Effectively interrupting the source of transmission is a critical step in ending the HIV epidemic. COMEBACK (NCT04519970) is a 48-week single-center study in Chicago implemented in September 2020, with its main objectives to reengage lost-to-care patients and rapidly reinitiate ART to promote VS and favorable PROs.Adults off ART ≥2 weeks, without history of significant B/F/TAF resistance or renal impairment, were rapidly started on B/F/TAF upon reengagement after same day collection of baseline labs and PROs. A retention screening assessment was used to stratify participants into case management (CM) tiers: Minimal, Moderate, or Advanced. An acuity assessment tool was adapted to determine whether participants needed additional support based on retention and VS. Currently, 80 of the expected 100 subjects are enrolled and 55 have reached the 24-week timepoint. Baseline and 6-month endpoints were analyzed for these participants.3, with a median viral load 7,402copies/mL, . Median time off ART was 2.6 months . For CM, participants were stratified into Minimal (71%) and Moderate (29%) tiers; none were identified as Advanced.At baseline (N=55), median age was 34 years , with 92.6% Black and 72.2% cisgender male. Median CD4+ was 338 cells/mmTable 1 reflects tier shifts through 24 weeks.Shifts in CM intensity differs from the HIV adherence self-efficacy PRO completed within 24 weeks, indicating that at least 50% underestimated their need to integrate and maintain adherence to ART treatment. Forty of 55 participants (72.7%) were retained-in-care at 6 months, with VS in 61.8% (N=34/55) by intention-to-treat and 85% (N=34/40) by observed analysis. No resistance to B/F/TAF was detected through 6 months.Note: The table reflects patients retained on study at their week 24 endpoint.VS was high for participants retained-in-care, but lapses in retention and shifts toward more intense CM were likely due to social determinants of health challenges, including incarceration, housing insecurity, and COVID-19-related disruptions in healthcare.Gregory Huhn, MD, MPHTM, Eli Lilly: Advisor/Consultant|Eli Lilly: Grant/Research Support|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Jannsen: Advisor/Consultant|Jannsen: Grant/Research Support|Merck: Advisor/Consultant|Viiv: Advisor/Consultant|Viiv: Grant/Research Support.


HepB-CpG  is a licensed hepatitis B vaccine with a novel adjuvant that requires only 2 doses  compared to a 3-dose  HepB-alum vaccine . Monitoring of safety outcomes following receipt of vaccines with novel adjuvants is important. Hence, as part of an FDA postmarketing commitment, we compared the incidence of new-onset immune-mediated diseases, herpes zoster (HZ), and anaphylaxis among recipients of HepB-CpG versus HepB-alum at Kaiser Permanente Southern California (KPSC).This cohort study included adults not on dialysis who received ≥1 dose of a hepatitis B vaccine from 8/7/2018 to 10/31/2019, during which HepB-CpG was routinely administered in 7 of 15 KPSC medical centers while HepB-alum was administered at the other 8 medical centers. Recipients of HepB-CpG or HepB-alum were followed through electronic health records for 13 months after receipt of the first dose during the vaccine accrual period for occurrence of pre-specified new-onset immune-mediated diseases, HZ, and anaphylaxis identified using diagnosis codes. Incidence rates were compared using Poisson regression with inverse probability of treatment weighting when there was 80% power to detect a relative risk (RR) of 5 for anaphylaxis and a RR of 3 for all other outcomesThere were 31,183 HepB-CpG and 38,442 HepB-alum recipients . Among immune-mediated events that occurred frequently enough for formal comparison, rates among HepB-CpG versus Hep-B-alum recipients were similar except for rheumatoid arthritis (RA) . (Table 1) After adjudication of new-onset RA, the adjusted RR was 0.93 . (Table 2) The adjusted RR for HZ was 1.06 . Anaphylaxis occurred in 0 HepB-CpG and 2 HepB-alum recipients.These data suggest no safety concerns for HepB-CpG compared to HepB-alum for select immune-mediated diseases, HZ, or anaphylaxis in this observational study of over 69,000 recipients of hepatitis B vaccines.Bradley Ackerson, MD, Dynavax: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Seqirus: Grant/Research Support Lina S. Sy, MPH, Dynavax: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support|Seqirus: Grant/Research Support Jeff Slezak, MS, ALK, Inc.: Grant/Research Support|Dynavax: Grant/Research Support|Novavax, Inc.: Grant/Research Support|Pfizer, Inc.: Grant/Research Support Lei Qian, PhD, Dynavax: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support Kristi Reynolds, PhD, Amgen: Grant/Research Support|Dynavax: Grant/Research Support|Merck: Grant/Research Support|Novartis: Grant/Research Support Runxin Huang, MS, Dynavax: Grant/Research Support Zendi Solano, BS, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support William Towner, MD, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|Merck: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|ViiV: Grant/Research Support Sijia Qiu, MS, Dynavax: Grant/Research Support|Moderna: Grant/Research Support Sarah Simmons, MPH, Dynavax: Grant/Research Support|Glaxo-Smith Kline: Grant/Research Support|Pfizer: Grant/Research Support Steven Jacobsen, MD, Dynavax: Grant/Research Support Katia J. Bruxvoort, PhD, MPH, Dynavax: Grant/Research Support|Gilead: Grant/Research Support|Glaxosmithkline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support|Seqirus: Grant/Research Support.


UPMC Antimicrobial stewardship (AS) includes independently functioning AS programs and a central tele antimicrobial stewardship (TASP) (1 ID pharmacist and 1 ID physician) that supports smaller hospitals with few on-site AS resources. We describe implementation of an AS clinical decision support system (CDSS) at 19 UPMC hospitals (12-695 staffed beds). Figure 1 is an example of the CDSS.The CDSS extracts clinical data to provide real-time alerts to AS teams. It also supports asynchronous communications between AS team members, including between a local AS and our TASP. CDSS utilization and intervention data from Oct 21 to Mar 22 are reported. Figure 2 shows hospital locations and the timeline for CDSS implementation. Table 1 shows implementation steps.Table 2 summarizes category alerts provided by the CDSS. Category 1 alerts were independently reviewed by local pharmacists. Category 2 alerts were reviewed either by local pharmacists or central TASP team. Figure 3 shows high CDSS usage over time with numerous unique users and frequent logins. Most users were pharmacists. CDSS usage was steady and increased in the final month included here. Communications between users were frequent and increased 46%. On average, 7033 CDSS generated alerts per month  were reviewed from Oct 21 to Mar22. Table 3 groups the alerts into successful, unsuccessful, or nonactionable interventions. 93% of actionable alerts (959 of 1029 per month) produced a successful outcome.After a rapid 5-month deployment across 19 hospitals this CDSS was successfully adopted as evidenced by sustained monthly use, increasing communications, and a high rate of accepted interventions on actionable alerts. A high rate of nonactionable alerts in the first 6 months was a limitation. Although this did not appear to limit CDSS use, sites implementing a CDSS should monitor for nonactionable alerts during early utilization and adjust as needed. CDSS has the potential to improve efficiency and consistency of AS within a health system. After a successful implementation, evaluation of impact on antimicrobial usage and clinical outcomes are important future metrics.J Ryan Bariola, MD, Infectious Disease Connect: Salary support|Merck: Grant/Research Support Tina Khadem, PharmD, Infectious Disease Connect: Salary support|Merck: Grant/Research Support Caley Yakemowicz, n/a, Infectious Disease Connect: Employee Courtney Simonick, n/a, Infectious Disease Connect: Stocks/Bonds Erin K. McCreary, PharmD, AbbVie: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|Merck: Advisor/Consultant|Shionogi: Advisor/Consultant|Summit: Advisor/Consultant Christina Andrzejewski, n/a, Melinta Therapeutics: employee John W. Mellors, MD, Abound Bio: Multiple|Abound Bio: Ownership Interest|Gilead Sciences: Advisor/Consultant|Infectious Disease Connect: Advisor/Consultant|Infectious Disease Connect: Ownership Interest Rima Abdel-Massih, MD, Infectious Disease Connect: Co founder and Chief Medical Officer|Infectious Disease Connect: Ownership Interest.


Clostridioides difficile infection (rCDI) is common - up to 35% of patients may recur. RBX2660 is a microbiota restoration therapy to reduce rCDI. Here we report 8 weeks HRQL results using the Clostridioides difficile Health-related Quality-of-Life Questionnaire (Cdiff32), a disease-specific instrument, from PUNCH CD3 .Recurrence of Cdiff32 includes three domains  and a total score . Changes in Cdiff32 from baseline to week 8 were compared between RBX2660 and placebo (PBO) using unadjusted and adjusted analyses controlling for baseline score, demographic and disease characteristics. Per trial protocol, missing data were imputed via last observation carried forward (LOCF); as-observed data were also analyzed. Patients experiencing recurrence after blinded treatment received open-label RBX2660 per physician discretion; these participants were excluded unless, per LOCF, data were available from the blinded period for week 8 use.A total of 206 patients  were included, with similar age (mean±SD) 61.1±16.9 yrs (RBX2660) and 57.3±16.4 yrs (PBO) and baseline Cdiff32 scores. More than half of the patients had multiple comorbidities. Cdiff32 scores improved significantly from baseline to weeks 1, 4, and 8 for both arms, with greater improvements for RBX2660 through week 8 . At week 8, statistical differences were found for mental domain  and total score , all favoring RBX2660. Results were similar for the as-observed analyses, with the adjusted physical domain also statistically favoring RBX2660.Most patients in this study reported improved HRQL. Improvements were observed in both arms, but RBX2660-treated patients had more robust and sustained improvements with statistically significant differences in Cdiff32 scores. This study suggests that microbiome restoration therapy might positively affect HRQL; future research may link these improvements directly with microbiota changes.Paul Feuerstadt, MD, FACG, AGAF, Ferring/Rebiotix Pharmaceuticals: Advisor/Consultant|Ferring/Rebiotix Pharmaceuticals: Grant/Research Support|Merck and Co: Advisor/Consultant|SERES Therapeutics: Advisor/Consultant|SERES Therapeutics: Grant/Research Support|Takeda Pharmaceuticals: Advisor/Consultant Erik R. Dubberke, MD, MSPH, Abbott: Advisor/Consultant|Ferring: Advisor/Consultant|Ferring: Grant/Research Support|Merck: Advisor/Consultant|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Seres: Advisor/Consultant|Summit: Advisor/Consultant|Synthetic Biologics: Grant/Research Support Amy Guo, PhD, Ferring Pharmaceuticals: Employee Adam Harvey, PhD, Ferring Pharmaceuticals: Employment Min Yang, MD, PhD, Analysis Group, Inc.: I am an employee of Analysis Group, Inc., which has received consulting fees from Ferring for the conduct of this study. Viviana García-Horton, PhD, Analysis Group, Inc.: Employee of Analysis Group, Inc., which received consulting fees from Ferring for the conduct of this study. Mirko Fillbrunn, PhD, Analysis Group, Inc.: I am an employee of Analysis Group, Inc., which has received consulting fees from Ferring for the conduct of this study. Glenn S. Tillotson, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support|Spero Pharmaceuticals: Advisor/Consultant|Taro Pharmaceuticals: Advisor/Consultant Lindy Bancke, PharmD, Rebiotix, a Ferring Company: Employee Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support|cidara: Advisor/Consultant|cidara: Grant/Research Support|Paratek: Grant/Research Support|Seres Health: Grant/Research Support|Summit: Grant/Research Support.


