Other specific DSP article suggested by Editorial Board
Non-typhoidal Salmonella Infections: Clinical Spectrum and Antimicrobial Susceptibility from Western India (2022-2025).
Authors: Panda JP, et al
Abstract
Background: Non-typhoidal Salmonella (NTS) causes illnesses ranging from gastroenteritis to invasive bloodstream infection, particularly in vulnerable hosts. Here the clinical profile and antimicrobial susceptibility of NTS isolates recovered at a tertiary-care hospital in Navi Mumbai is described.
Methods: A retrospective case series of consecutive NTS isolates recovered from blood and stool was conducted between January 2022 and December 2025. Identification and MIC-based susceptibility testing were performed using automated platforms; azithromycin and chloramphenicol were tested by gradient diffusion or disc diffusion. Results were interpreted according to CLSI M100.
Results: Eighteen isolates were recovered from 17 patients (15 blood and 3 stool). The median age of patients with invasive infection was 57 years (range, 0.5-84). Among adults with invasive NTS (n=12), 11 (91.7%) had comorbidities. Three invasive cases occurred in children aged 6 months to 2 years; one had a structural urinary tract abnormality. Among invasive cases, 7/15 (46.7%) required intensive care, 3/15 (20.0%) developed septic shock, and 5/15 (33.3%) developed acute kidney injury. No in-hospital mortality occurred; one late death was unrelated to the index episode. Ciprofloxacin non-susceptibility occurred in 6/15 (40.0%) blood isolates, comprising 2 intermediate and 4 resistant isolates; one of three stool isolates was intermediate. One blood isolate was ceftriaxone-resistant with a presumptive ESBL phenotype detected by VITEK 2 AES. All isolates were susceptible to meropenem and trimethoprim-sulfamethoxazole. All tested isolates were susceptible to chloramphenicol (15/15). Azithromycin results (15/15) fell within the susceptible range using S. Typhi criteria because NTS-specific CLSI breakpoints are unavailable.
Conclusions: In this small single-centre series, most adults with invasive NTS had comorbidities, and bloodstream infections were frequently severe. Ciprofloxacin non-susceptibility and a ceftriaxone-resistant isolate with a presumptive ESBL phenotype support culture-guided therapy, local antibiogram review, antimicrobial stewardship, and continued surveillance.
Other specific DSP article suggested by Editorial Board
Impact of an Antimicrobial Stewardship intervention on clinical and economic outcomes in Outpatient Parenteral Antimicrobial Therapy (OPAT) for urinary tract infections: a quasi-experimental study.
Authors: Gómez-Zorrilla S, et al.
Abstract
Introduction: Urinary tract infections (UTIs) are a common indication for Outpatient Parenteral Antimicrobial Therapy (OPAT) and often involved prolonged intravenous (IV) treatments. A theory-informed Antimicrobial Stewardship (AMS) intervention was implemented to optimize antibiotic duration and promote IV-to-oral switching in OPAT patients with UTIs.
Methods: This pre-post quasi-experimental single-center study included adults with UTIs managed through OPAT. The intervention was designed using behaviour change techniques, and structured as a bundle of quality improvement strategies to optimize antibiotic prescribing. Primary outcomes: [1] the proportion of patients receiving appropriate treatment duration and [2] the proportion of those with microbiological confirmation and an oral option, who were switched to oral. Secondary outcomes: adverse events, 90-day recurrence and readmission, healthcare resource consumption.
Results: 314 patients were included. Post-intervention patients were more often male, and with a history of recurrent UTI. Other baseline characteristics were comparable. Appropriate antibiotic duration increased from 44.4% (baseline) to 83.3% (intervention period) (p≤0.001), IV-to-oral switch rates from 62.8% to 85.7% (p≤0.001). In adjusted analyses, the intervention was independently associated with appropriate duration (OR 6.70, 95% CI 3.79-11.85), IV-to-oral switching (OR 3.57, 95% CI 1.56-8.19), fewer 90-days UTI recurrences (OR 0.41, 95% CI 0.21-0.80) and no increase in 90-days readmissions. A significant reduction in healthcare cost was achieved with a median difference of -648.8€ (95% CI -1050.0 to -247.7). Conclusions: A structured AMS intervention for UTIs in OPAT improved appropriate antibiotic duration, increased IV-to-oral switching, and reduced healthcare costs without compromising clinical safety. Behavior-informed stewardship strategies can optimize antimicrobial use in OPAT care.
