The edition · Infectious Diseases
An E. coli vaccine failed despite strong antibody responses, and azithromycin at cesarean cut postpartum infection
A discontinued nine-valent E. coli vaccine in 17,701 older adults, a meta-analysis of what predicts poor CD4 recovery on suppressive HIV treatment, a US adoption study of adjunctive azithromycin at unscheduled cesarean delivery, and an FDA supplement for oral ketoconazole.
The edition in brief
The phase 3 E.mbrace trial gave a nine-valent conjugate vaccine (ExPEC9V) or placebo to 17,701 adults aged 60 or older with a recent urinary tract infection. The trial stopped early at a futility analysis: 24 invasive E. coli cases from vaccine serotypes (11 vs 13) gave a vaccine efficacy of 14.6% (95% CI -106.6 to 65.4), despite robust antibody responses, and development has been discontinued. A meta-analysis of 59 studies of people with HIV and suppressed viral load identified predictors of poor CD4 recovery, including advanced HIV stage (OR 2.66), hepatitis C (1.85), tuberculosis (1.77) and intravenous drug use (1.67); it is observational and cannot show how to treat non-response. A US difference-in-differences study of 1.66 million deliveries found adjunctive azithromycin at unscheduled cesarean rose from 2.2% to 39.6% after the 2016 trial, with postpartum infection falling by an adjusted 2.0 percentage points relative to vaginal births. The FDA record for a ketoconazole supplement carries no clinical detail, and it is an administrative filing, not a safety communication. The pearl covers taking cultures before antibiotics in suspected sepsis.
A nine-valent E. coli vaccine did not prevent invasive disease in older adults
No E. coli vaccine is available; keep to cultures, source control and local resistance patterns in older adults with urinary sepsis.
FDA records a supplement to a generic ketoconazole application
No change to prescribing follows from this FDA entry; check current labelling for the product in use.
Poor CD4 recovery on suppressive HIV treatment tracks with coinfection and late presentation
Check for coinfection and confirm sustained viral suppression in patients with poor CD4 recovery; do not alter effective therapy on CD4 alone.
Take cultures before the first antibiotic dose in suspected sepsis
Take cultures before antibiotics in suspected sepsis, and review the choice once results return.
Adjunctive azithromycin at unscheduled cesarean spread widely and postpartum infection fell
Consider auditing your unit's azithromycin use at unscheduled cesarean delivery against the trial evidence and local guidance.
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