Impact of fluoroquinolone cascade reporting of urine samples on antibiotic prescribing rates in a network of urgent care clinics.

Cascade reporting is an antimicrobial stewardship strategy that has been successfully implemented in inpatient settings, but evidence of its impact on outpatient settings is scarce. We report on the impact on fluroquinolone prescribing at a network of urgent care clinics following the implementation of cascade reporting of Enterobacterales in urine cultures.

Impact of Rapid Susceptibility Testing System on the Management of Gram-Negative Bacteremia in a Network of Community Hospitals.

BACKGROUND: Rapid initiation of optimal antimicrobial therapy is crucial for the management of Gram-negative (GN) bacteremia. We aimed to evaluate the impact of Accelerate PhenoTM (AxDx) system on change in therapy and length of stay among patients with GN bacteremia. METHODS: We conducted a retrospective cohort study of adult patients hospitalized who had at least 1 blood culture with presence of Enterobacterales. We compared clinical outcomes among patients who had their blood cultures processed through standard methods alone vs AxDx. RESULTS: We identified 255 bacteremia episodes among 243 unique patients. In the AxDx group, 31.1% of patients had deescalation of antibiotics within 48 h from blood culture collection compared to 20.0% of patients in the control group (P = 0.09). We found no impact of AxDx on the odds of deescalation at 48 h from blood culture collection [odds ratio (OR) 1.80 (95% CI 0.91-3.56), P = 0.09] or Gram stain report [OR 1.61 (95% CI 0.86-3.01), P = 0.14]. Escalation in therapy at 48 h from blood culture collection occurred in 16.8% and 16.9% of patients in the AxDx and control groups, respectively (P = 0.99). There was no impact on the odds of escalation at 48 h from blood culture collection [OR 0.99 (95% CI 0.47-2.11), P = 0.99] or Gram stain report [OR 1.26 (95% CI 0.57-2.80), P = 0.57]. No differences were seen in length of stay and mortality between the 2 groups. CONCLUSIONS: The impact of rapid identification and susceptibility technologies may differ according to the setting in which they are implemented.

Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents.

Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.

Coagulase-negative staphylococcal infections.

Coagulase-negative staphylococci (CNS) are differentiated from the closely related but more virulent Staphylococcus aureus by their inability to produce free coagulase. Currently, there are over 40 recognized species of CNS. These organisms typically reside on healthy human skin and mucus membranes, rarely cause disease, and are most frequently encountered by clinicians as contaminants of microbiological cultures. However, CNS have been increasingly recognized to cause clinically significant infections. The conversion of the CNS from symbiont to human pathogen has been a direct reflection of the use of indwelling medical devices. This article deals with the clinical syndromes, epidemiology, prevention, and management of infections caused by this unique group of organisms.