Impact of SARS-CoV-2 Infection on Physical Fitness in Air Force Basic Trainees.

Introduction: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on physical fitness in previously healthy adults is not well understood. In this study, we assess the impact of SARS-CoV-2 infection on the physical fitness test (PT) scores of Air Force basic trainees.

Materials And Methods: SARS-CoV-2 testing data and trainee fitness test scores for the calendar year 2021 were obtained from U.

Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in an Active-Duty Military Population.

There is limited data on Human Immunodeficiency Virus Pre-exposure Prophylaxis (PrEP) use and persistence in the military. Despite universal access to care, there is concern that PrEP persistence may be lower in military populations due to logistical challenges and perceived stigma. This study evaluated the persistence rates as well as reasons for PrEP discontinuation in a military cohort.

Positivity and Follow-up Testing of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in Universally Screened Female Basic Military Trainees.

Introduction: Follow-up testing is recommended three months after patients initially test positive with Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Follow-up testing adherence in the United States has been reported below one third of women, even in universally insured populations. We assessed both the positivity of CT and GC infections in female basic military trainees and the rates of follow-up testing for those who tested positive.

Universal versus targeted coronavirus disease 2019 (COVID-19) arrival antigen testing on subsequent COVID-19 infections in military trainees.

In this retrospective cohort study of military trainees, symptomatic-only coronavirus disease 2019 (COVID-19) arrival antigen testing decreased isolation requirements without increasing secondary cases compared to universal antigen testing. Symptomatic-only arrival antigen testing is a feasible alternative for individuals entering a congregant setting with a high risk of COVID-19 transmission.

A narrative review on antimicrobial dosing in adult critically ill patients on extracorporeal membrane oxygenation.

The optimal dosing strategy of antimicrobial agents in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) is unknown. We conducted comprehensive review of existing literature on effect of ECMO on pharmacokinetics and pharmacodynamics of antimicrobials, including antibacterials, antifungals, and antivirals that are commonly used in critically ill patients. We aim to provide practical guidance to clinicians on empiric dosing strategy for these patients.

Etiology of Leukemoid Reaction in Patients Undergoing Extracorporeal Membrane Oxygenation.

Introduction: Nosocomial infections are frequent in patients receiving extracorporeal membrane oxygenation (ECMO). Leukemoid reaction, defined as >50,000 white blood cells (WBCs) per microliter, has been associated with infections in some populations. As ECMO is associated with significant inflammation activation between the patient's immune system and the circuit components, it is hypothesized that leukemoid reactions may have low specificity for identifying new infections in patients receiving ECMO.

The Impact of Infectious Diseases Scholarly Mentorship on Subsequent Infectious Disease Fellowship Application.

Introduction: Infectious diseases physicians invest significant time mentoring medical students and internal medicine residents through research projects as well as case reports. Although having an infectious diseases mentor has been shown to be associated with subsequent infectious diseases fellowship application, the impact of specific scholarly activities on future application to infectious diseases fellowship is unknown.

Methods: All research and case reports published or presented from Brooke Army Medical Center between 2014 and 2022 with an infectious diseases senior author and a medical student or internal medicine resident first author were evaluated.

Infectious diseases and infection control prevention strategies in adult and pediatric population on ECMO.

As survival after ECMO improves and use of ECMO support increases in both pediatric and adult population, there is a need to focus on both the morbidities and complications associated with ECMO and how to manage and prevent them. Infectious complications during ECMO often have a significant clinical impact, resulting in increased morbidity or mortality irrespective of the underlying etiology necessitating cardiorespiratory support. In this review article, we discuss the prevention, management, challenges, and differences of infectious complications in adult and pediatric patients receiving ECMO support.

A systematic review of variability in the reporting of extracorporeal membrane oxygenation-associated infections and recommendations for standardization.

Background: Extracorporeal membrane oxygenation (ECMO) utilization has surged in recent years, particularly amidst the COVID-19 pandemic, yet standardization of ECMO-associated infection (EAI) reporting remains lacking.

Methods: This systematic review assessed 60 studies from 2018 to 2023 in PubMed, which used key words related to EAIs. Adherence to reporting data elements that may bias reporting, including the use of standardized rates of infections per 1,000 patient days, describing the use of antimicrobial prophylaxis, infection control, and culture practices, describing the definitions for infection by site, and listing pathogens by infection site were evaluated by study.

Epidemiology and clinical significance of persistent bacteremia in severely burned patients.

Background: The utility of follow-up blood cultures (FUBC) for gram-negative bloodstream infections (BSIs) are controversial due to low rates of positivity. However, recent studies suggest higher rates of positivity in critically ill patients. The utility of FUBC in gram-negative BSI in patients with severe burn injuries is unknown.

Fever and Leukocytosis Are Poor Predictors of Bacterial Coinfection in Patients With COVID-19 and Influenza Who Are Receiving Extracorporeal Membrane Oxygenation.

