Isavuconazole (ISA) is a newer triazole that has activity against most mold species and has been utilized for prophylaxis as well as treatment in patients with hematologic malignancies (HM) and hematopoietic stem cell transplant (HSCT). However, several studies have documented breakthrough invasive fungal infections (bIFIs). Thus, we conducted a systematic review and meta-analysis to investigate the incidence of bIFIs among patients receiving ISA prophylaxis.MethodsWe conducted a systematic review and meta-analysis of the published literature using the concept of ISA, HSCT, and HM from 5 search engines. In patients with HSCT and HM, the pooled incidence of bIFI while undergoing ISA prophylaxis was calculated via the DerSimonian-Laird random effect model.ResultsThe systematic review and meta-analysis included 35 and 19 studies, respectively. In total, 991 patients were identified as using ISA prophylaxis, and the majority had either acute myeloid leukemia or myelodysplastic syndrome (69.9%). The pooled incidence of proven/probable bIFI was 7% (95% CI, 4%–12%, I2 = 55%). The most common pathogen was Aspergillus species (43.1%), followed by Candida (22.4%) and Mucorales (12.1%). In 19 studies, mortality rates were documented and ranged between 0% and 100%; the majority of which were >50%.ConclusionsIn patients with HM or HSCT, we found a high incidence of bIFI while undergoing ISA prophylaxis, with high mortality. Given the lack of randomized clinical trials evaluating ISA in this indication, its role in prophylaxis remains unclear.

Vaccine immunogenicity is reduced in kidney transplant recipients (KTRs), especially in those using mycophenolate mofetil (MMF). Whether replacement of MMF by everolimus improves vaccine immunogenicity is unknown.MethodsKTRs were randomized 1:1 to continue MMF or switch to everolimus. Participants received one coronavirus disease 2019 (COVID-19) booster vaccination and two herpes zoster (HZ) vaccinations at 6, 10 and 14 weeks postrandomization. Primary outcome was the neutralizing antibody response 28 days after COVID-19 vaccination. Secondary outcomes included antibody and T-cell responses 28 days after COVID-19 and HZ vaccination, and safety.ResultsIn 110 KTRs, COVID-19 vaccination resulted in comparable Omicron XBB.1.5 neutralizing antibody titers in the everolimus versus MMF group (308 [74.4–1314] vs 327 [115–897]; P = .83), whereas severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Spike-specific T-cell responses were slightly lower with everolimus (118 [32.1–243] vs 228 [113–381] spot-forming cells [SFCs]/106 peripheral blood mononuclear cells [PBMCs]; P = .02). HZ vaccination led to higher varicella zoster virus (VZV) glycoprotein E (gE)–specific immunoglobulin G titers with everolimus (2192 [888–4523] vs 1101 [440–2078] 50% endpoint titer; P = .004), while VZV gE-specific T-cell responses were similar (85.0 [27.5–155] vs 115 [50.0–258] SFCs/106 PBMCs; P = .24). Besides known side effects, everolimus led to more bacterial infections (27.3% vs 11.1%; P = .03).ConclusionsSix weeks’ replacement of MMF by everolimus in KTRs does not improve COVID-19 booster vaccine immunogenicity, whereas 10 weeks’ replacement enhances humoral HZ vaccine immunogenicity. While replacing MMF by everolimus may improve vaccine responses, its timing and potential risks require careful consideration.

Patients with overt immunosuppression are at risk of cytomegalovirus infection, which can lead to, or develop during, ICU admission. Learn more about its broad clinical presentations, risk factors…

By studying the bone marrow aspiration samples of 20 individuals with prior coronavirus disease 2019, we showed deficient generation of spike-specific long

Invasive fungal infections, significantly impact hospitalized and immunocompromised populations. Recent trends showed a shift from Candida albicans to non-albicans Candida (NAC) species, raising concerns about antifungal resistance.ObjectivesOur study focuses on the distribution of fungal species in blood cultures obtained from different healthcare settings, including hospitals, long-term care facilities, and community health centers in the Venetian region of Italy.MethodsWe retrospectively analyzed all consecutive blood culture isolates across 5 hospitals, 38 long-term care facilities, and 24 sample collection centers (blood exams and culture) from 2019 to 2023.ResultsBetween 2019 and 2023, 11,552 microorganisms were isolated from blood cultures; 693 (6.0%) were fungi. The yearly prevalence ranged from 5.2% in 2019 to 6.1% in 2023. C. albicans isolates decreased significantly, from 60.0% in 2019 to 43.1% in 2023. NAC species showed significant growth, particularly C. parapsilosis sensu stricto (from 23.6% in 2019 to 28.8% in 2023), C. tropicalis (from 0.0% in 2019 to 7.2% in 2023), and N. glabratus (from 9.1% in 2019 to 11.8% in 2023). Medical wards consistently recorded the highest number of cases (429/693, 61.9%), with C. albicans predominating in earlier years. Resistance to amphotericin B rose sharply in C. parapsilosis ss. (22.5% in 2022), while fluconazole resistance in N. glabratus remained high (peaking at 85.7% in 2021).ConclusionThe increasing dominance of NAC species and rising resistance trends underscore the necessity for enhanced diagnostics, infection prevention, and antifungal stewardship. Future research should incorporate clinical data to optimize fungemia management strategies.

Researchers have identified strains of one of the world's most dangerous pathogens that are five times more likely to acquire antifungal resistance.

Doubts remain about the best treatment for managing premalignant lesions (HSIL) associated with anal cancer.

Abstract. Based on expert consensus, the American Society of Transplantation recommends 7–14 days of preventive antibiotic therapy for solid organ transpla

In an acute care hospital, 6 of 108 (5.6%) fidaxomicin-treated patients with Clostridioides difficile infection were infected with isolates with reduced fi

Despite increasing burden of injecting-related bacterial and fungal infection, there has been no recent synthesis of their epidemiology. We performed a systematic review and meta-analysis evaluating prevalence and incidence of injecting-related infection among people who inject drugs.

Measles, mumps, and rubella (MMR) vaccine is a live-attenuated vaccine usually contraindicated within the first 2 years of hematopoietic cell transplant (HCT). The objective of this study was to asses...

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If you’re an ID doctor, there’s a lot to be grouchy about these days. This. This. THIS! The list is long — and growing. Longtime readers with an interest in ID: I ask that you please contact your memb...

We report the detection of a clade 2.3.4.4b A(H5N1) reassortant virus with a neuraminidase surface protein derived from a North American lineage low-pathogenic avian influenza virus. This virus cau...

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Please see my separate post from today for this week’s government updates at https://drruth.substack.com/p/special-issue-government-updates-096.

The decision offers patients with antimicrobial resistance, who have limited or no treatment options, a new alternative.

ALT: a newspaper that says daily prophet on the top of it