Mycobacteroides abscessus outbreak and mitigation in a cardiothoracic transplant population: the problem with tap water.

Background: Hospital outbreaks caused by Mycobacteroides abscessus complex are a major cause for concern in vulnerable patients such as the cardiothoracic transplant population.

Aim: To describe the outbreak investigation and mitigation steps undertaken to address an increase in healthcare-associated M. abscessus complex cases in an inpatient cardiothoracic transplant population.

Identifying transmission in a hospital outbreak investigation using whole-genome sequencing and SNP phylogenetic analysis.

poses a global public health challenge, causing multiple outbreaks within healthcare facilities. Despite advancements in strain typing for various infectious diseases, a consensus on the genetic relatedness threshold for identifying transmission in local hospital outbreaks remains elusive. We investigated genetic variations within our local isolate collection using whole-genome-based single nucleotide polymorphism (SNP) phylogenetic analysis.

Dental pulp mesenchymal stem cells-response to fibrin hydrogel reveals ITGA2 and MMPs expression.

Regenerative endodontic procedures (REP) aim at reestablishing tooth vitality by replacing the irreversibly damaged dental pulp removed by the dental practitioner with a new functional one. The current treatment of advanced caries relies on the replacement of the inflamed or necrosed dental pulp with an inert filling material. This leads to a functional but non-vital tooth, which lacks the ability to sense dental tissue damage, and to protect from further bacterial attack.

A population pharmacokinetic model of polymyxin B based on prospective clinical data to inform dosing in hospitalized patients.

Objectives: To develop a population pharmacokinetic (PK) model with data from the largest polymyxin B-treated patient population studied to date to optimize its dosing in hospitalized patients.

Methods: Hospitalized patients receiving intravenous polymyxin B for ≥48 hours were enrolled. Blood samples were collected at steady state and drug concentrations were analysed by liquid chromotography tandem mass spectrometry (LC-MS/MS).

Monkeypox-Associated Central Nervous System Disease: A Case Series and Review.

Objective: Monkeypox virus (MPXV) disease has been declared a public health emergency by the World Health Organization, creating an urgent need for neurologists to be able to recognize, diagnosis, and treat MPXV-associated neurologic disease.

Methods: Three cases of MPXV-associated central nervous system (CNS) disease occurring during the 2022 outbreak, and their associated imaging findings are presented, with 2 cases previously published in a limited capacity in a public health bulletin.

Results: Three previously healthy immunocompetent gay men in their 30s developed a febrile illness followed by progressive neurologic symptoms with presence of a vesiculopustular rash.

Tecovirimat Use in Ambulatory and Hospitalized Patients With Monkeypox Virus Infection.

In this case series of 20 ambulatory and hospitalized adult patients treated for monkeypox virus at a large academic medical center in Chicago, Illinois, tecovirimat use was reserved for those with or at high risk of severe disease, delayed because of logistical and clinical factors, but well tolerated.

Carbapenem-resistant Enterobacterales standardization across a large health care system.

Carbapenem-resistant Enterobacterales (CRE) are multidrug resistant organisms that pose a significant risk in the health care setting. Standardized identification ensures prompt isolation and is imperative to maintain patient safety.

Impact of early antimicrobial stewardship intervention in patients with positive blood cultures: results from a randomized comparative study.

Background: Antimicrobial stewardship intervention (ASI) appears to be necessary to realize the full benefits of rapid diagnostic technologies in clinical practice. This study aimed to compare clinical outcomes between early ASI paired with matrix-associated laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) compared with MALDI-TOF with standard of care (SOC) reporting in patients with positive blood cultures.

Methods: Adult patients with positive blood cultures and organism speciation via MALDI-TOF admitted between February 2015 and September 2015 were randomized to ASI or SOC in a 1:1 fashion.

The value of repeat patient testing for SARS-CoV-2: real-world experience during the first wave.

Introduction: Reports of false-negative quantitative reverse transcription PCR (RT-qPCR) results from patients with high clinical suspension for coronavirus disease 2019 (COVID-19), suggested that a negative result produced by a nucleic acid amplification assays (NAAs) did not always exclude the possibility of COVID-19 infection. Repeat testing has been used by clinicians as a strategy in an to attempt to improve laboratory diagnosis of COVID-19 and overcome false-negative results in particular.

Aim: To investigate whether repeat testing is helpful for overcoming false-negative results.

Occupational COVID-19 exposures and secondary cases among healthcare personnel.

Throughout the COVID-19 pandemic, healthcare personnel (HCP) have been at high risk of exposure to SARS-CoV-2, both from patients and co-workers. This paper summarizes occupational exposures to SARS-CoV-2 and secondary cases among HCP at a large health system. Key findings indicate that transmission of COVID-19 to HCP is low, especially with close adherence to PPE guidelines, but lapses in infection prevention practices, including dining together and omitting eye protection during patient care, especially at times when COVID-19 is circulating widely in the community increase the risk of exposure and subsequent transmission to HCP.

An unusual case of osteomyelitis.

is a gram-positive organism found in food products as well as naturally occurring in air and on surfaces. We present the first known case of osteomyelitis caused by machine injection injury. The patient was treated with emergent surgical debridement as well as doxycycline for a soft tissue infection.

Development of an antibacterial nanocomposite hydrogel for human dental pulp engineering.