The incidence of complications in Gram negative bloodstream infection (GN-BSI) is not clearly defined. This retrospective cohort study evaluates the incidence of complications within 90 days of GN-BSI and examines the predictors for these complications.Hospitalized adult patients with monomicrobial GN-BSI at Prisma Health-Midlands hospitals in South Carolina between 1/1/2012 and 6/30/2015 were evaluated. Complications of GN-BSI were defined as endocarditis, septic arthritis, osteomyelitis, spinal infections, deep seated abscesses, and recurrent GN-BSI within 90 days of the initial episode. Clinical and microbiological variables were assessed as potential risk factors for complications, including initial response to antimicrobial therapy within the first 72-96 hours of GN-BSI using the early clinical failure criteria. Kaplan-Meier analysis and multivariate Cox proportional hazards regression were used to examine the incidence and risk factors of complicated GN-BSI, respectively.Escherichia coli was the most common bacteria . Overall, 13.9% developed complications within 90 days of GN-BSI. The median time to identification of these complications was 5.2 days from the index GN-BSI (interquartile range 1-28 days). The incidence of complications was notably higher in BSI due to Serratia species (39.7%), Proteus mirabilis (35.7%), and Pseudomonas aeruginosa (21.5%) than other bacteria . Independent risk factors for complications included early clinical failure criteria, non-urinary source, presence of indwelling prosthetic devices, BSI due to Serratia species, P. mirabilis or P. aeruginosa, and persistent GN-BSI (Table).A total 752 patients with GN-BSI were included in the study. The median age was 66 years and 380 (50.6%) were women. The urinary tract was the most common source of GN-BSI  and At least 13.9% of patients developed complications within 90 days of GN-BSI. Risk of development of complications may be predicted by specific host and microbiological factors. Stratification of patients based on these risk factors may aid in identifying patients requiring further diagnostic work up for early detection of complications.Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck & Co: Advisor/Consultant|Merck & Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant.


Pill burden associated with antiretroviral multiple-tablet regimens (MTR) can impact adherence. The shift to single-tablet regimens (STR) has lagged for people living with HIV (PLWH) covered by Medicaid. This study examines persistence, adherence, healthcare resource utilization (HCRU), and costs by STR or MTR use for new initiators and treatment-experienced PLWH over a 1-year study period.A linked patient population was applied using data from IQVIA’s Prescription Claims (Rx), Professional Fee Claims (Dx), and Hospital Charge Data Master (CDM). A 6-month pre-index period was used to assess study eligibility and baseline characteristics. A 12-month post-index period was used to descriptively evaluate treatment patterns and HCRU/costs. Two mutually exclusive cohorts were created based on STR or MTR use during the selection window (01/2018-07/2019). For the STR cohort, date of the first STR claim during the selection window was termed the index date. For the MTR cohort, the date of the first MTR drug during the selection window was termed the index date.The final sample comprised 4,603 PLWH in the STR cohort and 2,728 in the MTR cohort (Table 1). The proportion persistent over the 1-year follow-up was higher among treatment experienced compared to new initiators, and higher for STR compared to MTR . The proportion adherent was higher among treatment experienced compared to new initiators, and higher for STR compared to MTR . HIV-specific per member per month (PMPM) pharmacy costs were higher among treatment experienced compared to new initiators, and higher for MTR compared to STR . Adherent PLWH had a lower proportion with ≥ 1 all-cause emergency room visit compared to non-adherent PLWH within a cohort/treatment status category; minimal differences in ≥ 1 all-cause hospitalization. Adherent PLWH had higher mean all-cause costs than non-adherent PLWH, driven by pharmacy costs. STR PLWH had lower mean all-cause total costs compared to MTR PLWH with the same adherence/treatment experience status .PLWH enrolled in Medicaid are more persistent and adherent to STR than MTR. Among PLWH adherent to antiretroviral therapy, STR offer potential cost savings over MTR for appropriate patients.Andrew P. Brogan, PhD, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Cindy Garris, MS, ViiV Healthcare: Employee|ViiV Healthcare: Stocks/Bonds Julie Priest, MSPH, ViiV Healthcare: Employee, Salary|ViiV Healthcare: Stocks/Bonds Victoria Divino, BA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Jing He, PhD, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Justin Chen, MHS, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support Mitch DeKoven, MHSA, IQVIA: Employee, Salary|ViiV Healthcare: Grant/Research Support.


The best stategy for prevention of invasive aspergillosis (IA) after lung transplantation (LTX) has not been determined. In 2016, Danish guidelines for IA prophylaxis was changed from 12 weeks of universal prophylaxis with voriconazole to targeted prophylaxis with posaconazole and inhaled amphotericin B for high risk patients. In a previous study we found significantly higher rates of adverse events in the period with universal prophylaxis. The objectives of this study were to compare rates of IA 1) in time periods before and after change of guidelines; 2) during persontime on vs. persontime without antifungal prophylaxis in the total study period.In a Danish nationwide study we included all adult lung transplant recipients (LTXr), 2010–2019. Proven and probable IA were defined using ISHLT criteria. Patients were censored at the first of following events: death, retransplantation, end of 2019, or one year after LTX. The cumulative hazard of IA was calculated using the Nelson Aalen estimator. Rates of IA were analyzed in bi- and multivariate Poisson regression models adjusted for the time period after LTX (0–6 and 6–12 months). Persontime on protocol prophylaxis (start to end + 14 days) was treated as time-updated variable.A total of 295 LTXr were followed for 245 person-years, of whom 183/193 vs. 6/102 initiated antifungal prophylaxis during the universal vs. the targeted prophylaxis period (Table 1). IA was diagnosed in 34/193 (17.6%) vs. 15/102 (14.7%) LTXr the first year after transplantation in the universal vs. targeted prophylaxis period. Overall, similar cumulative hazards of IA were observed between the universal and targeted prophylaxis period . The adjusted incidence rate ratio (aIRR) of IA during the universal vs. targeted prophylaxis period was 1.30 (95% CI 0.69–2.44), (Table 2). In the total study period, the aIRR of IA during persontime on vs. persontime without antifungal prophylaxis was 0.87 (95% CI 0.40–1.88), (Table 2).Characteristics of lung transplant recipients in time periods with universal voriconazole and targeted posaconazole and inhaled amphotericin B prophylaxis.Proven and probable invasive aspergillosis including anastomosis infection, trakeobronkitis and pneumonia according to ISHLT criteria. *) Underlying diseases categorized as high risk of invasive aspergillosis.Incidence rates (IR) and incidence rate ratios (IRR) of invasive aspergillosis in lung transplant recipients in two multivariate models.Poisson regression models comparing rates of IA in model 1) during universal prophylaxis time period versus targeted prophylaxis time period and in model 2) during persontime on prophylaxis (start to end + 14 days) versus persontime without prophylaxis in the total study period 2010–2019.Adjusted for time after LTX IRR: Bivariable model including the listed variables in bold and adjustment for time after transplantation (time-updated). Fully adjusted IRR: Multivariable model with adjustment for sex, age, high risk underlying disease, single/double lung transplant, Aspergillus prior to transplantation and time after transplantation (time-updated).Abbreviations: LTX = lung transplant recipients; CI = confidence interval; IR = incidence rates per 100 person-years; IRR = incidence rate ratio; Ref. = reference.Cumulative hazards of invasive aspergillosis the first year after lung transplantation in time periods with universal voriconazole versus targeted posaconazole and inhaled amphotericin B prophylaxis.A strategy of targeted prophylaxis, for high risk patients only, may be preferred over universal voriconazole prophylaxis after LTX due to similar rates of IA and lower rates of adverse events.Maiken C. Arendrup, DMSci, PhD, MD, Chiesi, Gilead: Honoraria|F2G, Cidara, Scynexis: Grant/Research Support Michael Perch, MD, Boeringer-Ingelheim: Travel grant|PulmonX: Expert Testimony|Roche: Grant/Research Support|Takeda: Expert Testimony|Therakos: Honoraria|Zambon: Advisor/Consultant|Zambon: Expert Testimony Marie Helleberg, PhD, DMSc, AstraZeneca: Advisor/Consultant|Gilead: Advisor/Consultant|Gilead: Honoraria|GSK: Advisor/Consultant|GSK: Honoraria|Janssen: Advisor/Consultant|Roche: Advisor/Consultant|Sobi: Advisor/Consultant.


A. baumannii.Antimicrobial resistance (AMR) genes of bacteria can be found in chromosomes or plasmids. Due to horizontal transfer from one bacterium to another, AMR genes on plasmids can be easily spread. However, distinguishing whether AMR genes are from plasmids or chromosomes is difficult. Here, we assessed two different approaches for identifying AMR genes on the plasmids of Genomic DNA from 30 clinical isolates was sequenced using Illumina NextSeq 550. Two approaches were applied to identify which AMR genes were on plasmids: isolation of plasmid DNA experimentally using plasmid isolation kit , and deduction of plasmid sequence from genomic DNA using the bioinformatic tool, plasmidSPAdes, which distinguishes the plasmid sequence based on the copy number. AMR genes from both approaches were identified using the open-source AMR database, ResFinder. The AMR gene data obtained from plasmids utilizing each approach were compared based on information from whole genome sequencing (WGS) data.blaOXA-23, a carbapenem resistant gene. However, blaOXA-23 was found from 40% isolates using plasmidSpades and 50% isolates using plasmid DNA. In 36.7% isolates, blaOXA-23 was found by both approaches.As shown in Table 1, both approaches produced differences in the number of contigs, largest contig size, and number of AMR genes identified. The average number of contigs using plasmidSPAdes with WGS data was 7.4 and the largest contig size was 52939 base pairs, while with isolated plasmid DNA and analyzed by SPAdes was 1025 and 32274 bp, respectively. Plasmid DNA contigs are more fragmented. The average number of AMR genes identified using plasmidSPAdes was 1.2 and using plasmid DNA was 4. AMR information from WGS data showed 73.3% isolates have bla OXA-23 identified in both could be on plasmids, while genes not identified from both could be on chromosomes. PlasmidSPAdes was a useful tool to discriminate plasmid sequence from WGS data. Stringent infection control measures can prevent spread of AMR gene containing plasmids in hospital settings.The information obtained by the two approaches for identifying resistance genes on plasmids mostly agreed with some exceptions. The Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing Keith S. Kaye, MD, MPH, Allecra: Advisor/Consultant|GlaxoSmithKline plc.: Receiving symposia honoraria|GlaxoSmithKline plc.: GlaxoSmithKline plc.-sponsored study 212502|Merck: Advisor/Consultant|qpex: Advisor/Consultant|Shionogi: Grant/Research Support|Spero: Advisor/Consultant Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System.


We aimed to describe website engagement and maintenance during the dynamic pandemic period.Antibiotic Stewardship Programs (ASPs) assist front-line clinicians in synthesizing emerging data and establishing best practices. Our ASP team directly maintained and edited an internal web application, Duke CustomID® during a 1-year pre-pandemic period through the Omicron surge: January 2019 to March 2022. We measured total page views (or “hits”), COVID-specific page hits, and days requiring COVID-specific page edits by week. Given fluctuations in hospitalization rates, we defined the primary outcome as the rate of hits divided by total hospitalizations. Weekly data were assessed graphically with positive COVID tests and COVID hospitalizations. We used negative binomial regression to quantify the association between COVID hospitalizations and hit rates and to trend engagement over time, adjusted for seasonality. We stratified data by COVID page and calculated a hit/edit ratio.We performed a descriptive, time-series analysis using Google Analytics software to measure engagement with Duke CustomIDFigure). Hits in the pre-pandemic period were median 1707 (range 1165-2354) per week, and hit rates median 1.95 per hospitalization (range 1.40-2.86). Peaks were observed in March 2020 (hit rate 4.59) and January 2022 (hit rate 3.87). On average, for every 100 COVID hospitalizations, the hit rate increased by 0.08 . Engagement slowly increased over the study period . COVID page edits per week had a median of 2 (range 0-12). Adult Inpatient Guidelines and COVID Monoclonal Antibody pages had highest use (Table).Engagement with CustomID® increased during the pandemic period, especially during surges (Duke CustomID Hits and Maintenance Efforts over the PandemicTop: COVID-specific CustomID hits per week (Green), Positive COVID tests per week (Blue) over timeMiddle: Total custom ID page hits relative to total hospitalizations per week , COVID hospitalizations (Red)Bottom: Number of edits to COVID-specific CustomID pages per week, stratified by management pages and drug pagesSeveral dates of significance are highlighted including the Emergency Use Authorizations (EUA) for remdesivir, the COVID Vaccines, and PaxlovidDuke CustomID COVID-19 Page Hits and EditsCOVID specific pages on Duke CustomID with total hits, edits, and ratio over the pandemicOur ASP’s website was a highly utilized, practical tool for disseminating practice-changing information during the pandemic. Use increased over time and especially during surges. An electronic reference customized for local practice and rapidly updated by ASPs offers critical support for front-line clinicians.Martha B. Adams, M.D., Custom Clinical Decision Support, Inc: Board Member|Custom Clinical Decision Support, Inc: Ownership Interest Richard H. Drew, PharmD MS, American College of Clinical Pharmacists: Publication royalties|Takeda: Advisor/Consultant|UpToDate: publication royalties Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties Michael J. Smith, M.D., M.S.C.E, Merck: Grant/Research Support|Pfizer: Grant/Research Support.


