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Updated Recommendations for Drug-Susceptible and Drug-Resistant Tuberculosis

The authors provide an update of recommendations for the treatment of tuberculosis, including cases with drug resistance. The recommendations include the use of newer drugs that have undergone clinical trials and shorter durations of therapy.

Restricting Remdesivir in an Immune Era: No Harm, Big Savings

A quasi-experimental, eight-hospital, pre-post restriction of remdesivir to only symptomatic, oxygen-requiring, immunocompromised adults during July 2023 to June 2024 led to a 90% reduction in remdesivir use (37.7% to 4.1%) without any increase in 14- or 28-day all-cause mortality, 30-day readmission, or hospital length of stay. Medium- and high-risk covariate models confirmed no mortality signal, while an intriguing rise in intensive care unit admission and mechanical ventilation use among the few post-intervention recipients was most consistent with residual confounding and confounding by indication (i.e., the sickest patients being channeled to receive therapy). In an era of widespread hybrid immunity from Omicron-descended variants, broad remdesivir formulary restriction can be implemented safely and can yield substantial cost savings without compromising outcomes.

Infectious Disease Updates

Do Gowns Help Prevent Transmission of Respiratory Viruses? How to Assess the ‘Wobble’ in Your IGRA?

Fecal Microbiota Transplant as First-Line Therapy for Primary C. difficile Infection

In a randomized controlled trial conducted in Norway, fecal microbiota transplantation (FMT) was noninferior to vancomycin for the treatment of primary Clostridioides difficile infection, with 66.7% of patients in the FMT group achieving clinical cure without recurrence compared to 61.2% in the vancomycin group over 60 days of follow-up.

In Vitro Activity of Newer Antibiotics Against CREs in the United States

The activity of newer beta-lactam/beta-lactamase combination antibiotics depends on the specific type of carbapenemase carried by carbapenem-resistant Enterobacterales.

Second BCG Dose to Prevent Tuberculosis in Adolescents

Despite a previous study raising the hope that giving Bacille Calmette-Guérin (BCG) vaccine to adolescents who previously had received BCG as newborns would better prevent sustained tuberculosis (TB) infections, a new study conclusively demonstrates that revaccination with BCG during adolescence has no statistically significant effect on the incidence of subsequent TB infection or sustained positivity of interferon gamma receptor assay tests.

Effects of COVID-19 on Antimicrobial Resistance in U.S. Hospitals

In a retrospective cohort study, researchers found that antimicrobial-resistant (AMR) infections increased during the COVID-19 pandemic from 182 to 193 per 10,000 hospitalizations. Recent antibiotic exposure, increased illness severity, and comorbidities were associated with AMR infections.

Contaminated Pediatric Blood Cultures

Falsely positive (contaminated) blood culture samples lead to unnecessary antimicrobial use, excessive testing, prolonged hospitalizations, and increased healthcare costs. In pediatric settings, the greatest risk of blood culture contamination is with infants younger than 1 year of age and with children in emergency department settings.

Why Does Colonization Become Active C. difficile?

These authors performed a nested case-control study to identify risk factors for the progression from Clostridioides difficile colonization to active infection in hospitalized persons.

Patients Hospitalized for Non-Severe COVID-19: No Benefit of CAP Antibiotics

A large population-based, retrospective, cohort study found there was no benefit for antibiotics targeting community-acquired pneumonia in patients hospitalized with non-severe COVID-19. These results provide evidence against antibiotic use in this population.