Incomplete documentation of β-lactam allergy in long-term care facility residents increases risk of high-risk antibiotic use for Clostridioides difficile infection.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Documented penicillin allergy and beta-lactam antibiotic use in Massachusetts long-term care facilities: opportunities for penicillin allergy delabeling.

In a cross-sectional study of 20 Massachusetts long-term care (LTC) facilities, 19% (n = 449) of residents received antibiotics, with approximately one-third having a documented penicillin allergy. This documented allergy decreased the likelihood of prescribing beta-lactam antibiotics for infections. Improved penicillin allergy assessments and delabeling could optimize antibiotic prescribing in LTC settings.

The IL-6 hypothesis in COVID-19: A phase 2, randomised, double-blind, placebo-controlled study to evaluate the efficacy and safety of free IL-6 sequestration by the monoclonal antibody sirukumab in severe and critical COVID-19.

Background: Upregulation of IL-6 has been associated with worse prognosis in COVID-19 patients. Impact on IL-6 signalling has mostly been limited to clinical outcomes in IL-6 receptor antagonist trials.

Methods: We performed a phase 2, randomised, double-blind, placebo-controlled trial (NCT04380961) of US-based hospitalised adults (<85 years) with laboratory-confirmed SARS-CoV-2 infection and severe (low levels of supplemental oxygen) or critical disease (high levels of oxygen supplementation).

Antibiotic allergy prevalence and documentation quality in Massachusetts long-term care facilities: A cross-sectional survey.

Background: Antimicrobial resistance poses a significant global health challenge, particularly affecting older adults who are more susceptible to infections and their complications. Accurate diagnosis and documentation of antibiotic allergies are essential for effective antimicrobial stewardship. Despite the recognized overdiagnosis of antibiotic allergies, comprehensive studies on this subject in long-term care (LTC) settings are limited.

Cefiderocol-associated brown chromaturia.

Cefiderocol is a novel siderophore cephalosporin antibiotic. In the present case report, a woman in her 70s presented with a 1-week history of altered mental status and progressive purulent discharge from a non-healing diabetic foot ulcer on her right heel. MRI of the right foot revealed chronic osteomyelitis of the calcaneum.

Clinical Impact of Noninvasive Plasma Microbial Cell-Free Deoxyribonucleic Acid Sequencing for the Diagnosis and Management of Pneumonia: A Single-Center Retrospective Study.

We present 23 cases of pneumonia (PCP) diagnosed with commercially available noninvasive plasma microbial cell-free deoxyribonucleic acid (mcfDNA) assay. Our findings suggest that plasma mcfDNA testing resulted in positive clinical impact for the diagnosis and treatment of PCP and coinfections in 82.6% of cases.

Blood culture utilization practices among febrile and/or hypothermic inpatients.

Background: Predictors associated with the decision of blood culture ordering among hospitalized patients with abnormal body temperature are still underexplored, particularly non-clinical factors. In this study, we evaluated the factors affecting blood culture ordering in febrile and hypothermic inpatients.

Methods: We performed a retrospective study of 15,788 adult inpatients with fever (≥ 38.

Severe, Refractory Immune Thrombocytopenia Occurring After SARS-CoV-2 Vaccine.

The rollout of the SARS-CoV-2 vaccine is underway, and millions have already been vaccinated. At least 25 reports of "immune thrombocytopenia" (ITP) or "thrombocytopenia" following the Moderna or Pfizer vaccine have been added to the Vaccine Adverse Event Reporting System (VAERS) in the US. ITP is a rare but known complication of several vaccinations.

Clinical Impact of Revised Cefepime Breakpoint in Patients With Bacteremia.

The impact of the revised Clinical and Laboratory Standards Institute interpretative criteria for cefepime in remains unclear. We applied the new breakpoint on 644 previously defined cefepime-susceptible isolates. We found no differences in mortality or microbiological failure, regardless of isolates being susceptible or cefepime-susceptible dose-dependent by current criteria.

Risk factors predicting Candida infective endocarditis in patients with candidemia.

Candida infective endocarditis (CIE) is a rare but serious complication of candidemia. Incidence and risk factors associated with CIE among candidemic patients are poorly defined from small cohorts. Identification of clinical predictors associated with this entity may guide more judicious use of cardiac imaging.

Incidence and Diagnostic Yield of Repeat Urine Culture in Hospitalized Patients: an Opportunity for Diagnostic Stewardship.

There is limited knowledge on the incidence, diagnostic yield, and cost associated with inappropriate repeat urine cultures. The factors that affect repeat urine culturing practices are not well understood. We conducted a retrospective study of adult inpatients who had ≥1 urine culture performed during their hospitalization between January 2015 and February 2018.

A Cluster of Cefepime-induced Neutropenia During Outpatient Parenteral Antimicrobial Therapy.

A cluster of cefepime-induced neutropenia (CIN) was identified from June 2017 to May 2018 in a regional outpatient parenteral antimicrobial therapy population. Our data suggest prolonged courses of cefepime (≥2 weeks), administered by rapid intravenous push, were associated with a higher risk of CIN.

Incidence and etiology of fever following seasonal influenza vaccination in hospitalized patients.

We conducted a retrospective cohort to examine the incidence and etiology of fever postinfluenza vaccination among hospitalized patients during the 2015-2016 influenza season. Fever occurred in 63 (1.5%) of 4,185 vaccinated patients.

Prognostic Factors and Treatment of Spinal Astrocytomas: A Multi-institutional Cohort Analysis.

Study Design: Retrospective cohort analysis of patients with spinal astrocytoma from multi-institutional data and the literature.

Objective: To determine the prognostic factors, treatment, and survival of patients.

Summary Of Background Data: Our current understanding of the epidemiology, prognosis, and optimal treatment of spinal astrocytoma is limited.

Hemobilia from Biliary Angiodysplasia Diagnosed with Cholangioscopy.

Biliary angiodysplasia is extremely rare. Our background search revealed only a few case reports in the English literature. We present a case of angiodysplasia of the proximal common bile duct in a patient with subacute upper gastrointestinal bleeding and symptomatic anemia.

Imipenem/cilastatin-induced acute eosinophilic pneumonia.

Drugs, toxins, and infections are known to cause acute eosinophilic pneumonia. Daptomycin and minocycline are the commonly reported antibiotics associated with acute eosinophilic pneumonia. In this study, we present a case of imipenem/cilastatin-induced acute eosinophilic pneumonia.

Cryptococcal Infection of the Ventriculoperitoneal Shunt in an Immunocompetent Patient.

Background: Ventriculoperitoneal shunting is an effective treatment for hydrocephalus. Ventriculoperitoneal shunt (VPS) infection is a common complication. Cryptococcus neoformans as an implicated organism is rare.