may not be sufficient to suppress all bacteria.

Facilitators and barriers of HIV pre-exposure prophylaxis use among four key populations in Iran

BackgroundPre-exposure prophylaxis (PrEP) significantly reduces HIV transmission, but it is not commonly prescribed in Iran. Therefore, this study aimed to identify facilitators and barriers to PrEP use among four key populations (KPs) in Iran.MethodsWe conducted in-depth qualitative interviews with female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and sexual partners of people living with HIV (PLHIV) to obtain deep insights into the participants’ experiences, beliefs, and viewpoints. We included HIV experts, including staff from the HIV control department, healthcare providers with HIV experience, health policymakers, infectious disease specialists, and university professors. We performed a content analysis to identify facilitators and barriers to PrEP implementation among KPs.ResultsWe interviewed seven FSW, seven MSM, four PWID, four sexual partners of PLHIV, and 18 HIV experts. The facilitator’s theme emerged in four main categories, including eight different factors: 1) Individual and interpersonal factors (motivations, fear of testing positive for HIV, and safety nets and financial support), 2) Age and sex differences, 3) Organizational factors (appropriate PrEP distribution, information sharing, and receipt of high-quality services, 4) Efficacy of PrEP. The barrier’s theme emerged in three main categories, including four factors: 1) Individual factors (insufficient knowledge and awareness, and fragile trust), 2) Cultural barriers, and 3) Organizational factors (inadequate infrastructure and organizational barriers).ConclusionsWe identified key facilitators and barriers to successful PrEP implementation among KPs in Iran. By addressing these barriers, Iran has an opportunity to include PrEP programs in its HIV prevention efforts for KPs.

Review of doxycycline for prophylaxis of sexually transmitted infections.

The surging rates of STIs necessitate medical practitioners in the appropriate specialties to focus on rapid recognition, treatment and prevention of these conditions. Through both pre- and post-exposure prophylaxis with doxycycline, dermatologists can provide up-to-date treatment in the field of venereology. Herein, we review the results of clinical trials in the available literature that investigate doxycycline prophylaxis in the prevention of bacterial STIs. A search was performed using the PubMED and Scopus databases which yielded six clinical trials for our review. Based on the results of these clinical trials, doxycycline prophylaxis offers significant reductions in bacterial STIs, specifically in men who have sex with men (MSM). Additional research is needed in other high-risk groups, including females. Moreover, additional research is needed to determine the effects of doxycycline prophylaxis on tetracycline resistance in STI-causing bacteria. As the utilization of doxycycline prophylaxis for STIs becomes more common, it is important that dermatologists become familiar with the data surrounding this prevention regimen and patient populations who may seek to know more about it. More research is needed to determine benefits in other subpopulations, antimicrobial resistance and cost effectiveness.

Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in an Active-Duty Military Population.

There is limited data on Human Immunodeficiency Virus Pre-exposure Prophylaxis (PrEP) use and persistence in the military. Despite universal access to care, there is concern that PrEP persistence may be lower in military populations due to logistical challenges and perceived stigma. This study evaluated the persistence rates as well as reasons for PrEP discontinuation in a military cohort. This study evaluated all active-duty service members who received PrEP between 2020 and 2022 at a large military infectious diseases clinic. All charts were examined to determine patient characteristics. Patients who discontinued PrEP were contacted to determine the reason for discontinuation and invited to restart PrEP. In total, 112 service members received PrEP during the study period. The cohort was predominantly male (99%) with a median age 30 [IQR: 26-34] and a median of 2 years [IQR: 0-3] receiving PrEP. The most common indication was multiple sexual partners with less than 100% condom use (88%). At the end of the study, most (79%) patients were still receiving PrEP including 33 (37%) at other facilities. Of the twenty-four service members who were no longer receiving PrEP, 18 (75%), were able to be contacted. No patients contacted were interested in restarting PrEP. In this cohort with universal access to care, PrEP persistence rates were greater than seen in other populations. While the most common reason for discontinuation was changes in sexual behavior, systemic factors still contributed to PrEP discontinuation. Future studies should elucidate the challenges to PrEP care in the military.

Perceptions, experiences and concerns with sexually transmitted infections among current and former PrEP users: a longitudinal qualitative study of gay, bisexual and queer men in Canada.

Background Pre-exposure prophylaxis (PrEP) use has been attributed to heightened rates of sexually transmitted infections (STIs), ostensibly due to increased condomless anal sex (CAS) and greater frequency of STI testing. Few qualitative studies have assessed how gay, bisexual and queer men (GBQM) who use PrEP perceive STIs and how these attitudes have evolved post-PrEP uptake. We investigated the perspectives of current and former PrEP users on STIs. Methods Annual, in-depth longitudinal interviews were conducted with 38 current and former PrEP users in Ontario (n =18) and British Columbia (n =20), Canada, as part of a mixed-methods implementation science study (2020-2022). Over 3years, 109 interviews were conducted. Data analysis included reflexive thematic coding and longitudinal recurrent cross-sectional analysis using NVivo 12. Results Four STI-related themes emerged: (1) lack of STI-related concerns due to treatment and prevention optimism, (2) stigma-related concerns, (3) perceived risk among other PrEP users due to increased CAS, and (4) inconsistent testing concerns among non-PrEP users. Over time, some STI-related anxieties decreased with increased knowledge and reduced stigma. However, concerns persisted for other participants due to perceived risky sexual behaviours among other PrEP users and non-PrEP users. Both current and former PrEP users who expressed STI-related apprehensions consistently indicated adopting risk-reduction strategies, including condom use and having fewer sexual partners throughout the study. Conclusions Findings show how varied STI perceptions and experiences among current and former PrEP users shaped sexual decision-making over time. Providers, public health experts, and policymakers should develop a more comprehensive strategy to address STI concerns among GBQM.

