Impact of a pharmacy-driven MRSA nares screening protocol on vancomycin discontinuation in a tele-antimicrobial stewardship model.

A pharmacist-driven protocol for methicillin-resistant Staphylococcus aureus nares screening and empiric vancomycin discontinuation was instituted in a community healthcare system utilizing a tele-antimicrobial stewardship program to reduce inappropriate use of vancomycin. The protocol and associated intervention resulted in a significant decrease in both vancomycin utilization and the rate of acute kidney injury.

Corrigendum to: Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male.

[This corrects the article DOI: 10.1093/ofid/ofab455.].

Real-world implementation and impact of a rapid carbapenemase detection test in an area endemic for carbapenem-resistant Enterobacterales.

A retrospective study was conducted to describe the impact of a molecular assay to detect the most common carbapenemase genes in carbapenem-resistant Enterobacterales isolates recovered in culture. Carbapenemases were detected in 69% of isolates, and assay results guided treatment modifications or epidemiologic investigation in 20% and 4% of cases, respectively.

Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male.

We present a case of a human immunodeficiency virus-negative man with syphilitic meningovascular disease with subjacent involvement of brain parenchyma leading to a mass-forming inflammatory lesion that was pathologically distinct from a typical gumma. Syphilis was diagnosed after tissue obtained from a brain biopsy demonstrated spirochetes consistent with Treponema pallidum and confirmed by 16S ribosomal RNA sequencing.

Impact of Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load on Risk of Intubation and Mortality Among Hospitalized Patients With Coronavirus Disease 2019.

BACKGROUND: Patients hospitalized with coronavirus disease 2019 (COVID-19) frequently require mechanical ventilation and have high mortality rates. However, the impact of viral burden on these outcomes is unknown. METHODS: We conducted a retrospective cohort study of patients hospitalized with COVID-19 from 30 March 2020 to 30 April 2020 at 2 hospitals in New York City. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load was assessed using cycle threshold (Ct) values from a reverse transcription-polymerase chain reaction assay applied to nasopharyngeal swab samples. We compared characteristics and outcomes of patients with high, medium, and low admission viral loads and assessed whether viral load was independently associated with intubation and in-hospital mortality. RESULTS: We evaluated 678 patients with COVID-19. Higher viral load was associated with increased age, comorbidities, smoking status, and recent chemotherapy. In-hospital mortality was 35.0% (Ct <25; n = 220), 17.6% (Ct 25-30; n = 216), and 6.2% (Ct >30; n = 242) with high, medium, and low viral loads, respectively (P < .001). The risk of intubation was also higher in patients with a high viral load (29.1%) compared with those with a medium (20.8%) or low viral load (14.9%; P < .001). High viral load was independently associated with mortality (adjusted odds ratio [aOR], 6.05; 95% confidence interval [CI], 2.92-12.52) and intubation (aOR, 2.73; 95% CI, 1.68-4.44). CONCLUSIONS: Admission SARS-CoV-2 viral load among hospitalized patients with COVID-19 independently correlates with the risk of intubation and in-hospital mortality. Providing this information to clinicians could potentially be used to guide patient care.

Synchronous communication facilitates interruptive workflow for attending physicians and nurses in clinical settings.

STUDY OBJECTIVE: Inter-clinician communication accounts for more than half of all information exchanges within the health care system. A non-participatory, qualitative time-and-motion observational study was conducted in order to gain a better understanding of inter-clinician communication behaviors, routine workflow patterns, and the use of information communication technologies (ICTs) within the clinical workspace. METHOD: Over a 5-day period, seven attending physicians and two nurses were shadowed for 2-4h at a time. Inter-clinician communication events were tracked in real-time using synchronized digital stopwatches. Observations were recorded on a paper-based, semi-structured observation tool and later coded for analysis. RESULTS: Nine hundred and eighty-seven communication events were observed over 2024.67 min. Clinicians were observed to spend the majority of their time on patient care (85.4% in this study) with about three-fourths of that time spent on indirect patient care (e.g. charting). Clinicians were observed to prefer using synchronous communication modes, which led to multitasking and created a highly interrupted workflow. Forty-two percent (n=415) of communication events were coded as interruptions and study participants were seen multitasking 14.8% of the time. Though each interruption was short-lived (on average 0.98+/-2.24 min for attending physicians), they occurred frequently. Both attending physicians and nurses were the recipients of more interruptions than they initiated. CONCLUSION: This study demonstrated that the clinical workspace is a highly interruptive environment. Multiple interruptions in the communication processes between clinicians consume time and have the potential to increase the risk of error. This workflow analysis may inform the development of communication devices to enhance inter-clinician communication by reducing interruptions or deferring interruptions to more appropriate times.

Effect of epicardial fat on ablation performance: a three-energy source comparison.

OBJECTIVES: To investigate the effect of epicardial fat on surgical atrial fibrillation ablation performance using an in vitro model. Two tissue models were employed to investigate standard penetration and maximal lesion depth performance of bipolar radiofrequency (RF), microwave, and laser energy sources. METHODS: Ventricular veal tissue was utilized in various thicknesses (3 mm, 5 mm, 7 mm, 15 mm). Epicardial fat was modeled by layering porcine fat (1 mm, 2 mm and 4 mm) on moistened tissue. In each group, 8 to 10 lesions were created. Post ablation, tissue samples were sectioned and ablation depth of each myocardial section measured using 1% tetrazolium tetrachloride dye solution. RESULTS: The laser energy source produced nearly 100% transmural lesions in almost all study groups irrespective of myocardium thickness and fat thickness. The microwave device maintained transmurality in all 3-mm and most 5-mm myocardium trials but fell to near zero with all 7-mm myocardium trials. The bipolar RF maintained transmurality only when no fat was applied. In the maximal lesion depth models, the laser was capable of producing lesions >8 mm with no fat and >6 mm with either 2 mm or 4 mm of fat present. The microwave produced lesions in the no fat (>6 mm) and 2-mm (>4 mm) fat group. The bipolar RF produced 83% transmurality with no fat and zero percent transmurality with 2 mm of fat present. CONCLUSIONS: Epicardial fat can severely limit transmurality in energy sources that utilize conductive heating. Laser energy was uniformly superior at producing both transmural and deep lesions irrespective of the presence of fat.