HISTOPLASMA CAPSULATUM PACEMAKER-RELATED ENDOCARDITIS PRESENTING AS ENDOGENOUS ENDOPHTHALMITIS.

Background/purpose: To report a unique case of pacemaker-related infective endocarditis manifesting as endogenous endophthalmitis with chorioretinitis secondary to Histoplasma capsulatum.

Methods: Case report.

Results: A 75-year-old man was diagnosed with blood culture-negative infective endocarditis and was admitted with deteriorating vision and ocular inflammation.

Reduced Cognitive Burden and Increased Focus: A Mixed-methods Study Exploring How Implementing Scribes Impacted Physicians.

Background: Understanding how medical scribes impact care delivery can inform decision-makers who must balance the cost of hiring scribes with their contribution to alleviating clinician burden.

Objective: The objective of this study was to understand how scribes impacted provider efficiency and satisfaction.

Design: This was mixed-methods study.

Feasibility of electronic sleep disorder screening in healthcare workers of a large healthcare system.

Study Objectives: Many healthcare workers live with sleep disorders and may be unaware of their condition. We aimed to ascertain sleep disorder symptoms including high-risk obstructive sleep apnea (hrOSA), significant insomnia, and excessive daytime sleepiness (EDS) by work shift in a sample of healthcare workers. We aim to inform the development of a mobile application for sleep disorder screening and electronically-delivered follow-up recommendations.

Clostridium septicum-infected aortic aneurysm or graft is a deadly diagnosis.

Background: Clostridium septicum is an anaerobic, motile, spore-forming, toxin-producing gram-positive bacillus that can lead to rapidly progressive gas gangrene due to the release of alpha toxin. Aortic aneurysm secondary to C. septicum infection is a rare condition with 60 cases reported in the literature; however, we have recently treated several patients with the condition in our large tertiary care and aortic center.

Dissemination and implementation of the ICAMP.

The current rate of immunizations for older adults does not meet the immunization goals for Healthy People 2020. Using a Social Ecological Model and Social Cognitive Theory, the purpose of this study was to disseminate and implement the Immunization Champions, Advocates and Mentors Program (ICAMP) into a variety of health care settings. This study used a single group pre-/post-test design.

Emergency department visits during outpatient parenteral antimicrobial therapy: a retrospective cohort study.

Objectives: Patients receiving outpatient parenteral antimicrobial therapy (OPAT) may require emergency department (ED) visits to manage complications. This study's purpose was to identify risk factors for ED visits during OPAT and risk factors for hospitalization among patients with ED visits.

Methods: All OPAT courses initiated between 1 January 2013 and 1 January 2017 at Cleveland Clinic were identified.

Fighting fungus with a laser and a hose: Management of a giant Candida albicans implantable cardioverter-defibrillator lead vegetation with simultaneous AngioVac aspiration and laser sheath lead extraction.

Infections involving internal cardiac devices can be very challenging to treat, and almost universally require complete device extraction for successful management. Of the pathogens that cause device-related endocarditis, fungi such as Candida albicans are notoriously difficult to manage because of their propensity to produce large vegetations and the need for long-term treatment with potentially toxic medications. Furthermore, individuals who develop fungal, device-associated endocarditis are typically among the most complex patients, with significant comorbidities that place them at high risk for open heart procedures such as surgical device extraction.

Shedding Light on Shingles: The Power of Prevention.

Shingles, or herpes zoster (HZ), is a common secondary infection caused by a reactivated varicella zoster virus (VZV). More than 95% of immunocompetent individuals aged at least 50 years are seropositive for VZV and are therefore at risk for developing HZ. Age-related increased incidence of HZ and its complications are thought to be related to the decline in cell-mediated immunity.

Navigating pneumococcal vaccination in adults.

With two nonequivalent vaccines available and different recommendations for different patient populations, vaccination against Streptococcus pneumoniae can be confusing. Here we try to clarify the situation.

Vascular access complications during outpatient parenteral antimicrobial therapy at home: a retrospective cohort study.

Objectives: The need for indwelling vascular access for outpatient parenteral antimicrobial therapy (OPAT) places patients at risk of vascular access complications. The purpose of this study was to describe vascular access complications during OPAT at home, and identify factors associated with their occurrence.

Methods: All OPAT courses carried out at home for patients at Cleveland Clinic in 2013 were identified from the institution's OPAT registry.

Ceftaroline fosamil: A super-cephalosporin?

Ceftaroline is a broad-spectrum cephalosporin used to treat infections caused by a variety of microorganisms, including methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Streptococcus pneumoniae. However, it is not active against Pseudomonas aeruginosa, Bacteroides fragilis, and carbapenem-resistant Enterobacteriaceae. Its approved indications include community-acquired bacterial pneumonia and bacterial infections of skin and skin structures.

The role of parental attitudes and provider discussions in uptake of adolescent vaccines.

