Ong F, Molenberghs G, Callegaro A
… +5 more, Van Der Elst W, Verbeke G, Stijven F, Keilegom IV, Abad AA
J Glob Infect Dis
· 2025 · PMID 40290204
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INTRODUCTION: Identifying hemagglutination inhibition (HI) antibody titers as a key immune correlate of protection (CoP) is crucial for developing, licensing, and monitoring the ongoing effectiveness of new influenza vac...INTRODUCTION: Identifying hemagglutination inhibition (HI) antibody titers as a key immune correlate of protection (CoP) is crucial for developing, licensing, and monitoring the ongoing effectiveness of new influenza vaccines. Using a new statistical methodology, we explored the link between an inactivated quadrivalent influenza vaccine's impact on HI antibody titers and its effectiveness against A/H1N1-associated influenza illness. METHODS: We utilized data from a phase 3, observer-blind, randomized, controlled trial in children aged 6-35 months to assess HI antibody titers as an immune CoP. The assessment used a statistical method developed within a causal inference framework and a new information-theoretic metric of surrogacy, the so-called individual causal association (ICA). RESULTS: The 75% and 85% uncertainty intervals of the ICA are 0.5511-0.8282 and 0.3632-0.8684, respectively, indicating a substantial reduction in the uncertainty about the vaccine's effect on the absence of infection when its impact on the HI antibody titers is known. CONCLUSIONS: The evaluation yielded evidence supporting the validity of HI antibody titers as a CoP for influenza infection.
Barik BS, Kar CD, Das S
… +5 more, Hussain T, Nayak S, Sahu AK, Sundaray S, Pati S
J Glob Infect Dis
· 2025 · PMID 40290203
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INTRODUCTION: Contacts of tuberculosis (TB) patients have an increased risk of latent TB infection (LTBI). Currently, it is diagnosed using one of the two methods: Tuberculin skin test (TST) or QuantiFERON-TB Gold Plus....INTRODUCTION: Contacts of tuberculosis (TB) patients have an increased risk of latent TB infection (LTBI). Currently, it is diagnosed using one of the two methods: Tuberculin skin test (TST) or QuantiFERON-TB Gold Plus. This study aims to estimate the concordance of TST and QFT-TB Gold Plus and associated factors among 73 healthcare workers (HCWs) and 172 household contacts (HHCs) who came in contact with active TB patients. This study was conducted from January to June 2023. METHODS: Prevalence and agreement were calculated. A regression analysis was performed to assess the predictors of discordance factors. RESULTS: The prevalence of latent TB was 20.40% ( = 50), defined as a positive result on either test. The overall agreement among participants was 62.04%, with a kappa coefficient of 0.26 (0.16-0.36, 95% confidence interval [CI]) (McNemar, < 0.001). A higher risk of LTBI was associated with BCG vaccination history, odd ratio 1.63, (95% CI 0.78-3.43) for TST and 0.51 (95% CI 0.22-1.15) for QFT, but this was not significant. Moreover, in our study, only the body mass index of 18.5-25 kg/m yielded an odds ratio of 2.33 (95%CI 0.77-6.47) for TST and 1.72 (95% CI 0.48-6.05) for QFT, was significant. Compared with QFT-TB Gold Plus, the sensitivity and specificity of TST were 80.65 (68.63-89.58) and 55.74 (48.22-63.06). CONCLUSION: TST exhibited a profound level of agreement with the QFT-Gold Plus assay but showed a higher rate of positivity due to some associated factors among HCWs, HHCs, and TB patients.
J Glob Infect Dis
· 2025 · PMID 40290202
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Accurate and rapid diagnosis is crucial for starting effective treatment for tuberculosis (TB) and mitigating the transmission. Globally, nearly one-third of all TB cases remain undetected each year and consequently thes...Accurate and rapid diagnosis is crucial for starting effective treatment for tuberculosis (TB) and mitigating the transmission. Globally, nearly one-third of all TB cases remain undetected each year and consequently these are not reported. On top of that, the emergence of drug-resistant TB poses an added challenge. In the past 15 years, several advances have been made for improved diagnosis, including liquid culture and drug susceptibility, line probe assay for drug resistance detection, and cartridge-based nucleic acid amplification tests for rapid diagnosis of TB and drug resistance detection. However, some challenges remain, despite the clear edge of these new advances over the age-old conventional methods. Despite these advances, accurate, affordable, and accessible diagnosis of TB remains a challenge, especially in rural and difficult-to-reach settings, where the most desirable test would be a point-of-care triage test. Nevertheless, several attempts are being made in this direction, and in this article, we review these research advances that can help the TB elimination from India.
