Structured Candida auris (C. auris) is an emerging fungal organism that has caused outbreaks in healthcare settings and become a major public health concern, particularly among medically vulnerable populations.MethodsUsing a retrospective case-control design, we investigated factors associated with C. auris clinical cases after prior colonization among patients identified in Florida healthcare facilities during January 1, 2019–December 31, 2023.ResultsWe identified 105 case-patients with documented clinical specimens after colonization and 578 control subjects with colonization only. Factors significantly associated with clinical cases included presence of ≥ 5 comorbid conditions (OR, 10.02; 95% CI, 4.07–24.7), ≥ 4 invasive devices (OR, 2.92; 95% CI, 1.70–5.03), or ≥ 3 recent medical procedures (OR, 2.32; 95% CI, 1.19–4.55). Also, fully dependent care required for eating (OR 2.80), mobility (OR 2.15), and transferring (OR 1.82) were associated with clinical case progression.DiscussionWe found a significant association with progression from screening colonization to clinical C. auris cases among patients with multiple comorbidities, invasive devices, recent invasive procedures, and poor functional status.ConclusionsIdentifying risk factors for clinical progression of C. auris after colonization could enable facilities to implement efficient testing protocols and infection prevention and control (IPC) measures to help prevent morbidity associated with invasive infections.

Social media has emerged as a powerful platform for modern medical education, yet best practices for training programs' use of it remain underdeveloped. With its visual format and high engagement rate...

Record-high 127.1/100,000 hospitalizations with co-circulating influenza A strains and similar in-hospital severity to prior years.

Track biological threats, share vital information, and collaborate on solutions for community protection and preparedness.

An Ebola virus outbreak in the Democratic Republic of the Congo has doubled in size and spread in the province where it started, raising fears of cross-border spillover into neighboring Angola, a heal...

The last time I did one of these quick “musings” posts, I listed 21, and someone asked me, “Why 21?” The answer — obviously — is that I originally planned on writing 20, but then had to add a 21st, ju...

HIV incidence and prevalence rates in emergency departments (EDs) around the nation warrant strategies to protect and sustain the HIV negative status of persons who are at risk for HIV. The ED provide...

The impact of pharmacokinetic variability of cabotegravir (CAB) and rilpivirine (RPV) long-acting (LA) injectable therapy on virological outcomes remains controversial. This study aimed to characterize the variability of CAB and RPV trough concentrations (Ctrough) and to identify the predictors of suboptimal exposure and virologic failure (VF) in a large real-world cohort.MethodsWe conducted a multicenter observational study including people with human immunodeficiency virus type 1 (HIV-1) initiating LA-CAB/RPV as maintenance therapy from January to December 2022, in whom CAB and RPV plasma Ctrough were determined as part of therapeutic drug monitoring (TDM).ResultsA total of 1674 CAB and 1687 RPV Ctrough measurements were collected from 736 people with HIV-1 (PWH). Significant interindividual variability in concentrations was observed. At month 1/month 3, 20%–30% of PWH had Ctrough <1120 ng/mL for CAB and 32 ng/mL for RPV. Predictors of lower Ctrough were body mass index (BMI) ≥30 kg/m2 and female sex at month 1, and only male sex at steady state. After a median follow-up of 12 (interquartile range, 9–16) months, VF occurred in 2.5% of PWH. At month 6 and month 12, VF was significantly associated with the presence of at least 2 risk factors (obesity, suboptimal Ctrough) (odds ratio [OR], 4.6, P = .047; OR, 5.15, P = .014), and CD4 nadir (OR, 0.56, P = .008; OR, 0.5, P = .001).ConclusionsOur large real-world study confirms significant variability in CAB and RPV exposure, with BMI and sex as key predictors of lower Ctrough. Suboptimal CAB and RPV Ctrough, particularly in people with obesity, increases the risk of VF during the first year of treatment, highlighting the usefulness of TDM in clinical practice.