Sexual dysfunction is common in eating disorders (EDs), but its relevance is often overlooked.To describe different ED clinical subgroups in terms of psychopathology, putative biological correlates, and consequences of dysregulated sexuality, focusing on the role of childhood trauma.Healthy controls (n=60), binge-purging (n=38), and restricting patients (n=24) were compared , using total scores of Eating Disorder Examination Questionnaire (EDE-Q), Emotional Eating Scale (EES), SCL-90-R Global Severity Index (GSI), Barratt Impulsiveness Scale (BIS-11), Difficulties in Emotion Regulation Scale (DERS), Childhood Trauma Questionnaire (CTQ), Female Sexual Functioning Index (FSFI), Hypersexual Behaviour Inventory (HBI), and patients’ hormonal profiles . Self-reported voluntary termination of pregnancy (VTP) and promiscuous sexual activity were recorded. For ED patients (N=62), regression analyses between significant variables and HBI were carried, applying moderation models for different CTQ scores.Table 1 outlines significant between-group comparisons . Binge-purging patients had higher FSH, LH, and ghrelin levels, more VTPs and promiscuity. HBI showed significant correlations with EES, SCL-90-R-GSI, DERS, CTQ, and ghrelin levels. CTQ moderated interactions for DERS and EES .Dysregulated sexuality is linked to emotion dysregulation and childhood trauma. Binge-purging patients experience adverse behavioural consequences.No significant relationships.


Psychodinae of the Afrotropical Region remain poorly understood. Slightly under 200 species have been described, but many countries have received very little attention from collectors and even countries where significant collection efforts have taken place have rarely had their collections studied in detail by specialist taxonomists.The Perithreticusneglectus sp. n. is described from the West Usambara Mountains, Tanzania, based on a male specimen collected in 1990. The new species is similar to Perithreticusanderseni Kvifte, 2015, which occurs in the same forest reserve, but can be separated by several genitalic characters, including the hypandrium well-developed with sclerotised anterior and posterior margins, gonocoxites narrower, the gonostyles with the slender apex shorter, the parameres shorter without pronounced basolateral projections and the surstylus with slightly fewer tenacula. The world fauna of Perithreticus now comprises five described species, of which two occur in the Afrotropical Region. Psychodidae material, collected by the University of Bergen's Tanzania expeditions in the early 1990s . The genus was later revised and redefined by Psychodajonesi Quate, 1955 from the genus, described a new Afrotropical species and speculated that Philosepedonforcipata Quate & Quate, 1967 and Philosepedonpectinata Quate & Quate, 1967 from Indonesia (Papua) might also belong to Perithreticus. Finally, Perithreticus species from Cuba and Costa Rica and presented the most recent diagnosis of the genus.The genus Perithreticus from the West Usambara Mountains, which is also the second species of Perithreticus to be described from the Afrotropical Region.In the present paper, I describe a second species of The specimen was dissected, macerated in potassium hydroxide (KOH) and mounted in Canada balsam on a slide. Illustrations and measurements were made using a Leitz Diaplan 20 compound microscope with a drawing tube and an ocular micrometer. Measurements are given in μm with an accuracy of 2.5 μm, except wings which are given in mm with an accuracy of 25 μm. Morphological terminology follows Kvifte, 2022sp. n.E57E4E34-C603-54C0-A95C-376F23B4106E0C6FEF11-AC20-413F-9167-A16A38322558Type status:Holotype. Occurrence: catalogNumber: B-10800.; Taxon: scientificName: Perithreticusneglectus Kvifte, 2022; order: Diptera; family: Psychodidae; genus: Perithreticus; specificEpithet: neglectus; Location: continent: Africa; country: Tanzania; stateProvince: Tanga; locality: Mazumbai forest reserve; verbatimLocality: Tanzania: Tanga Region, W. Usambara Mts., Mazumbai, Loc. B; decimalLatitude: -4.800; decimalLongitude: 38.500; geodeticDatum: WGS8; Identification: identifiedBy: Kvifte, Gunnar Mikalsen; Event: samplingProtocol: Malaise trap; year: 1990; month: 11; day: 3; verbatimEventDate: 03/11/1990; fieldNumber: B; Record Level: institutionCode: ZMUBAdult male (n=1). Head (Fig. Thorax with anepisternum with trapezoid hair patch, anterior spiracle with prolonged U-shaped posterior suture delimiting it from anepisternal hair patch; anepimeron triangular with sinusoid lower margin, ventral suture of anepimeron reaching about halfway into sclerite; posterior spiracle with operculum evenly setose; mid-coxa with anteromesal field of setae; Wing (Fig. 1 infuscate; hyaline field below R1 reaching level of medial fork; radial fork clearly distad of medial fork and around same level as CuA; outlines of R5 and M4 more strongly sclerotised than other veins; origin of R5 with dark spot; jugum broadly angular U-shaped.t male n=. Head (Ft male n=. Head (Ft male n=. Head (FTerminalia (Fig. th, gonocoxal condyles with triangular plate laterally and narrow strip-like plate medially; gonostyli bluntly acuminate, covered in spiniform sensilla, with subapical trichiform sensilla nearly the length of broad gonostylar base; aedeagus with basiphallus short, about a third of length of distiphallus, divided into two phallomeres that fuse after a drop-shaped basal aperture, forming long parallel-sided rod-like distiphallus; parameres elongate curved subtriangular with lateral margins concave and mesal margins convex, blunt apically, basally with small pointed lateral processes; aedeagus reaching further than parameres; epandrium (Fig. lia Fig. D, E symmium Fig. E wider tCan be recognised by the following combination of characters: radial fork distad of medial fork, hypandrium with large unsclerotised area medially, aedeagus parallel-sided with triangular parameres shorter than aedeagus, parameres with triangular basolateral expansions poorly developed, surstylus with 6 tenacula, gonostyle with subapical trichiform sensilla (see also key in neglectus, "overlooked", "neglected", referring to the specimen not being included in the initial revision of Afrotropical Psychodini by From Latin Only known from the type locality in the Mazumbai Forest Reserve, West Usambara Mountains, Tanzania.


Xanthorhoeedmondsii  , originally described under Hypochroma Guenée, [1858], a junior homonym of Hypochroma Herrich-Schäffer, [1855] , is assessed using genitalia morphology and analysis of mitochondrial DNA sequences.The generic assignment of the geometrid moth Disclisioprocta Wallengren, 1861 (Larentiinae). In agreement with morphology, the molecular analysis clustered X.edmondsii with species of Disclisioprocta in a well-supported monophyletic group distantly related to members of Xanthorhoe Hübner, [1825]. Accordingly, Disclisioproctaedmondsii  comb. nov. is proposed.Morphological characters revealed closeness to the type species of  Lepidoptera, Geometridae), whose taxonomy remains insufficiently studied   is known from Chile and Argentina  (Bougainvilleaglabra Choisy (Nyctaginaceae) were misidentified as Chrismopteryxundularia , based on comparison with material from central Chile deposited in the Museo Nacional de Historia Natural de Santiago (X.edmondsii.The geometrid moth rgentina . It was nominae) . IndividSantiago . SubsequX.edmondsii revealed remarkable morphological differences with Xanthorhoemontanata , the type species of Xanthorhoe Hübner, [1825], suggesting instead closeness with Disclisioproctastellata , the type species of Disclisioprocta Wallengren, 1861. The aim of this study is to propose a new generic assignment for X.edmondsii, based on genitalia morphology and analysis of mitochondrial DNA sequences.Morphological characters of the genitalia of geometrid moths are extremely useful in generic assignments , which cB.glabra in the Azapa Valley , Arica Province, northern Chile. Photos of the genitalia were taken with a Leica Flexacam C1 digital camera attached to a Leica M125 stereomicroscope. Each image was constructed with about 5–10 photos assembled with the software Helicon Focus 8. The specimens of X.edmondsii are deposited in the “Colección Entomológica de la Universidad de Tarapacá” (IDEA), Arica, Chile. The specimens of D.stellata are deposited in the “Coleção Pe. Jesus de Santiago Moure (DZUP)”, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.Specimens examined in this study were collected at light or reared from larvae collected on Lepidoptera, including Geometridae (X.edmondsii was submitted to a Maximum Likelihood (ML) analysis with additional representatives of Larentiinae downloaded from BOLD  comb. nov.7F01F488-1D65-5433-9EE2-75152F1D8F2CHypochromaedmondsii Butler, 1882, p. 364. Xanthorhoeedmondsii : Chrismopteryxundularia : Type status:Other material. Occurrence: individualCount: 5; occurrenceID: 99F2E982-FCB8-5FF0-B368-3F12C8EFF0A6; Taxon: scientificName: Disclisioproctaedmondsii ; higherClassification: Insecta;Lepidoptera;Geometridae;Larentiinae; Location: continent: South America; country: Chile; stateProvince: Arica; locality: Azapa Valley; decimalLatitude: -18.52; decimalLongitude: -70.18; Identification: identifiedBy: Héctor A. Vargas; identificationRemarks: Genitalia slides HAV-1281, 1284, 1286, 1583, 1584; Event: samplingProtocol: Bougainvilleaglabra January 2006Two males, three females emerged February 2006, reared fom larvae collected on ; Record Level: type: PhysicalObject; language: en; institutionCode: "Colección Entomológica de la Universidad de Tarapacá" (IDEA); basisOfRecord: "PreservedSpecimen"Type status:Other material. Occurrence: individualCount: 3; occurrenceID: 591A91A6-F832-5EFC-85C4-F03775D0D824; Taxon: scientificName: Disclisioproctaedmondsii ; higherClassification: Insecta;Lepidoptera;Geometridae;Larentiinae; Location: continent: South America; country: Chile; stateProvince: Arica; locality: Azapa Valley; decimalLatitude: -18.52; decimalLongitude: -70.18; Identification: identifiedBy: Héctor A. Vargas; identificationRemarks: Genitalia slides HAV-1283, 1285, 1287; Event: samplingProtocol: Two males, one female September 2006 at light; Record Level: type: PhysicalObject; language: en; institutionCode: "Colección Entomológica de la Universidad de Tarapacá" (IDEA); basisOfRecord: "PreservedSpecimen"Type status:Other material. Occurrence: individualCount: 1; associatedSequences: BOLD Process ID GEONC001-22; occurrenceID: 6C800146-205F-5AA7-85A5-4470D74FCA88; Taxon: scientificName: Disclisioproctaedmondsii ; higherClassification: Insecta;Lepidoptera;Geometridae;Larentiinae; Location: continent: South America; country: Chile; stateProvince: Arica; locality: Azapa Valley; decimalLatitude: -18.52; decimalLongitude: -70.18; Identification: identifiedBy: Héctor A. Vargas; identificationRemarks: Genitalia slide HAV-1580; Event: samplingProtocol: One male May 2022 at light; Record Level: type: PhysicalObject; language: en; institutionCode: "Colección Entomológica de la Universidad de Tarapacá" (IDEA); basisOfRecord: "PreservedSpecimen"Larentiinae  was 10.3–10.5% (K2P) with D.natalata and 11.0–11.5% with D.stellata, while the distance between the latter two was 6.2–7.1%. The alignment was suitable for phylogenetic analysis, as no evidence of stop codons was detected and the index of substitution saturation was smaller than the critical value  in the Xia test. The ML analysis ) with high support. Although each genus had reasonable statistical support in the ML analysis, relationships between genera were not resolved.Genetic distance of sis Fig.  clustereDisclisioprocta deserves further assessments based on better knowledge of the morphology of related genera, the morphological similarities between the genitalia of D.edmondsii (Fig. D.stellata (Fig. D.edmondsii from Xanthorhoe. The type species of this genus has an elongated rod-like uncus, costa as a sclerotised free arm extending beyond the cucullus apex, sacculus lacking a projection and numerous spine-like cornuti in the male and a short antrum and two elongated plate-like signa with small spines in the female (Although the identification of synapomorphies for sii Fig.  and D.stata Fig.  provide e female .D.edmondsii clustered with two other representatives of Disclisioprocta in a well-supported clade, distantly related to members of Xanthorhoe (Fig. D.stellata and D.natalata as sister species agrees with the already highlighted remarkable morphological similarity of their genitalia (D.edmondsii with D.natalata and D.stellata seem higher than commonly reported for other Larentiinae genera (Disclisioprocta harbours several more species than the three recognised until recently (Disclisioprocta, the genetic distance of D.edmondsii to other congenerics would be smaller. Alternatively, further studies could reveal D.edmondsii as a member of another, either described or undescribed, lineage of generic level, sister to Disclisioprocta. In the meantime, its placement in this genus seems a better solution than its previous adscription to Xanthorhoe, in spite the deep genetic distance with congenerics.The result of the ML analysis is congruent with the genitalia morphology, since hoe Fig. . The groenitalia . The gene genera . Howevere genera  suggest recently . AccordiDisclisioprocta with the Neotropical Ptychorrhoe Warren, 1900 in a clade sister to Euphyiini (Ptychorrhoe remain unknown, impeding comparisons with D.edmondsii. Further morphological and molecular phylogenetic studies involving members of the Euphyiini + Xanthorhoini complex (Larentiinae.Recent molecular phylogenetic analyses clustered uphyiini . Unfortu complex  are enco


