In this week's top infectious disease stories, a Pennsylvania teen became the state's fourth measles death in weeks, the CDC reported a 17% summer surge in rabies exposure calls, new research revisited whether cefepime raises mortality risk, a multihospital review examined ceftriaxone's safety after state alerts, and examining Legionella pneumonia diagnostics.
Ceftriaxone is a third-generation cephalosporin first approved by the FDA in 1982. It is widely used in clinical practice guidelines due to its broad antimicrobial coverage, convenient dosing, favorable pharmacokinetics, and generally mild adverse effect profile.1,2 In the first quarter of 2025, public health alerts emerged from several state health departments, warning of potential serious adverse events temporally associated with ceftriaxone.3,4 The Centers for Disease Control and Prevention (CDC), in collaboration with state and local health departments, initiated an investigation due to reports of serious adverse events following administration of injectable ceftriaxone. These reported events included cardiac arrest and death. Although the reported clusters of events were limited to a few states, several other state health departments also distributed alerts, requesting reports of serious adverse events to assist with the investigation. In response, the authors of this study conducted a retrospective review across a multihospital health care system to better characterize these events and compare their frequency with those associated with other intravenous (IV) cephalosporins.5
Another measles-related death has occurred in Pennsylvania, marking the fourth in just a matter of weeks. Yesterday, the Mifflin County coroner announced an 18-year-old resident had died “due to complications of measles,” which was identified as acute disseminated encephalomyelitis (ADEM).1
No other information about the teen was shared by the coroner or the state health department. Just a few days ago, the Jefferson County, PA, coroner announced
There is a high probability that cefepime treatment increases risk of mortality relative to other ß-lactam antibiotics, albeit with effect that is small and potentially mitigable, according to interpretations of a new systematic review and bayesian meta-analysis.1
That determination is congruent with a 2007 report of a relative increase in mortality, 2 but contrasts with the FDA finding no increased mortality in its investigation of the data from that report and of unpublished, industry-sponsored trials.3
A 17% increase in calls this summer to the CDC regarding potential human rabies exposures, marked by news of attacks by river otters (Lake Tahoe, Anchorage Alaska), beavers (New Jersey, Maryland) and bats (multiple national parks), seems to have been anticipated by a Clinician Outreach webinar from the CDC in April, and has prompted a recent Health Advisory.1,2
Legionella species are gram-negative bacteria found in natural fresh water and soil; however, the bacteria are usually not present in adequate amounts to cause disease in individuals unless amplified and aerosolized in manmade water or cooling systems.1-3 In human-formed water systems, such as hot tubs, plumbing, fountains, cooling towers that use centralized air-cooling systems, and shower heads, Legionella can proliferate and become transmissible to susceptible individuals through aerosolization, with Legionella pneumophila causing the majority of disease and serogroup 1 as the most commonly detected.4
