To evaluate the interferon-gamma-releasing assays QuantiFERON-tuberculosis (TB) Gold and T-SPOT.TB in addition to tuberculin skin test (TST) for diagnosis of latent tuberculosis infection in HIV patients. Prospective cross-sectional study for asymptomatic HIV-infected outpatients from a large University hospital. Simultaneous performance of QuantiFERON-TB Gold, T-SPOT.TB and TST. Incidence and risk factors for a positive test reaction and the concordance (kappa) between the tests were investigated. Of 286 enrolled patients, 81% were men; median age was 44 years, the median CD4 cell count 408/microl (range 7-1510) with a median nadir of 126/microl (range 0-749). A number of patients (63.8%) had undetectable HIV RNA (<50 copies/ml). Both T-SPOT.TB and QuantiFERON-TB showed more positive test results than TST: 25.2 and 20.0% (P = 0.133) compared with 12.8% (P < 0.001 and P = 0.008, respectively). Agreement between T-SPOT.TB and TST (kappa = 0.201) respectively QuantiFERON-TB and TST (kappa = 0.335) was fair, but only poor between the serological assays (kappa = 0.146). T-SPOT.TB provided more indeterminate results than QuantiFERON-TB (8 vs. 1/256, P < 0.01). Patients with a positive QuantiFERON-TB result had higher median CD4 cell counts (457 vs. 405 cells/microl for patients with negative result, P = 0.044); the amount of released interferon-gamma correlated with CD4 cell counts (rho = 0.199; P < 0.002). T-SPOT.TB results were independent from CD4 cell counts. In HIV-infected patients from a low prevalence TB country, both interferon-gamma assays are more sensitive than TST, but seem to be less sensitive than in immunocompetent patients. The blood tests show poor agreement and differ in their dependence on the CD4 cell count.

Objectives: Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail. Methods: Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list. Results: In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died. Conclusions: Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.

Pyogenic liver abscesses (PLA) remain a significant clinical problem. Unfortunately, little is known about current bacterial susceptibility profiles and the incidence of multidrug resistant organisms (MDROs) causing PLA in Western countries. Yet, this crucial information is pivotal to guide empirical antibiotic therapy. Aim of this study was to provide detailed characteristics of PLA with a special focus on underlying bacterial pathogens and their susceptibility to antibiotics. A retrospective study of patients diagnosed with PLA from 2009 to 2015 in a large tertiary reference center in Germany was performed in order to characterize PLA and antimicrobial susceptibility profiles of causative bacterial species. Overall, 86 patients were included. The most common causes of PLA were bile duct stenosis/obstruction (31.4%) and leakage of biliary anastomosis (15.1%). Frequent predisposing diseases were malignancies (34.9%), diabetes (24.4%) and the presence of liver cirrhosis (16.3%). Of note, Enterococcus spp. were the most frequently cultured bacterial isolates (28.9%), and in 1/3 of cases vancomycin resistance was observed. In addition, a relevant frequency of gram-negative MDROs was identified. In particular, an alarming 10% and 20% of gram-negative bacteria were resistant to carbapenems and tigecycline, respectively. Of note, MDRO status did not predict ICU stay or survival in multivariate regression analysis. The mortality rate in our series was 16.3%. Our study demonstrates an as yet underreported role of Enterococcus spp., often associated with vancomycin resistance, as well as of gram-negative MDROs causing PLA.

Objectives: We studied the impact of tenofovir disoproxil fumarate, given as an antiretroviral medication, on patients with chronic hepatitis B virus (HBV) co-infection. Methods: The polymerase gene-sequence evolution and quantitative HBV loads (HBVL) were observed for 48 weeks in patients taking tenofovir-containing antiretroviral therapy. The patients were grouped according to baseline strata: high-replicative virus (>6 log copies/mL), low-replicative virus at detectable virus loads (<6 log) and HBs-antigen-positive, HBV-DNA-negative individuals. Results: Thirty-one patients were evaluated. The median decline in 20 patients with high-replicative HBV infection was −5.37 log (range: 3.57–7); 11 out of 20 decreased to undetectable levels (lower limit of detection = < 200 copies/mL) and another three were below 400 copies/mL. Out of six patients with detectable HBV-DNA at week 48 (HBVL result: range 3.36–4.32 log₁₀), we were able to carry out a re-sequence in four patients. We did not observe relevant emerging resistance mutations, or a relevant virus load re-increase from nadir (>+0.5 log). The patients with low-replicative virus (n = 9) and the baseline DNA-negative patients (n = 2) had an undetectable HBV-DNA at week 48. Two patients became HBeAg-negative; one DNA-negative patient became HBsAg-negative. Conclusions: Tenofovir is effective in treating HBV infection in HIV patients. Patients with high-replicative virus may benefit from this treatment strategy by a reduction in replicative status, a precondition for improved hepatic function. A few patients showed low-level HBV replication. Indicators for clinical HBV-resistance to tenofovir were not observed.