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Development of the Susceptibility-Spectrum Discrepancy Index (S2DI): A novel metric for antimicrobial stewardship in hospitalised patients.
Authors:Tsuzuki S, et al.
Abstract
Objectives: Optimising parenteral antimicrobial use is central to antimicrobial resistance control, yet its appropriateness is difficult to assess. The aim was to develop a quantitative indicator to evaluate the appropriateness of parenteral antimicrobial therapy in hospitalised patients with bloodstream infections.
Methods: The Susceptibility-Spectrum Discrepancy Index (S2DI) was developed , reflecting the discrepancy between antimicrobial susceptibility of blood culture isolates and the spectrum width of prescribed agents. Using a database from 67 National Hospital Organization hospitals in Japan, we identified patients with Staphylococcus aureus or Escherichia coli bacteraemia from 2017 to 2023. An expert panel of 10 infectious disease physicians independently ranked antimicrobial susceptibility (A) and spectrum width of commonly used agents (B). S2DI was defined as B minus A on day 7 after treatment initiation, with values closer to zero indicating more appropriate therapy. S2DI was calculated for individual cases, aggregated at the hospital level, and analysed using linear mixed-effects models with hospital-level random effects.
Results: A total of 4,505 S. aureus and 9,563 E. coli bacteraemia cases were included. Median S2DI was 1 (IQR 0-1) for S. aureus and 2 (IQR 0-3) for E. coli. For both pathogens, later calendar years were significantly associated with more favourable S2DI, suggesting gradual improvement in antimicrobial use. In E. coli bacteraemia, female sex and younger age were also associated with more appropriate therapy.
Conclusions: Although variation across hospitals persists, appropriateness of parenteral antimicrobial use has improved over time. S2DI is a simple metric that may support optimisation of antimicrobial use.
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Single-dose ceftriaxone plus 7-day doxycycline versus single-dose benzathine penicillin G plus 7-day doxycycline in the treatment of early syphilis in people with HIV: a pilot randomized noninferiority trial
DOI: 10.1093/ofid/ofag483
Authors: Tzong-Yow Wu
Abstract
Background: Both ceftriaxone (CRO) and doxycycline demonstrate activity against Treponema pallidum and bacteria causing sexually transmitted infections (STIs); however, the efficacy of their combination in a shorter duration remains unclear. We compared single-dose, 1-g CRO plus 7-day doxycycline (CRO/Doxy) with single-dose, 2.4-MU benzathine penicillin G plus 7-day doxycycline (BPG/Doxy) in treating early syphilis among people with HIV (PWH).
Methods: In this pilot randomized clinical trial, eligible participants were randomized to receive CRO/Doxy or BPG/Doxy. Rapid plasma reagin (RPR) titers were determined at baseline and at weeks 4, 12, 24, 36 and 48. PCR assays were conducted at baseline and at week 4 to detect T. pallidum and other STI-causing bacteria in oral rinse, urethral swab, and rectal swab samples to assess microbiologic responses. The primary outcome was the serologic responses of syphilis, defined as a 4-fold or greater decline of RPR titer at week 24.
Results: From March 2023 to September 2024, 56 and 53 PWH with early syphilis were randomized to receive CRO/Doxy and BPG/Doxy, respectively. At baseline, 31.2% (n=34) had chlamydia, 13.8% (n=15) gonorrhea, and 6.4% (n=7) Mycoplasma genitalium coinfection. In the ITT analysis, compared to the participants receiving BPG/Doxy, those receiving CRO/Doxy showed lower serologic response rate at 24 weeks (60.7% vs 75.5%; difference, -14.8 percentage points; 95% CI, -32.0 to 2.5). The microbiologic response rates of syphilis, chlamydia and M. genitalium infection were comparable between groups.
Conclusion: In the ITT analysis, CRO/Doxy was not noninferior to BPG/Doxy for early syphilis treatment among PWH at 24 weeks.”