Lenacapavir (LEN), a potent first-in-class inhibitor of HIV-1 capsid function, is in development as a long-acting agent for treatment and prevention of HIV-1.CAPELLA is an ongoing, phase 2/3 study in heavily treatment-experienced (HTE) people with HIV-1 (PWH) with multidrug-resistance. 36 participants were randomized (2:1) to add oral LEN or placebo to their failing regimen. At D15, those on oral LEN received subcutaneous (SC) LEN 927 mg (Q6M); those on placebo started the oral LEN lead-in, followed by SC Q6M. All randomized participants initiated an investigator-selected, optimized background regimen (OBR) at D15. An additional 36 participants started OBR concurrent with LEN  in a non-randomized cohort. We report the Week (W) 52 efficacy and safety results from both cohorts.st and 2nd SC doses, respectively). Most ISRs were mild or moderate. The most common AEs (excluding injection site reactions) were nausea and diarrhea (14% each).Of 72 participants enrolled, 25% were female, 38% Black, median age 52 years, 64% had CD4 < 200 cells/µL, 46% had HIV-1 resistant to all 4 major classes , and 53% had OBR with 1 or no fully active agents. At W52, 78% (56/72) achieved VL< 50 c/mL and 82% (59/72) achieved VL< 200 c/mL via FDA Snapshot algorithm. CD4 count increased by a median 84 cells/µL (Q1 to Q3: 21 to 153) and the proportion of participants with CD4 count ≥200 cells/ul increased from 36% at baseline to 68% at W52. Ten participants had emergent LEN resistance (8 previously reported); 4 of 10 subsequently suppressed. The median (range) duration of follow up on LEN was 71 (13–111) weeks. One participant discontinued due to injection site nodule (Grade 1). The most common injection site reaction (ISR) was swelling (28% [20/72] and 17% [12/70] after the 1In HTE PWH, subcutaneous LEN was well tolerated and in combination with OBR led to high and sustained rate of virologic suppression at W52. These results support the potential role for LEN for treatment of multi-drug resistant HIV-1 infection.Sorana Segal-Maurer, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|JANSSEN THERAPEUTICS: Honoraria|ViiV: Honoraria Benoit Trottier, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Honoraria|Merck: Advisor/Consultant|Merck: Honoraria|ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Honoraria Jason Brunetta, M.D., Gilead Canada: Advisor/Consultant|Gilead Canada: Honoraria|Gilead Canada: Conference Attendance Sponsorship|Viiv Canada: Advisor/Consultant Hui Wang, PhD, Gilead Sciences: Employment|Gilead Sciences: Stocks/Bonds Nicolas A. Margot, MA, Gilead Sciences: Employment|Gilead Sciences: Stocks/Bonds Hadas Dvory-Sobol, PhD, Gilead Sciences: Employment|Gilead Sciences: Stocks/Bonds Martin S Rhee, MD, Gilead Sciences: Stocks/Bonds Jared Baeten, MD, PhD, Gilead Sciences: Employee|Gilead Sciences: Stocks/Bonds Jean-Michel Molina, MD; PhD, GIlead: Board Member|GIlead: Grant/Research Support|Merck: Board Member|Merck: Expert Testimony|ViiV: Board Member.


We tested the association of lipid metabolites with ankle-brachial index (ABI) in the LLFS. Minimum ABI from doppler was used. Participants underwent phlebotomy after >8 hours fasting. Plasma metabolites were isolated via solid phase extraction. Lipid metabolites (N=193) were measured using RPLC-MS and corrected for batch effects in 948 participants. We used linear mixed models adjusted for age, sex, site, fasting, and relatedness. Twenty metabolites were associated with ABI (FDR P<0.05), of which 17/20 were triacyclglycerol (TAG) species, plus cholesterol ester (22:6), phosphatidylcholine (35:7), and phosphatidylethanolamine (38:7). After additional adjustment for traditional ABI risk factors, only two TAGs  were significantly associated after multiple testing correction. While not significant in the base model, the metabolite lysophosphatidylcholine (18:3) demonstrated a marginally significant protective association after full adjustment (P=0.014). While triglycerides are known correlates of atherosclerotic deposition, these findings may identify novel metabolic correlates of peripheral vascular health in long-lived individuals.


Severe COVID-19 infection is characterized by a dysregulated hyperinflammatory state that contributes to morbidity and mortality. Immunomodulatory therapy has been shown to improve outcomes. We investigated if abatacept, CTLA-4-Ig, a selective costimulation modulator, provides additional benefit when added to standard of care.We conducted a double-blind, randomized, placebo-controlled trial evaluating abatacept  compared to standard of care (including remdesivir and dexamethasone) in patients hospitalized with COVID-19 pneumonia. The primary outcome was median time to recovery by day 29. Key secondary endpoints included 28-day mortality.A total of 1019 patients received an infusion (509 assigned to abatacept and 510 to placebo), constituting the analyzed modified intention-to-treat cohort. The mean age 54.9 years (SD 14.65), 60.5% were male, 44.2% Hispanic or Latino and 13.7% black. Patients were evenly matched in terms of severity of illness, and comorbidities. Participants randomized to abatacept did not show a statistically significant difference in the primary endpoint with a recovery rate ratio of 1.135  compared to placebo. The median (IQR) time to recovery was 9 days  for both groups. The 28-day mortality in the abatacept arm was 11.0% and in control arm 15.0% ), with a 37.8% lower odds of dying in patients receiving abatacept. The improvement in mortality was demonstrated for patients requiring low or high flow O2 at baseline but was not seen in patients who required mechanical ventilation or ECMO at time of randomization. Subgroup analysis identified the strongest effect in those with baseline CRP >75mg/L, age >65 and diabetics. Safety data demonstrated slightly lower risk of adverse events. Rates of secondary infections were similar (abatacept 16.1% and placebo 14.3%).Although single-dose IV abatacept did not demonstrate statistically significant improvement in time to recovery, it did show a substantial reduction in 28-day mortality compared to standard of care.Reynold Panettieri, Jr., MD, AstraZeneca: Advisor/Consultant|AstraZeneca: Grant/Research Support|AstraZeneca: Honoraria|Equillium: Grant/Research Support|Genentech: Advisor/Consultant|Genentech: Grant/Research Support|Janssen: Grant/Research Support|MedImmune: Grant/Research Support|Merck: Honoraria|Novartis: Grant/Research Support|Origo: Grant/Research Support|RIFM: Advisor/Consultant|RIFM: Grant/Research Support|Sanofi: Honoraria|Vault Health: Grant/Research Support Jane A. O'Halloran, MD PhD, Janssen Scientific Affairs, LLC: Grant/Research Support Michael A. Maldonado, MD, Bristol Myers Squibb: Employee|Bristol Myers Squibb: Stocks/Bonds William G. Powderly, MD, Merck: Advisor/Consultant.


Data are currently limited on the performance of SARS-CoV-2 RNA levels as predictors or surrogate markers for clinical outcomes in outpatients with mild-to-moderate COVID-19.This exploratory analysis used data from 2205 non-hospitalized adults who enrolled between August 2020 and July 2021 and participated in placebo-controlled evaluations of two monoclonal antibody (mAb) agents (bamlanivimab [n=317] or amubarvimab/romlusevimab [n=837]), and an open-label cohort of bamlanivimab recipients [n=1051] as part of the ACTIV-2/A5401 platform trial. SARS-CoV-2 RNA levels were measured in anterior nasal (AN) swabs and plasma at day 0 (pre-treatment) and AN at day 3. We fit regression models to estimate the association between RNA level or detection and subsequent hospitalization/death within 28 days of enrollment.10 copies/mL [cp/mL]) and mAb (2.3 vs 4.9) groups. For placebo recipients, higher Day 0 AN RNA was associated with an increasing risk of hospitalization/death, ranging from 3% to 16% for < 2 and ≥ 6 log10 cp/mL, respectively. Although only 1% had quantifiable plasma SARS-CoV-2 RNA, there was a similar trend for day 0 plasma RNA: 5% hospitalizations/death for undetectable RNA, 16% for detectable but not quantifiable RNA, and 80% for ≥ 2 log10 cp/mL. Among 485 placebo recipients with days 0 and 3 AN RNA results, the risk of subsequent hospitalization/death was highest among those with ≥ 5.0 log10 cp/mL at both days  and lowest for those with unquantifiable levels at both days . Higher AN RNA at day 3 (adjusted for day 0 RNA) was associated with subsequent hospitalization/death among placebo recipients (relative risk (RR): 1.4 per log10 cp/mL; 95%CI: 1.0, 2.1), but not mAb recipients .One-hundred four participants (53/571 [9%] on placebo and 51/1634 [3%] on mAb) died or were hospitalized through day 28. Median AN RNA levels were lower at day 3 compared to day 0 in both placebo |Merck: Advisor/Consultant|Ridgeback Biopharmaceuticals: Research funding provided to the University of North Carolina|Roche: Advisor/Consultant|Syneos: Adjudication committee (Influenza) Paul Klekotka, MD, PhD, Eli Lilly: Employee|Eli Lilly: Stocks/Bonds David A. Margolis, MD MPH, Brii Biosciences: Stocks/Bonds David A. Wohl, M.D., Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Lilly: Grant/Research Support|ViiV: Advisor/Consultant|ViiV: Grant/Research Support Eric S. Daar, M.D., Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Merck: Advisor/Consultant|ViiV: Advisor/Consultant|ViiV: Grant/Research Support Davey M. Smith, M.D., M.A.S., Arena Pharmaceuticals: Advisor/Consultant|Bayer Pharmaceuticals: Advisor/Consultant|Brio Clinical.: Advisor/Consultant|Fluxergy: Advisor/Consultant|Kiadis: Advisor/Consultant|Linear Therapies: Advisor/Consultant|Matrix BioMed: Advisor/Consultant|Model Medicines: Advisor/Consultant|Signant Health: Advisor/Consultant|VxBiosciences: Advisor/Consultant Judith S. Currier, M.D., MSc, Merck: Advisor/Consultant.