Routine antibiotic prophylaxis and early implant failure: is there a link?

A systematic search was conducted across multiple databases (PubMed via MEDLINE, Cochrane Library, and Web of Science) up to October 1st, 2023. Manual screening of reference lists was performed, alongside searches in clinical trial registries to ensure comprehensive coverage. Only randomized controlled trials (RCTs) that compared antibiotic prophylaxis with no antibiotics or placebo in systemically healthy individuals undergoing dental implant surgery were included. Studies with a high risk of bias, non-randomized studies, and those without a placebo or control group were excluded. Studies focusing on medically compromised patients or other implant techniques (such as mini-implants or immediate placement in sites with apical pathology) were also excluded. Data extraction was carried out independently by two authors, with disagreements resolved through discussion among all review authors. The risk of bias for each included randomized controlled trial (RCT) was evaluated using the Cochrane Risk of Bias tool (RoB-2). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. Meta-analyses were conducted using a random-effects model, and heterogeneity was checked with both the I² statistic and Q test. A total of 1267 studies were initially identified, with seven randomized controlled trials (RCTs) ultimately meeting the inclusion criteria, comprising data from 1,859 participants and 3014 implants. Four studies were high quality, and three were of moderate quality. Meta-analyses of these studies showed no statistically significant association between the use of antibiotic prophylaxis and a reduction in early dental implant failure (RR: 0.66, 95% CI: 0.30-1.47). The number needed to treat (NNT) to prevent one implant failure was 143, indicating a limited effect of antibiotics in preventing early implant failure. The study concluded that routine antibiotic prophylaxis does not significantly reduce the risk of early implant failure in medically fit patients. Given the very limited benefit and the concern of increasing antibiotic resistance, routine use of antibiotics in dental implant surgery should be avoided.

Correlates of pre-exposure prophylaxis (PrEP) use among college students in the United States

Introduction HIV rates in the US continue to be high despite the availability of effective prevention medication such as pre-exposure prophylaxis (PrEP). Little is known about how undergraduate college students engaging with campus healthcare services use PrEP. This study of a national sample of undergraduate college students explored the sociodemographic and behavioral factors associated with PrEP use. Methods Data were collected as part of the National College Health Assessment (NCHA). Logistic regression models were used to estimate the likelihood of PrEP use. Results PrEP use was low (3.0%) and was associated with recent anal sex and identifying as men or transwomen. Being unsure about one’s HIV testing history was associated with higher odds of PrEP use, a potential concern considering how crucial HIV testing is to PrEP adherence. Discussion College students may benefit from more explicit discussions around HIV tests and the results of those tests as well as targeted messaging campaigns around PrEP.

Antibiotic Prophylaxis for Elective Pediatric Laparoscopic Cholecystectomies

BackgroundThe Surgical Infection Society (SIS) guidelines recommend against the use of surgical antibiotic prophylaxis (SAP) for low-risk patients undergoing elective laparoscopic cholecystectomies. MethodsUsing National Surgical Quality Improvement Program (NSQIP) data, 5440 pediatric patients were identified who underwent laparoscopic cholecystectomy from 2021 to 2022. Patients who had immunodeficiency, active malignancy, American Society of Anesthesiologists (ASA) physical status classification 3–5, procedure indicated for infection, emergent procedure, received intravenous antibiotics before the prophylaxis window, or missing SAP data were excluded. Results3959 patients were included in the analysis. Among these patients, 3570 (90.2 %) received SAP. Overall incidence of 30-day superficial incisional surgical site infection (SSI), deep incisional SSI, and organ space SSI were 0.9 %, 0.0 %, and 0.1 %, respectively. The incidence of superficial incisional SSI was significantly higher in the patients who did not receive SAP (SAP 0.8 %, no SAP 2.1 %; p = 0.024). The incidence of organ space SSI was also significantly higher in the patients who did not receive SAP (SAP 0.1 %, no SAP 0.8 %; p = 0.008). There was no difference in the incidence of C. diff colitis (SAP 0.1 %, no SAP 0.0 %; p = 1.000). Multivariable modeling, controlling for Hispanic ethnicity, age, and gender, demonstrated patients that received SAP were significantly less likely to have any postoperative SSI compared to patients who did not receive SAP (OR = 0.35). ConclusionHospitals are not currently compliant with SIS guidelines regarding omission of antibiotic prophylaxis for low-risk patients undergoing elective laparoscopic cholecystectomies. The authors advocate for additional studies and reassessment of current guidelines for pediatric patients given the above findings. Type of StudyRetrospective comparative study. Level of EvidenceIII.

The Use of Antifungal Prophylaxis Is Associated with Worse Outcomes in Patients with Newly Diagnosed AML Treated with Venetoclax/HMA: A Retrospective Analysis of Patients in the Flatiron Health Database

The Use of Antifungal Prophylaxis Is Associated with Worse Outcomes in Patients with Newly Diagnosed AML Treated with Venetoclax/HMA: A Retrospective Analysis of Patients in the Flatiron Health Database