SASPI Ltd.
Systematic review/Scoping review with large effect size
Clinical features and outcome of brain abscess after introduction of CT and MRI: A meta-analysis
Citation:- 10.1016/j.jinf.2024.106394
Authors: Jacob Bodilsen et al.,
Highlights
The aetiology of brain abscess was dominated by oral cavity bacteria
The clinical presentation was unspecific or consisted meningitis due to rupture
The case-fatality rate was 12% and has not improved during the two recent decades
Fundamental underlying mechanisms for development of brain abscess remain unknown
Systematic review/Scoping review with large effect size
What is the most effective antibiotic monotherapy for severe Pseudomonas aeruginosa infection? A systematic review and meta-analysis of randomized controlled trials
Citation:- 10.1016/j.cmi.2024.12.036
Authors: Dorit Tekes-Manuva et al.,
Highlights
In this systematic review and meta-analysis of definite antipseudomonal monotherapy for P. aeruginosa infection, the study found no evidence for clinical benefit differences among direct antibiotic comparisons, but all subgroup analyses were underpowered to detect significant differences.
Systematic review/Scoping review with large effect size
Fungal infection in patients treated with Bruton’s Tyrosine Kinase inhibitor, from epidemiology to clinical outcome: A systematic review
Citation:- 10.1016/j.cmi.2024.12.032
Authors: Charles Gibert et al.,
Highlights
25,215 patients who received Bruton Tyrosine Kinase inhibitor (BTKi) from 92 retrospective and prospective clinical trials/cohort studies and 211 patients who received BTKi from 115 case reports/case series were included.
Among clinical trials/cohorts, 736 IFI were reported, including 234 candidiasis (31.8%), 227 aspergillosis (30.8%), and 124 PJP (16.8%).
Among case reports/case series, 155 (73.5%) had chronic lymphocytic leukemia and 56 (26.5%) had other maligancies.
The main IFI were aspergillosis (n=107, 50.7%), cryptococcosis (n=33, 15.6%), Pneumocystis jirovecii pneumonia (n=26, 12.3%), and mucormycosis (n=23, 10.9%).
The median delay between initiation of BTKi and IFI was 2.3, 4.0, 3.0 and 3.0 for aspergillosis, cryptococcosis, PJP and mucormycosis, respectively.
Survival rate improved when BTKi was discontinued during infection
Systematic review/Scoping review with large effect size
Comparative efficacy and safety of treatment regimens for Pneumocystis jirovecii pneumonia in people living with HIV – A systematic review and network meta-analysis of randomized controlled trials
Citation:- 10.1016/j.cmi.2024.12.024
Authors: Stefan Hatzl et al.,
Highlights
In the network meta-analysis, Clindamycin/Primaquine ranked best (surface-under-the-cumulative-ranking-curve, 0.8), followed by IV Pentamidine (0.8) and TMP-SMX (0.8) regarding treatment failure.
Regarding all-cause-mortality, TMP-SMX was superior to atovaquone in direct comparison, but no treatment was superior in the full network analysis.
Dapsone-TMP (0.7) and IV Pentamidine (0.8) ranked highest for mortality reduction.
For safety and tolerability, comparator drugs consistently outperformed TMP-SMX, with significant reductions in toxicity observed for Dapsone-TMP, inhaled Pentamidine, and Atovaquone. Inhaled Pentamidine (0.9) was the best tolerated, followed by Trimetrexate (0.8) and Atovaquone (0.8).
TMP-SMX should be reassessed as the stand-alone first-line therapy for PCP in People With HIV, given the better tolerability and comparable efficacy of other treatments. In places with access to alternative drugs for PCP treatment, the analysis suggests that alternative regimens may offer comparable effectiveness, providing flexibility to use alternative treatments when comorbidities necessitate it.
