Joan Duggan

Infection with Campylobacter fetus can result in bacteremia and disseminated endovascular infection or extraintestinal infections such as osteomyelitis, septic arthritis, or meningoencephalitis. We present a case of a 36-year-old man with HIV who developed bacteremia and a left psoas muscle abscess after an acute episode of gastroenteritis due to C. fetus. The gastroenteritis appeared to resolve rapidly, but weakness, fatigue, and back pain started the following week. Magnetic resonance imaging of the lumbar spine revealed a left psoas abscess. The patient was treated with ertapenem for four weeks and had a resolution of back pain at the three-month follow-up visit but was then lost to follow-up. This case highlights the importance of accurate initial identification and treatment of systemic campylobacteriosis in immunocompromised hosts and the potential for dissemination.

In a single-center retrospective follow-up study, no difference in retention in care or virologic suppression was noted between rapid and delayed initiation of antiretroviral therapy at 6-year follow up in participants who were antiretroviral naive. Further study is needed to assess the long-term impact of rapidly starting antiretroviral therapy.

Using multiple pharmacies has been linked to negative outcomes including increased inappropriate drug use, toxicity, and mortality, yet up to half of all patients in the US use multiple pharmacies. A pilot survey was administered to measure pharmacy use in people living with HIV (PWH) and examine the associated attitudes and outcomes. In a midwestern HIV clinic, a convenience sample was surveyed based on using single (SPU) versus multiple pharmacies (MPU). One hundred forty-two subjects participated (69 SPU; 73 MPU): 75% male, 59% white, and > 70% being ≥ 40 years old. There was a trend towards increased recall of self-reported CD4 and viral load status for SPUs vs MPUs [OR 2.26 (95%, 0.91–5.64)]. SPU participants indicated acquiring all meds in one place [Likert Scale weighted average (LS WA) = 4.45], proximity (LS WA = 3.64), the identification of adverse effects (LS WA = 4.17), and concerns about missing potential drug-drug interactions (LS WA = 4.06) as reasons for preferring a single pharmacy. The desire to keep HIV status private (LS WA = 3.65) was noted as a significant reason for using a separate pharmacy specifically for acquiring antiretrovirals in MPU participants. Results indicate patients often have justifiable reasons for using single versus multiple pharmacies.

Introduction Fungal prosthetic joint infections comprise less than 1% of prosthetic joint infections. Thus, little is known regarding optimal management. This study aims to characterize the microbiology, surgical and medical management, and outcomes for these complex infections. The objectives of this study were to assess the impact of surgical approach, antifungal treatment, fungal species, and time to onset of infection from initial surgery on patient outcomes. Methods A retrospective record review over 12 years was performed in two health systems that included patients with a deep culture positive for a fungal isolate and the presence of a prosthetic joint. A literature review was performed using the same inclusion criteria. A total of 289 cases were identified and analyzed. Results Candida was the most common isolate, and a two-stage revision was the most commonly employed surgical modality. The type of surgical intervention had a statistically significant relationship with outcome (P = 0.022). Conclusions Two-stage revision with extended antifungal therapy is preferred in these infections due to higher rates of positive outcomes.

Translation: The University of Toledo Journal of Medical Sciences is the online journal launched by the University of Toledo. Manuscripts will be considered on the understanding that they report original work and are not under consideration for publication by any other journal. The journal publishes original articles reporting experimental results of basic or clinical research, case reports, and reviews. The journal uses a single blind peer review system and each manuscript, based on the results presented in its original submission, will be evaluated by two student reviewers and one faculty reviewer. This process will provide an opportunity for medical students, graduate students, residents, fellows and faculty to publish research observation in a timely manner.

Translation: The University of Toledo Journal of Medical Sciences is the online journal launched by the University of Toledo. Manuscripts will be considered on the understanding that they report original work and are not under consideration for publication by any other journal. The journal publishes original articles reporting experimental results of basic or clinical research, case reports, and reviews. The journal uses a single blind peer review system and each manuscript, based on the results presented in its original submission, will be evaluated by two student reviewers and one faculty reviewer. This process will provide an opportunity for medical students, graduate students, residents, fellows and faculty to publish research observation in a timely manner.

