Rapid Respiratory Microbiological Point-of-Care Testing and Antibiotic Use in Primary Care – A Randomized Clinical Trial
The primary outcome — same-day antibiotic prescribing — was identical in both groups at 45%, demonstrating no overall benefit of RM-POCT. The authors conclude that an RM-POCT testing only for viruses and atypical bacteria is unlikely to be clinically or cost-effective in primary care, as pathogen detection does not imply pathogen causation, particularly from nonsterile sites such as the nose and throat. Clinical implications: Adding multiplex respiratory panels to the workflow will not reduce antibiotic overuse without integrated stewardship interventions; host-response biomarkers, such as CRP, point-of-care testing has stronger evidence for safely reducing prescribing. Full Access: JAMA
Efficacy And Safety of Cefepime–Nacubactam and Aztreonam–Nacubactam Compared with Imipenem–Cilastatin for Complicated Urinary Tract Infection or Acute Uncomplicated Pyelonephritis (Integral-1): A Double-Blind, Randomized Phase 3 Trial
The Integral-1 trial was a global, double-blind, randomized phase 3 study that enrolled 614 adults with complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis across 79 sites. The primary composite endpoint of clinical cure plus microbiological eradication at test of cure was achieved by 82% of the cefepime–nacubactam group, 72% of the aztreonam–nacubactam group, and 61% of the imipenem–cilastatin group. Clinical implications: These results position cefepime–nacubactam as a promising carbapenem-sparing option for hospitalized patients with Gram-negative cUTI or pyelonephritis, including resistant strains — a critical need given rising ESBL prevalence — with the ongoing Integral-2 trial extending evaluation to carbapenem-resistant Enterobacterales. Full Access: The Lancet
Increase in Travel-Associated and Locally Acquired Dengue Cases — United States, 2024
The CDC report describes a marked increase in both travel-associated and locally acquired cases of Dengue fever in the United States during 2024, reaching record levels compared with prior years. Most cases were linked to international travel, but autochthonous transmission was increasingly identified in states such as Florida, Texas, and California.
Contributing factors include higher global dengue incidence, increased travel volume, and expansion of Aedes mosquito vectors influenced by climate and environmental conditions.
Clinical implications: Urgent Care clinicians should include the need for heightened suspicion of dengue in febrile returning travelers and awareness of possible local transmission in select US regions. Public health response should emphasize early testing, vector control, and clinician education to prevent missed diagnoses and limit further spread. Full Access: CDC
Clinical Characteristics, Antibiotic Resistance Trends, and Associated Molecular Epidemiology Traits in Escherichia coli Isolates Producing Neonatal Bacteremia
The study characterizes Escherichia coli isolates causing neonatal bacteremia, focusing on clinical features, antimicrobial resistance patterns, and molecular epidemiology. It found a predominance of specific virulent lineages associated with neonatal invasive disease, alongside concerning rates of resistance to commonly used empiric antibiotics. Extended-spectrum β-lactamase (ESBL)–producing strains were notably present. Clinical implications: These findings support the need to reassess empiric neonatal sepsis regimens in regions with high resistance and emphasize ongoing surveillance integrating microbiology and genomic data to guide antibiotic stewardship. Full Access: OFID