Background: Fever and leukocytosis are 2 parameters commonly cited in clinical practice as indications to perform an infectious workup in patients receiving extracorporeal membrane oxygenation (ECMO), but their utility is unknown.

Methods: All patients who received ECMO between December 2014 and December 2020 with influenza or COVID-19 were included in this retrospective cohort study. Cultures were included if they were drawn from patients without signs of decompensation.

Infectious etiologies among post-donation deferrals in a military blood donation center.

Background: The burden of transfusion-transmitted infections among blood recipients remains low due to extensive pre- and post-donation screening. However, the military has the unique challenge of providing blood in austere environments with limited testing capabilities. This study evaluates the infectious etiologies of deferred blood donors at a large military blood donation center.

Follow-up of Military Blood Donors Who Test Positive for Syphilis.

Background: Several large studies have demonstrated that syphilis carries a risk of future sexually transmitted infections (STI), such as human immunodeficiency virus. There are limited data on outcomes of syphilis infections that occur in populations that undergo universal syphilis screening, such as blood donors. Military trainees who donate blood can be followed through their military career to determine the future risk of STIs.

Sensitivity of Symptom-Based Screening for COVID-19 in Active Duty Basic Trainees.

Introduction: Symptomatic Coronavirus Disease 2019 (COVID-19) screening has been a cornerstone of case identification during the pandemic. Despite the myriad of COVID-19 symptoms, symptom screens have primarily focused on symptoms of influenza-like illnesses such as fever, cough, and dyspnea. It is unknown how well these symptoms identify cases in a young, healthy military population.

The utility of sepsis scores for predicting blood stream infections in extracorporeal membrane oxygenation.

Introduction: Extracorporeal membrane oxygenation (ECMO) is an increasingly used modality of life support with high risk for nosocomial infections. The accuracy of sepsis prediction tools in identifying blood stream infections (BSI) in this population is unknown as measurement of multiple variables commonly associated with infection are altered by the circuit.

Methods: This study compares all blood stream infections for patients receiving ECMO between January 2012 and December 2020 to timepoints when blood cultures were negative using the Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction Score (LODS), American Burn Association Sepsis Criteria (ABA), Systemic Inflammatory Response Syndrome (SIRS) scores.

Treatment and outcome of gram-positive bacteremia in patients receiving extracorporeal membrane oxygenation.

Background: While guidance exists for management of blood stream infections with various invasive devices, there are currently limited data to guide antibiotic selection and duration for bacteremia in patients receiving extracorporeal membrane oxygenation (ECMO).

Objective: To evaluate the treatment and outcomes of thirty-six patients with Staphylococcus aureus and Enterococcus bacteremia on ECMO support.

Methods: Blood culture data was retrospectively analyzed from patients with Staphylococcus aureus bacteremia (SAB) or Enterococcus bacteremia who underwent ECMO support between March 2012 and September 2021 at Brooke Army Medical Center.

Clearance of blood stream infections in patients receiving extracorporeal membrane oxygenation: a retrospective single-center cohort study.

Background: There are limited data on the treatment of blood stream infections (BSIs) in patients receiving extracorporeal membrane oxygenation (ECMO). Current guidance recommends documenting clearance only in fungal and Gram-positive BSIs. This study investigates the incidence and clinical significance of blood stream infections with positive repeat cultures (BSIPRC) in ECMO as well as clinical factors that may predict positive repeat cultures.

An RNA Interference (RNAi) Toolkit and Its Utility for Functional Genetic Analysis of ().

RNA interference (RNAi) is a powerful tool whose efficacy against a broad range of targets enables functional genetic tests individually or systematically. However, the RNAi pathway has been lost in evolution by a variety of eukaryotes including most Leishmania sp. RNAi was retained in species of the subgenus , and here we describe the development, optimization, and application of RNAi tools to the study of .

Infections complicating extracorporeal membrane oxygenation in patients with traumatic injuries.

Introduction: Extracorporeal Membrane Oxygenation (ECMO) has increasing utility in adult patients with traumatic injuries. There is currently limited data on the pathogens complicating a trauma patient's ECMO course, making empiric antibiotic decisions difficult. This study aims to characterize the types of infection among patients with traumatic injuries on ECMO.

Outcomes of Fungemia in Patients Receiving Extracorporeal Membrane Oxygenation.

There are limited data on the treatment of fungal infections complicating extracorporeal membrane oxygenation (ECMO). In 14 patients who developed fungal bloodstream infections on ECMO, 8 (57%) survived to discharge. Of the 5 patients completing treatment prior to decannulation, 2 (40%) developed recurrent fungal infections.

Response to a Serogroup B Meningococcal Disease Case Among Military Trainees.

We describe the public health response to a military trainee who developed serogroup B meningococcal disease while sharing underwater breathing equipment. Despite high transmission risk, with rapid isolation and postexposure prophylaxis administration, there were no secondary cases. This case supports carefully weighing serogroup B meningococcal vaccination in high-risk settings.