J Glob Infect Dis
· 2025 · PMID 40290201
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INTRODUCTION: The study aimed to evaluate the risk factors linked to poor outcomes in pediatric patients diagnosed with tubercular bacterial meningitis (TBM). METHODS: A retrospective cohort study was conducted at King G...INTRODUCTION: The study aimed to evaluate the risk factors linked to poor outcomes in pediatric patients diagnosed with tubercular bacterial meningitis (TBM). METHODS: A retrospective cohort study was conducted at King George's Medical University in India, focusing on children diagnosed with TBM ( = 514) over a 5-year period from 2019 to 2023. The study evaluates various aspects of TBM in this population, including clinical presentation, diagnostic methods, and outcomes. Statistical analyses for the study were conducted using SPSS version 16.0 (SPSS, Chicago, IL, USA). RESULTS: Out of a total of 514 patients with TBM, 98 (19.1%) patients experienced a poor outcome. Multivariate analysis identified several factors associated with a poor outcome: age over 5 years ( = 0.829, = 0.002, odds ratio [OR] = 2.291, 95% confidence interval [CI]: 1.344-3.904), altered consciousness ( = 1.040, < 0.001, OR = 2.829, 95% CI: 1.686-4.747), a cerebrospinal fluid (CSF)-to-plasma glucose ratio <50% ( = -0.892, = 0.001, OR = 0.410, 95% CI: 0.244-0.688), hydrocephalus ( = 1.050, = 0.003, OR = 2.857, 95% CI: 1.417-5.760), and lack of Bacille Calmette-Guerin (BCG) immunization ( = 1.291, < 0.001, OR = 3.638, 95% CI: 2.150-6.156). CONCLUSION: The study identified key risk factors for poor outcomes in childhood TBM, including age over 5 years, high CSF protein levels, coma, hydrocephalus, and inadequate BCG immunization. These factors underline the severity of childhood TBM as a public health issue and emphasize the need for timely initiation of antituberculosis therapy.
J Glob Infect Dis
· 2025 · PMID 40290200
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Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome of immune dysregulation that results in multiorgan failure; HIV and histoplasmosis are known triggers of HLH. A young patient with AIDS was found to...Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening syndrome of immune dysregulation that results in multiorgan failure; HIV and histoplasmosis are known triggers of HLH. A young patient with AIDS was found to have disseminated histoplasmosis and met criteria for HLH. Despite 10 days of treatment with liposomal amphotericin B, she developed shock and acute respiratory distress syndrome and ultimately died. The few reported cases of HLH due to histoplasmosis in AIDS offer a variety of treatment approaches. There have been successful outcomes combining amphotericin with chemotherapies for HLH. Targeted therapies for HLH may be considered on a case-by-case basis in the setting of concurrent disseminated histoplasmosis and HIV/AIDS.
Rodriguez D, Equilia S, Roca C
… +6 more, Ludi E, Espada G, García Z, Machuca B, Clark T, Gilman RH
J Glob Infect Dis
· 2025 · PMID 40290199
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INTRODUCTION: Antimicrobial resistance (AMR) is a growing threat to global public health. In hospitals, infant mortality due to bacterial sepsis is associated with AMR. The epidemiology of AMR in Bolivia (a lower-middle-...INTRODUCTION: Antimicrobial resistance (AMR) is a growing threat to global public health. In hospitals, infant mortality due to bacterial sepsis is associated with AMR. The epidemiology of AMR in Bolivia (a lower-middle-income country) has not been sufficiently discussed. The aim of this study was to analyze AMR patterns over 8 years at a pediatric hospital in patients with hospital-acquired bloodstream infections. METHODS: This is a retrospective and analytical revision of AMR in bacteria isolated from blood cultures, performed between 2012 and 2019, in a pediatric hospital in Bolivia. Data analysis was conducted with Stata v14.0, and Fisher's exact tests were used to determine statistical significance. RESULTS: Four hundred and fifty-five (7.2%) positive blood cultures were identified from 6315 blood culture reports between 2012 and 2019. was the most frequently isolated bacteria and showed a significant change in its AMR profile over the 8 years of the study. Gram-negative bacteria and were also frequently isolated, and all demonstrated high levels of resistance to commonly used antibiotics. Overall, most of the clinically important microorganisms had high rates of AMR. CONCLUSIONS: In the present study, we report that isolated bacteria showed significant resistance to multiple drugs, and most demonstrated increased resistance over time. Worryingly, . showed an increasing resistance to commonly used antibiotics. Overall, despite the limitations, our study, which is one of the first of its kind in Bolivia, demonstrates the need for stricter policies of antibiotic stewardship in similar settings due to the global threat of AMR.
