Despite advances in antiretroviral therapy (ART), real-world data remain limited regarding clinical characteristics and healthcare utilization according to ART use among people living with human immunodeficiency virus (PLWH), as well as patterns of ART use in this population. This retrospective cohort study used a US healthcare claims database to identify adult PLWH from 2021 to 2024. Primary cohort included those with ≥3 human immunodeficiency virus (HIV)-1 diagnosis codes within 3 years (third code defined the index date). A nested cohort included PLWH with ≥1 ART prescription claim(s) within 180 days of follow-up. All-cause and HIV-related inpatient hospitalizations and emergency room (ER) visits were assessed before and after index date. Pharmacotherapy change within 180 days after index was assessed for the nested cohort. In the primary cohort of 51,837 PLWH, mean age was 46.5 years; 17.5
Skin and soft tissue infections are common ambulatory infections. Among purulent (suppurative) skin infections, Staphylococcus aureus is responsible for the vast majority. Incision and drainage is a critical part of treatment and adjunctive antibiotics further increase cure rates. Given the rise of antibiotic-resistant S aureus, empiric antibiotics should include coverage for local circulating S aureus strains. Treatment duration is typically 7 days after surgical drainage, assuming adequate clinical response. This article summarizes diagnosis, surgical, and antibiotic management of S aureus skin infections.
INTRODUCTION:Both inactivated influenza vaccine and live attenuated influenza vaccine (LAIV) (indicated for use in children aged 2-17 years) effectively prevent influenza transmission and related outcomes. Despite high transmission among children, vaccination practices in Sweden focus primarily on targeting individuals at higher risk of influenza-related illness and mortality, including older adults. The objective of this study was to assess the cost-effectiveness of increasing LAIV coverage among children aged 2-17 years. METHODS:We developed a de novo health economic model (HEM) that included a dynamic transmission model (DTM) component to estimate population-level outcomes for a typical influenza season in Sweden. The DTM implemented a compartmental structure to model the prevalence of three influenza strains over a 1-year time horizon. The HEM used a decision-tree structure to translate epidemiological outputs into clinical and economic outcomes. The model simulated theoretical vaccination scenarios, comparing a reference scenario based on historical vaccination coverage with an intervention with LAIV in which coverage among children aged 2-17 years was increased from 0.36% to 25%. RESULTS:Increasing the uptake of LAIV in 2-17-year-olds could prevent a further 505,824 influenza infections in a typical season, two-thirds of which would be prevented in the indirect population (adults and children aged < 2 years). The model estimated this to translate into 33,419 fewer cases requiring medical attention, of which 1929 were hospitalizations, ultimately preventing 193 intensive care unit admissions and 99 deaths. The intervention scenario was considered cost-effective from a payer perspective (direct costs only; incremental cost-effectiveness ratio of SEK 73,266 per quality-adjusted life year) and dominant (cost-saving) from a societal perspective. Sensitivity and scenario analyses showed that results were robust to changes in key model parameters, maintaining cost-effectiveness. CONCLUSIONS:In Sweden, the implementation of LAIV is estimated to be cost-effective in 2-17-year-olds by reducing disease burden and healthcare costs in both children and the broader population.
The pneumococcal vaccine landscape now includes multiple vaccines differing in age indications and serotype compositions. While clinical attributes such as effectiveness, safety, and disease coverage are key considerations, healthcare professionals (HCPs) also confront operational aspects of vaccination, such as managing multiple vaccines across pediatric and adult populations which are less well characterized. This study assessed HCP priorities and practical considerations for pneumococcal vaccine selection and the additional serotype coverage required to justify use of an adult-specific vaccine instead of the same vaccine across children and adults. This cross-sectional online survey involved 500 HCPs (physicians, nurses, and pharmacists) from Australia, Canada, France, Mexico, and Taiwan. The perceived importance of pneumococcal vaccination, practical considerations, perceived challenges and benefits of using a single vaccine across age groups versus separate age-specific vaccines, and the serotype coverage difference to justify use of multiple pneumococcal vaccines strategies were assessed. Pneumococcal vaccination was rated as important by 97.6
The purpose of this study was to describe the clinical outcomes in patients with complex infections caused by carbapenem-resistant pathogens who were treated with eravacycline (ERV) containing regimens. A retrospective chart review was conducted at Hospital St. Georg in Leipzig, Germany, a municipal tertiary care center with specialized departments for infectious diseases and tropical medicine, septic surgery, and severe burn injuries, between 1 January 2023 and 31 December 2025. Eight patients (median age 38 years, 75
Machine learning (ML) models have been increasingly applied to support the diagnosis of bloodstream infections (BSI), particularly through the analysis of large routinely collected healthcare datasets. However, it remains uncertain whether large sample sizes alone are sufficient to achieve high diagnostic accuracy. We performed a systematic review and meta-analysis to evaluate the diagnostic performance of ML-based models for BSI in large cohorts. MEDLINE, Embase, and Web of Science were systematically searched from inception to December 31, 2025 (Prospero registration CRD420251080948). We included observational studies evaluating ML models for BSI diagnosis with ≥ 1000 patients or BSI episodes and reporting sufficient data to reconstruct diagnostic accuracy measures. Pooled sensitivity and specificity were estimated using a bivariate random-effects Reitsma model. Secondary analyses included pooled area under the summary receiver operating characteristic curve (SROC-AUC), predictive values, subgroup analyses, and meta-regression. Twenty-four retrospective studies were included. Most studies evaluated adult hospitalized patients and used routinely collected structured data, including laboratory, vital sign, and administrative variables. Tree-based ensemble algorithms were the most commonly used architectures. The pooled sensitivity and specificity were 76.6
