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Background: Risk of community-acquired Clostridium difficile infection (CA-CDI) following antibiotic treatment specifically for urinary tract infection (UTI) has not been evaluated. Methods: We conducted a nested case-control study at Kaiser Permanente Northern California, 2007–2010, to assess antibiotic prescribing and other factors in relation to risk of CA-CDI in outpatients with uncomplicated UTI. Cases were diagnosed with CA-CDI within 90 days of antibiotic use. We used matched controls and confirmed case-control eligibility through chart review. Antibiotics were classified as ciprofloxacin (most common), or low risk (nitrofurantoin, sulfamethoxazole/trimethoprim), moderate risk, or high risk (e.g. cefpodoxime, ceftriaxone, clindamycin) for CDI. We computed the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the relationship of antibiotic treatment for uncomplicated UTI and history of relevant gastrointestinal comorbidity (including gastrointestinal diagnoses, procedures, and gastric acid suppression treatment) with risk of CA-CDI using logistic regression analysis. Results: Despite the large population, only 68 cases were confirmed with CA-CDI for comparison with 112 controls. Female sex [81% of controls, adjusted odds ratio (OR) 6.3, CI 1.7–24), past gastrointestinal comorbidity (prevalence 39%, OR 2.3, CI 1.1–4.8), and nongastrointestinal comorbidity (prevalence 6%, OR 2.8, CI 1.4–5.6) were associated with increased CA-CDI risk. Compared with low-risk antibiotic, the adjusted ORs for antibiotic groups were as follows: ciprofloxacin, 2.7 (CI 1.0–7.2); moderate-risk antibiotics, 3.6 (CI 1.2–11); and high-risk antibiotics, 11.2 (CI 2.4–52). Conclusions: Lower-risk antibiotics should be used for UTI whenever possible, particularly in patients with a gastrointestinal comorbidity. However, UTI can be managed through alternative approaches. Research into the primary prevention of UTI is urgently needed.

We report a case of chagasic encephalitis diagnosed by 28S rRNA sequencing. The diagnosis of chagasic encephalitis is challenging, given the broad differential diagnosis for central nervous system lesions in immunocompromised patients and low sensitivity of traditional diagnostics. Sequencing should be part of the diagnostic armamentarium for potential chagasic encephalitis.

Infectious diseases are a risk when traveling internationally, and it is important to know the potential disease burden of a region and take appropriate preventative actions before traveling. For individuals with HIV, there are special considerations and contradictions for various vaccines and medications as well as interactions with likely antiviral drugs. The purpose of this review is to summarize the vaccine and medication recommendations for travelers with HIV infection. We also review recent studies to update these recommendations. The recommendation for yellow fever vaccine has changed in June of 2016, and it is now a once in a lifetime vaccine instead of being given every 10 years. A new cholera vaccine, Vaxchora™ was approved in 2016. Since it is a live vaccine, its impact on immunocompromised individuals is still not fully known. A recent study found that immunocompromised patients responded well to the hepatitis A vaccine, although acquiring immunity may take longer than in non-immunocompromised people. There are some new anti-viral medicines that need to be considered with interactions for other travel medicines, in particular, the anti-malaria drugs. This review provides current knowledge on how HIV-infected and immunocompromised persons respond to medications and vaccines for prevention of infectious diseases in travelers. These recommendations will be useful to recommend safer travel for the HIV-infected patient. Some newer vaccines and medications will need further evaluation and assessment to determine safety and impact on HIV-positive travelers.

Risk of community-acquiredWe conducted a nested case-control study at Kaiser Permanente Northern California, 2007-2010, to assess antibiotic prescribing and other factors in relation to risk of CA-CDI in outpatients with uncomplicated UTI. Cases were diagnosed with CA-CDI within 90 days of antibiotic use. We used matched controls and confirmed case-control eligibility through chart review. Antibiotics were classified as ciprofloxacin (most common), or low risk (nitrofurantoin, sulfamethoxazole/trimethoprim), moderate risk, or high risk (e.g. cefpodoxime, ceftriaxone, clindamycin) for CDI. We computed the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the relationship of antibiotic treatment for uncomplicated UTI and history of relevant gastrointestinal comorbidity (including gastrointestinal diagnoses, procedures, and gastric acid suppression treatment) with risk of CA-CDI using logistic regression analysis.Despite the large population, only 68 cases were confirmed with CA-CDI for comparison with 112 controls. Female sex [81% of controls, adjusted odds ratio (OR) 6.3, CI 1.7-24), past gastrointestinal comorbidity (prevalence 39%, OR 2.3, CI 1.1-4.8), and nongastrointestinal comorbidity (prevalence 6%, OR 2.8, CI 1.4-5.6) were associated with increased CA-CDI risk. Compared with low-risk antibiotic, the adjusted ORs for antibiotic groups were as follows: ciprofloxacin, 2.7 (CI 1.0-7.2); moderate-risk antibiotics, 3.6 (CI 1.2-11); and high-risk antibiotics, 11.2 (CI 2.4-52).Lower-risk antibiotics should be used for UTI whenever possible, particularly in patients with a gastrointestinal comorbidity. However, UTI can be managed through alternative approaches. Research into the primary prevention of UTI is urgently needed.