Brucellosis Initially Misidentified as Bacteremia: A Case Report and Review of the Literature.

Automated identification systems may misidentify , the causative agent of brucellosis, which may be re-emerging in the United States as the result of an expanding feral swine population. We present a case of likely associated with feral swine exposure that was misidentified as , a phylogenetic relative.

Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines.

Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers.

Persistent Value of the Stethoscope in the Age of COVID-19.

The stethoscope has long been at the center of patient care, as well as a symbol of the physician-patient relationship. While advancements in other diagnostic modalities have allowed for more efficient and accurate diagnosis, the stethoscope has evolved in parallel to address the needs of the modern era of medicine. These advancements include sound visualization, ambient noise reduction/cancellation, Bluetooth (Bluetooth SIG Inc, Kirkland, Wash) transmission, and computer algorithm diagnostic support.

Clinical relevance of metronidazole and peripheral neuropathy: a systematic review of the literature.

The objective of this paper was to review and evaluate the literature on metronidazole-associated peripheral neuropathy and determine the relevance in clinical practice. MEDLINE/PubMed, EBSCO, and Google Scholar were searched through February 2017 using the search terms metronidazole and peripheral neuropathy, or polyneuropathy, or paresthesia, or neurotoxicity. Relevant case reports, retrospective studies, surveys, and review articles were included.

Decrease in Candida bloodstream infections in veterans in Atlanta.

Despite the recent focus on prevention of health care-associated infections, rates of Candida bloodstream infections in adults have remained unchanged until recently. We report a decline of Candida bloodstream infections, not explained by changes in broad-spectrum antibiotic use, but coinciding with infection control policies aimed at central venous catheter maintenance.

Antibiotic use in US hospitals: quantification, quality measures and stewardship.

A majority of patients hospitalized in the US hospitals receive an antibiotic during their hospitalization. Furthermore, up to half of antibiotics prescribed in hospitals are inappropriate. In the setting of continued emergence of antibiotic-resistant pathogens and a limited pipeline of new antimicrobials, attention to optimizing antibiotic use in healthcare settings is essential.

Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features.

Background: Patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection are often presumed to remain colonized when they are readmitted to the hospital. This assumption underlies the hospital practice that flags MRSA-positive patients so that these patients can be placed in contact isolation at hospital admission and, when necessary, be given the appropriate empirical therapy and/or antibiotic prophylaxis.

Methods: To determine the duration of and factors associated with MRSA colonization among patients following discharge, we designed a cohort study of patients hospitalized between October 1, 2007, and July 31, 2009, at the Atlanta Veterans Affairs Medical Center, a 128-bed acute care facility.

Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in residents of Veterans Affairs long-term care facilities: role of antimicrobial exposure and MRSA acquisition.

Objective: To identify risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) acquisition in long-term care facility (LTCF) residents.

Design: Multicenter, prospective cohort followed over 6 months.

Setting: Three Veterans Affairs (VA) LTCFs.

Cepheid Xpert MRSA cycle threshold in discordant colonization results and as a quantitative measure of nasal colonization burden.

We analyzed the cycle threshold (C(T)) of PCR surveillance MRSA swabs obtained from veterans. Lower C(T) on admission was associated with a positive culture from nasal swabs at discharge. Compared to PCR, direct plating of nasal swabs performed poorly, especially for patients with an elevated C(T).

Emerging trends in antibiotic use in US hospitals: quality, quantification and stewardship.

Three major trends in antibiotic use in US hospitals have emerged over the last few years: antibiotics as quality metrics, persistent use of different measures of antibiotic consumption and the emergence of antibiotic stewardship programs. Compared with Europe, where approaches are heterogeneous but generally consistent, the USA currently lacks the infrastructure to monitor antibiotic resistance and antibiotic consumption locally. Both have implemented programmatic strategies for prudent antibiotic use.

Nursing home-associated infections in Department of Veterans Affairs community living centers.