Gurung S, Chatterjee A, Yonzan R
… +7 more, Majumdar A, Chhophel TP, Tewari E, Sharma DK, Banu H, Sarkar MC, Dutta S
J Glob Infect Dis
· 2025 · PMID 40290198
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INTRODUCTION: Rotavirus is a frequent cause of gastroenteritis in young children. It is seasonal in many countries but occurs year-round in India.Since the launch of the Rotavirus Vaccine (RVV) morbidity and mortality in...INTRODUCTION: Rotavirus is a frequent cause of gastroenteritis in young children. It is seasonal in many countries but occurs year-round in India.Since the launch of the Rotavirus Vaccine (RVV) morbidity and mortality in children have greatly decreased. This study was carried out prior to the inclusion of RVV in the state vaccination schedule in 2019. The objective of the study was to estimate the burden of Rota Virus Gastroeneteritis in kids under 5 years of age, attending a government tertiary care hospital in the state and to identify the common circulating genotypes of Rotavirus. METHODS: Stool samples from children with more than three episodes of loose stool that were negative for bacterial enteric pathogens were tested by Enzyme Linked Immunosorbent Assay (ELISA) for Rotavirus antigen. Positive stool samples were transported to the Regional Viral Research and Diagnostic Laboratory at National Institute for Cholera and Enteric Diseases for genotyping. RESULTS: 200 stool samples were screened and 40 samples (20%) were positive for Rotavirus antigen by ELISA. G3P [8] - 33% (9/27), followed by G1P[8] -15%(4/27) and G2P4 - 11%( 3/27) were the most common genotypes. CONCLUSION: Rotavirus is a significant cause of gastroenteritis in children under five years of age in the Indian state of Sikkim.
Pandey S, Gupta MK, Rai P
… +4 more, Patra A, Begum NN, Halder P, Guha SK
J Glob Infect Dis
· 2025 · PMID 40290197
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Human brucellosis is a chronic systemic infection mostly presenting as afebrile illness with musculoskeletal complaints with organomegaly and diagnosis is based on serology. The diagnostic tests are sparsely available in...Human brucellosis is a chronic systemic infection mostly presenting as afebrile illness with musculoskeletal complaints with organomegaly and diagnosis is based on serology. The diagnostic tests are sparsely available in India and even less prescribed. We report six cases of human of brucellosis presenting as fever with rheumatic manifestation along with their outcome.
