Infectious Diseases

SMI linked to higher infection mortality, especially respiratory and gastrointestinal

In a UK population cohort of 84,494 adults with severe mental illness (SMI) matched to controls, SMI increased infection mortality (aHR 1.58). Risk was largest for gastrointestinal infections (aHR 2.01) and elevated for respiratory (aHR 1.69) and renal/urinary infections (aHR 1.70). Authors recommend prioritizing preventative measures, including influenza and pneumococcal vaccines, for adults with SMI. Applicability is to adults with SMI in UK primary-care–linked populations; unmeasured confounding remains possible. 1

Antibiotic decisions need more than culture susceptibility alone

This review warns that blind adherence to culture and susceptibility reports can cause therapeutic failure and resistance propagation. It emphasizes integrating microbiology with pharmacokinetics/pharmacodynamics, site-specific drug penetration, and host factors. Clinicians should distinguish colonization from infection and recognize intrinsic or inducible resistance before altering therapy. Practical application: use susceptibility data as one input among PK/PD, guideline recommendations, and the clinical trajectory. 2

Prognostic factors associated with mortality in necrotizing soft‑tissue infection

Systematic review and meta-analysis of 41 cohorts (168,261 patients) identified higher mortality with older age and higher Charlson index. Chronic liver disease, chronic kidney disease, and immunosuppression were associated with increased mortality. Disease severity markers—hypotension, bacteremia, AKI, coagulopathy, thrombocytopenia, and shock—also predicted death and should prompt escalation. Most included studies were retrospective cohorts; use these factors to inform escalation and family counseling, not as sole determiners of care. 3