The purpose of this study was to examine the relationship between parental vaccine attitudes, the number of specific vaccines discussed with a provider, and immunization outcomes including discussing immunization with their teen, knowledge of adolescent vaccine schedule, and their son or daughter being up-to-date on recommended vaccines using a nationally weight sample. Parents completed an internet-based survey between December 2012 and January 2013 and we computed a vaccine attitude scale (higher scores indicating stronger and more positive attitudes toward vaccination of teen) for each parent and categorized them into one of three groups: low (n=76), medium (n=207) or high (n=215). We also constructed a vaccine discussion scale representing the number of vaccines discussed with their adolescent's physician.

Heart valve culture and sequencing to identify the infective endocarditis pathogen in surgically treated patients.

Background: Testing excised valves in surgically treated infective endocarditis (IE) patients provides an opportunity to identify the microbial etiology of IE. Microbial sequencing (universal bacterial, mycobacterial, or fungal polymerase chain reaction followed by DNA sequencing) of valves can identify microorganisms accurately, but the value it adds beyond information provided by blood and valve cultures has not been adequately explored.

Methods: Three hundred fifty-six patients who underwent surgery for active IE from January 1, 2010, to January 1, 2013, were identified from our cardiovascular information registry and outpatient parenteral antibiotic therapy registry.

Clinical utility of cerebral angiography in the preoperative assessment of endocarditis.

Cerebral angiography is an invasive procedure utilized without supporting guidelines in preoperative evaluations of infective endocarditis (IE). It is used to identify mycotic intracranial aneurysm, which is suspected to increase the risk of intracranial bleeding during cardiac surgery. Our objectives were to: (1) assess the utility of cerebral angiography by determining which subset of IE patients benefit from its performance; and (2) identify clinical and noninvasive screening tests that can preclude the need for invasive cerebral angiography.

Adverse events, healthcare interventions and healthcare utilization during home infusion therapy with daptomycin and vancomycin: a propensity score-matched cohort study.

Objectives: Vancomycin and daptomycin are the two most frequently prescribed parenteral antimicrobials for resistant Gram-positive bacterial infections. The purpose of this study was to compare antimicrobial adverse event rates and associated healthcare interventions and healthcare utilization in patients treated with the two antimicrobials.

Methods: All patients aged ≥18 years, discharged home from Cleveland Clinic on outpatient parenteral antimicrobial therapy (OPAT) with daptomycin or vancomycin between 1 July 2007 and 30 June 2010 were screened.

Association of laboratory test result availability and rehospitalizations in an outpatient parenteral antimicrobial therapy programme.

Objectives: Laboratory tests are usually requested for monitoring during outpatient parenteral antimicrobial therapy (OPAT), but these recommendations are not always followed. The purpose of this study was to determine whether rehospitalization during the OPAT course is associated with the availability of these test results to the treating physician.

Methods: Electronic health records (EHRs) from all patients in the Cleveland Clinic OPAT registry with start dates from 1 January to 28 February 2011 were reviewed in a retrospective cohort study.

Identifying barriers to adult pneumococcal vaccination: an NFID task force meeting.

Pneumococcal infection is common in adults, and invasive disease is associated with a high mortality rate. Pneumococcal polysaccharide vaccine can prevent invasive pneumococcal disease and is recommended for people aged ≥ 65 years and for younger adults with high-risk chronic conditions; however, vaccination rates are suboptimal in all of these groups. A multidisciplinary task force meeting examined ways to increase vaccination rates in the target populations.

Endovascular infections caused by Histoplasma capsulatum: a case series and review of the literature.

Context: Endovascular infection is an uncommon but devastating manifestation of histoplasmosis, which is often diagnosed late in disease.

Objectives: To evaluate the clinical and pathologic characteristics of patients with endovascular infections caused by Histoplasma capsulatum.

Design: All cases of patients with documented endovascular histoplasmosis at a single tertiary care center in an endemic region during the period 1993-2010 were reviewed.

Antimicrobial stewardship at transition of care from hospital to community.

Mandatory infectious disease consultation for parenteral antimicrobials at hospital discharge resulted in avoiding postdischarge parenteral antimicrobials in 28% of patients. No emergency department visit or rehospitalization within 30 days for these patients was a consequence of parenteral antimicrobial avoidance. Antimicrobial stewardship at transition of care is effective in reducing unnecessary antimicrobial use.

Contribution of infectious disease consultation toward the care of inpatients being considered for community-based parenteral anti-infective therapy.

Background: In the acute care setting in a multidisciplinary healthcare environment, the contribution of infectious disease (ID) specialists to overall patient care is difficult to measure. This study attempts to quantify the contribution of ID specialists when consulted for an activity specific to ID practice, community-based parenteral anti-infective therapy (CoPAT).

Methods: In February 2010, an electronic form for requesting ID consultations was introduced in the computerized provider order entry (CPOE) system at the Cleveland Clinic.