J Glob Infect Dis
· 2024 · PMID 39886092
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INTRODUCTION: Methicillin-resistant (MRSA) colonization in neonatal intensive care units (NICUs) is a significant global health concern, leading to severe infections, extended hospital stays, and substantial economic bu...INTRODUCTION: Methicillin-resistant (MRSA) colonization in neonatal intensive care units (NICUs) is a significant global health concern, leading to severe infections, extended hospital stays, and substantial economic burdens on health-care systems. To develop effective infection control strategies, we need to fill existing gaps in our understanding of MRSA epidemiology in neonates. The aim of this systematic review is to provide an extensive analysis of the proportion of MRSA colonizations in NICUs. METHODS: We used a comprehensive search strategy across databases such as Medline, Embase, Global Health, Web of Science, and Global Index Medicus, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were independently reviewed and selected based on a variety of criteria, including the inclusion of neonates tested for MRSA colonization during NICU stay, and the reporting of community-acquired and hospital-acquired MRSA (CA-MRSA and HA-MRSA) incidence levels. Exclusion criteria included studies outside NICUs, those focused on specific MRSA outbreaks or clinical infections, review studies, and those lacking abstracts or full texts. Five authors independently extracted data, which was summarized and checked for quality. Statistical analysis included a random-effects model to compute pooled proportions, stratification by geographical location, evaluation of heterogeneity, and examination of publication bias. RESULTS: Our systematic review evaluated 62 studies out of an initial 536 records identified. The majority of the selected studies were conducted in high-income countries, primarily in the United States. From these studies, we estimated a cumulative incidence rate of 7.2% for MRSA colonization in NICUs. When the source of MRSA was considered, CA-MRSA incidence was 2.7%, while HA-MRSA incidence was notably higher at 11%. A subgroup analysis showed geographical differences in the cumulative incidence of MRSA colonization in NICUs, with Brazil having the lowest incidence and Taiwan the highest. The proportion of HA-MRSA colonization also varied significantly by country, with South Korea reporting higher incidence rates than the United States. However, the differences in CA-MRSA colonization rates between countries and WHO regions were not statistically significant. CONCLUSIONS: Our systematic review found a cumulative incidence of 7.2% for MRSA colonization in NICUs, with HA-MRSA (11%) being more prevalent than CA-MRSA (2.7%). Regional variations were detected, with Taiwan exhibiting the highest cumulative incidence and South Korea having both the highest CA-MRSA and HA-MRSA. These findings underline the substantial public health impact of MRSA, especially in NICUs, necessitating context-specific prevention and control strategies. Future research should strive to address these regional disparities and aspire to attain a more globally representative understanding of MRSA colonization rates.
J Glob Infect Dis
· 2024 · PMID 39886090
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Melioidosis, caused by , is a challenging infectious disease with global implications, primarily affecting Southeast Asia. We present the case of a 24-year-old male with a curious history of tobacco use, presenting with...Melioidosis, caused by , is a challenging infectious disease with global implications, primarily affecting Southeast Asia. We present the case of a 24-year-old male with a curious history of tobacco use, presenting with fevers, weight loss, and genitourinary symptoms. Diagnostic challenges arose as symptoms mimicked other diseases. Disseminated melioidosis was confirmed via Gram staining and positron emission tomography scan findings, emphasizing the disease's diverse clinical manifestations. Treatment with ceftazidime and cotrimoxazole led to prompt recovery. Notably, the patient's tobacco use linked to contaminated water highlights a unique transmission route. This case underscores the need for heightened awareness and preventive measures in endemic regions.
Shankaraiah RH, Masthi NRR, Poornima MK
… +5 more, Kiruffi V, Sowmyashree S, Dutta T, Mahajan M, Desai S
J Glob Infect Dis
· 2024 · PMID 39886089
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INTRODUCTION: Rabies monoclonal antibody (mAb) is a life-saving immune-biological for postexposure prophylaxis (PEP) in all Category III animal exposures. A novel cocktail of mAbs derived using recombinant DNA technology...INTRODUCTION: Rabies monoclonal antibody (mAb) is a life-saving immune-biological for postexposure prophylaxis (PEP) in all Category III animal exposures. A novel cocktail of mAbs derived using recombinant DNA technology is presently available for usage. The WHO recommends monitoring the clinical use and outcomes of mAb products. METHODS: An open-label, postmarketing study was conducted at the anti-rabies clinic in the southern part of India. PEP was provided to all the study participants per the national guidelines. All the subjects were assessed for any adverse events (AEs) following PEP up to 35 days; if any, were treated free of cost at the study center. RESULTS: The present study included 309 subjects across all age groups, 59.2% were adults, 33.3% of children, and 7.5% elderly. Majority of the patients were exposed to dogs (89.6%) and most of them had lacerations (86.3%) in different parts of their body. A total of 19 (6.2%) AEs were reported. All the AEs were local reactions, namely pain (2.6%), erythema (1.4%), tenderness (1%), induration (0.6%), and swelling (0.6%). All reported AEs were mild (Grade 1 severity) and resolved completely with symptomatic treatment. CONCLUSION: The novel cocktail of mAbs was safe for PEP in Category III animal exposures across all the age groups and supports its continued and improved usage for Universal Health Coverage to prevent rabies.
