Pathogen genomics in healthcare: overcoming barriers to proactive surveillance.

Pathogen genomic surveillance in healthcare has the potential to enhance patient safety by detecting outbreaks earlier, thereby reducing morbidity and mortality. Despite benefits, there are barriers to adoption, including cost, expertise, and lack of standardized methodologies and incentives. This commentary advocates for 1) investment from healthcare payors, public health, and regulatory bodies and 2) additional research on genomic surveillance for improving patient outcomes and reducing infections.

Development and validation of an antimicrobial stewardship clinical decision-support tool to improve the management of urinary tract infections versus asymptomatic bacteriuria in hospitalized patients.

Objective: To assess the effectiveness of a 3-question decision-support tool to guide the diagnosis and treatment of urinary tract infections (UTIs) in acute care hospitalized patients as an antibiotic and diagnostic stewardship initiative.

Design: Retrospective cohort study.

Setting: Four acute care hospitals within the same health system in Miami, FL.

Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) harboring mupirocin and biocide resistance genes in a large health care system.

Background: We aimed to determine the prevalence of genes associated with high-level mupirocin and biocide resistance in methicillin-resistant Staphylococcus aureus (MRSA) isolates among hospitalized patients and to characterize their genomic and epidemiologic features.

Methods: Study conducted on an integrated health system. Clinical cultures with MRSA from hospitalized patients collected between March 1, 2023, and January 20, 2024 underwent prospective whole-genome sequencing, including assessment for the presence of markers of resistance against mupirocin (mupA) and biocides (qac).

Duration of antibiotic therapy for multidrug resistant Pseudomonas aeruginosa pneumonia: is shorter truly better?

Background: The 2016 IDSA guideline recommends a treatment duration of at least 7 days for hospital-acquired (HAP)/ventilator-associated pneumonia (VAP). The limited literature has demonstrated higher rates of recurrence for non-glucose fermenting gram-negative bacilli with short course therapy, raising the concern of optimal treatment duration for these pathogens. Therefore, we aimed to compare the outcomes for patients receiving shorter therapy treatment (≤ 8 days) versus longer regimen (> 8 days) for the treatment of multidrug resistant (MDR) Pseudomonas pneumonia.

Factors Associated With Poor Clinical and Microbiologic Outcomes in Candida auris Bloodstream Infection: A Multicenter Retrospective Cohort Study.

Background: Candida auris has become a growing concern worldwide because of increases in incidence of colonization and reports of invasive infections. There are limited data on clinical factors associated with poor outcomes in patients with C. auris bloodstream infection (BSI).

Navigating the Challenges of Candida auris Colonization in Rehabilitation Settings.

Candida auris is a highly transmissible yeast that is capable of causing invasive and fatal infections, particularly among persons with underlying medical conditions. Its incidence is rising, especially among patients cared for in post-acute care facilities. Individuals colonized with the yeast may be cared for in inpatient rehabilitation settings, without heightened risk for invasive infection and/or transmission to others, as long as appropriate infection control measures are followed.

Impact of In-house Polymerase Chain Reaction Screening on Admission on the Incidence Rates of Surveillance and Blood Cultures With and Associated Cost Savings.

Background: The impact of strategies for rapid diagnostic screening of on hospital operations has not been previously characterized. We describe the implementation of in-house polymerase chain reaction (PCR) testing on admission for screening of colonization with associated process improvements, and financial impact.

Methods: This study was conducted across an integrated health system.

Effectiveness of a sodium hypochlorite isotonic solution in decolonization of patients with Candida auris: Learnings from a county health care system.

Background: Candida auris (CA) is an organism that has spread globally over the last decade. We conducted a quality improvement project with the aim of decreasing or eliminating skin colonization of patients with CA through a modified bathing protocol.

Methods: An isotonic hypochlorite solution was added to routine bathing protocols for hospitalized patients colonized with CA.

The Relationship between Hypertension and Periodontitis: A Cross-Sectional Study.

Recent evidence suggests an association between hypertension and periodontitis, although the pathways and implications underlying both chronic conditions are still poorly understood. Therefore, the aim of this study was to evaluate the relationship between hypertension and periodontitis through an observational clinical study using periodontal, physical, and biochemical analyses in hypertensive and non-hypertensive individuals with periodontitis. A total of one hundred patients were divided into two groups.

The Effect of Non-Surgical Periodontal Treatment on Patients with Combined Refractory Arterial Hypertension and Stage III, Grade B Periodontitis: A Preliminary Prospective Clinical Study.

We sought to evaluate the effects of non-surgical periodontal treatment (NSPT) on periodontal clinical parameters, systemic blood pressure (BP), and plasma levels of systemic inflammation markers in patients with combined refractory arterial hypertension (RAH) and stage III grade B periodontitis. Twenty-seven participants with RAH and periodontitis received NSPT. The analyzed clinical parameters were probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI).

