COVID-19 outbreaks in nursing homes in Los Angeles County, March 2020-April 2022.

Introduction: Nursing home (NH) residents have an elevated risk of coronavirus disease 2019 (COVID-19) infection and severe outcomes. However, literature regarding outbreak outcomes at the facility level is limited.

Methods: NH outbreaks beginning between March 1, 2020, and February 22, 2022, at facilities under Los Angeles County jurisdiction were assigned to 1 of 6 time periods defined by dominant variants, surges in community transmission, and vaccination levels.

Successful Distribution of Tecovirimat During the Peak of the Mpox Outbreak - Los Angeles County, June 2022-January 2023.

Tecovirimat is the first-line antiviral treatment recommended for severe mpox or for persons with mpox who are at risk for severe disease; tecovirimat is available in the United States under an expanded access investigational new drug (IND) protocol. During the 2022-2023 mpox outbreak, local U.S.

Save the Mekong Delta from drowning.

Policy must address drivers, not just symptoms, of subsidence.

Preliminary Experience With the Human Acellular Vessel: A Descriptive Case Series Detailing Early Use of a Bioengineered Blood Vessel for Arterial Repair.

Background: An infection-resistant, immediately available conduit for trauma and urgent vascular reconstruction remains a critical need for successful limb salvage. While autologous vein remains the gold standard, vein-limited patients and size mismatch are common issues. The Human Acellular Vessel (HAV) (Humacyte, Inc.

Quantitative Analysis of Tug Sign: An Endoscopic Finding of Eosinophilic Esophagitis.

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterized by esophageal inflammation and dysfunction, with a rising incidence affecting approximately 1:1000 individuals worldwide. Chronic inflammation can lead to tissue remodeling in the esophagus with fibrosis in the lamina propria that is partially responsible for symptoms and complications of EoE. At times, a firmness to the esophagus can be appreciated with a noticeable force required to obtain biopsies from EoE.

Case of an atypical pituitary abscess.

A pituitary abscess is a rare intrasellar infection. Correct identification can be challenging preoperatively given its non-specific symptoms and imaging findings. We report a case of a young woman presenting with secondary amenorrhea, visual field deficits and a 2.

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 Among Skilled Nursing Facility Residents and Staff Members-Los Angeles County, August-September 2020.

Background: The prevalence of current or past coronavirus disease 2019 in skilled nursing facility (SNF) residents is unknown because of asymptomatic infection and constrained testing capacity early in the pandemic. We conducted a seroprevalence survey to determine a more comprehensive prevalence of past coronavirus disease 2019 in Los Angeles County SNF residents and staff members.

Methods: We recruited participants from 24 facilities; participants were requested to submit a nasopharyngeal swab sample for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing and a serum sample for detection of SARS-CoV-2 antibodies.

Diagnostic Performance of an Antigen Test with RT-PCR for the Detection of SARS-CoV-2 in a Hospital Setting - Los Angeles County, California, June-August 2020.

Prompt and accurate detection of SARS-CoV-2, the virus that causes COVID-19, has been important during public health responses for containing the spread of COVID-19, including in hospital settings (1-3). In vitro diagnostic nucleic acid amplification tests (NAAT), such as real-time reverse transcription-polymerase chain reaction (RT-PCR) can be expensive, have relatively long turnaround times, and require experienced laboratory personnel.* Antigen detection tests can be rapidly and more easily performed and are less expensive.

Effect of Contact Precautions on Staphylococcus aureus and Clinical Outcomes of Colonized Patients in the Neonatal Intensive Care Unit.

Background: Staphylococcus aureus is a common pathogen in neonatal intensive care units (NICUs), yet little is known about the effect of contact precautions and clinical outcomes of colonized patients.

Methods: Retrospective cohort study of all neonates from August 2014 to November 2018 colonized with either methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S.

Outbreak Investigations: A Brief Primer for Gastroenterologists.

Transmission of pathogens during endoscopy and subsequent outbreak investigations generated by potential nosocomial transmissions have become a major concern for gastroenterologists. These investigations have resulted in significant media coverage for individual institutions and can cause massive disruption to the institution if not handled well. Gastroenterologists should have a central role in investigation of these outbreaks and management of the communications and patient notification that is required.

Coronavirus Disease 2019 (COVID-19) Infections Among Healthcare Workers, Los Angeles County, February-May 2020.

Across the world, healthcare workers (HCW) are at a greater risk of infection by coronavirus disease 2019 (COVID-19) due to the nature of their work. The Los Angeles County Department of Public Health (LAC DPH) set out to understand the impact of COVID-19 on healthcare facilities and HCWs by tracking and analyzing data from case-patient interviews of HCWs. As of 31 May, over 3 months into the pandemic, nearly 5500 positive HCWs were reported to LAC DPH, representing 9.

Seafood graded oral food challenge outcomes in a pediatric tertiary care center.