Awadh AA, Alharthi AA, Alghamdi BA
… +4 more, Alghamdi ST, Baqays MK, Binrabaa IS, Malli IA
J Glob Infect Dis
· 2024 · PMID 39886088
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INTRODUCTION: Hepatitis B and C are viral infections causing chronic liver inflammation and, when left untreated, lead to cirrhosis and a risk for hepatocellular carcinoma, the most common type of primary liver cancer wi...INTRODUCTION: Hepatitis B and C are viral infections causing chronic liver inflammation and, when left untreated, lead to cirrhosis and a risk for hepatocellular carcinoma, the most common type of primary liver cancer with high mortality. The hepatitis B virus-hepatitis C virus (HBV-HCV) coinfection leads to a faster progression to advanced liver diseases and higher hepatocellular carcinoma (HCC) risk than monoinfection. Unlike the relative risk for HCC due to either HBV or HCV, no recent analysis of the risk for HBV-HCV coinfection exists. METHODS: Based on PRISMA recommendations and guidelines, we developed a search strategy by combining the keywords ("hepatitis B") and ("hepatitis C") and ("hepatocellular carcinoma" or "liver cancer"). First, we performed a title and abstract screening and, later, a full-text screening. We extracted the demographic characteristics, such as gender, age, study design, sample size, country, and biomarkers of hepatitis B surface antigen (HBsAg), HBV DNA, HBeAg, anti-HCV, and HCV RNA. The data were assessed for quality, and the Review Manager software was used for the meta-analysis. RESULTS: We included 63 studies. The pooled analysis showed that the risk of HCC was significantly higher in the case-cohort who were positive for HBsAg (odds ratio [OR] = 9.70 [3.75, 25.12], = 0.0001), HBV DNA or HBeAg (OR = 22.77 [10.00, 51.88], = 0.0001), HBV and HCV coinfection (OR = 46.07 [26.33, 80.60], = 0.0001) than the control cohort. CONCLUSION: Chronic HBV and HCV infections are major risk factors for HCC, and their coinfection was significantly associated with an increased risk of HCC than monoinfection.
Batalha FA, da Silva EF, Serra PT
… +9 more, Dos Santos RO, Salimo ZM, Chaves YO, Fagundes MÍ, Feuser PE, de Souza VC, Naveca FG, de Ávila RAM, Nogueira PA
J Glob Infect Dis
· 2024 · PMID 39886087
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INTRODUCTION: The tools to distinguish relapse from reinfection are needed in malaria-endemic areas. We evaluated seroprevalence against sets of specific peptides to the block 2 region of -merozoite surface protein-1 (Pv...INTRODUCTION: The tools to distinguish relapse from reinfection are needed in malaria-endemic areas. We evaluated seroprevalence against sets of specific peptides to the block 2 region of -merozoite surface protein-1 (PvMSP1) to detect parasite clones. METHODS: We applied amplicon deep sequencing (ADS) of block 2 region of the MSP-1 gene () to determine cocirculating parasite clones within eight -infected individuals. Based on this, a seroprevalence of IgM and IgG antibodies against sets of peptides of different block-2 haplotypes was validated. After, we evaluated the seroprevalence in plasma of 72 pregnant women, from which 31 had recurrent infections. RESULTS: ADS revealed one block 2 haplotype clone infecting five of eight -infected individuals. In all, IgM antibodies, not IgG, recognized only a set of peptides specific to the block 2 haplotype determined by ADS. In the other three patients, ADS determined three concurrent block 2 haplotype clones, among whom there was always one haplotype that predominated with more than 95% of high-quality reads and two other smaller haplotypes with up to 5% and the least was <1%. We observed higher IgM levels against haplotype-specific peptides corresponding to the predominant clone. The seroprevalence of pregnant women showed that anti-haplotype-specific IgM detected coinfection with parasite clones per pregnant woman and we also observed levels of anti-haplotype-specific IgM in primary infection increased in some recurrent episodes. CONCLUSION: IgM against sets of peptides specific to different haplotypes may be employed as a serological marker for parasite clones in vivax malaria.