Staphylococcus argenteus (SAR) is a novel species within the S. aureus (SAU) complex. SAR has been misidentified as SAU but has been increasingly reported worldwide as a pathogen. This study evaluated the prevalence of SAR causing bloodstream infection (BSI) in US centers, and the phenotypic, genotypic, and clinical outcomes associated with SAR BSI.785 SAU (326/459 MRSA/MSSA) from blood cultures (BC) of patients in 31 sites located in all 9 US Census Divisions during the SENTRY Antimicrobial Surveillance Program for 2019 were included. Isolates were screened for SAR by multiplex PCR. Isolates were subjected to MALDI-TOF and susceptibility (S) testing using the CLSI method. Isolates were subjected to genome sequencing, followed by DNA analysis.S. schweitzeri. SAR (ST2198) from patient 1 was S to all agents tested, as were the other 2 strains (ST2250 and ST1223), except for oxacillin. The latter 2 strains carried SCCmec type IV(2B) and a dfrG was also detected in the ST2250 lineage strain. All 3 strains carried multiple virulence genes.0.4% (3/785) SAR were detected and originated from Milwaukee , Houston , and Seattle . Patient 1 had a SAR recovered from BC 10 days after admission, but additional clinical information was not available. Patient 2 had end-stage renal disease and was admitted due to MRSA bacteremia/endocarditis, along with septic embolism in the lungs and brain. SAR grew from BC on day 4 and vancomycin was prescribed; the patient died on day 24. Patient 3 presented fever and chills in the 24 hours pre-admission, with a medical history significant for catheter-associated BSI. SAR was cultured from BC upon admission, and the patient received linezolid (5 days), but BCs remained positive. The central line was removed, and BCs cleared thereafter. MALDI-TOF generated highest scores for SAR for all 3 strains, but scores ≥2.0 were also obtained for SAU and mecA and various virulence genes.Low prevalence of SAR causing BSI was observed in US hospitals in 2019; however, SAR can clearly cause invasive infections. ST2250 has predominantly been detected in the USA and Canada, but this study showed distinct lineages causing BSI, including strains carrying Rafael Mendes, BS, JMI Laboratory: Grant/Research Support Lalitagauri M. Deshpande, PhD, Melinta: Grant/Research Support|Pfizer: Grant/Research Support Cecilia G. Carvalhaes, MD, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support Rodrigo E. Mendes, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Nabriva Therapeutics: Grant/Research Support|Office for Assistant Secretary of Defense for Health Affairs: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support|Spero Therapeutics: Grant/Research Support.


Clostridioides difficile.1,2 The incidence of Clostridioides difficile infection (CDI) in persons ≥ 65 years old is greater than in those < 65 years old,3 with 1 in 11 CDI patients ≥ 65 years old dying within 1 month of diagnosis.4 We report the efficacy and safety of RBX2660, a microbiota-based live biotherapeutic, in patients with recurrent CDI (rCDI) who were ≥ 65 years old with comorbidities. This is a subgroup analysis of the PUNCH CD3 trial (NCT03244644), a prospective, multicenter, randomized, double-blind, placebo-controlled phase 3 trial.Disruptions to gut microbiota composition can result in dysbiosis and subsequent intestinal colonization by opportunistic pathogens such as Participants enrolled in PUNCH CD3 were ≥ 18 years old with documented rCDI who completed standard-of-care antibiotic therapy prior to treatment with RBX2660 or placebo. Treatment success was defined as remaining recurrence-free 8 weeks after intervention. In this subgroup analysis, we assessed outcomes of participants ≥ 65 years old with underlying cardiac disorders, chronic kidney disease (CKD), and gastrointestinal (GI) disorders. The treatment-emergent adverse events (TEAEs) were summarized for the double-blind treatment period within 8 weeks and censored if a patient received open-label RBX2660 after CDI recurrence.Figure 1). In the total safety population, the overall incidence of TEAEs was 52% with RBX2660 treatment compared to 44% with placebo treatment; mild events accounted for most of the difference (40% vs 30%) (Table 1). The overall incidence of TEAEs was 51% in RBX2660-treated participants ≥ 65 years old and 61%, 68%, and 51% in those participants with a cardiac disorder, CKD, or GI disorder, respectively. Most TEAEs were mild or moderate in severity and related to a pre-existing condition.In the modified intent-to-treat population, 119 of 262 participants (45%) were ≥ 65 years old. Of these 119 participants, 42% had a cardiac disorder, 19% had CKD, and 61% had a GI disorder; the respective RBX2660 treatment success rates were 69%, 68%, and 67% (RBX2660 is safe and efficacious across a range of medically complex patients and consistently reduced rCDI in adults ≥ 65 years old, regardless of baseline comorbidities.Glenn S. Tillotson, PhD, Ferring Pharmaceuticals: Advisor/Consultant|Paratek Pharmaceuticals: Grant/Research Support|Spero Pharmaceuticals: Advisor/Consultant|Taro Pharmaceuticals: Advisor/Consultant Paul Feuerstadt, MD, FACG, AGAF, Ferring/Rebiotix Pharmaceuticals: Advisor/Consultant|Ferring/Rebiotix Pharmaceuticals: Grant/Research Support|Merck and Co: Advisor/Consultant|SERES Therapeutics: Advisor/Consultant|SERES Therapeutics: Grant/Research Support|Takeda Pharmaceuticals: Advisor/Consultant Stuart Johnson, M.D., Ferring Pharmaceuticals: Membership on Ferring Publication Steering Committee|Ferring Pharmaceuticals: Employee|Summit Plc: Advisor/Consultant Adam Harvey, PhD, Ferring Pharmaceuticals: Employment.


Aspergillus (including azole-resistant strains), resistant moulds , and dimorphic moulds. Information on absolute bioavailability and effect of food upon the pharmacokinetics (PK) of OLO when administered as a 30 mg tablet, including feasibility of alternative enteral delivery, is required for appropriate guidance on dosing.OLO is a novel antifungal active vs. Healthy male and female subjects in Cohorts A and B  participated in 3 treatment periods; single doses of 150 mg OLO as a 2-h IV infusion, a fasted PO dose (after overnight fast), and a fed single PO dose (30 min after starting a high fat breakfast). Healthy subjects in Cohort C participated in 2 treatment periods and received fasted single doses of 150 mg OLO either PO as intact tablets or via NG tube (tablets dispersed in water). PK sampling was performed for 120 h after each dose, with at least 10 days between dosing occasions per subject.max (Table 1). Multiple post-dose OLO peaks were observed for most subjects regardless of dose route or fed state; peaks typically coincided with meal times .The absolute bioavailability of a fasted single PO dose of OLO was found to be 67%. Administering OLO in the presence of food resulted in slight reduction in overall exposure, with an approximate 30% reduction in COLO systemic exposure was similar for intact tablets given PO and tablets dispersed in water given via NG tube (Table).Statistical Analysis of Olorofim PK parameters for Cohorts A, B and COLO (30 mg tablet) has good oral bioavailability and based upon the minimal impact of a high-fat breakfast upon overall exposure, can be administered with or without food. No dose adjustment is needed if switching from oral dosing with intact tablets to dosing tablet in water via NG tube.Karen Cornelissen, PhD, F2G: Employee Paul A. Newell, MB BS, AstraZeneca: Stocks/Bonds|F2G: Stocks/Bonds John H. Rex, MD, Advent Life Sciences: Operating Partner|Advent Life Sciences: Ownership Interest|AMR Action Fund: Advisor/Consultant|AstraZeneca: Stocks/Bonds|Basilea Pharmaceutica: Advisor/Consultant|Bugworks Research, Inc.: Advisor/Consultant|F2G, Limited: Employee|F2G, Limited: Stocks/Bonds|Forge Therapeutics: Advisor/Consultant|GlaxoSmithKline: Advisor/Consultant|Pfizer Pharmaceuticals: Honoraria|Sumitovant: Advisor/Consultant Samuel Israel, MBBS, Labcorp: Eemployee James Bush, MB ChB, PhD, Labcorp: Employee |Labcorp: Stocks/Bonds.


The European Confederation of Medical Mycology (ECMM) collected data on epidemiology, risk factors, treatment, and outcomes of culture proven candidemia across Europe in order to assess how adherence to guideline recommendations correlate with outcomes.Each participating hospital  included the first ∼10 culture proven IC cases after 01-Jul-18 and entered data into the ECMM Candida III database on the FungiScope™ platform. EQUAL Candida Scores (10.1111/myc.12746) reflecting adherence to recommendations of IDSA and ESCMID Guidelines were assessed.A total of 632 Candidemia cases were included from 64 institutions in 20 European countries. Patients characteristics are displayed in Table 1. Overall mortality was 45% (286/632), and hospital stay was prolonged (median 2 days) for completion of parenteral therapy only in 16% (100/621) of patients. EQUAL Candida Score was evaluable for 589 cases with candidemia . Candida scores correlated significantly with duration of hospitalization  and - after exclusion of patients hospitalized < 7 days (n=119) - were significantly higher in patients who survived versus those who died (p< 0.001). Duration of hospitalization was in median 16 days after diagnosis of candidemia. Initial echinocandin treatment was associated a.) with lower overall mortality  versus those without initial echinocandin therapy , and b.) with longer duration of hospitalization among survivors . In those where candidemia was treated for at least 14 days, 78% (239/306) survived, compared to 66% (67/102) in those treated for less than 14 days, but who survived beyond day 14 after diagnosis.Initial echinocandin treatment was associated with increased overall survival, but also longer duration of hospitalization . Overall mortality of IC was 45%. EQUAL Candida scores were significantly higher on those who survived, indicating that adherence to clinical guidelines may increase survival.Martin Hoenigl, n/a, Astellas: Grant/Research Support|Gilead: Grant/Research Support|NIH: Grant/Research Support|Pfizer: Grant/Research Support|Scynexis: Grant/Research Support Maiken C. Arendrup, DMSci, PhD, MD, Chiesi, Gilead: Honoraria|F2G, Cidara, Scynexis: Grant/Research Support Oliver A. Cornely, Prof. Dr., Abbott: Honoraria|Abbvie: Advisor/Consultant|Actelion: Board Member|Al-Jazeera Pharmaceuticals: Honoraria|Allecra Therapeutics: Board Member|Amplyx: Advisor/Consultant|Amplyx: Grant/Research Support|Astellas: Honoraria|Basilea: Advisor/Consultant|Basilea: Grant/Research Support|Biocon: Advisor/Consultant|Biosys: Advisor/Consultant|BMBF: Grant/Research Support|Cidara: Advisor/Consultant|Cidara: Board Member|Cidara: Expert Testimony|Cidara: Grant/Research Support|CoRe Consulting: Stocks/Bonds|Da Volterra: Advisor/Consultant|DLR: Grant/Research Support|DZIF: Grant/Research Support|Entasis: Board Member|EU Directorate-General for Resarch and Innovation: Grant/Research Support|F2G: Grant/Research Support|German Patent and Trade Mark Office: German patent (DE 10 2021 113 007.7)|Gilead: Advisor/Consultant|Gilead: Grant/Research Support|Grupo Biotoscana/United Medical/Knight: Honoraria|Hikma: Honoraria|IQVIA: Board Member|Janssen: Board Member|Matinas: Advisor/Consultant|Matinas: Grant/Research Support|MedPace: Advisor/Consultant|MedPace: Grant/Research Support|MedScape: Honoraria|MedUpdate: Honoraria|Menarini: Advisor/Consultant|Merck/MSD: Grant/Research Support|Merck/MSD: Honoraria|Molecular Partners: Advisor/Consultant|MSG-ERC: Advisor/Consultant|Mundipharma: Grant/Research Support|Mylan: Honoraria|Noxxon: Advisor/Consultant|Octapharma: Advisor/Consultant|Octapharma: Grant/Research Support|Paratek: Board Member|Pardes: Advisor/Consultant|Pfizer: Grant/Research Support|Pfizer: Honoraria|Projektträger Jülich: Grant/Research Support|PSI: Advisor/Consultant|PSI: Board Member|Pulmocide: Board Member|Scynexis: Advisor/Consultant|Scynexis: Grant/Research Support|Seres: Advisor/Consultant|Shionogi: Board Member|Wiley (Blackwell): Editor-in-Chief, Mycoses.