The Kingdom of Saudi Arabia (KSA) hosts millions of Hajj and Umrah pilgrims annually, and it aims to welcome 30 million external (international) Umrah pilgrims annually by 2030 (Saudi Vision 2030). These mass gatherings pose significant risks for infectious disease transmission. We extended a previous meta-population model of Neisseria meningitidis transmission during Hajj to include Umrah pilgrimage and assessed the impact of varying vaccination coverage rates (VCRs) among pilgrims on meningococcal meningitis (MM) cases. The model population was divided into five clusters: residents of the pilgrimage sites (Makkah/Madinah); the broader KSA population; and non-KSA populations from high-, medium-, and low-transmission settings. The model incorporated age, pilgrim movement patterns, and VCRs. The model was calibrated with data from 1995 to 2011 and validated with data from 2012 to 2024. MM cases under various vaccination and pilgrim scenarios were simulated for the 2025–2034 period. Umrah accounted for approximately 90
Background: Salmonellosis is a major global public health concern, commonly caused by serovars such as Salmonella enterica serovar Typhimurium and Salmonella enterica serovar Enteritidis. Rare serovars, however, may represent underrecognized links between environmental reservoirs and human infection. Salmonella enterica serovar Haifa is a sporadic serotype primarily associated with livestock and environmental sources and has previously been reported in Indian poultry but not in human clinical cases to date. Case Presentation: A 70-year-old male with a history of type 2 diabetes, presented with acute watery diarrhea and dehydration. One week prior to symptom onset, the patient reported direct contact with cattle and poultry in a rural setting. Laboratory investigations revealed leucopenia and elevated procalcitonin (3.73 ng/mL). Stool culture yielded non-lactose fermenting colonies on MacConkey agar and H2S-producing colonies on Hektoen enteric agar. The isolate was identified via VITEK 2 and confirmed as Salmonella enterica serovar Haifa by the National Institute for Research in Bacterial Infections (NIRBI). Antimicrobial susceptibility testing (AST) revealed that the isolate showed resistance to ampicillin, ceftriaxone, and ciprofloxacin. The patient was successfully treated with a three-day course of intravenous Azithromycin (1 g) and achieved rapid clinical recovery. Conclusions: To the best of our knowledge, this case represents the first reported human infection caused by S. Haifa in India. The finding highlights the potential zoonotic risk of rare non-typhoidal Salmonella serovars and emphasizes the importance of surveillance, routine serotyping, and antimicrobial resistance monitoring within a One Health framework.
This subgroup analysis of the FORTRESS study aimed to evaluate clinical and microbiological outcomes, treatment patterns, and safety of intravenous fosfomycin (FOS)-containing regimens for the treatment of infections due to carbapenem-resistant (CR) Gram-negative bacteria in a real-world setting. Interim data from patients treated with FOS for infections due to CR pathogens were analyzed from the ongoing prospective, multicenter, multinational, observational FORTRESS study. Key outcomes included patient demographics, clinical and infection characteristics at baseline, treatment patterns, and indications of FOS use, as well as clinical, microbiological, and safety outcomes. Exploratory Firth univariate and multivariate logistic regression were performed to identify factors associated with successful clinical response. The subgroup included 161 patients (median age 60 years, 30.4
Borna disease virus 1 (BoDV-1) encephalitis has a (sub)acute and mostly fatal course. Initial flu-like symptoms are typically followed by rapid progressive panencephalitis and death within weeks. No curative therapy exists so far. We present a long-term survivor with distinctive clinical, imaging, and pathophysiological features. A previously healthy male in his fifties was admitted in summer 2023 with (sub)acute encephalitis (cerebrospinal fluid, CSF: 132 cells/µl, no pathogen detection). Brain magnetic resonance imaging (MRI) demonstrated vasogenic edema affecting basal ganglia, temporal and limbic regions bilaterally. Despite high-dose steroids, the clinical condition of the patient slowly worsened. Three months later, BoDV-1 reactive antibodies were detected by elevated titers in CSF (1:320) and serum (1:5120). Treatment with favipiravir, corticosteroids, and mycophenolate mofetil (MMF) was initiated. After recovery for months, the patient developed progressive bilateral optic atrophy, cognitive decline, and a sleep disorder resembling Kleine–Levin syndrome. Translocator protein (TSPO)-PET revealed widespread microglial activation, confirmed by targeted cortical biopsy. Immunosuppressive therapy was escalated with anakinra, cyclophosphamide, and intrathecal dexamethasone, achieving temporary stabilization. In the summer of 2025, a severe brainstem syndrome emerged, accompanied by increased TSPO uptake in the brainstem and detection of BoDV-1 RNA in CSF for the first time. Despite another treatment with favipiravir and high-dose corticosteroids, the patient remained in a minimally conscious state. This exceptional case with long-term survival in BoDV-1 encephalitis gives important insights: BoDV1-associated neuroinflammation leading to a slowly progressive decline can be visualized by TSPO-PET. Late BoDV-1 RNA detection and subacute re-exacerbation after prolonged survival provides evidence that BoDV-1 persists in human brain tissue.