Systematic review/Scoping review with large effect size
Decoding community-acquired pneumonia: a systematic review and analysis of diagnostic criteria and definitions used in clinical trials
Citation:- 10.1016/j.cmi.2024.12.028
Authors: Markus Fally et al.,
Highlights
In total, 7,173 records were identified through our searches. After removing records not fulfilling the eligibility criteria, 170 studies were included. Diagnostic criteria were provided in 69.4% of studies, and the term “community-acquired” was defined in 55.3% of studies. The most frequently included diagnostic criteria were pulmonary infiltrates (94.1%), cough (78.8%), fever (77.1%), dyspnoea (62.7%), sputum (57.6%), auscultation/percussion abnormalities (55.9%), and chest pain/discomfort (52.5%). The different criteria were used in 87 different sets across the studies. The term “community-acquired” was defined in 57 different ways.
The diagnostic criteria and definitions of CAP in RCTs exhibit significant heterogeneity. Standardising these criteria in clinical trials is crucial to ensure comparability across studies.
Other specific DSP article suggested by Editorial Board
Diagnostic performance of metagenomic next-generation sequencing among hematological malignancy patients with bloodstream infections after antimicrobial therapy
Citation:- 10.1016/j.jinf.2024.106395
Authors: Yueyi Xu et al.,
Highlights
Antibiotic use reduces the detection rate of mNGS for bloodstream infections.
mNGS is superior to blood culture in detecting pathogens after antibiotic treatment.
The duration of mNGS positivity is linked to septic shock and adverse infection outcomes.
Persistent mNGS positivity may indicate antimicrobial resistance and therapy failure.
Multi-centric observational study with large effect
Microbial Landscape in Cerebrospinal Fluid of Suspected Intracranial Infections Based on Clinical Metagenomics, a Multicentre Retrospective Study
Citation:- 10.1016/j.jinf.2024.106385
Authors: Huili Zhou et al.,
Highlights
The study depicted the pathogen landscape in the cerebrospinal fluid of patients with suspected intracranial infections.
EBV and Anelloviridae, often overlooked viruses, were widely detected in the cohort, and these pathogens exhibited specific neurological imaging abnormalities and were correlated with certain cerebrospinal fluid biochemical and routine test results.
Multi-centric observational study with large effect
Mortality predictors and definition proposal for complicated coagulase-negative Staphylococcus bacteremia. A multicenter prospective cohort study
Citation:- 10.1016/j.cmi.2024.12.016
Authors: Benedetta Varisco et al.,
Abstract
Objective: To explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSI), and to identify predictors for mortality.
Methods: Prospective cohort study conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteremia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteremia assessed.
Results: Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteremia was identified in 240/445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases were 53/240 (22.1%) and 24/205 (11.7%), respectively (p=0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (HR 1.03, 95%CI 1.01-1.05), cerebrovascular disease (HR 2.58, 95%CI 1.45-4.58), immunosuppressive therapy (HR 2.16, 95%CI 1.22-3.84), SOFA score (HR 1.09, 95%CI 1.03-1.16), and complicated bacteremia (HR 2.14, 95%CI 1.29-3.53). A catheter-related source of bacteremia was found to be protective (HR 0.49, 95%CI 0.30-0.80). When specific criteria to define complicated bacteremia were included, fever ≥72h was associated with increased risk of death (HR 2.52, 95%CI 1.52-4.17) and early catheter removal was protective (HR 0.47, 95%CI 0.26-0.83).
Conclusions: A high proportion of patients presented complicated bacteremia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.
Others
Current epidemiology of infectious encephalitis: a narrative review
Citation:- 10.1016/j.cmi.2024.12.025
Authors: Lærke Storgaard Duerlund et al.,
Abstract
The incidence of infectious encephalitis ranged from 1.4 to 13.8 cases per 100,000 per year with a bimodal peak in infants and older adults. Herpes viruses remain the most common causes of sporadic encephalitis with Herpes simplex virus type 1 and Varicella Zoster virus reported most frequently. In endemic regions, arboviruses such as Japanese encephalitis virus and West Nile virus contribute significantly to the disease burden. Climate change is adding to the spread of these vector-borne viruses and thereby both altering the geographic distribution of causative agents and increasing the frequency of outbreaks. Evidence on risk factors associated to encephalitis is scarce and hampered by the absence of population-based case-control studies. The prognosis of infectious encephalitis remains unchanged during recent decades with high case-fatality rates and may vary according to e.g. aetiology, age, and presence of immuno-compromising conditions or other comorbidities. Importantly, a substantial proportion of survivors are left with disabling neurological sequalae.