Background: There are sparse data regarding the predictors of positive oral food challenges and reaction severity for seafood in children.

Objective: Identify clinical characteristics in children with seafood allergy who were most likely to experience a negative oral food challenge (OFC).

Methods: A retrospective chart review was performed for children who had a graded OFC to seafood at a pediatric tertiary care center from 2008 through 2019.

Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals.

Objective: To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.

Design: Retrospective cohort study.

Setting: Eight tertiary-care referral general hospitals in California.

Minimizing central line-associated bloodstream infections in a high-acuity liver transplant intensive care unit.

Background: Increases in liver transplant patient perioperative acuity have resulted in frail immunosuppressed patients at elevated risk for nosocomial infections. Avoiding central line-associated bloodstream infections (CLABSIs) is paramount to facilitate transplantation and post-transplant recovery. In 2015, our liver transplant intensive care unit (ICU) CLABSIs accounted for more than 25% of all CLABSI at our institution.

Effect of Algorithm-Based Therapy vs Usual Care on Clinical Success and Serious Adverse Events in Patients with Staphylococcal Bacteremia: A Randomized Clinical Trial.

Importance: The appropriate duration of antibiotics for staphylococcal bacteremia is unknown.

Objective: To test whether an algorithm that defines treatment duration for staphylococcal bacteremia vs standard of care provides noninferior efficacy without increasing severe adverse events.

Design, Setting, And Participants: A randomized trial involving adults with staphylococcal bacteremia was conducted at 16 academic medical centers in the United States (n = 15) and Spain (n = 1) from April 2011 to March 2017.

Practical methods for effective vancomycin-resistant enterococci (VRE) surveillance: experience in a liver transplant surgical intensive care unit.

Objective: We evaluated the utility of vancomycin-resistant Enterococcus (VRE) surveillance by varying 2 parameters: admission versus weekly surveillance and perirectal swabbing versus stool sampling.

Design: Prospective, patient-level surveillance program of incident VRE colonization.

Setting: Liver transplant surgical intensive care unit (SICU) of a tertiary-care referral medical center with a high prevalence of VRE.

Primary Prevention of Clostridium difficile-Associated Diarrhea: Current Controversies and Future Tools.

Purpose Of Review: Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in hospitalized patients and rates in most places have not decreased significantly despite broad efforts by both hospitals and public health entities. This review aims to provide readers with a better understanding of the limitations of current prevention strategies. We also review potential future tools that may be available for the primary prevention of CDI in the next decade.

Safely reprocessing duodenoscopes: current evidence and future directions.

Highly publicised outbreaks of various infections related to the use of duodenoscopes have increased public awareness of the once arcane and largely ignored subject of endoscope reprocessing. Since 2015, national professional societies, multiple federal agencies, and even the US Senate have written reports and guidelines on duodenoscope reprocessing. However, their recommendations are sometimes contradictory and difficult to implement, and new research on the topic is published regularly which further complicates the situation.

Noninfectious Hospital Adverse Events Decline After Elimination of Contact Precautions for MRSA and VRE.

OBJECTIVETo evaluate the impact of discontinuing routine contact precautions (CP) for endemic methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) on hospital adverse events.DESIGNRetrospective, nonrandomized, observational, quasi-experimental study.SETTINGAcademic medical center with single-occupancy rooms.

Multidrug Resistant Acinetobacter baumanii: A 15-Year Trend Analysis.

From 2000 to 2009, rates of multidrug-resistant Acinetobacter baumanii increased 10-fold to 0.2 per 1,000 patient days. From 2010 to 2015, however, rates markedly declined and have stayed below 0.

Duodenoscope-Related Outbreak of a Carbapenem-Resistant Klebsiella pneumoniae Identified Using Advanced Molecular Diagnostics.

Background: Carbapenem-resistant Klebsiella pneumoniae infections are increasingly prevalent in North American hospitals. We describe an outbreak of carbapenem-resistant K. pneumoniae containing the blaOXA-232 gene transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures.

Prevalence and Outcomes of Primary Immunodeficiency in Hospitalized Children in the United States.

Background: Primary immunodeficiency diseases (PIDDs) are rare yet life-threatening chronic conditions in children. The prevalence and outcomes of PIDDs in the pediatric population in the United States are not well understood.

Objective: The objectives of this study were to (1) determine the epidemiology of children hospitalized with PIDD in the United States and (2) characterize the clinical outcomes of hospitalized children with PIDDs.

Changing sediment budget of the Mekong: Cumulative threats and management strategies for a large river basin.

Two decades after the construction of the first major dam, the Mekong basin and its six riparian countries have seen rapid economic growth and development of the river system. Hydropower dams, aggregate mines, flood-control dykes, and groundwater-irrigated agriculture have all provided short-term economic benefits throughout the basin. However, it is becoming evident that anthropic changes are significantly affecting the natural functioning of the river and its floodplains.