Preventing Surgical Site Infections: Implementing Strategies Throughout the Perioperative Continuum.

Surgical site infections (SSIs) are a considerable cause of patient morbidity and mortality and are associated with increased hospital lengths of stay as well as increased health care costs to both patients and health care facilities. Substantial advances have been made in infection control practices throughout the perioperative setting to prevent SSIs and improve patient quality of care. Preventing and reducing SSIs requires a multifaceted approach encompassing the continuum of medical and surgical care.

Impact of fluoroquinolone cascade reporting of urine samples on antibiotic prescribing rates in a network of urgent care clinics.

Cascade reporting is an antimicrobial stewardship strategy that has been successfully implemented in inpatient settings, but evidence of its impact on outpatient settings is scarce. We report on the impact on fluroquinolone prescribing at a network of urgent care clinics following the implementation of cascade reporting of Enterobacterales in urine cultures.

Clinical utility of methicillin-resistant nasal polymerase chain reaction (PCR) assays beyond respiratory infections.

We estimated the predictive value of methicillin-resistant (MRSA) nasal polymerase chain reaction (PCR) for blood, bone, and soft-tissue cultures. The specificities were 88.8%, 88.

Comparison of the performance of a clinical classification tree versus clinical gestalt in predicting sepsis with extended-spectrum beta-lactamase-producing gram-negative rods.

A clinical decision tree was developed using point-of-care characteristics to identify patients with culture-proven sepsis due to extended-spectrum β-lactamase-producing (ESBL-PE). We compared its performance with the clinical gestalt of emergency department (ED) clinicians and hospital-based clinicians. The developed tree outperformed ED-based clinicians but was comparable to inpatient-based clinicians.

Clinical prediction models for mortality in patients with covid-19: external validation and individual participant data meta-analysis.

Objective: To externally validate various prognostic models and scoring rules for predicting short term mortality in patients admitted to hospital for covid-19.

Design: Two stage individual participant data meta-analysis.

Setting: Secondary and tertiary care.

Factors associated with non-guideline-adherent treatment for gonorrhea and chlamydia among outpatient prescriptions in the Unites States.

Patients at risk for sexually transmitted infections (STI) frequently receive care at non-specialized outpatient clinics staffed by physicians and advanced practice clinicians (APCs). Retrospective cohort study including adult patients diagnosed with chlamydia and/or gonorrhea at urgent care (UC), family medicine (FM), internal medicine (IM) or obstetrics and gynecology (Ob-Gyn) clinics. The effect of type of clinician on guideline-adherent treatment was estimated using logistic regression adjusted for age, type of clinic, type of infection, and (in female patients) pregnancy status.

COVID-19 Trials: Who Participates and Who Benefits?

Objectives: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately afflicted vulnerable populations. Older adults, particularly residents of nursing facilities, represent a small percentage of the population but account for 40% of mortality from COVID-19 in the United States. Racial and ethnic minority individuals, particularly Black, Hispanic, and Indigenous Americans have experienced higher rates of infection and death than the White population.

Impact of Rapid Susceptibility Testing System on the Management of Gram-Negative Bacteremia in a Network of Community Hospitals.

Background: Rapid initiation of optimal antimicrobial therapy is crucial for the management of Gram-negative (GN) bacteremia. We aimed to evaluate the impact of Accelerate PhenoTM (AxDx) system on change in therapy and length of stay among patients with GN bacteremia.

Methods: We conducted a retrospective cohort study of adult patients hospitalized who had at least 1 blood culture with presence of Enterobacterales.

Impact of Fibrosis-4 Index Prior to COVID-19 on Outcomes in Patients at Risk of Non-alcoholic Fatty Liver Disease.

Background: Severity of disease and outcomes in patient with COVID-19 has been associated with several risk factors tied to the metabolic syndrome.

Aims: We conducted a study with the objective of describing the association between the baseline Fibrosis-4 (FIB-4) index prior to SARS-CoV-2 infection and the severity of COVID-19 among patients at risk of non-alcoholic fatty liver disease (NAFLD).

Methods: This was a retrospective cohort study of patients with at least two risk factors for metabolic syndrome diagnosed with COVID-19.

Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings.

Objective: The BioFire FilmArray Respiratory Panel (RFA) has been proposed as a tool that can aid in the timely diagnosis and treatment of respiratory tract infections but its effect on antibiotic prescribing among adult patients has varied. We evaluated the impact of RFA result on antibiotic days of therapy (DOTs) in 2 distinct cohorts: hospitalized patients and patients discharged from the emergency department (ED).

Design: Retrospective cohort study.

Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials.

Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.