The correct citation is: Bacurau AGM, Sato APS, Francisco PMSB (2021) Reasons for nonadherence to vaccination for influenza among older people in Brazil. PLoS ONE 16(11): e0259640.


Real-world effectiveness of fixed dose dolutegravir/lamivudine (DTG/3TC) two-drug regimens (2DR) during the first 24 months of availability in the US was compared to common three-drug regimens (3DRs) among suppressed antiretroviral therapy (ART)-experienced people living with HIV (PLWH).® Cohort were followed until 30APR2021 . Univariate Poisson regression (incidence rates) and Cox proportional hazards marginal structural models were employed to assess confirmed virologic failure  or regimen discontinuation.Suppressed  PLWH initiating DTG/3TC 2DR, bictegravir (BIC)-3DR, or DTG-3DR between 01MAY2019 and 31OCT2020 in the OPERAOverall, 8037 PLWH were included in the analysis (Table). Virologic failure incidence rates were low, ranging from 0.66 (DTG/3TC) to 1.78 (DTG 3DR) per 100 person-years. Compared to DTG/3TC, only DTG 3DR was associated with an increase in the hazard of virologic failure. Discontinuation incidence rates ranged from 8.30 (BIC 3DR) to 24.9 (DTG 3DR) per 100 person-years. The discontinuation hazard was 69% greater with DTG 3DRs and 49% lower with BIC 3DRs compared to DTG/3TC. Regardless of regimen, most discontinuers were suppressed (VL< 200 copies/mL) at the time of discontinuation . Discontinuations following an adverse diagnosis/side effect were uncommon with DTG/3TC 2DR (3%) and DTG 3DR , and higher with BIC 3DR discontinuation . The most common reason for DTG 3DR discontinuations was regimen simplification (21%); no reason was given for >50% of the discontinuations in each group.Among ART-experienced, virologically suppressed PLWH, virologic failure was rare after switching to DTG/3TC 2DR, BIC 3DR or DTG 3DR. Most discontinuations were not attributed to the treatment , suggesting other reasons for discontinuation despite high levels of suppression and tolerability.Gerald Pierone, Jr., MD, Gilead: Grant/Research Support|GSK-VIIV: Grant/Research Support Jennifer S. Fusco, BS, AIDS Healthcare Foundation: Client of my employer|EMD Serono: Client of my employer|Gilead Sciences: Client of my employer|Janssen: Client of my employer|Merck & Co.: Client of my employer|TheraTechnologies: Client of my employer|ViiV Healthcare: Client of my employer Laurence Brunet, PhD, AIDS Healthcare Foundation: Client of my employer|EMD Serono: Client of my employer|Gilead Sciences: Client of my employer|Janssen: Client of my employer|Merck & Co: Client of my employer|TheraTechnologies: Client of my employer|ViiV Healthcare: Client of my employer Vani Vannappagari, MBBS, MPH, PhD, ViiV Healthcare: I am full time employee of ViiV Healthcare and receive GlaxoSmithKline stock as part of my compensation package|ViiV Healthcare: Stocks/Bonds Supriya Sarkar, PhD, MPH, ViiV Healthcare: Salary|ViiV Healthcare: Stocks/Bonds Cassidy Henegar, PhD, MSPH, GlaxoSmithKline: Stocks/Bonds|ViiV Healthcare: full-time employee Andrew Zolopa, MD, ViiV Healthcare: full time employee|ViiV Healthcare: Stocks/Bonds Gregory P. Fusco, MD, MPH, AIDS Healthcare Foundation: Client of employer|EMD: Grant/Research Support|Gilead Sciences: Client of employer|Janssen: Client of employer|Merck & Co.: Client of employer|Theratechnologies: Client of employer|ViiV Healthcare: Client of employer.


Historically, EC had been a common infection in the pre-azole era, and it was associated with thrush, cytopenia, chemotherapy, and debility in patients (pts) with malignancy. However, the presentation and outcomes of EC in cancer pts in the current era of new cancer treatments and frequent use of azoles as antifungal prophylaxis are scarcely studied.We retrospectively reviewed the risk factors, clinical and laboratory features, and outcome of pathology-documented EC in pts at MD Anderson Cancer Center from January 2017 to October 2021. We followed established criteria for the endoscopy grade of EC :715-9). We used a binary multivariable logistic regression model to determine independent risk factors for treatment failure (defined as relapse within 1 year from EC diagnosis) among pts who received fluconazole for EC treatment.Among 323 pts with EC, 290 pts (90%) had solid tumors; only 33 pts (10 %) had hematological malignancies. Only 7 (2%) of pts had prior antifungal prophylaxis Esophageal cancer was most common (35%), followed by lung cancer (10.8%), gastric cancer (10.2%), and colon cancer (5.9%). 229 pts (71%) received chemotherapy within 30 days prior to EC diagnosis. The most common symptoms were dysphagia (39%), nausea (20%), and odynophagia (15%); 33% of EC pts were asymptomatic. Oral thrush (2%) was uncommon. Most patients (83%) had non-ulcerative EC (endoscopic grade 1-2), 13% had grade 3, and 4% had grade 4 EC. 206 pts (64%) received antifungal treatment . Among pts treated with fluconazole, 27 (13%) had treatment failure. Underlying esophageal disease was the only independent predictor of fluconazole treatment failure on multivariate analysis .In a large cohort of 323 contemporary pts with EC the entity is predominantly encountered in pts with solid tumor on no antifungal prophylaxis, especially the ones with underlying esophageal pathology which is a predictor of azole treatment failure. Concomitant thrush was uncommon, and in 1/3 of pts EC was only an endoscopic finding.Dimiitrios P. Kontoyiannis, MD, ScD, PhD (hon), AbbVie: Advisor/Consultant|Astellas Pharma: Advisor/Consultant|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Cidara Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Merck: Advisor/Consultant.


P. aeruginosa (PSA) and A. baumannii-calcoaceticus complex (ACB) as part of the SENTRY Antimicrobial Surveillance Program.Cefiderocol (CFDC) is a siderophore-conjugated cephalosporin with activity against Gram-negative bacteria. CFDC and comparator activities were analyzed against resistant and molecularly characterized 2,241 PSA and 682 ACB were consecutively collected from 63 US sites in 2020-2021. Susceptibility testing was performed by broth microdilution and CFDC testing used iron-depleted media. FDA and CLSI breakpoints were used for CFDC. CLSI criteria were applied to comparators, except for imipenem-relebactam (IMR) that used FDA breakpoints. Isolates with a resistance phenotype to ≥ 3 classes were defined as multidrug resistant (MDR). ACB and PSA with imipenem and/or meropenem (MER) MIC ≥4 μg/mL or ceftazidime (CAZ) and/or cefepime MIC ≥ 16 μg/mL were subjected to next-generation genome sequencing for screening of acquired carbapenemase genes.50/90, 0.06/0.25 μg/mL) and did  meet the MIC screening criteria. CFDC also had similar MIC50 values (0.12 μg/mL) against the MDR and carbapenemase-positive PSA populations, whereas other agents had compromised activity. 42.5% (290/682) of ACB met the MIC screening criteria, while 35.9% (245/682) had an MDR phenotype, and 27.3% carried carbapenemase genes . In general, CFDC, IMR, meropenem-vaborbactam, MER, ceftazidime-avibactam, and CAZ had activity against ACB that did not meet the MIC screening criteria, but only CFDC  was active against the resistant ACB subsets.31.6%  and 16.9%  of PSA met the MIC screening criteria and showed an MDR phenotype, respectively (Table). Carbapenemase genes were detected in 6 (< 1%) PSA. CFDC had similar MIC against PSA that did not , Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Shionogi: Grant/Research Support Mariana Castanheira, PhD, AbbVie: Grant/Research Support|Cidara: Grant/Research Support|GSK: Grant/Research Support|Melinta: Grant/Research Support|Pfizer: Grant/Research Support|Shionogi: Grant/Research Support.


Dear Editor,Trichophyton rubrum , Peking Union Medical College Youth Fund (3332017168) and Six Major Talent Summit in Jiangsu Province (No.WSN-030).Congcong Zhang: Article writing; Case analyzing; Patient follow-up.Hao Chen: History collecting; Picture taking.None declared.


Perlodinella Klapálek, 1912 is a small stonefly genus in the Palearctic areas of China and its biodiversity is underestimated.Perlodinella, Perlodinellashennongjia sp. nov. in the Dajiuhu National Wetland Park of Shennongjia Forestry District, Hubei Province, central China. The description and illustrations of the new species are provided, based on male adults, female adults and eggs. The new species can be distinguished from its congeners by the characters of male and female genitalia and the egg structure.This paper reports a new species of  Plecoptera) are known as a relatively small group of hemi-metabolous aquatic insects. The stonefly genus Perlodinella Klapálek, 1912 belongs to Perlodidae and is distributed in the Palearctic areas of China  from the genus Rauserodes Zwick, 1999  for half an hour to extrude the aedeagus and eversible paraproct lobes. Immature eggs were taken from inside of the female abdomen. Observations and measurements were performed with a SDPTOP SZM45 stereomicroscope. Colour images were taken using a Canon EOS 6D digital camera with a Canon MP-E 65 mm 5X macro lens. All images were optimised and assembled into plates with Adobe Photoshop CS6. The holotype and paratypes are deposited in the Insect Collection of Jiangsu University of Science and Technology, Jiangsu Province, China (ICJUST). The terminology of wing venation follows that of Chen, Xu & Shen, 2022sp. n.A82179F1-AE25-551F-8966-02877E7BF06B0DB574AB-1770-4CB3-81AB-FC4BE4A3C26BType status:Holotype. Occurrence: individualCount: 1; sex: male; Taxon: kingdom: Animalia; phylum: Arthropoda; class: Insecta; order: Plecoptera; family: Perlodidae; genus: Filchneria; specificEpithet: shennongjia; taxonRank: species; nomenclaturalCode: ICZN; Location: country: China; stateProvince: Hubei; municipality: Shennongjia Forestry District; locality: Dajiuhu National Wetland Park; verbatimElevation: 1551 m; verbatimCoordinates: 110°7′33.9″N, 31°27′5″E; Identification: identifiedBy: Zhi-Teng Chen; Event: verbatimEventDate: 31-03-2022; Record Level: institutionCode: ICJUSTType status:Paratype. Occurrence: individualCount: 11; sex: 7 males, 4 females; Taxon: kingdom: Animalia; phylum: Arthropoda; class: Insecta; order: Plecoptera; family: Perlodidae; genus: Filchneria; specificEpithet: shennongjia; taxonRank: species; nomenclaturalCode: ICZN; Location: country: China; stateProvince: Hubei; municipality: Shennongjia Forestry District; locality: Dajiuhu National Wetland Park; verbatimElevation: 1551 m; verbatimCoordinates: 110°7′33.9″N, 31°27′5″E; Identification: identifiedBy: Zhi-Teng Chen; Event: verbatimEventDate: 31-03-2022; Record Level: institutionCode: ICJUSTBody length (from anterior of head to posterior of paraprocts) 13.0-15.0 mm (examined specimen number = 8), living male near habitat stream and male in ethanol both dark brown Figs .Head mostly dark brown dorsally, pale ventrally Fig. ; triocelPronotum subquadrate Fig. , lateralAbdominal segments mostly dark Figs , 4, 5, sBody length 17.0-19.0 mm (examined specimen number = 4), mostly dark brown Fig. . Colour Macropterous Figs , 7; foreAbdomen dorsally dark brown; abdominal sterna 1-7 with a continuous dark brown, median stripe, lateral areas pale Fig. . AbdominLength ca. 800 μm; width ca. 400 μm. Trilateral (Fig. The new species is diagnostic by the following combination of features: mesothoracic furcasternum branches reaching posterior of furcal pits; hind-wings with broad anal area; male abdominal segments 1-4 divided into distinct terga and sterna; terga 6-9 not elevated at posterior half, with dense posterolateral hair patches; terga 8-10 with scattered sensilla basiconica on posterior half; tergum 10 strongly elevated, dorsally covered with dense short spines and sparse sensilla basiconica, apex blunt, ventrally with scattered sensilla basiconica; aedeagus membranous, thumb-shaped, dorsally covered with sparse dark spines, ventrally covered with dense dark spines, apex with sparse pale spines; paraproct sclerite basally resembling a parallelogram, apex inwardly pointed, anterior and inner margins dark, not connected basally; eversible paraproct lobe short, near bulbous, covered with dense pale spines and several scattered dark spines; female abdominal sterna 1-7 with a continuous dark median stripe, sternum 8 with four subtriangular dark sclerites, sterna 9-10 pale and short; subgenital plate broad, elongated and rounded; eggs trilateral, with both longitudinal and transverse ridges, micropyles present.Perlodinellashennongjia sp. nov. can be easily distinguished from P.kozlovi and P.epiproctalis by the unlobed epiproct (P.unimacula, P.microlobata, P.fuliginosa and P.tatunga by the rounded female subgenital plate without any notch or lobes (P.apicalis by the absence of dark brown femora and downcurved hook on paraproct (P.mazehaoi by the distinctly shorter male tergum 10 and different shape of female subgenital plate (P.tibetensis by the paraproct sclerites pointing inwards instead of outwards (epiproct , from P.or lobes , Wu 1973araproct , from P.al plate  and fromoutwards .The new species is named after its type locality, the Shennongjia Forestry District.The new species is currently only known from the Shennongjia Forestry District, Hubei Province, China.