Rajesh C, Thomas A, Eapen JJ
… +7 more, Yusuf S, John EE, Valson AT, Alexander S, David VG, Michael JS, Varughese S
J Glob Infect Dis
· 2024 · PMID 39886085
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INTRODUCTION: The aim of the study was to study the clinical profile and outcomes of nocardiosis in renal allograft recipients. METHODS: This was a retrospective study of clinical outcomes in consecutive renal allograft...INTRODUCTION: The aim of the study was to study the clinical profile and outcomes of nocardiosis in renal allograft recipients. METHODS: This was a retrospective study of clinical outcomes in consecutive renal allograft recipients with infection over a 22-year period (2000-2022) from a tertiary care center in Southern India. The clinical data were obtained from electronic medical records and patient files. RESULTS: A total of 1970 patients underwent renal transplantation at Christian Medical College, Vellore, India, between January 1, 2000, and December 31, 2022. During this period, 26 patients were diagnosed to have infection. Half (50%) of the patients had fever and cough as their initial presentation, 7 (26.9%) patients presented with cutaneous abscesses, 2 (7.6%) patients were incidentally detected to have lung nodules during routine follow-up, 2 (7.6%) patients presented with headache accompanied by fever, and 3.8% had graft abscess. The diagnosis was made by isolating the organism in culture from one or more of the following samples: sputum, blood, pus, or lung biopsy (either computed tomography [CT]-guided or bronchoscopic aspirate culture). Eight patients required bronchoscopy and two patients required CT-guided biopsy for obtaining samples for diagnosis. All patients were similarly managed initially with a reduction of immunosuppression and appropriate antibiotics as per culture sensitivity. All 26 patients responded to induction treatment with meropenem (or imipenem) and trimethoprim-sulfamethoxazole (co-trimoxazole) followed by maintenance treatment with co-trimoxazole. Five (19.2%) out of 26 patients received Minocycline in induction and maintenance treatment regimens as in four patients isolates were resistant and one patient had allergic reaction to Cotrimoxazole. All patients had stable graft function. Two patients succumbed after 2 months of diagnosis with Gram-negative sepsis. CONCLUSIONS: At present, there exists no single serological test to diagnose infection in patients. Multiple initially obtained cultures may be negative because of the slow growth of the organism and variable colony morphology. Hence, infected specimens should be obtained by aggressive approaches if the index of suspicion is high. Procedures such as bronchoscopic lavage and aspiration of abscess are invaluable toward making a diagnosis. In our study, eight patients required invasive diagnostic procedures such as bronchoalveolar lavage and CT-guided lung biopsy since initial Gram stain and sputum culture were negative. In conclusion, it is crucial to maintain a high level of suspicion and conduct thorough investigations among post renal transplant recipients. This approach facilitates early diagnosis, prompt initiation of appropriate treatment which helps prevent the spread of disease.
Luu T, Fan A, Shaw R
… +7 more, Dalal H, Adams J, Santarossa M, Reid G, Tsai S, Clark NM, Albarillo FS
J Glob Infect Dis
· 2024 · PMID 39886084
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INTRODUCTION: Antibiotic stewardship is a critical aspect of managing cancer patients with febrile neutropenia (FN) to limit the development of drug-resistant organisms and minimize adverse drug effects. Thus, it has bee...INTRODUCTION: Antibiotic stewardship is a critical aspect of managing cancer patients with febrile neutropenia (FN) to limit the development of drug-resistant organisms and minimize adverse drug effects. Thus, it has been recommended that patients with FN receiving empiric antibiotics should be re-evaluated for safe antibiotic de-escalation. METHODS: Subjects treated with meropenem for febrile neutropenia who met Loyola University Medical Center's (LUMC) criteria for de-escalation were stratified based on whether meropenem was de-escalated, and 30-day all-cause mortality for both groups was assessed. RESULTS: 181 patients met criteria for meropenem de-escalation. Sixty patients (31.3%) were ade-escalated (MDE), and 121 subjects were not (NDE). The 30-day all-cause mortality was 8.3% ( = 5/60 subjects) in the MDE group and 2.4% ( = 3/121) in the NDE group but was not statistically significant (=0.1). Median hospital length of stay was 13 days in the MDE group versus 20 days in the NDE group ( = 0.049). CDI rate was also lower in the de-escalated group. In addition, consultations by infectious diseases physicians were more common in the de-escalation group. Logistic regression model demonstrated positive culture (OR 4.78, = 0.03), including positive blood culture (OR 8.05, = 0.003), and GVHD (OR 19.44, = 0.029), and were associated with high rates of appropriate de-escalation. Immunosuppression (OR 0.22, = 0.004) was associated with lower rates of appropriate de-escalation. CONCLUSION: Appropriate meropenem de-escalation in FN patients is safe and can result in improved clinical outcomes.