Top 5 Infectious Disease News Stories Week of November 16-22

Oral Vancomycin Reduces CDI by 64% in Stem Cell Transplant Patients

A recent study demonstrated that oral vancomycin prophylaxis (OVP) significantly reduces the incidence of Clostridioides difficile infection (CDI) in autologous stem cell transplant (ASCT) recipients during hospitalization, without increasing the risk of infection after discharge. Conducted at a single institution, the study followed 254 ASCT patients from January 2012 to December 2021. Those who received OVP (125 mg twice daily) had a 4% CDI rate, compared to 11% in the non-OVP group, with a p-value of 0.03. No increased risk of CDI was observed in the 180 days after discharge. The study also identified longer hospital stays as a contributing factor to higher CDI risk. Lead investigator Michael Williams, PharmD, noted that while OVP reduced in-hospital CDI rates, concerns about long-term antibiotic resistance and microbiome disruption remain. These findings support OVP as an effective strategy for preventing CDI in ASCT patients and potentially other immunocompromised populations, especially those with neutropenia. Further research, including randomized controlled trials, is needed to refine treatment protocols and explore broader applications.

Biktarvy Shows Long-Term Efficacy and Safety in HIV/HBV Coinfection After Three Years

A recent analysis from the ALLIANCE Phase III study, presented at the 2024 HIV Glasgow Conference, highlighted the long-term efficacy and safety of Biktarvy, a TAF-based regimen, for treating adults with HIV/HBV co-infection. After three years of treatment, Biktarvy showed sustained high rates of HIV-1 RNA suppression (99%) and HBV DNA suppression (80.2%) at Week 144. The study also demonstrated superior Hepatitis B suppression with faster and higher rates of HBeAg seroconversion, ALT normalization, and S antigen loss compared to a TDF-based regimen. Principal investigator Dr. Anchalee Avihingsanon noted that Biktarvy was well-tolerated, with 32% of patients reporting mild to moderate side effects and only 1% discontinuing due to adverse events. These findings suggest Biktarvy may be a promising long-term treatment for HIV/HBV co-infected patients, though further studies are needed, particularly for those with severe liver conditions. The results emphasize the importance of early antiretroviral therapy (ART) initiation for optimal outcomes in co-infected individuals.

Preventing Foodborne Illness: A Closer Look at the Recent E coli Outbreak

In a recent interview, Nicole M. Iovine, MD, PhD, an infectious disease expert, discussed the risks associated with E. coli O121, the strain linked to a recent outbreak involving organic carrots from Grimmway Farms. This strain can cause severe illness, including kidney failure and hemolytic uremic syndrome (HUS), and antibiotics can worsen the infection. Iovine highlighted that organic farming practices, particularly the use of compost and manure, may contribute to foodborne contamination. While organic farming avoids chemical pesticides, improper manure handling can introduce harmful pathogens. She emphasized the importance of proper food safety practices, such as washing produce, peeling when possible, and maintaining good hand hygiene, especially for vulnerable populations like children, the elderly, and immunocompromised individuals. Iovine stressed the need for vigilance in food handling to prevent foodborne illness.

Climate Change Responsible for 19% of Today’s Rising Dengue Incidence Rates

A new study presented at the 2024 American Society of Tropical Medicine and Hygiene meeting highlights the growing threat of dengue as a vector-borne disease worsened by climate change. Led by Erin Mordecai from Stanford University, the research links rising temperatures to increased dengue infections, with climate change responsible for 19% of current cases. The study predicts a 40%-60% rise in global dengue cases over the next 25 years, with some regions, including parts of Peru, Brazil, and Mexico, facing a 150%-200% spike. Areas entering the optimal temperature range for dengue transmission are at the highest risk, and new regions, such as parts of the U.S., may experience increased local transmission. The study emphasizes the need for enhanced surveillance and proactive public health strategies to combat the spread of dengue in the face of climate-induced temperature shifts.

7-Day Antibiotic Regimen Found Noninferior to 14-Day Treatment for Bloodstream Infections

The BALANCE trial, a large randomized controlled study, found that a 7-day antibiotic regimen for bloodstream infections is as effective as the traditional 14-day treatment, with no significant difference in 90-day mortality. Involving over 3,600 patients across 74 hospitals, the trial demonstrated that shorter treatment durations could reduce healthcare costs, lower the risk of antimicrobial resistance, and provide a viable option for critically ill patients, including those in ICUs. Despite some non-adherence, the results support using a 7-day course as a non-inferior alternative to longer treatments, aligning with antibiotic stewardship goals and the CDC's efforts to reduce unnecessary antibiotic use.