We evaluated the immune response to COVID-19 vaccines in several specific populations at high risk of severe COVID-19.in vitro neutralization assay) were evaluated at one month after the second dose of COVID-19 vaccine.Participants from the French national multi-center prospective cohort study ANRS0001S COV-POPART were included (11 specific subpopulations: and 2 control groups (18–64 years and over 65 years)). In this preliminary analysis patients and controls who had received at least two vaccine doses have been included. Percentages ) of participants with anti-Spike SARS-CoV-2 IgG antibodies (ELISA) and specific neutralizing antibodies  or neuromyelitis optica spectrum disorders, 61 hypogammaglobulinemia, 401 diabetic, 739 obeses non-diabetic and 476 HIV) and 1053 controls (893: 18–64 years and 160 over 65 years). Median age was 51.7 years [InterQuartile range: 40.8 – 60.9] and 50.7% were male. Most of the participants received BNT162b2 vaccine (86.4%). In the control group, 100%  of those aged 18–64 and 99.4%  of those over 65 years developed anti-Spike IgG antibodies.PLWHIV, cancer and diabetic patients had high rate of responders after two doses with 98.3% , 93.0%  and 92.0% , respectively. The lowest percentage of responders was found in patients with SOT , HSCT  and hypogammaglobulinemia . In both control groups, the frequency of neutralizing antibodies was similar to the anti-Spike IgG antibody response. In the immunodeficient populations, neutralizing antibodies responders tended to be less frequent than anti-Spike antibodies responders. Similar trends than for IgG antibody were identified .Anti-Spike and Neutralizing antibody (Ab) responses (95% CI) one month after the second dose of COVID-19 vaccine in specific and control populations.Lower COVID-19 vaccine humoral response was observed in specific populations than in controls, especially in patients with hypogammaglobulinemia, HSCT and SOT.Paul LOUBET, MD, PhD, pfizer: Board Member Odile Launay, MD, PhD, AstraZeneca: Financial|GlaxoSmithKline: Advisor/Consultant|GlaxoSmithKline: Grant/Research Support|Johnson & Johnson: Advisor/Consultant|Johnson & Johnson: Grant/Research Support|MD: Advisor/Consultant|Moderna: Advisor/Consultant|MSD: Data safety monitoring board|Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support|Sanofi Pasteur: Advisor/Consultant|Sanofi Pasteur: Grant/Research Support|Sanofi Pasteur: Data safety monitoring board.


Treatment for people living with HIV-1 (PLWH) continues to advance with a two-drug regimen (2DR) approach. Dolutegravir/lamivudine (DTG/3TC) is indicated as a 2DR for both treatment-naïve and virally suppressed PLWH. Despite high and sustained virologic efficacy for DTG-based 2DRs observed in clinical trials, there is limited evidence in US real world clinical settings. This study characterizes prescribing behaviors and treatment outcomes for DTG-based 2DR in the real world.TANDEM was a retrospective medical chart review conducted across 24 US sites. Eligible PLWH were adults initiated on single tablet DTG/3TC or DTG/rilpivirine prior to Sept/30/2020 with a minimum clinical follow-up of six months. Treatment-naïve PLWH had no prior history of HIV therapy. Clinical characteristics, treatment history and outcomes were abstracted. Analyses were descriptive. Reported here are viral outcomes for the DTG/3TC cohort of treatment-naïve PLWH with baseline viral loads (VLs) ≥ 100,000 (c/mL).From an overall sample of 469 PLWH on DTG-based 2DR, 318 received DTG/3TC. Of the DTG/3TC cohort, 126 were treatment-naïve. Of the treatment-naïve, 58 PLWH had known VLs available at DTG/3TC initiation. For those with baseline VLs ≥ 100,000 c/mL, 9 had values 100,000-250,000 c/mL while 7 were > 250,000 c/mL. Characteristics of this sub-cohort are described in Table 1. Overall, the most common reason for DTG/3TC initiation in this sub-cohort was patient preference (n=5), followed by avoidance of long-term toxicities and convenience (both n=3). For those with VLs between 100-250k, median CD4 count was 312 while 8/9 became virally suppressed (HIV-1 RNA < 50c/mL) and 1 PLWH had missing data. For those with VLs > 250k, median CD4 count was 114 while 6/7 became virally suppressed and 1 PLWH had missing data. One of these 6 PLWH experienced virologic rebound yet remained on DTG/3TC.These real world results reflect data from clinical trials, demonstrating DTG/3TC is effective and well tolerated in the real world. Nearly all DTG/3TC users, regardless of baseline VL, experienced sustained virologic suppression with few treatment discontinuations. Caution should be used when extrapolating these results due to limited population size of the sub-cohorts.Paul Benson, DO, AAHIVS, ViiV Healthcare: Advisor/Consultant|ViiV Healthcare: Speakers Bureau and Advisory Boards Cindy Donovan, PharmD, Johnson & Johnson: Stocks/Bonds|ViiV Healthcare: Employee/Salary|ViiV Healthcare: Stocks/Bonds Gavin Harper, BA, ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare.|ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare Deanna Merrill, PharmD, MBA, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds Katie L. Mycock, MChem, ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare|ViiV Healthcare: Adelphi Real World were paid consultants (CRO) to conduct the observational research study on behalf of ViiV Healthcare Alan Oglesby, MPH, GlaxoSmithKline (GSK): Employment|GlaxoSmithKline (GSK): Stocks/Bonds Jimena Patarroyo, PharmD, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds|ViiV Healthcare: Stocks/Bonds Aimee Metzner, PharmD, AAHIVP, ViiV Healthcare: Salaried employee|ViiV Healthcare: Stocks/Bonds.


Colonization with multi-drug resistant bacteria (MDR) in solid organ transplant (SOT) recipients increases the risk of post-transplant bacterial infection. MDR colonization impact on graft survival and mortality is not well established.2 statistic.A search was executed by an expert librarian on PROSPERO, OVID Medline, Ovid EMBASE, Wiley Cochrane Library, ProQuest dissertations and Theses Global and SCOPUS, from inception until October 26, 2021. Adult SOT colonized with Methicillin resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococci (VRE), Extended-spectrum beta-lactamase (ESBL) or AmpC producing bacteria, carbapenem resistant Enterobacteriaceae (CRE), or MDR Pseudomonas were included and compared to non-colonized SOT. Pairs of reviewers screened abstracts and full studies for inclusion, and extracted data independently. We used RevMan to conduct a meta-analysis using random effects models to calculate the pooled risk ratio (RR) with 95% confidence interval (CI) for the incidence of infection, mortality, and graft failure. Statistical heterogeneity was determined using the IPRISMA chart, systemic review and metanalysis on Impact Of Colonization By Multi Drug Resistant Bacteria on Graft Survival, Risk of Infection, and Mortality in Recipients of Solid Organ Transplant.2= 66%; VRE mortality: RR= 1.64 , I2= 44%; MRSA infection: RR= 4.07 , I2= 59%; MRSA mortality RR=1.47 , I2= 35%). ESBL and CRE colonization were associated with increased risk of infection (ESBL: RR=9.87 (6.12-15.93); p< 0.001), I2=13%; CRE: RR= 13.64 (95%CI 5.73-32.47); p< 0.001), I2= 66%). CRE colonization was associated with increased mortality, RR=5.79 , I2=0%.59 articles spanning from 1989 to 2021 were included . Liver transplant (43 studies) and VRE colonization (17 studies) were the most common organ and MDR pathogen. MDR surveillance was performed by culture (71%) and PCR (6.7%). In liver transplant recipients, VRE and MRSA colonization were associated with increased infection risk, but not mortality , IWhile colonization with MRSA and VRE in liver transplant was not associated with increase mortality, CRE colonization was associated with almost 6-fold increased risk of death. These data should be taken into account when stratifying the risk of transplant.Carlos Cervera, Associate Professor, Astra-Zeneca: Advisor/Consultant|AVIR Pharma: Grant/Research Support|AVIR Pharma: Honoraria|Lilly: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Merck: Honoraria|Sunovion: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: Honoraria|VerityPharma: Advisor/Consultant Dima Kabbani, MD, MSc, AVIR Pharma: Grant/Research Support|AVIR Pharma: Honoraria|GSK: Honoraria|Merck: Grant/Research Support.


