Impact of mandatory nucleic acid amplification test (NAAT) testing approval on hospital-onset infection (HO-CDI) rates: A diagnostic stewardship intervention.

Misclassification of colonization as hospital-onset infection (HO-CDI) can lead to unnecessary treatment of patients and substantial financial penalties for hospitals. We successfully implemented mandatory PCR testing approval as a strategy to optimize testing, which was associated with a significant decline in the monthly incidence of HO-CDI rates and lowering of our standardized infection ratio to 0.77 (from 1.

Characteristics and outcomes of Hispanic/Latinx patients with coronavirus disease 19 (COVID-19) requiring hospitalization in Rhode Island: a retrospective cohort study.

Objective: Explore potential racial/ethnic differences, describe general clinical characteristic, and severe outcomes (intensive care unit [ICU] admission, mechanical ventilation [intubation], and death) between Hispanic/Latinx (hereafter: Hispanics or Latinx community) and non-Hispanic patients hospitalized with COVID-19.

Methods: Retrospective cohort of 326 patients hospitalized with COVID-19 through April 19, 2020. Sociodemographic and hospital course data were collected and analyzed.

Convalescent Plasma for Patients With Severe Coronavirus Disease 2019 (COVID-19): A Matched Cohort Study.

Background: The efficacy of convalescent plasma (CP) for the treatment of coronavirus disease 2019 (COVID-19) remains unclear.

Methods: In a matched cohort analysis of hospitalized patients with severe COVID-19, the impact of CP treatment on in-hospital mortality was evaluated using univariate and multivariate Cox proportional-hazards models, and the impact of CP treatment on time to hospital discharge was assessed using a stratified log-rank analysis.

Results: In total, 64 patients who received CP a median of 7 days after symptom onset were compared to a matched control group of 177 patients.

Hydroxychloroquine use in hospitalised patients with COVID-19: An observational matched cohort study.

Aim: To assess the efficacy and safety of hydroxychloroquine with or without azithromycin) in hospitalized adult patients with COVID-19.

Methods: We utilized a hospital based prospective data registry. The primary end point was to assess the impact of hydroxychloroquine with or without azithromycin, on outcome, length of hospitalization, and time to clinical improvement.

Co-infection with SARS-CoV-2 and Human Metapneumovirus.

The novel coronavirus (now called SARS-CoV-2) initially discovered in Wuhan, China, has now become a global pandemic. We describe a patient presenting to an Emergency Department in Rhode Island on March 12, 2020 with cough and shortness of breath after a trip to Jamaica. The patient underwent nasopharyngeal swab for a respiratory pathogen panel as well as SARS-CoV-2 RT-PCR.

Antimicrobial Stewardship in Community Hospitals.

Antimicrobial Stewardship Programs (ASP) help hospitals optimize antibiotic utilization, minimize the risk of developing antibiotic resistance and improve patients' health outcomes. Community hospitals can successfully implement an ASP that incorporates CDC-defined core elements of hospital ASP. The antimicrobial stewardship model should be customized to leadership, available resources and targeted interventions.

Total Joint Arthroplasty in Patients with Human Immunodeficiency Virus.

With the advent of highly active antiretroviral therapy (HAART), total joint arthroplasty has become a safe and effective procedure for patients infected with the human immunodeficiency virus (HIV). A correlation between a low CD4+ count (<200 cells/mm3) and major postoperative complications such as deep joint infection has been postulated, although high-level studies are not available in the literature. As most studies have not demonstrated an increase in the incidence of deep-vein thrombosis in patients with HIV/AIDS (acquired immunodeficiency syndrome), our recommendation is to use the standard prophylaxis that is followed by the operating surgeon.

Renal Function Recovery and HIV Viral Suppression Following Tenofovir Discontinuation for Renal Impairment.

Background: Tenofovir associated nephrotoxicity (TDFN) is well recognized. This study describes the trend of renal function recovery and virologic consequences after cessation of tenofovir (TDF) for suspected TDFN.

Methods: This was a retrospective chart review of 241 patients who underwent HLA-B*5701 allele testing between January 2007-December 2010.

Outpatient parenteral antibiotic therapy in an academic practice in Rhode Island.

Outpatient parenteral antimicrobial therapy (OPAT) is an increasingly utilized treatment modality that has been proven to be safe and cost effective for treating infections that require prolonged antimicrobial treatment. Adequate patient selection, a structured OPAT team with an effective communication system, and routine clinical monitoring are key elements to establish a successful OPAT program. The Miriam Hospital Infectious Diseases Clinic offers a multidisciplinary OPAT model coordinated by infectious diseases specialists and serves as a major referral center in Rhode Island.

Monitored viral load: a measure of HIV treatment outcomes in an outpatient setting in Rhode Island.

Community viral load measurements have been postulated to be a population-based biomarker of HIV disease. We propose the use of the monitored community viral load (mCVL) as an aggregate measure of viral load among persons receiving HIV care with available HIV-1 plasma viral loads and applied it to our clinic population from 2003-2010. We demonstrated a reduction in mCVL from 16,589 copies/ml to 11,992 copies/ml that correlated with a rising rate of antiretroviral use and HIV viral suppression; however, differences among risk populations were observed.

Care at the Crossroads: Navigating the HIV, HCV, and Substance Abuse Syndemic.

For patients with both HIV/HCV coinfection and substance addiction, multidisciplinary teams can facilitate coordination of care and improve clinical outcomes. Such teams should include HIV/HCV treatment providers, mental health specialists, case managers, social workers, and substance abuse counselors.