Antibiotics remain a mainstay of therapy for diabetic foot osteomyelitis (DFO), but optimal duration of therapy remains unclear.ObjectivesTo evaluate the effect of duration of antibiotic therapy on treatment success for DFO.Data SourcesMedline, EMBASE and Cochrane CENTRAL databases were utilized to search for eligible studies from inception to 31 December 2024.Study eligibility criteriaWe included studies that reported antibiotic therapy duration and treatment outcomes for treatment of DFO.ParticipantsPatients receiving antibiotic therapy for treatment of DFO.InterventionsAntibiotic therapyAssessment of risk of biasThe Joanna Briggs Institute critical appraisal tools were used.Methods of data synthesisRandom-effects meta-analysis was used to assess the pooled treatment success rates for ≤6 weeks and >6 weeks antibiotic therapy. Treatment success by treatment modality and study design were also assessed.ResultsThirty-three studies, including 6 RCTs and 27 observational cohorts were included in this review. The pooled treatment success rate was 74% (95% CI: 69%, 80%) for both patients receiving ≤6 weeks and >6 weeks antibiotic therapy. Included RCTs demonstrated pooled success rates of 65% (95% CI: 49%, 80%) and 74% (95%CI: 62%, 85%) for ≤6 weeks and >6 weeks antibiotics respectively. There was only minor difference between patients receiving antibiotic therapy alone (73%, 95% CI: 62%, 82%) versus combined antibiotics with surgical therapy (75%, 95% CI: 66%, 82%). Heterogeneity was high (I2 = 90%).ConclusionsAlthough treatment success rates were equivalent for varying durations of antibiotic therapy, high heterogeneity in study design makes these results difficult to translate to clinical practice. Standardizing study design for future research and allocating treatments by risk profile will be essential for improving understanding of DFO therapy.Graphical abstractDownload: Download high-res image (463KB)Download: Download full-size image

Importance  The US Food and Drug Administration (FDA) has issued a warning and a label change regarding a potential association between trimethoprim-sulfamethoxazole (TMP-SMX) and acute respiratory failure in healthy adolescents and young adults.Objective  To examine the 30-day risk of a hospital visit (ie, hospitalization or emergency department visit) with acute respiratory failure in adolescents and young adults aged 10 to younger than 25 years old newly dispensed oral TMP-SMX compared with new users of amoxicillin or a cephalosporin.Design, Setting, and Participants  This retrospective, population-based, new-user cohort study in Ontario, Canada (2003-2023) used linked administrative health care data. The TMP-SMX vs amoxicillin and TMP-SMX vs cephalosporins cohorts both included adolescents and young adults aged 10 to younger than 25 years who were newly dispensed oral TMP-SMX, amoxicillin, or cephalosporins for 3 or more days from an outpatient pharmacy. Data were analyzed from January 1 to April 30, 2025.Exposure  TMP-SMX for 3 days or more.Main Outcomes and Measures  The primary outcome was a composite outcome of the 30-day risk of a hospital visit with acute respiratory failure (defined as a diagnosis of acute respiratory failure or receipt of mechanical ventilation, tracheotomy, or extracorporeal membrane oxygenation). Secondary outcomes were the individual components of the composite outcome, all-cause hospitalization, and all-cause mortality. Overlap weighting on the propensity score was used to balance comparison groups on 84 indicators of baseline health. Weighted risk ratios were obtained using log-binomial regression and weighted risk differences using binomial regression. Sensitivity analyses using a negative control outcome, and case-crossover analysis were also performed.Results  The TMP-SMX vs amoxicillin cohort included 575 218 individuals (44 801 TMP-SMX users and 530 417 amoxicillin users; median age after weighting, 19 years [IQR, 16-22 years]; 74.3% female). The TMP-SMX vs cephalosporins cohort included 248 236 individuals (51 197 TMP-SMX users and 197 039 cephalosporin users; median age after weighting, 19 years [IQR, 16-22 years]; 72.3% were female). The risk of the composite outcome occurred in 15 of 44 801 patients (0.03%) who started TMP-SMX and in 49 of 530 417 (0.01%) who started amoxicillin (number of weighted events, 7 of 21 579 [0.03%] for TMP-SMX and 2 of 21 579 [0.01%] for amoxicillin; weighted risk ratio, 2.79 [95% CI, 1.01-7.71]; weighted risk difference, 0.02% [95% CI, 0.001%-0.04%]). The risk of the composite outcome occurred in 17 of 51 197 patients (0.03%) who started TMP-SMX and in 21 of 197 039 (0.01%) who started cephalosporins (number of weighted events, 8 of 20 538 [0.04%] for TMP-SMX and 3 of 20 538 [0.01%] for cephalosporins; weighted risk ratio, 2.85 [95% CI, 1.11-7.31]; weighted risk difference, 0.02% [95% CI, 0.005%-0.05%]). Results were consistent in sensitivity analyses.Conclusions and Relevance  These findings suggest that the 30-day risk of a hospital visit with acute respiratory failure was higher among those receiving TMP-SMX compared with those receiving amoxicillin or cephalosporins. These findings supported the FDA warning, and if replicated, the risks should be carefully weighed against the benefits of TMP-SMX use. Regulatory agencies could reinforce the FDA warning, and product monographs and prescribing guidelines should be updated and revised accordingly.

