Infectious Diseases

Rapid AST for gram-negative bacteremia did not improve 30-day global outcomes

In this 7-center randomized trial of 850 patients with gram-negative bacteremia, rapid phenotypic AST plus standard testing did not improve DOOR at day 30. The probability of a more favorable DOOR with rapid testing was 48.8% (95% CI, 45.3%-52.4%), below the predefined superiority threshold. Median time to effective therapy within 3 days was similar between groups, despite faster susceptibility reporting. Rapid AST accelerated antibiotic escalation or de-escalation by about 14 hours, without differences in mortality, ICU use, or length of stay. 1

Antifungal therapy lowered 60-day mortality in COVID-19–associated pulmonary aspergillosis

This European multicenter cohort included 259 ICU patients with probable or proven COVID-19–associated pulmonary aspergillosis. Most patients (91.5%) received antifungal therapy, predominantly azoles, with baseline characteristics similar between treated and untreated groups. Antifungal treatment was associated with substantially lower 60-day mortality (HR 0.31, 95% CI 0.17-0.59); weighted analysis showed HR 0.28 (95% CI 0.13-0.58). Older age, immunosuppressive treatment, and remdesivir administration were independently associated with higher mortality, whereas male sex was protective. 2

SARS-CoV-2 antigen self-testing improved case detection with acceptable accuracy and strong uptake

This systematic review and meta-analysis included 61 studies (87 datasets) with over 25 million participants using commercial SARS-CoV-2 antigen self-tests. Self-testing detected 31 cases per 1000 individuals, missing an estimated 14% compared with molecular testing. Overall test positivity was 7 per 1000, and false positives occurred in 0.4% of tests, indicating good specificity in most settings. Number needed to test was 75 for symptomatic and 1002 for asymptomatic individuals, underscoring reduced efficiency in low-prevalence screening. 3

Stopping CMV antivirals at <200 IU/mL safely shortened therapy after kidney transplant

This retrospective cohort of 1048 CMV IgG–positive kidney recipients compared two DNAemia thresholds for ending preemptive antiviral therapy. Using a higher discontinuation threshold (<200 IU/mL) shortened time to treatment withdrawal (23 vs 27 days; P<0.001) compared with requiring undetectable DNAemia. CMV recurrence and disease rates were similar between periods (12.2% vs 10.8%), as were refractory CMV, acute rejection, and graft function. Recurrences occurred slightly earlier with the higher threshold, but only older donor age and earlier CMV onset predicted recurrence. 4