Risk factors for treatment of asymptomatic bacteriuria in a rural health system.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Asymptomatic bacteriuria is often inappropriately treated, leading to antimicrobial-related adverse events and contributing to antimicrobial resistance. This study examined the asymptomatic bacteriuria treatment rate at a rural Wisconsin health system and the patient-specific factors that may be influencing clinicians' decisions to treat. METHODS: This is a retrospective descriptive report of patients admitted from January to May 2022 at 7 rural Wisconsin hospitals. Patients were included if they were a hospitalized adult with asymptomatic bacteriuria. Patients were excluded if they had a urinary tract abnormality, active infection, symptoms of a urinary tract infection, a planned urological surgery, or treatment or prophylaxis for a urinary tract infection within 72 hours of admission, were immunocompromised, or were transferred from an outside facility. Electronic and manual chart abstraction were used for data collection. RESULTS: Of 429 patients with a positive urine culture, 137 patients with asymptomatic bacteriuria were included in the study. The median age was 75 years, and most patients were female (80.3%). The treatment rate of asymptomatic bacteriuria was 78.1%, amounting to 393 days of unnecessary antimicrobial therapy. Symptoms of fatigue (P = 0.014) and altered mentation (P < 0.006) and urinalysis results of nitrite positivity (P = 0.026) and pyuria (P < 0.001) were each independently associated with antimicrobial treatment. CONCLUSION: Despite guideline recommendations to avoid treatment of asymptomatic bacteriuria, treatment rates in rural hospitalized patients remain high. Nonspecific signs and symptoms of altered mentation and fatigue as well as laboratory findings of nitrite positivity and pyuria were factors associated with a decision to treat. Future stewardship efforts should speak to the poor specificity of these factors.

Sternal osteomyelitis caused by Gordonia bronchialis in an immunocompetent patient following coronary artery bypass surgery.

Skin commensals, especially gram-positive cocci, are the usual microbial organisms that cause post-operative sternal wound infections. Rarely, environmental bacteria such as Gordonia spp. have been implicated as etiological agents in post-cardiac procedure surgical site infections. We report a case of a patient who presented with post-coronary artery bypass sternal osteomyelitis caused by this uncommon pathogen, and review relevant medical literature to identify commonalities in presentation, diagnosis and management. Repeat isolation of Gordonia bronchialis in the setting of post-procedure wound infection should raise suspicion for a real pathogenicity. Definitive identification requires a broad range of bacterial PCR DNA amplification and sequencing followed by susceptibility testing as treatment may require a prolonged course of antibiotics.

Perianal North American blastomycosis.

Cutaneous North American blastomycosis most often results from the hematogenous spread of Blastomyces dermatitidis following pulmonary infection. Cutaneous lesions, which may be either verrucous or ulcerative plaques, commonly occur on or around orifices contiguous to the respiratory tract. We report the case of a 57-year-old man with cutaneous North American blastomycosis who presented with a well-demarcated, firm, moist, verrucous perianal plaque 4 months following the onset of a prolonged upper respiratory tract infection. Dissemination of B dermatitidis to the perianal skin is rare, but North American blastomycosis should be considered in the broad differential diagnosis of perianal lesions in any patients who have lived in or traveled to endemic regions.

Streptococcus pyogenes sternoclavicular septic arthritis in a healthy adult.

Sternoclavicular septic arthritis is a rare infection, accounting for approximately 1% of septic arthritis in the general population. Staphylococcus aureus is the predominant etiologic agent, and it usually occurs in relatively young adults with some type of predisposition to infection. We report, to the best of our knowledge, the first case of group A streptococcal, sternoclavicular arthritis in a previously healthy 62-year-old male patient. We present a detailed history and physical examination, with laboratory findings, imaging studies, cultures, and therapy.

Bilateral prosthetic knee infection by Campylobacter fetus.

We present the first documented case of a bilateral prosthetic knee joint infection with Campylobacter fetus. Our patient's risk factors included age, the presence of prosthetic joints, and potential exposure through his contact with farm animals. It is important to be aware of the possibility of C fetus joint infections in high-risk patients who present with pain after total joint arthroplasty.

Outbreak of Burkholderia cepacia bacteremia traced to contaminated hospital water used for dilution of an alcohol skin antiseptic.

OBJECTIVE: To identify the source of an epidemic of Burkholderia cepacia bloodstream infections during 7 years (411 episodes in 361 patients). DESIGN: Outbreak investigation. SETTING: A 250-bed university hospital in Beirut, Lebanon. METHODS: Matched case-control and retrospective cohort studies, and microbiological surveillance and polymerase chain reaction-restriction fragment length ascertainment were employed. Special media and filtration techniques were used to isolate organisms from water and diluted alcohol solutions. RESULTS: In a group of 50 randomly selected case-matched patients from 1999, the positive blood cultures were concomitant with fever in 98%, intravenous phlebitis in 44%, and recurrent bacteremia in 20%. Fever disappeared approximately 6 hours after intravenous catheter removal. Polymerase chain reaction-restriction fragment length polymorphism revealed strain homogeneity in patient, water, and alcohol isolates. Contaminated tap water had been used to dilute alcohol for skin antisepsis and for decontamination of the caps of heparin vials. Only sporadic cases directly attributable to breach of protocol were reported after single-use alcohol swabs were substituted. CONCLUSION: This is potentially the largest single-source nosocomial bloodstream infection outbreak ever reported, and the first report of an alcohol skin antiseptic contaminated by tap water as a source for nosocomial bacteremia.