Background: Little is known about factors contributing to nursing home-associated infections (NHAIs). We conducted a survey of residents in 133 Department of Veterans Affairs community living centers to determine the roles of indwelling device use, bed locations, and treatment codes on NHAIs.

Methods: A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted on November 14, 2007.

Health care-associated and community-associated methicillin-resistant Staphylococcus aureus infections: A comparison of definitions.

Background: Different approaches are used to classify methicillin-resistant Staphylococcus aureus (MRSA) infections as either community-acquired (CA-MRSA) or health care-associated MRSA (HA-MRSA).

Methods: We collected information on patients seen at the Atlanta Veterans Affairs Medical Center with MRSA infections from June 2007 through May 2008. We classified MRSA infections as either HA or CA using an epidemiologic definition and an antibiotic susceptibility phenotype rule.

Hospitalization earlier than 1 year prior to admission as an additional risk factor for methicillin-resistant Staphylococcus aureus colonization.

Our case-control study sought to identify risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission among patients with no known healthcare-related risk factors. We found that patients whose most recent hospitalization occurred greater than 1 year before their current hospital admission were more likely to have MRSA colonization. In addition, both the time that elapsed since the most recent hospitalization and the duration of that hospitalization affected risk.

Does hand hygiene compliance among health care workers change when patients are in contact precaution rooms in ICUs?

Background: Hand hygiene compliance rates among health care workers (HCW) rarely exceed 50%. Contact precautions are thought to increase HCWs' hand hygiene awareness. We sought to determine any differences in hand hygiene compliance rates for HCW between patients in contact precaution and those not in any isolation.

Risk factors associated with methicillin resistance among Staphylococcus aureus infections in veterans.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging concern in infectious disease practice. Although MRSA infections occur in a wide variety of anatomic sites, the majority of studies considering the risk factors for methicillin resistance among S. aureus infections have focused on MRSA bacteremia.

A multicenter study on optimizing piperacillin-tazobactam use: lessons on why interventions fail.

We examined interventions to optimize piperacillin-tazobactam use at 4 hospitals. Interventions for rotating house staff did not affect use. We could target empiric therapy in only 35% of cases.

Measuring the scope and magnitude of hospital-associated infection in the United States: the value of prevalence surveys.

Health care-associated infections are a major public health concern both in the United States and abroad, contributing to increased morbidity, mortality, and health care costs. As a consequence of changes in health care delivery and increasing demands on infection prevention, targeted surveillance has become common in the United States, focusing on areas of the hospital where a patient's risk for health care-associated infection is greatest, as opposed to hospital-wide surveillance; the latter can be used to estimate the national burden of health care-associated infections. Many countries have shown that prevalence surveys can be used to quantify the burden of disease and to help establish priorities to accomplish national goals of prevention of health care-associated infection.

Prevalence of nursing home-associated infections in the Department of Veterans Affairs nursing home care units.

Background: The Department of Veterans Affairs (VA) is the largest single provider of long-term care in the United States. The prevalence of nursing home-associated infections (NHAIs) among residents of VA nursing home care units (NHCUs) is not known.

Methods: A Web-based point prevalence survey of NHAIs using modified Centers for Disease Control and Prevention definitions for health care-associated infections was conducted in the VA's 133 NHCUs on November 9, 2005.

Antimicrobial-associated risk factors for Clostridium difficile infection.

Antimicrobial therapy plays a central role in the pathogenesis of Clostridium difficile infection (CDI), presumably through disruption of indigenous intestinal microflora, thereby allowing C. difficile to grow and produce toxin. Investigations involving animal models and studies performed in vitro suggest that inhibitory activity against C.

Importance of bacterial burden among methicillin-resistant Staphylococcus aureus carriers in a long-term care facility.

Objective: To evaluate the prevalence and transmission of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization, as well as risk factors associated with MRSA carriage, among residents of a long-term care facility (LTCF).

Design: Prospective, longitudinal cohort study.

Setting: A 100-bed Veterans Administration LTCF.