Infectious Diseases — New This Week · Jun 18

A lighter trial week with one practice-shaping headline: the HIVMA/IDSA HIV Primary Care Guidance Panel formally states it no longer treats post–June 2025 CDC ACIP recommendations as reliable and names the sources to use instead (CID). From OFID (open access): pharmacist-led direct oral penicillin de-labeling even in high-risk histories, the stewardship case for stopping quinolone prophylaxis in HSCT, real-world lenacapavir in MDR HIV (with an HIV-2 caveat), the low yield of annual IGRA screening in PWH, and an instructive KS-IRIS case. No new practice-changing RCTs this window (last week's fosfomycin ESBL-cUTI trial picked up its editorial). The curated high-yield set is below; the full lists live in the per-journal Markdown summaries.

Clinical Infectious Diseases (CID)

CID

Guideline · HIV/Vaccines High yield · ID/IM

Clarification to HIVMA/IDSA HIV Primary Care Guidance Immunization Recommendations

For immunizing people with HIV, which source does the guidance panel now consider reliable?

Key takeaway. The panel no longer recommends CDC ACIP as a reliable source of immunization recommendations after June 2025. Use instead the HHS OI Panel immunization section plus guidance from IDSA, ACP, AAFP, AAP, and ACOG. Rationale: after the entire ACIP was dismissed/replaced (June 2025), recommendations stopped following the codified GRADE evidence review and Evidence-to-Recommendation framework (and the Jan 2026 childhood schedule change skipped a formal ACIP vote). Fellow implication: anchor PWH vaccine decisions to the HHS OI Panel + named society guidance.

PDF: hivma-idsa-hiv-primary-care-immunization-clarification.pdf · 10.1093/cid/ciag384

CID

Major Study · Stewardship

Lower yield

DASC-LOT Framework & S3 ("Start, Stop, Select") Metric for Inpatient Antimicrobial Use

Can antimicrobial use be benchmarked separately for initiation, duration, and spectrum?

Key takeaway. A risk-adjusted framework combining DASC (Days of Antimicrobial Spectrum Coverage) and LOT (length of therapy) into a composite S3 metric (start/stop/select), shown as a per-hospital radar chart; derived/validated across 118 VHA hospitals with wide between-hospital variation. A stewardship-metrics methods advance — summary only (no discrete fellow-level fact to card). Editorial: ciag390.

10.1093/cid/ciag389 · editorial 10.1093/cid/ciag390

Also new this week (CID): the fosfomycin ESBL-cUTI editorial (ciag347, Manesh & Paterson) was filed into last week's ciag345 trial bundle. Screened out: correction to the BIOFIRE pneumonia-panel study (ciag380), and three correspondence/letters (LLM-assisted CAUTI surveillance ciag373; BeBoP generalizability reply ciag379; bone biopsy in diabetic-foot osteomyelitis ciag378).

Open Forum Infectious Diseases (OFID) · open access

OFID

Stewardship · Allergy High yield · ID/IM

Direct Oral Amoxicillin Challenge in High-Risk Penicillin-Allergy Histories (Pharmacist-Directed)

Can high-risk (IgE-type, ≥10-yr-old) penicillin-allergy histories be de-labeled without skin testing?

Key takeaway. In 169 inpatients with high-risk histories (urticaria/angioedema/anaphylaxis/dyspnea ≥10 yr ago), a pharmacist-led direct oral amoxicillin challenge de-labeled 94.1%, with only 5.9% mild reactions and no severe reactions. Fellow implication: remote IgE-type histories can often skip skin testing and go to a protocolized direct oral challenge, expanding β-lactam access.

PDF: amoxicillin-direct-oral-challenge-penicillin-allergy-delabel.pdf · 10.1093/ofid/ofag344

OFID

Stewardship · HSCT High yield · ID

Discontinuing Fluoroquinolone Prophylaxis in HSCT Pre-engraftment Neutropenia (Meta-analysis)

If you stop routine quinolone prophylaxis in HSCT, does infection-related mortality rise?

Key takeaway. Discontinuation raised BSI incidence but did not significantly increase infection-related mortality (pooled RR 1.26; 95% CI 0.71–2.23); Gram-negative BSIs after stopping were less likely resistant. Prophylaxis cuts BSIs but drives MDR. Fellow implication: supports reconsidering routine quinolone prophylaxis as a stewardship measure — low-certainty before–after data.