The most effective treatment for fungal prosthetic joint infections remains unclear. Most cases are treated with two-stage revisions combined with systemic antifungal medications. To date, the largest studies of total hip arthroplasty and total knee arthroplasty fungal infections have included 37 and 45 patients, respectively. A retrospective record review of patients admitted in two health systems between January 1, 2007 and December 31, 2018 with prosthetic joints and a deep culture of the joint positive for fungal organisms was performed as well as a review of the literature. A Pubmed and Embase search of the English-language literature from Jan 1, 1980 to Jan 1, 2023 was performed with review of the pertinent references for cases meeting the following case definition: individual with prosthetic joint and positive deep tissue culture for fungus. 159 patients fit criteria. 73 patients had knee replacements, 62 patients had hip replacements, and 5 had other joint involvement. 52% were female. 137 patients had yeast involvement, with Candida species being predominant, while 11 had mold and 11 with dimorphic infections. 55 patients were treated with two-stage revisions, 44 received one-stage revisions, 32 received debridement only or Girdlestone procedure, and 1 required amputation. 141 reported details on antifungal therapy. After performing multivariate analysis, polyene treatment was found to be associated with higher rate of recovery, p=0.042. However, there was a trend towards recurrence requiring surgical intervention in patients treated with polyenes, p=0.067. 22.6% had a poor outcome, including recurrence, amputation, or death. Surprisingly, polyenes did not underperform when compared to other antifungal therapy. Prospective research assessing optimal surgical treatment modality and antifungal therapy is needed as this infection is associated with high morbidity and mortality. All Authors: No reported disclosures

Multiple pharmacy use has been linked to decreased patient adherence, inappropriate drug use, adverse drug reactions, and increased mortality. Despite negative outcomes, multi-pharmacy use has increased and nearly half of all patients in the US now use multiple pharmacies. In this study, the attitudes towards multiple pharmacy use (MPU) versus single pharmacy use (SPU) for PLWH (people living with HIV) were assessed. A convenience sample of patients in a single midwestern Ryan White clinic was surveyed. There were 24 questions with two additional questions for users of multiple pharmacies. Questions were related to patient demographics, current CD4 count (CD4), viral load (VL) status, amount of time to receive medications, missed doses, comorbidities, and patient preferences. A 5-point Likert Scale (LS; 1 = strongly disagree, 5 = strongly agree) was used to assess reasons for SPU versus MPU, including for MPU if antiretroviral medications were filled separately. Respondents Demographics (cont). Respondent Demographics SPUs chose a single pharmacy for reasons of convenience and safety. MPUs who chose to fill their antiretroviral therapy at a separate pharmacy stated concerns for stigma/privacy as a major contributing factor. Patient preferences should be strongly considered regarding SPU or MPU. Interestingly, MPUs were less likely to be aware of their clinical status. All Authors: No reported disclosures

Serratia marcescens is a gram-negative bacillus that is an opportunistic agent in respiratory tract infections, urinary tract infections, and septicemia. It is rarely a cause of infective endocarditis, but in cases of endocarditis, it follows a rapid and devastating course. A previously healthy female in her mid-50s presented with fever, abdominal pain, right lower extremity pain, and diarrhea. Blood cultures were positive for S. marcescens, and additional evaluation revealed infarction in the spleen and kidneys, raising concern for endocarditis with associated embolic phenomena. The patient was subsequently found to have an embolus in the right popliteal artery and underwent a right popliteal thromboembolectomy. Antimicrobial therapy with cefepime and gentamicin was begun. A transesophageal echocardiogram revealed a large, mobile mitral valve vegetation. Care was complicated by intracranial hemorrhage, and the decision was made to withdraw care. A review of the databases Embase and PubMed revealed 63 additional cases of S. marcescens endocarditis. Analysis of these cases demonstrated a preponderance of aortic and mitral valve involvement, not tricuspid valve involvement, despite a risk factor of intravenous drug use in over 60% of cases. Mortality was 50%, and sequelae such as congestive heart failure and renal insufficiency occurred in the majority of survivors. In conclusion, S. marcescens is a rare but devastating cause of endocarditis with a primary risk factor of intravenous drug use but with a predilection for left-sided valvular lesions, not right-sided lesions.

Long-acting cabotegravir (CAB-LA) provides an exciting new option for pre-exposure prophylaxis (PrEP) in multiple populations. In this Perspective, we consider the unique pharmacokinetics of CAB-LA and the potential impact on the prescribing of CAB-LA, specifically in cis-women of reproductive potential.