AbstractChikungunya virus (CHIKV) has emerged as a serious candidate for “Disease X”—the name for an unknown agent that could cause a global pandemic. This paper searches for the unique traits of CHIKV that match that designation. Critical mutations like E1-A226V and E2 L210Q have driven CHIKV’s rapid adaptability and its transmission from Aedes mosquitoes to over 110 countries around the world. Public health impact is amped because the virus can cause debilitating diseases including chronic arthritis and severe neonatal complications. Populations remain vulnerable despite a recently approved vaccine, as there is little distribution of it and no treatments for the virus. By underscoring urbanization, climate change, and global travel as ecologic and genetic factors that enable the emergence and persistence of CHIKV, this paper emphasizes that these critical enablers of CHIKV need to be addressed both in the context of host range and transmission potential. However, phylogenetic studies and surveillance data for its capacity to sustain transmission cycles show how important it is to be included in improved global health strategies. Improved early detection, improved vector control, equitable vaccine distribution, and greater international collaboration are critical to reduce the pandemic potential of CHIKV. This paper aims to explore the genetic adaptations of CHIKV that have driven its increased transmission and expanded geographic spread. It examines how key mutations enable the virus to adapt to different mosquito vectors, contributing to its pandemic potential. The paper also assesses the epidemiological and environmental factors influencing CHIKV’s emergence and persistence, alongside the public health challenges posed by limited vaccine availability and treatment options. Finally, it highlights prevention strategies and the importance of global preparedness to reduce the risk of widespread outbreaks.

Non-profit focused on educating and engaging the public, communities, and healthcare professionals about infectious diseases across the lifespan #IDsky

PARIS (Reuters) -The bird flu virus that has been spreading among wild birds, poultry and mammals could lead to a pandemic worse than COVID-19 if the virus mutates to transmit between ​humans, the hea...

Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are among the leading causes of acute respiratory infection. We evaluated the risk of severe outcomes in adults hospitalized with hMPV compared to RSV at Kaiser Permanente Southern California.MethodsWe performed a retrospective cohort analysis in adults aged ≥18 years who tested positive for hMPV or RSV from 7 days prior to 2 days after the date of hospital admission between 2011 and 2024. Outcomes included length of hospital stay, intensive care unit (ICU) admission, occurrence of complications, readmission, and mortality. Risk ratios (RR) and hazard ratios (HR) were estimated for hMPV compared to RSV hospitalizations.ResultsThis study included 2859 hMPV-associated and 3029 RSV-associated hospitalizations. Approximately 30% of hMPV and RSV hospitalizations had an extended hospital stay (≥7 days) and about 15% were admitted to the ICU. The risk of an extended hospital stay was lower in hMPV than RSV hospitalizations (RR: 0.91 [95% CI: 0.84–0.99]). Over half of hMPV and RSV hospitalizations had pneumonia diagnoses; the risk was higher in hMPV hospitalizations (RR: 1.17 [1.12–1.23]). 1-year mortality risk was lower in hMPV compared to RSV hospitalizations (HR: 0.84 [0.74-0.94]). The risk of most outcomes, including the occurrence of complications, exacerbation of chronic diseases, in-hospital mortality, and readmission was comparable between hMPV and RSV hospitalizations.ConclusionsBoth hMPV and RSV hospitalizations were associated with substantial and similar healthcare resource utilization and morbidity, highlighting the importance of clinical appreciation of severe outcomes associated with hMPV in hospitalized adults.