Estimating attributable risk (AR) through self-controlled case series (SCCS) analyses alone may limit generalizability because SCCS only incorporate vaccinated patients with the outcome (e.g., Guillain-Barré syndrome [GBS]) who may differ from the recommended vaccinee population. We aimed to demonstrate background event incidence rates’ impact on vaccine-specific GBS ARs and to standardize ARs across different vaccine studies by applying a generalizable, population-based GBS background rate to better estimate the expected population-level ARs. We identified post-licensure SCCS vaccine studies and GBS background rates using US Medicare data via targeted literature review. GBS control period rates from SCCS vaccine studies were extracted or calculated. Population-level ARs were calculated for each vaccine using two published and two hypothetical background GBS rates and the original SCCS-generated incidence rate ratios (IRRs). Published vaccine-specific GBS IRRs ranged from 2.02 (95
Infection is a common and potentially fatal complication during the treatment of hematological diseases, particularly in the context of chemotherapy-induced immunosuppression. The nonselective use of antibiotic prophylaxis in patients with neutropenia in China has persistently accelerated antimicrobial resistance. Early identification of patients at high risk for infection before clinical symptom onset could enable targeted preventive strategies; however, reliable and biologically informed screening approaches remain limited. We developed a prediction model for infection risk stratification in newly diagnosed patients with hematological conditions. Plasma metagenomic next-generation sequencing was performed in a prospective cohort of 230 patients. Among them, 116 patients provided prechemotherapy, non-neutropenic plasma samples (cohort A), and 114 patients provided postchemotherapy, neutropenic samples (cohort B). Microbial community profiles were analyzed, and machine learning approaches were applied to construct classifiers for neutropenia status and subsequent infection risk. Plasma metagenomic profiling revealed a complex microecological landscape in patients with hematological conditions and identified distinct microbial features associated with neutropenia. A trained random forest classifier successfully distinguished patients without neutropenia from patients with neutropenia, achieving an area under the receiver operating characteristic curve of 0.8324. Importantly, a microorganism-based random forest model was established to predict patients at high risk of infection, yielding an area under the curve of 0.942. Nested cross-validation demonstrated high classification accuracy, correctly identifying 99.1
Most people with HIV (PWH) achieve immune recovery with antiretroviral therapy (ART); however, a clinically relevant subset, known as immune non-responders (INRs), fails to restore CD4+ T-cell counts despite sustained virological suppression and shows persistent immune dysfunction. Growth differentiation factor 15 (GDF-15), a stress-responsive cytokine associated with inflammation, aging, chronic disease, and multimorbidity, has not been characterized across distinct HIV viro-immunological phenotypes. We conducted an exploratory cross-sectional study including 80 PWH classified as ART-naïve individuals, virally suppressed INRs, elite controllers (ECs), and ART-treated immune responders (IRs), as well as 20 HIV-negative controls. Plasma GDF-15 levels were measured by immunoassay. Associations with log-transformed GDF-15 concentrations were assessed using multivariable linear regression including age, CD4+ T-cell nadir, and INR status. INRs showed the highest plasma GDF-15 levels (median, 1143.9 pg/ml), significantly exceeding those observed in ART-naïve individuals, ECs, IRs, and HIV-negative controls (all p ≤ 0.002). GDF-15 levels correlated positively with age, time since HIV diagnosis, and ART duration, and inversely with CD4+ T-cell nadir and the CD4/CD8 ratio (all p ≤ 0.001). In adjusted analysis, INR status remained independently associated with higher log-transformed GDF-15 levels (β = 0.271, 95
Mycobacterial skin and soft tissue infections (SSTIs) represent a diagnostically challenging and heterogeneous group of diseases caused by nontuberculous mycobacteria (NTM), M tuberculosis complex, and M leprae. This review will focus on SSTIs caused by NTM. Rapidly growing mycobacteria predominate in iatrogenic and health care-associated infections, while M marinum and M ulcerans are linked to aquatic exposure. Diagnostic delay remains a universal challenge due to nonspecific presentations and the need for specialized laboratory techniques. Treatment requires pathogen-specific combination regimens. This review summarizes the epidemiology, clinical manifestations, diagnostic approach, and treatment strategies of mycobacterial SSTIs, with emphasis on NTM.
