A practical approach to preparing your ICU for epidemics and pandemics.

PURPOSE OF REVIEW: Major outbreaks of infectious diseases, including epidemics and pandemics, are increasing in scope and frequency, threatening public health and straining the capacity of health systems worldwide. High-consequence infectious diseases (HCIDs), including highly pathogenic respiratory viruses and viral hemorrhagic fevers, are both contagious and virulent, and these pathogens thus are topics of special concern for pandemic planning. RECENT FINDINGS: The COVID-19 pandemic demonstrated how a major disease outbreak can negatively impact all aspects of hospital functioning. Identification of patients with HCIDs needs careful clinical evaluation and coordination with public health authorities. Staff safety and patient care require appropriate infection prevention precautions, including personal protective equipment. Surges of ill patients may lead to significant strain, with increased ICU patient mortality. Strategies to reduce the impact of surge appear to reduce mortality, such as tiered staffing models and load-leveling across health systems. SUMMARY: Pandemics and HCIDs are a significant threat to global health, and ICUs play a major role in the care of affected patients. Critical care professionals must work to ensure that our hospitals are prepared to identify and care for these patients in advance of the next emergency.

Which Topics Drive Dissemination? Alternative Bibliometrics Analysis of the Highest-Ranking Articles in 3 Infectious Diseases Journals Before COVID-19.

Dissemination of research is paramount to improving patient care. Historically, dissemination is reported in conventional bibliometrics. However, with the increased utilization of digital platforms for communication, alternative bibliometrics describe more real-time dissemination of information. This study documents dissemination of publication topics in infectious diseases journals prior to the COVID-19 pandemic.

Impact of the COVID-19 pandemic on non-COVID-19 community-acquired pneumonia: a retrospective cohort study.

BACKGROUND: The COVID-19 pandemic could impact frequency and mortality of non-COVID-19 community-acquired pneumonia (CAP). Changes in frequency, patient mix, treatment and organ dysfunction could cascade together to increase mortality of CAP during compared with pre-COVID-19. METHODS: Hospitalised CAP patients at St. Paul's Hospital, Vancouver, Canada pre-COVID-19 (fiscal years 2018/2019 and 2019/2020) and during COVID-19 pandemic (2020/2021 and 2021/2022) were evaluated. RESULTS: In 5219 CAP patients, there was no significant difference prepandemic versus during pandemic in mean age, gender and Charlson Comorbidity Score. However, hospital mortality increased significantly from pre-COVID-19 versus during COVID-19 (7.5% vs 12.1% respectively, (95% CI for difference: 3.0% to 6.3%), p<0.001), a 61% relative increase, coincident with increases in ICU admission (18.3% vs 25.5%, respectively, (95% CI for difference: 5.0% to 9.5%) p<0.001, 39% relative increase) and ventilation (12.7% vs 17.5%, respectively, (95% CI for difference: 2.8% to 6.7%) p<0.001, 38% relative increase). Results remained the same after regression adjustment for age, sex and Charlson score. CAP hospital admissions decreased 27% from pre-COVID-19 (n=1349 and 1433, 2018/2019 and 2019/2020, respectively) versus the first COVID-19 pandemic year (n=1047 in 2020/2021) then rose to prepandemic number (n=1390 in 2021/2022). During prepandemic years, CAP admissions peaked in winter; during COVID-19, the CAP admissions peaked every 6 months. CONCLUSIONS AND RELEVANCE: This is the first study to show that the COVID-19 pandemic was associated with increases in hospital mortality, ICU admission and invasive mechanical ventilation rates of non-COVID-19 CAP and a transient, 1-year frequency decrease. There was no winter seasonality of CAP during the COVID-19 pandemic era. These novel findings could be used to guide future pandemic planning for CAP hospital care.

Adoption and Utilization of Social Media Among Adult and Pediatric Infectious Diseases Divisions and Fellowship Programs in the United States.