PDF: quinolone-prophylaxis-discontinuation-hsct-bsi-meta.pdf · 10.1093/ofid/ofag358

OFID

HIV · New agent High yield · ID

Real-World Lenacapavir in Multidrug-Resistant HIV (French Compassionate Use)

Lenacapavir works in salvage HIV-1 — but how does it perform in HIV-2?

Key takeaway. Among 42 highly treatment-experienced patients (33 HIV-1, 9 HIV-2) on lenacapavir + optimized background, week-26 suppression was effective in HIV-1 (≈67%; CAPELLA was 81%) but poor in HIV-2 (≈22%) — consistent with lenacapavir being 11–14× less potent against HIV-2. Resistance was rare, clustering in extensive baseline resistance / poor adherence. Fellow implication: good salvage option in HIV-1; do not rely on it in HIV-2.

PDF: lenacapavir-mdr-hiv-french-compassionate-use.pdf · 10.1093/ofid/ofag353

OFID

TB · HIV screening High yield · ID

Value of Yearly IGRA Screening for Latent TB in People With HIV (Non-Endemic Settings)

Is routine annual IGRA screening for LTBI worthwhile in PWH in a low-TB-incidence setting?

Key takeaway. Of 1898 PWH with ≥2 IGRAs over 5 years, only 12 developed new LTBI — very low yield. Fellow implication: favor targeted (risk-based) rather than universal annual IGRA screening in PWH in non-endemic settings, consistent with current guidance.

PDF: yearly-ltbi-igra-screening-pwh-nonendemic.pdf · 10.1093/ofid/ofag227

OFID Case Reports

Kaposi Sarcoma-Associated IRIS (KS-IRIS) With Visceral Disease and Pericardial Tamponade · HIV

High yield · ID

Key lesson. A 27-yr-old ART-naïve man with advanced HIV developed KS-IRIS after ART: gastric (visceral) KS + a large pericardial effusion with early tamponade (700 mL drained) despite minimal cutaneous disease — up to 40% of visceral KS occurs without a sentinel skin lesion. KS-IRIS risk factors: HIV-1 RNA >100,000, hematocrit <30%, detectable plasma HHV-8 DNA, T1 staging. First-line for high-burden/visceral KS or KS-IRIS is liposomal doxorubicin; steroids can paradoxically worsen KS.

PDF: ks-iris-advanced-hiv-visceral-pericardial-case.pdf · 10.1093/ofid/ofag363

Also new this week (OFID) — summary only: DOOR-endpoint development for ABSSSI (ofag320, +editorial ofag321) & DOOR-FRAME post-hoc of BALANCE (ofag142) — outcome-ranking methods; invasive pneumococcal disease in Australian children pre/post-COVID (ofag275, serotype 3 predominant); RSV hospitalization burden in adults 18–64 (ofag341, ~48/100,000); timing of bronchoscopy + plasma microbial cfDNA in immunocompromised pneumonia (ofag361, ≤3 days higher yield); conservative management of breast-implant infections (ofag351, fistula predicts failure); maternal/newborn GBS serology US vs South Africa (ofag340); recalibrated MDR risk score in ICU (ofag359, low sensitivity); high HBV prevalence in PWH (ofag346, MWCCS); cost-effectiveness of differentiated HIV service delivery in 4 African settings (ofag257); RIMOXCLAMIN vs WHO-MDT for multibacillary leprosy in Brazil (ofag332); and a kynurenine metabolic-pathway analysis in severe influenza/COVID (ofag316).

Personal-study digest — original paraphrases for educational use; figures drawn from the archived full text / PDF. CID via IDSA/OUP subscription; OFID is open access (CC-BY). Window June 18–26, 2026. Key DOIs — CID: 10.1093/cid/ciag384, 10.1093/cid/ciag389 (editorial 10.1093/cid/ciag390), 10.1093/cid/ciag347. OFID: 10.1093/ofid/ofag344, 10.1093/ofid/ofag358, 10.1093/ofid/ofag353, 10.1093/ofid/ofag227, 10.1093/ofid/ofag363.