Australia’s progress towards the elimination of cervical cancer as a public health problem

Human adenovirus (HAdV) is a common cause of pediatric acute respiratory illness (ARI), contributing to 5–13% of cases worldwide. Clinical manifestations vary by HAdV species and type; therefore, delineating type-specific disease presentations and understanding severity of specific HAdV types' disease may help develop targeted interventions.MethodsWe conducted a multicenter, prospective study within the New Vaccine Surveillance Network to characterize HAdV types. Children <18 years old with ARI were enrolled in the emergency department or inpatient setting at 7 US children's hospitals from 1 December 2016 to 30 November 2019. Respiratory specimens were collected and tested for HAdV and other viruses. Subsequently, typing was conducted on HAdV specimens using single-plex real-time PCR assays targeting sequences in the hexon gene. Comparisons between HAdV types were performed to determine differences in characteristics and outcomes. Generalized linear mixed effects models were used to evaluate severity.ResultsAmong the 1843 HAdV-positive cases, 1402 specimens (76%) were typed. The most common types detected were HAdV-C1 (n = 439), HAdV-C2 (n = 393), and HAdV-B3 (n = 221). Children with HAdV-B7 (n = 78) had higher odds of severe outcomes compared to those with other HAdV types (aOR = 2.05; 95% CI: 1.24, 3.40). Symptom presentation varied across types within species B, C, and E; while all species had high frequency of upper respiratory symptoms, species B cases presented with a higher frequency of non-respiratory manifestations.ConclusionsAmong children with HAdV-positive ARI, those with HAdV-B7 had higher odds of severe outcomes. These findings suggest heterogeneity in clinical presentation and severity among HAdV types, emphasizing the importance of HAdV type in future prevention and treatment strategies.

World Health Organization supports “spatial repellents” to prevent malaria, but it’s unclear who will pay for them

While flu levels are still low, a strain that's wreaked havoc in the U.K. and Canada is behind most cases so far in the U.S., mostly affecting kids.

AbstractThree critically ill or fatal avian influenza A(H5N1) human infections have been reported in North America since November 2024. Notably, all were infected with genotype D1.1 instead of B3.13, the dominant genotype before November 2024. Here, we demonstrated that D1.1 could replicate to higher titers in human nasal and airway organoid-derived transwell monolayers from 6 donors. D1.1 exhibited a better binding to α2,3- and α2,6-linked SA than B3.13. No significant differences in most inflammatory or antiviral cytokines/chemokines was observed. These observations suggest that D1.1 is better adapted to both the upper and lower human respiratory tract epithelium than B3.13.

Humanity did surprisingly well so far, considering how unprepared it was to respond to the coronavirus disease 2019 (COVID-19) threat. By blending old and in...

ALT: a man wearing sunglasses and a green shirt is sitting in a car with a child behind him .

Antimicrobial resistance (AMR) is a key global public health threat. Developing healthcare worker awareness and knowledge in AMR and antimicrobial stewardship (AMS) are UK national action plan targets. Competency frameworks have been developed to support improved undergraduate teaching, but their uptake is unclear.MethodsA targeted survey was sent to all UK medical schools to determine curriculum learning objectives (LOs) on AMR/AMS and distribution of teaching opportunities across courses. Replies were mapped to the six McMaster competency framework domains to identify areas of strength and potential gaps in undergraduate teaching models.ResultsReplies were received from 50/52 (96.2%) medical schools. AMR/AMS teaching through dedicated teaching sessions was offered by 32/50 (64.0%), whereas 11/50 (22.0%) had fully integrated courses and 7/50 (14.0%) were unable to identify any LOs. Data on dedicated teaching provision (mean 7.7 h/course, IQR 3.0–10.5) were provided by 32/50 (64.0%). Evidence for mapping to the McMaster competencies was highly variable, ranging from 1/50 (2.0%) to 35/50 (70.0%) across the six key domains. Where identified, mapping to knowledge-based competencies was observed to be significantly greater than to practical-based competencies (OR 3.2, 95% CI 2.5–4.1, P < 0.0001). Ten of 50 (20.0%) highlighted learning opportunities in clinical years were opportunistic, variable, indirect or incidental.ConclusionsCurrent approaches to UK undergraduate AMR/AMS medical education appear limited, with greater focus on knowledge-based competencies and less focus on practical skills. Reliance on opportunistic teaching in clinical years presents challenges for programme assurance and impact assessment. Minimizing unwanted variability in medical school teaching and learning in AMR/AMS should be pursued, and inclusion in the UK Medical Licensing Assessment content map may provide such an opportunity.