Background: Social media (SoMe) is ubiquitous, but its adoption and utilization by infectious diseases (ID) divisions are poorly characterized in the United States. Methods: A systematic search of US ID fellowship/division Twitter, Facebook, and Instagram accounts occurred in November-December 2021. Social media account and program characteristics, post frequency and content, and other measures of SoMe adoption and utilization were recorded and compared between adult and pediatric programs. Posts were thematically categorized as social, promotional, educational, recruitment, or other. Results: Of 222 ID programs identified, 158 (71.2%) were adult and 64 (28.8%) pediatric. Seventy (31.5%) Twitter, 14 (6.3%) Facebook, and 14 (6.3%) Instagram accounts were identified from US programs. Twitter accounts were associated with larger programs and higher match rates. More adult than pediatric programs had Twitter accounts (37.3% vs 17.2%, P = .004); utilization was similar between adult and pediatric programs. Most Twitter posts were educational (1653 of 2859, 57.8%); most Facebook posts were promotional (68 of 128, 53.1%); and most Instagram posts were social (34 of 79, 43%). Facebook was the earliest adopted SoMe platform, but Twitter and Instagram have more recent growth. Rate of Twitter account creation increased from 1.33 accounts/month in the year before March 2020 (coronavirus disease [COVID] pandemic declaration) to 2.58 accounts/month in the year after March 2020 (P = .18). Conclusions: Social media remains underutilized across ID divisions, but COVID-19 and virtual recruiting may have influenced recent account creation. Twitter was the most frequently used ID program SoMe platform. Social media may benefit ID programs in recruitment and amplification of their trainees, faculty, and specialty.

Demographic Representation Among Speakers and Program Committee Members at the IDWeek Conference, 2013-2021.

BACKGROUND: In 2016, the IDWeek program committee was charged with ensuring gender equity in speaker sessions. Whether this charge also resulted in more opportunities for historically underrepresented speakers is unknown. METHODS: We conducted a retrospective analysis of trends in the demographic composition of IDWeek speakers and program committee members between 2013 and 2021. We used descriptive statistics to summarize data, χ2 tests to compare speaker demographics between 2013-2016 (before 2016) and 2017-2021 (after 2016), and Cochran-Armitage tests for trend. Each speaker slot was considered an independent event. RESULTS: A total of 5482 speaker slots were filled by 3389 individuals from 2013 to 2021. There was a linear increase in female speakers from 38.6% in 2013 to 58.4% in 2021 (P < .001). The proportion of white speakers decreased overall from 84.9% in 2013 to 63.5% in 2021. Compared with white speakers, more slots were filled by Asian speakers after 2016 versus before 2016 (20.1% vs 14.8%, respectively; P < .001). Program committee members from 2013-2021 were >80% non-Hispanic white; <5% of committee members identified as black, American Indian, Alaska Native, Native Hawaiian, Pacific Islander, or Hispanic. More program committee slots were filled by women after 2016 than before 2016 (52.7% vs 33.9%; P = .004). CONCLUSIONS: Intentional consideration of gender equity by the program committee was associated with equitable gender representation of invited speakers at IDWeek after 2016. Gradually, the proportions of IDWeek speakers from historically excluded racial/ethnic approached their respective proportions in the IDSA membership. White speakers remained overrepresented relative to membership proportions until 2021, and gaps in program committee racial/ethnic demographic representation highlights opportunities for continued inclusion, diversity, access, and equity at IDWeek.

Efficacy of a bioburden reduction intervention on mobile phones of critical care nurses.

BACKGROUND: Current literature identifies mobile phones of staff as potential vectors for hospital-acquired infection. METHODS: A pre-post, quasi-experimental study was conducted in a 20 bed intensive care unit (ICU). Surface bioburden of personal and shared mobile phones was estimated with a luminometer, expressed in Relative Light Units (RLU). Effects of a simple sanitizing wipe-based disinfection routine were measured at baseline, and at 1, 3, 6, and 12 months after implementation of the disinfection routine. RESULTS: Personal mobile phones and shared phones of 30 on-shift ICU nurses were analyzed at each collection. RLUs for personal phones decreased from baseline to 12 months post-intervention (Geometric mean 497.1 vs 63.36 RLU; adj P < .001), while shared unit phones also demonstrated a decrease from baseline to 12 months post-intervention (Geometric mean 417.4 vs 45.90 RLU; adj P < .001). DISCUSSION: No recommended practice yet exists for disinfection of mobile phones in the acute care setting. The disinfection method and routine used in this study may have implications for use in acute care settings to reduce opportunities for infectious disease transmission.

Lower Respiratory Tract Coinfection in the ICU: Prevalence and Clinical Significance of Coinfection Detected via Microbiological Analysis of Bronchoalveolar Lavage Fluid With a Comparison of Invasive Methodologies.