Other specific DSP article suggested by Editorial Board
Similar Efficacy, Safety, and Immune Improvement Through 96 Weeks in Individuals With Limited HIV-1 Treatment Options Using Twice-Daily Dolutegravir- or Fostemsavir-Based Regimens
DOI: 10.1093/ofid/ofag487
Authors: Antonella Castagna
Abstract
Abstract: Constructing suppressive regimens for individuals with multidrug-resistant HIV-1 can be challenging. Separate analyses of 96-week outcomes from the phase 3 VIKING-3 and BRIGHTE studies demonstrate that twice-daily dolutegravir-based and fostemsavir-based regimens each provide robust viral suppression, favorable safety profiles, and CD4+ T-cell count improvement in this population.
Other specific DSP article suggested by Editorial Board
Rising Incidence of NDM-Producing Carbapenem-Resistant Enterobacterales, 10 U.S. Sites, 2018-2023
DOI: 10.1093/ofid/ofag477
Authors: Nadezhda Duffy
Abstract
Background:We described the changing epidemiology of New Delhi metallo-β-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) in 10 U.S. sites conducting population-based CRE surveillance during 2018–2023.
Methods: A CRE case was defined as the first isolation of Escherichia coli, Enterobacter spp., or Klebsiella spp. resistant to ≥1 carbapenem from a sterile site or urine in a surveillance-area resident within a 30-day period. Cases were classified as healthcare-associated or community-associated. Incidence rates were calculated using census data; trends were assessed using the Mann–Kendall test. Multivariable logistic regression was used to compare NDM- and Klebsiella pneumoniae carbapenemase-producing (KPC)-CRE. A subset of isolates underwent whole genome sequencing.
Results: During 2018-2023, CRE incidence increased from 5.34 to 7.65 per 100,000 population (P=0.02). NDM-CRE incidence increased from 0.07 to 0.66 per 100,000 population (P=0.02); no significant trend was observed for KPC-CRE. Odds of being an NDM-CRE case were increased for community-associated versus healthcare-associated cases (adjusted odds ratio [aOR], 3.2; 95% confidence interval [CI], 1.98–5.17) and for cases aged 0–24 years versus ≥75 years (aOR, 3.99; 95% CI, 1.59–10.02). Genomic analysis showed diversity of sequence types among NDM- versus KPC-CRE.
Conclusions: Increases in CRE incidence appear to be driven by NDM-CRE, which are more likely than KPC-CRE to be community-associated. Continued surveillance is recommended to understand changes in epidemiology.”
Other specific DSP article suggested by Editorial Board
A Randomized, Double-Blind Clinical Trial of One vs. Two Doses of High-Dose Influenza Vaccine in Solid Organ Transplant Recipients
DOI: 10.1093/ofid/ofag494
Authors: Kevin Escandón
Abstract
Background: Solid organ transplant recipients (SOTRs) exhibit suboptimal immune responses to standard-dose (SD) influenza vaccines. High-dose (HD) vaccines and booster strategies show promise but the optimal vaccination approach for SOTRs remains undefined. We sought to evaluate a double vs. a single HD influenza vaccine regimen, with the hypothesis that the double HD would yield superior immunogenicity.
Methods: This randomized clinical trial during the 2023–2024 and 2024–2025 influenza seasons compared the immunogenicity, clinical outcomes, and safety of 2 HD one month apart vs. 1 HD influenza vaccines in 65 adult SOTRs at the University of Minnesota. The study comprised three visits: baseline, 1-month follow-up, and 4-month follow-up.
Results: The primary analysis showed greater but no statistically significant geometric mean fold rises (GMFRs) of ID80 neutralizing and binding antibody titers from baseline to 4-month follow-up in the 2 HD group compared with the 1 HD group. However, exploratory analyses focusing on the period before to after the second injection (1 month to 4 months) showed statistically significant differences in GMFRs for both ID80 neutralizing and binding titers of most strains when comparing the 2 groups. Two participants from the 1 HD group developed laboratory-confirmed influenza. Adverse event frequency was balanced between groups, with reactogenicity symptoms within 7 days of injection being grade 1.
Conclusions: While a single HD vaccine provides an initial immune response, an HD booster appeared to improve overall immune responses to influenza strains contained in the vaccine formulation, although confirmation in larger adequately powered studies is needed.”