Hydrogel-based regenerative endodontic procedures (REPs) are considered to be very promising therapeutic strategies to reconstruct the dental pulp (DP) tissue in devitalized human teeth. However, the success of the regeneration process is limited by residual bacteria that may persist in the endodontic space after the disinfection step and contaminate the biomaterial. The aim of this work was to develop an innovative fibrin hydrogel incorporating clindamycin (CLIN)-loaded Poly (d,l) Lactic Acid (PLA) nanoparticles (NPs) to provide the hydrogel with antibacterial properties.

The intersection of hand hygiene, infusion pump contamination, and high alarm volume in the health care environment.

Background: Researchers have found that lack of hand hygiene and environmental contamination are sources of infection transmission in the health care environment. One factor that may lead to lack of hand hygiene is alarm fatigue, the sensory overload that results when clinicians are exposed to an excessive number of alarms, causing them to silence alarms without taking proper precautions. In this study, we report hand hygiene compliance and infusion pump contamination in the context of infusion pump alarm prevalence.

Successful treatment of a intra-articular infection.

A 78-year-old woman with a long-term ankle spacer with antibacterials developed an intra-articular infection. Treatment with systemic antifungal therapy plus an amphotericin B moulded cement spacer was successful.

Implementation of a cefazolin-based stewardship pathway for methicillin-susceptible Staphylococcus aureus bloodstream infections paired with infectious diseases consultation.

Methicillin-susceptible Staphylococcus aureus (MSSA) infections have been successfully treated both with cefazolin and antistaphylococcal penicillins; cefazolin appears effective in MSSA bloodstream infections (BSIs). Thus, our antimicrobial stewardship programme (ASP) implemented a clinical pathway supporting cefazolin use in MSSA-BSIs and restricting oxacillin use to infectious diseases (ID) consultation due to cefazolin's lower cost and more convenient dosing. This before and after quasi-experimental study was conducted to describe the impact on outcomes and process of care measures associated with implementing this pathway among patients with MSSA-BSI.

Inappropriate Clostridium difficile Testing and Consequent Overtreatment and Inaccurate Publicly Reported Metrics.

BACKGROUND The nationally reported metric for Clostridium difficile infection (CDI) relies solely on laboratory testing, which can result in overreporting due to asymptomatic C. difficile colonization. OBJECTIVE To review the clinical scenarios of cases of healthcare facility-onset CDI (HO-CDI) and to determine the appropriateness of C.

Hand Hygiene: An Update.

The medical field has long recognized the importance of hand hygiene in preventing health care-associated infections, yet studies indicate that this important task is performed only 40% of the time. Health care workers cite several barriers to optimal performance of hand hygiene, but the time required to perform this task is foremost among them. Introduction of alcohol-based hand rubs, bundled interventions, and incorporation of technologies designed to monitor and promote hand hygiene all represent promising advances in this field.

Respiratory syncytial virus outbreak on an adult stem cell transplant unit.

Background: An increase in respiratory syncytial virus type B (RSV-B) infections was detected on an adult hematology/oncology and stem cell transplant unit during March 2015. This prompted an outbreak investigation.

Methods: Nosocomial cases were defined as RSV-B-positive patients who developed respiratory virus symptoms ≥ 7 days after admission to the unit or were readmitted with symptoms ≤ 7 days since last discharge from the unit.

Reducing catheter-associated urinary tract infections in a neuro-spine intensive care unit.

A collaborative effort reduced catheter-associated urinary tract infections in the neuro-spine intensive care unit where the majority of infections occurred at our institution. Our stepwise approach included retrospective data review, daily rounding with clinicians, developing and implementing an action plan, conducting practice audits, and sharing of real-time data outcomes. The catheter-associated urinary tract infection rate was reduced from 8.

On the use of Arion ater to biomonitor environmental pollution by Cd, Cu, Fe, Mn and Zn, with a special insight into the population variability.

The suitability of Arion ater as a biomonitor of Cd, Cu, Fe, Mn and Zn was assessed. Individual specimens were collected from 22 sampling sites. Slugs from 3 of the sites were analysed individually, whereas the slugs from the other sites were pooled to make a composite sample for each site.

The burden of mucosal barrier injury laboratory-confirmed bloodstream infection among hematology, oncology, and stem cell transplant patients.

Objective: To evaluate the impact and burden of the new National Healthcare Safety Network surveillance definition, mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI), in hematology, oncology, and stem cell transplant populations.

Design: Retrospective cohort study.

Setting: Two hematology, oncology, and stem cell transplant units at a large academic medical center.

Use of acid-fast bacilli staining to determine the need for airborne infection isolation precautions: a comparison of respiratory specimens.

Institution of appropriate airborne infection isolation (AII) precautions for patients with suspected Mycobacterium tuberculosis is critical to prevent disease transmission. We compared the yield of acid-fast bacilli smears from different types of respiratory specimens and found that smear sensitivity was highest for specimens obtained by endotracheal aspirates (92%), followed by sputum (79%), and then by bronchoalveolar lavage (37%). As a result of this study, our institutional policy regarding discontinuation of AII precautions was amended.

Influence of ACB complex genospecies on clinical outcomes in a U.S. hospital with high rates of multidrug resistance.

Objectives: Bacteria within the Acinetobacter calcoaceticus-Acinetobacter baumannii (ACB) complex commonly cause nosocomial infection and are often multidrug resistant. Advances in genospecies typing allow for speciation within the ACB complex; however, little is known about the effect of genospecies on patient outcomes.

Methods: Adult patients with ACB complex bacteremia from Jan 2005-Oct 2012 were included.