Infectious Diseases

Vancomycin heteroresistant MRSA bacteremia is common and outcomes worsen under vancomycin therapy

In a prospective cohort of 842 adults with MRSA bacteremia in South Korea, 22% of isolates displayed a vancomycin-heteroresistant (hVISA) phenotype. hVISA was strongly associated with hospital-acquired infection, prior anti-MRSA therapy, vancomycin exposure, and higher vancomycin MICs. Overall, patients with hVISA had lower 90-day mortality than those with fully susceptible strains, suggesting a resistance–virulence trade-off. However, among hVISA infections treated with vancomycin, mortality more than doubled, bacteremia persisted longer, and relapse rates increased fivefold. 1

Contact precautions without single rooms prevented ESBL-E cross-transmission in a mixed ICU

This 19-month prospective ICU study enrolled 1042 patients, including 82 ESBL-E index carriers. Three hundred sixty-five ESBL-E–negative patients were cohoused with ESBL-E–positive index patients under contact precautions but without single-room isolation. Only three cohoused patients became ESBL-E–positive, and whole-genome sequencing showed none matched their respective index strain. Thus, in this endemic ICU with short lengths of stay, contact precautions alone prevented genetically confirmed ESBL-E cross-transmission. 2

Tissue mNGS substantially improves pathogen detection compared with conventional tests

This retrospective study included 70 patients who underwent tissue metagenomic next-generation sequencing (mNGS) plus conventional microbiological tests (CMTs) for suspected infection. Among 44 confirmed infections, tissue mNGS sensitivity was 72.7% versus 29.5% for CMTs, with no significant specificity difference. mNGS improved detection of aerobic bacteria, Mycobacterium tuberculosis, nontuberculous mycobacteria, fungi, and was especially superior in polymicrobial infections. Among infectious cases, 50% were mNGS-only positive, 6.8% CMT-only positive, and 22.7% positive by both methods. 3

Same-day ART initiation in LMICs improves viral suppression and retention at 6–12 months

This systematic review and meta-analysis pooled 12 randomized trials of same-day ART initiation (SDI) for adults with HIV in low- and middle-income countries. Trials newly introducing SDI showed improved viral suppression at 6–12 months (RR 1.18, 95% CI 1.06–1.30; moderate-certainty). Retention in care at 6–12 months also improved (RR 1.12, 95% CI 1.00–1.25; low-certainty). Trials aiming to enhance SDI where already available were heterogeneous and mostly yielded low to very low certainty for additional benefit. 4