New York State adopted a COVID-19 vaccination requirement for all healthcare workers in September 2021, but they allowed medical exemptions. We examined reasons and frequency of medical exemption requests in an academic medical center.We conducted active surveillance of all medical exemption requests in a tertiary care academic center in Central NY. Age, gender, reason for request, prior acceptance of other required vaccines, letter of support from employee provider, adjudication of the request, and impact of the decision on COVID-19 vaccine acceptance were collected prospectively since the mandate became effective.Among 8,776 HCWs, 108 requested medical exemptions, among those 57 (53%) were denied, 39 (36%) were granted temporary exemption, and 12 (11%) were permanent (Table). Females were more likely to request medical exemptions compared to males, 92 (85%) versus 16 (15%), respectively. Overall, 94 (87%) of the HCWs had a letter from their provider in support of their exemption. Nevertheless, only 47% of those qualified for permanent or temporary exemption using CDC guidelines. The most common reasons for requesting exemption included: having natural immunity, receiving monoclonal antibodies, experiencing a common reaction to previous COVID-19 vaccination, and having an underlying medical condition . The majority of individuals who had a request denied or who received a temporary medical exemption were subsequently vaccinated, 63% and 79%, respectively .Demographic and other characteristics among health care workers (HCW) requesting medical exemptions.Reasons for requesting medical exemption from COVID-19 vaccination requirement by request determination.COVID-19 vaccine uptake among health care workers (HCW) requesting medical exemptions to COVID-19 vaccination. *One HCW received alternative COVID-19 vaccine.Females were more likely to request a medical exemption to vaccination and their requests were often supported by their providers. Future efforts should focus on educating both health care providers and the public about actual medical contraindications or precautions to vaccination to improve overall vaccination rates.Jana Shaw, MD,MS,MPH, Pfizer: Advisor/Consultant Stephen J. Thomas, MD, Clover: case adjudication committee (compensated for time)|EdJen: Advisor/Consultant|Icosavax: data monitoring (compensated for time)|Island Pharma: Ownership Interest|Merck: Advisor/Consultant|Moderna: chair, safety monitoring committee (compensated for time)|New Day Diagnostics: Honoraria|Pfizer: Advisor/Consultant|PrimeVax: Ownership Interest|Sanofi Pasteur: Advisor/Consultant|Takeda: Advisor/Consultant|Takeda: case adjudication committee (compensated for time)|Vaxxinity: data monitoring committee (compensated for time).


Sophie Groot Wassink should be included as first author in the author byline. Their affiliation is 1: the Department of Human Resource Studies, Tilburg University, Tilburg, The Netherlands. This author states they have no competing interests to declare.https://doi.org/10.1371/journal.pone.0222518The correct citation is: Groot Wassink S, Van Wingerden J, Poell RF (2019) Meaningful work and resilience among teachers: The mediating role of work engagement and job crafting. PLoS ONE 14(9): e0222518. The updated author contributions are as follows:Conceptualisation: SGW, JvWData Curation: JvWFormal analysis: JvWWriting–original draft: SGW, JvW, RFPWriting–review & Editing: JvW


Pseudomonas aeruginosa are global antimicrobial resistance threats. Cefepime-taniborbactam (FTB) is an investigational β-lactam/ β-lactamase inhibitor combination that is active against Enterobacterales and Pseudomonas aeruginosa expressing serine and metallo-β-lactamases. CERTAIN-1 (Cefepime Rescue with Taniborbactam in cUTI) evaluated FTB efficacy and safety in the treatment of cUTI.Carbapenem-resistant Enterobacterales and multidrug resistant CERTAIN-1 was a randomized, double blind, double dummy, Phase 3 study comparing FTB to meropenem (MEM) in adults hospitalized with cUTI or AP. The primary endpoint was the composite  response at the test of cure (TOC) visit in the microITT population. Patients were randomized 2:1 to FTB 2.5g IV q8h or MEM 1g IV q8h for 7 days or up to 14 days in patients with bacteremia. The non-inferiority margin was -15.0% and a pre-specified test for superiority for the primary endpoint was performed following confirmation of non-inferiority.> 65 years represented 38.0% of the microITT population and bacteremia was present in 13.1% of patients. Composite success was achieved in 70.0% and 58.0% of FTB and MEM patients, respectively . FTB was statistically superior to MEM for the primary endpoint at the TOC  and statistical superiority was sustained at the late follow up visit (LFU). Analyses of secondary endpoints and subgroups were consistent with the primary efficacy analysis. Treatment-emergent adverse events (TEAEs) were observed in 35.5% of FTB patients and 29.0% of MEM patients. Serious adverse events occurred in 2.0% and 1.8% of FTB and MEM patients, respectively. The most common TEAEs were headache  and diarrhea .A total of 661 patients were randomized and 436 patients (66.0%) were included in the microITT population, including 42.2% with AP and 57.8% with cUTI. Patients Following 7 days of therapy, FTB was statistically superior to MEM for the primary endpoint at the TOC. Composite success for FTB remained statistically superior to MEM at the LFU visit. FTB was safe and well-tolerated with a safety profile similar to MEM.Paul C. McGovern, MD, Paratek Pharmaceuticals: Stocks/Bonds|Venatorx Pharmaceuticals: employee|Venatorx Pharmaceuticals: Stocks/Bonds Florian Wagenlehner, MD, Glaxo Smith Kline: Advisor/Consultant|Spero Pharmaceuticals: Advisor/Consultant|Venatorx Pharmaceuticals: Advisor/Consultant Leanne Gasink, MD, MSCE, Amplyx Pharmaceuticals: Advisor/Consultant|CSL Behring: Advisor/Consultant|Pfizer: Advisor/Consultant|Spero Therapeutics: Advisor/Consultant|Venatorx Pharmaceuticals: Advisor/Consultant|Vera Therapeutics: Advisor/Consultant Greg Moeck, PhD, Venatorx Pharmaceuticals: Employee|Venatorx Pharmaceuticals: Stocks/Bonds Patrick L. McLeroth, MD, Labcorp: Full time employee|Labcorp: Stocks/Bonds Mary Beth Dorr, PhD, Merck: Past employee|Merck: Stocks/Bonds|Pfizer: Stocks/Bonds|Venatorx: Employee Aaron Dane, MSc, Amplyx: Advisor/Consultant|AN2 therapeutics: Advisor/Consultant|Artizan: Advisor/Consultant|Cidara: Advisor/Consultant|ContraFect: Advisor/Consultant|Correvio: Advisor/Consultant|Davolterra: Advisor/Consultant|Destiny Pharma: Advisor/Consultant|Entasis: Advisor/Consultant|F2G Limited: Advisor/Consultant|GSK: Advisor/Consultant|Humanigen: Advisor/Consultant|Kymab: Advisor/Consultant|Modis: Advisor/Consultant|Orca: Advisor/Consultant|Pfizer: Advisor/Consultant|Phico: Advisor/Consultant|Pled Pharma: Advisor/Consultant|Rare Thyroid: Advisor/Consultant|Roche: Advisor/Consultant|Scynexis: Advisor/Consultant|Sinovent: Advisor/Consultant|Spero Therapeutics: Advisor/Consultant|Transcrip: Advisor/Consultant|Venatorx: Advisor/Consultant Tim Henkel, MD, PhD, Venatorx Pharmaceuticals: Stocks/Bonds.


Hypocharassus Mik, 1879 has only been recorded in the Nearctic and Oriental regions and, to date, it contains four known species.The genus Hypocharassuscavitarsussp. n. is described from Korea. This is the first record of this genus in the Palearctic Region. A description of the new species and a key to the Hypocharassus species are presented herein. Hypocharassus Mik, 1879 contains four species and has only been recorded in the Nearctic and the Oriental Regions. This genus was erected by H.gladiator, from Georgia, USA. Similarly, Drepanomyia, based on D.pruinosus (= H.pruinosus) from Florida, USA; however, Hypocharassus. Later, H.farinosus and H.sinensis were recorded from Taiwan and Guangxi, China, by The genus Crustacea or marine plankton , compound microscope (Olympus BX50) and Michrome 16 CMOS camera . Specimens are preserved in dry condition for observing and 95% ethanol for later molecular diagnosis. All specimens examined in this study were deposited in the collection of the School of Applied Biosciences, Kyungpook National University, Daegu, Korea.6E65F3BD-006E-5968-A9DD-E929EBE558299878BD39-6122-42D8-AA69-F29094F1A581Type status:Holotype. Occurrence: recordedBy: Young-Kun Kim & Sang Jae Suh; sex: male; lifeStage: adult; Taxon: scientificName: Hypocharassuscavitarsus; family: Dolichopodidae; Location: country: Korea; countryCode: KR; stateProvince: Jeollanam-do; county: Sinan-gun; municipality: Imja-myeon; locality: Samdu-ri; verbatimLatitude: 35°03'46.7"N; verbatimLongitude: 126°03'31.2"E; Event: year: 2021; month: 6; day: 19Type status:Paratype. Occurrence: recordedBy: Young-Kun Kim & Sang Jae Suh; sex: 4 females; lifeStage: adult; Taxon: scientificName: Hypocharassuscavitarsus; family: Dolichopodidae; Location: country: Korea; countryCode: KR; stateProvince: Jeollanam-do; county: Sinan-gun; municipality: Imja-myeon; locality: Samdu-ri; verbatimLatitude: 35°03'46.7"N; verbatimLongitude: 126°03'31.2"E; Event: year: 2021; month: 6; day: 19Type status:Paratype. Occurrence: recordedBy: Young-Kun Kim & Sang Jae Suh; sex: 11 males,7 females; lifeStage: adult; Taxon: scientificName: Hypocharassuscavitarsus; family: Dolichopodidae; Location: country: Korea; countryCode: KR; stateProvince: Chungcheongnam-do; county: Taean-gun; municipality: Taean-eup; locality: Donae-ri; verbatimLatitude: 36°49'03.4"N; verbatimLongitude: 126°19'17.9"E; Event: year: 2021; month: 7; day: 14Male ; postvertical seta proclinate and convergent and approximately 1–2 times longer than ocellar seta; frons broadened upwards; width between frons and face as long as compound eye at anterior view; face slightly broadened downwards; clypeus subparallel downwards and apically round; compound eye with tiny pale setulae between facets; upper postocular setae black in a single row; lower postocular setae pale and combined with occipital setae; upper occiput flat; lower occiput with thick pale setae; antenna black; scape bare; pedicel setose at apical margin; postpedicel check mark shape and ventral projection 2/5 times shorter than dorsal projection; arista-like stylus thick and two segmented and apical segment minutely longer than basal segment and placed apically; palpus basally grey and apically yellow with pale setulae; proboscis large and black with pale setulae  seta and some pale setulae; 3–5 tiny intra-alar setae, 1 (rarely 2) presutural supra-alar, 3 postsutural supra-alar, 1 (rarely 2) notopleural, 1 postalar setae present; posterial scutum round; scutellum approximately 0.5 times shorter than width and apically round; 2–3 (rarely 4) scutellar setae present and as long as length of scutellum and laterals slightly smaller than median seta; proepisternum with pale setulae; anepisternum, katepisternum, anepimeron, katepimeron, meron and laterotergite bare.Legs mainly metallic bluish green with thick whitish pruinosity; all coxae and trochanter with pale setulae; fore femur and mid femur with pale setulae and 1 apical posteroventral seta, except black dorsal setulae at apical half; hind femur with black dorsal and pale ventral setulae and 1 apical anterodorsal and 1 posteroventral seta; all tibiae with 1–3 anterodorsals and 1–3 posterodorsal setae and apical ring of setae; all tarsi with 2 long ventral setae at apex of tarsomeres 1–4, respectively; tarsomere 1 grey and almost same or slightly shorter than total length of tarsomeres 2–5; tarsomeres 2–5 basally yellow and apically grey; fore tarsomere 4 with anterior projection and 2 setae at apex; fore tarsomere 5 anteriorly crooked and gradually widened towards apex and with anterior projection at base; mid tarsomeres 4 and 5 gradually broadened towards apex; mid tarsomeres 5 cone-shaped; hind tarsomeres 4 and 5 slightly broadened towards apex, but less broad than mid tarsomeres 4 and 5; all claws long, approximately twice longer than pulvillus; basal half of fore anterior claw broad, almost equal to width of pulvillus; all empodium pale, narrow feather shaped and curved upwards; pulvillus greyish brown  tarsomere 5 of fore tarsus.Korea .Hypocharassussinensis Yang, 1998 which is identified by the female type specimen, can be separated from the new species by five pairs of scutellar setae and two times larger body size (approximately 13 mm). H.farinosus Becker, 1922 also can be distinguished from the new species by the brown halter and calypter, absence of anterior projection at base of fore tarsomere 5 and absence of basally broad fore anterior claw (Fig. This new species and Oriental species can be distinguished easily from two Nearctic species by the absence of scape setae. While, compared to new species and Oriental species, they have relatively similar morphological features. However, each can be identified by the following characteristics.