Infectious Diseases

Completed TB preventive therapy in PLWH on ART sharply lowers TB diagnoses in Mozambique

In Mozambique, 341,844 persons with HIV recently starting ART were assessed for subsequent TB diagnoses by TB preventive therapy (TPT) status. TB incidence was 3.1 per 1,000 person-years after completed TPT, versus 11.0 with incomplete TPT and 21.6 with no TPT. Completed TPT thus correlated with roughly seven-fold lower TB diagnosis rates compared with no TPT. These data strongly support scaling, monitoring, and ensuring completion of TPT as a core element of national TB/HIV programs. 1

Jail-based HCV test, treat, and navigate strategy is highly cost-effective for PWID

A dynamic network model of 1,552 people who inject drugs simulated jail-community HCV transmission and interventions over 60 years. Without jail-based strategies, projections included 21,349 person-years of infection, 662 incident infections, and 240 HCV deaths per 1,000 PWID. Combined jail entry testing, in-jail treatment, and post-release navigation reduced person-years of infection by 35%, incidence by 47%, and deaths by 40%. This strategy’s incremental cost-effectiveness ratio was $11,000 per QALY versus no jail intervention, far below common US thresholds. Adding treatment and navigation outperformed testing alone and remained favorable across sensitivity analyses, supporting correctional HCV scale-up. 2

Ceftazidime–avibactam and meropenem–vaborbactam show similar mortality but different resistance profiles in KPC infections

In a propensity-score–weighted cohort of 73 patients with KPC-producing Enterobacterales infections, 30-day mortality was similar between ceftazidime–avibactam and meropenem–vaborbactam. However, resistance emerged more often with ceftazidime–avibactam (12%) and not with meropenem–vaborbactam (0%). Reported ceftazidime–avibactam resistance mechanisms included porin mutations in Klebsiella pneumoniae and R2-loop structural changes in AmpC for Enterobacter cloacae complex. These findings suggest meropenem–vaborbactam may be preferable when resistance emergence is a major concern. 3

Real-time stewardship for early oral step-down safely shortens therapy in uncomplicated non-staph bacteremia

A quasi-experimental stewardship intervention promoted early IV-to-oral switch for uncomplicated non-staphylococcal bloodstream infections over two 4-month periods. Among eligible patients, oral transition rates increased from 59% before intervention to 93% after implementation. Ninety-day clinical failure remained 7% in both groups, indicating no observed harm from greater oral use. Mean total antibiotic duration decreased from 12.15 to 10.76 days, while length of stay, readmissions, and adverse events were unchanged. 4