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BackgroundPeople living with human immunodeficiency virus (HIV) may have numerous risk factors for acquiring coronavirus disease 2019 (COVID-19) and developing severe outcomes, but current data are conflicting.MethodsHealth-care providers enrolled consecutively, by nonrandom sampling, people living with HIV (PWH) with lab-confirmed COVID-19, diagnosed at their facilities between 1 April and 1 July 2020. Deidentified data were entered into an electronic Research Electronic Data Capture (REDCap) system. The primary endpoint was a severe outcome, defined as a composite endpoint of intensive care unit (ICU) admission, mechanical ventilation, or death. The secondary outcome was the need for hospitalization.ResultsThere were 286 patients included; the mean age was 51.4 years (standard deviation, 14.4), 25.9% were female, and 75.4% were African American or Hispanic. Most patients (94.3%) were on antiretroviral therapy, 88.7% had HIV virologic suppression, and 80.8% had comorbidities. Within 30 days of testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 164 (57.3%) patients were hospitalized, and 47 (16.5%) required ICU admission. Mortality rates were 9.4% (27/286) overall, 16.5% (27/164) among those hospitalized, and 51.5% (24/47) among those admitted to an ICU. The primary composite endpoint occurred in 17.5% (50/286) of all patients and 30.5% (50/164) of hospitalized patients. Older age, chronic lung disease, and hypertension were associated with severe outcomes. A lower CD4 count (ConclusionsSevere clinical outcomes occurred commonly in PWH with COVID-19. The risks for poor outcomes were higher in those with comorbidities and lower CD4 cell counts, despite HIV viral suppression.Clinical Trials RegistrationNCT04333953.

We assessed whether implementation of matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry without antimicrobial stewardship support would impact antimicrobial utilization and clinical outcomes in inpatient pneumonia. Implementation significantly reduced time to organism identification and time to optimal therapy but did not have a detectable impact on clinical outcomes.

The purpose of this review is to investigate the evolution and epidemiology of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms and the current and future treatment options for infections caused by KPC-producing isolates. The emergence of resistance in Enterobacteriaceae producing carbapenemases globally has increased the challenges in treating infections caused by these organisms. One of the prominent mechanisms of resistance is the production of KPC enzymes. Infections caused by organisms producing KPCs have limited treatment options and are associated with poor clinical outcomes. The rapid rise of KPC-producing organisms necessitated the use of drugs with pharmacokinetic and toxicity limitations, including polymyxins, tigecycline, fosfomycin, and aminoglycosides. The availability of new beta-lactamase inhibitor combinations that are effective against KPC-producing organisms represent an advance in safety and efficacy. Several agents are currently being studied that have activity against KPC-producing organisms and appear to represent promising additions to our armamentarium. KPC-producing organisms cause infections with high morbidity and mortality. Limited treatment options are available, though new therapies have been developed. Pipeline agents are likely to have a place in therapy for the treatment of infections caused by KPC-producing isolates.

Background Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry decreases time to identification (ID) and has been shown to improve antibiotic utilization when combined with real-time AS intervention. We assessed the impact of MALDI-TOF without additional AS support in patients with inpatient pneumonia. Methods This was a single-center quasi-experimental study of adult patients with a pneumonia who had a positive respiratory culture with bacteria that were identified by MALDI-TOF from August 2016–February 2017 (Pre-MALDI-TOF) and August–February 2018 (Post-MALDI-TOF). The primary endpoint was the time to initiation of optimal therapy before and after MALDI-TOF. The secondary endpoints included: clinical cure at 7 days; inpatient antibiotic duration; infection-related length of stay (LOS); overall LOS; excess antibiotic days; and costs. T-tests, Mann–Whitney U, and chi-squared tests were used for comparisons where appropriate. Results Table 1: Time to Optimal Therapy and Intervention Opportunities Pre-MALDI-TOF (180) Post-MALDI-TOF (180) P-Value Total opportunities for interventions, n (%) 152 (84) 168 (93) 0.007 De-escalation performed, n/N (%) 105/152 (69) 124/152 (74) 0.40 Escalation performed, n/N (%) 29/152 (19) 34/152 (20) 0.79 Time to Identification, h, median, IQR 63 [46–72] 32 [24–46]