Pneumonia remains a significant cause of morbidity and mortality, with increasing interest in the detection and clinical significance of coinfection. Further investigation into the impact of bronchoalveolar lavage (BAL) sampling methodology and efficient clinical utilization of microbiological analyses is needed to guide the management of lower respiratory tract infection in the ICU. DESIGN: Retrospective observational study. SETTING: ICUs at a single center between August 1, 2012, and January 1, 2018. PATIENTS: Mechanically ventilated adult patients who underwent BAL testing during an ICU admission were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: BAL methodology (bronchoscopic vs nonbronchoscopic), microbiological diagnostic testing, and clinical outcomes measures were obtained. Chi-square or Fisher exact tests assessed associations between categorical variables, whereas Kruskal-Wallis tests analyzed differences in distributions of measures. BAL samples from 803 patients met inclusion criteria. Coinfection was detected more frequently via bronchoscopic BAL compared with nonbronchoscopic BAL (26% vs 9%; p < 0.001). Viruses were detected more frequently in bronchoscopic (42% vs 13%; p < 0.001) and bacteria in nonbronchoscopic (42% vs 33%; p = 0.011) BALs. A positive correlation between mortality and the number of organisms isolated was identified, with 43%, 48%, and 58% 30-day mortality among those with 0, 1, and more than 2 organisms, respectively (p = 0.003). Viral organism detection was associated with increased 30-day mortality (56% vs 46%; p = 0.033). CONCLUSIONS: Even in the setting of standardized institutional techniques, retrospective evaluation of bronchoscopic and nonbronchoscopic BAL methodologies did not reveal similar microbiologic yield in critically ill patients, though bronchoscopic BAL overall yielded more organisms, and occurrence of multiple organisms in BAL was associated with worse outcome. Prospective data are needed for direct comparison of both methods to develop more standardized approaches for use in different patient groups.

#SoMe the Money! Value, Strategy, and Implementation of Social Media Engagement for Infectious Diseases Trainees, Clinicians, and Divisions.

Social media platforms have revolutionized how we consume information, along with how to effectively present communication, education, and advocacy efforts. There is profound value in leveraging social media within these aspects for the field of infectious diseases, for divisions and individual clinicians. Herein, we provide the rationale to incorporate social media as a key competency for infectious diseases training and specific guidance on aspects of education and strategic development of new accounts critical for success.

Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies.

Throughout human history, infection has been the leading cause of morbidity and mortality, with pain being one of the cardinal warning signs. However, in a substantial percentage of cases, pain can persist after resolution of acute illness, manifesting as neuropathic, nociplastic (eg, fibromyalgia, irritable bowel syndrome), or nociceptive pain. Mechanisms by which acute infectious pain becomes chronic are variable and can include immunological phenomena (eg, bystander activation, molecular mimicry), direct microbe invasion, central sensitization from physical or psychological triggers, and complications from treatment. Microbes resulting in a high incidence of chronic pain include bacteria such as the Borrelia species and Mycobacterium leprae, as well as viruses such as HIV, SARS-CoV-2 and herpeses. Emerging evidence also supports an infectious cause in a subset of patients with discogenic low back pain and inflammatory bowel disease. Although antimicrobial treatment might have a role in treating chronic pain states that involve active infectious inflammatory processes, their use in chronic pain conditions resulting from autoimmune mechanisms, central sensitization and irrevocable tissue (eg, arthropathy, vasculitis) or nerve injury, are likely to cause more harm than benefit. This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes.

Prevention of Central-Line Associated Bloodstream Infections: 2021 Update.

Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.

Leveraging Existing and Soon-to-Be-Available Novel Diagnostics for Optimizing Outpatient Antibiotic Stewardship in Patients With Respiratory Tract Infections.

Respiratory tract infections (RTIs) drive many outpatient encounters and, despite being predominantly viral, are associated with high rates of antibiotic prescriptions. With rising antibacterial resistance, optimization of prescribing of antibiotics in outpatients with RTIs is a critical need. Fortunately, this challenge arises at a time of increasing availability of novel RTI diagnostics to help discern which patients have bacterial infections warranting treatment. Effective implementation of antibiotic stewardship is needed, but optimal approaches for ambulatory settings are unknown. Future research needs are reviewed in this summary of a research summit convened by the Infectious Diseases Society of America in the fall of 2019.