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A personal narrative is presented which explores the author's experience as a foreign-born infectious diseases (ID) physicians facing immigration challenges.

Candida infective endocarditis (CIE) is a rare but serious complication of candidemia. Incidence and risk factors associated with CIE among candidemic patients are poorly defined from small cohorts. Identification of clinical predictors associated with this entity may guide more judicious use of cardiac imaging. We conducted a retrospective analysis of all inpatients aged ≥18 years diagnosed with candidemia at our institution. CIE was diagnosed by fulfilling two of the major Duke criteria: specifically a vegetation(s) on echocardiogram and positive blood cultures for Candida spp. We used univariable and multivariable regression analyses to identify risk factors associated with CIE. Of 1,873 patients with candidemia, 47 (2.5%) were identified to have CIE. In our multivariable logistic model, existing valvular heart disease was associated with a higher risk for CIE (adjusted odds ratio [aOR], 7.66; 95% confidence interval [CI], 2.95–19.84). Predictors that demonstrated a decreased risk of CIE included infection with C. glabrata (aOR, 0.17; 95% CI, 0.04–0.69), hematologic malignancy (aOR, 0.09; 95% CI, 0.01–0.68), and receipt of total parenteral nutrition (aOR, 0.38; 95% CI, 0.16–0.91). The 90-day crude mortality for CIE was 48.9%, similar to the overall non-CIE mortality of 41.9% (P  = .338). We identified a set of clinical factors that can predict the presence of CIE among patient with candidemia. These findings may reduce the need for unnecessary expensive and invasive imaging studies in a subset of patients with a lower risk profile for endocarditis and alternative infection source. [ABSTRACT FROM AUTHOR]

A cluster of cefepime-induced neutropenia (CIN) was identified from June 2017 to May 2018 in a regional outpatient parenteral antimicrobial therapy population. Our data suggest prolonged courses of cefepime (≥2 weeks), administered by rapid intravenous push, were associated with a higher risk of CIN. [ABSTRACT FROM AUTHOR]

Background: Upregulation of IL-6 has been associated with worse prognosis in COVID-19 patients. Impact on IL-6 signalling has mostly been limited to clinical outcomes in IL-6 receptor antagonist trials., Methods: We performed a phase 2, randomised, double-blind, placebo-controlled trial (NCT04380961) of US-based hospitalised adults (<85 years) with laboratory-confirmed SARS-CoV-2 infection and severe (low levels of supplemental oxygen) or critical disease (high levels of oxygen supplementation). Patients received sirukumab 5 mg/kg or placebo single dose IV on Day 1 plus standard of care. The primary endpoint was time to sustained clinical improvement up to Day 28 based on an ordinal scale. Secondary endpoints included clinical improvement, all-cause mortality, and safety. Following an interim analysis, the protocol was amended to only recruit patients with critical COVID-19., Findings: From May 2020 to March 2021, 209 patients were randomised; 112 had critical disease (72 sirukumab, 40 placebo) at baseline. Median time to sustained clinical improvement in critical patients was 17 and 23 days in the sirukumab and placebo groups (HR, 1∙1; 95% CI, 0∙66-1∙88; p > 0∙05). At Day 28, 59∙4% versus 55∙0% of patients achieved clinical improvement with sirukumab versus placebo and rates of all-cause mortality were 24∙6% versus 30∙0%, respectively. Rates of grade ≥3 adverse events were comparable between the sirukumab and placebo groups (25∙9% vs 32∙9%; all patients)., Interpretation: In critical COVID-19 patients who received sirukumab, there was no statistically significant difference in time to sustained clinical improvement versus placebo despite objective sequestration of circulating IL-6, questioning IL-6 as a key therapeutic target in COVID-19., Competing Interests: Declaration of Competing Interest Robert L. Gottlieb served as coordinating national principal investigator and as a consultant for this trial. He reports service on scientific advisory boards for AbbVie, AstraZeneca, Eli Lilly, Gilead Sciences, GSK, and Roche, and consulting via his institution for Kinevant Sciences, also related to COVID-19. Service on speakers bureau with Alnylam Pharmaceuticals and Pfizer, consultancy to Alnylam, research support from CareDx, and a gift-in-kind to his institution from Gilead Sciences to support NCT03383419 are also reported, all outside the submitted work. Meredith Clement has received research support (grants to institution) from Gilead Sciences and ViiV Healthcare, has served on advisory boards for Roche Diagnostics Corporation and ViiV Healthcare. Paul Cook is a PI for the following: NIH, Janssen, Gilead, ViiV, Seres, and Finch. Audra Deveikis, Kap Sum Foong, Philip Robinson, and Cedric W. Spak have nothing to declare. Jihad Slim serves on speakers bureaus for Gilead, ViiV, Merck, Janssen, AbbVie, and Thera. Katleen Callewaert is an employee of Janssen Pharmaceutica NV. Annemie Buelens, Sandra De Meyer, Liesbeth Van Wesenbeeck, and Erika Van Landuyt are employees of Janssen Pharmaceutica NV and own stock in Johnson & Johnson. Wai Ling Mo is an employee of Janssen-Cilag Limited. Inge Verbrugge and Magda Opsomer were employees of Janssen Pharmaceutica NV at the time of the study. Yanli Zhuang and Jacon Chien were employees of Janssen Research & Development, LLC at the time of the study., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Cefiderocol is a novel siderophore cephalosporin antibiotic. In the present case report, a woman in her 70s presented with a 1-week history of altered mental status and progressive purulent discharge from a non-healing diabetic foot ulcer on her right heel. MRI of the right foot revealed chronic osteomyelitis of the calcaneum. Surgical debridement was performed, and the tissue cultures grew extensively drug resistant (XDR) Pseudomonas aeruginosa , XDR Acinetobacter baumannii and Enterococcus faecalis The patient received ampicillin-sulbactam and cefiderocol. The antibiotic treatment course was complicated by brown urine discolouration. Investigations were unrevealing for haemoglobinuria, myoglobinuria and bilirubinuria. A side effect from cefiderocol was suspected and subsequently discontinued. Her urine colour returned to its normal colour within 3 days of discontinuation of cefiderocol., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2023. No commercial re-use. See rights and permissions. Published by BMJ.)