Infectious diseases physician management of cryptococcal meningitis in North America-Is single high-dose liposomal amphotericin B being used?

BACKGROUND: Several recent randomized trials have been conducted in resource-limited settings for cryptococcal meningitis that have rapidly innovated international guidelines. The 2010 Infectious Diseases Society of America (IDSA) cryptococcal meningitis guideline has not been updated with recent trials. The 2022 AMBITION-cm trial found that a single 10-mg/kg dose of liposomal amphotericin B plus daily flucytosine and fluconazole for 2 weeks was noninferior to 1 week of amphotericin B deoxycholate with flucytosine. It is unknown whether physicians in high-resource settings are using this regimen or more traditional regimens. METHODS: We developed an electronic survey in June 2023 to better understand whether physician members of the IDSA Emerging Infections Network (EIN) and Mycoses Study Group Education and Research Consortium (MSG-ERC) had used the AMBITION-cm induction regimen, would use the regimen in hypothetical clinical scenarios, and what perceived barriers to use existed. RESULTS: A total of 242 of 561 (43%) physicians responded to the survey, of whom 205 provided care for persons with cryptococcal meningitis in the last year. Overall, 29 (14%) had used the AMBITION-cm regimen, and 176 (86%) had not. In various hypothetical clinical scenarios, only ∼10% of 209 respondents selected the AMBITION-cm regimen as preferred. Perceived barriers to uptake included the applicability of trials performed in low-resource settings to high-resource settings, that the regimen is not recommended in the 2010 IDSA guidelines, and the applicability to persons without HIV. CONCLUSIONS: Most respondents had not used the single-dose liposomal amphotericin B regimen, but the regimen is being used. Further study of this regimen in other patient populations and settings is necessary

Parent Stars of Extrasolar Planets VII: New Abundance Analyses of 30 Systems

The results of new spectroscopic analyses of 30 stars with giant planet and/or brown dwarf companions are presented. Values for Teff and [Fe/H] are used in conjunction with Hipparcos data and Padova isochrones to derive masses, ages, and theoretical surface gravities. These new data are combined with spectroscopic and photometric metallicity estimates of other stars harboring planets and published samples of F, G, and K dwarfs to compare several subsets of planet bearing stars with similarly well-constrained control groups. The distribution of [Fe/H] values continues the trend uncovered in previous studies in that stars hosting planetary companions have a higher mean value than otherwise similar nearby stars. We also investigate the relationship between stellar mass and the presence of giant planets and find statistically marginal but suggestive evidence of a decrease in the incidence of radial velocity companions orbiting relatively less massive stars. If confirmed with larger samples, this would represent a critical constraint to both planetary formation models as well as to estimates of the distribution of planetary systems in our galaxy.Comment: 27 pages, 13 figures. Accepted for publication in The Astronomical Journa