Prevalence of Acinetobacter baumannii and Candida auris in Patients Receiving Mechanical Ventilation.

Importance: To date, only 1 statewide prevalence survey has been performed for Acinetobacter baumannii (2009) in the US, and no statewide prevalence survey has been performed for Candida auris, making the current burden of these emerging pathogens unknown. Objective: To determine the prevalence of A baumannii and C auris among patients receiving mechanical ventilation in Maryland. Design, Setting, and Participants: The Maryland Multi-Drug Resistant Organism Prevention Collaborative performed a statewide cross-sectional point prevalence of patients receiving mechanical ventilation admitted to acute care hospitals (n = 33) and long-term care facilities (n = 18) between March 7, 2023, and June 8, 2023. Surveillance cultures (sputum, perianal, arm/leg, and axilla/groin) were obtained from all patients receiving mechanical ventilation. Sputum, perianal, and arm/leg cultures were tested for A baumannii and antibiotic susceptibility testing was performed. Axilla/groin cultures were tested by polymerase chain reaction for C auris. Main Outcomes and Measures: Prevalence of A baumannii, carbapenem-resistant A baumannii (CRAB), and C auris. Prevalence was stratified by type of facility. Results: All 51 eligible health care facilities (100%) participated in the survey. A total of 482 patients receiving mechanical ventilation were screened for A baumannii and 470 were screened for C auris. Among the 482 patients who had samples collected, 30.7% (148/482) grew A baumannii, 88 of the 148 (59.5%) of these A baumannii were CRAB, and C auris was identified in 31 of 470 (6.6%). Patients in long-term care facilities were more likely to be colonized with A baumannii (relative risk [RR], 7.66 [95% CI, 5.11-11.50], P < .001), CRAB (RR, 5.48 [95% CI, 3.38-8.91], P < .001), and C auris (RR, 1.97 [95% CI, 0.99-3.92], P = .05) compared with patients in acute care hospitals. Nine patients (29.0%) with cultures positive for C auris were previously unreported to the Maryland Department of Health. Conclusions: A baumannii, carbapenem-resistant A baumannii, and C auris were common among patients receiving mechanical ventilation in both acute care hospitals and long-term care facilities. Both pathogens were significantly more common in long-term care facilities than in acute care hospitals. Patients receiving mechanical ventilation in long-term care facilities are a high-risk population for emerging pathogens, and surveillance and prevention efforts should be targeted to these facilities.

C. auris and neighborhood socioeconomic vulnerability in the state of Maryland from 2019 to 2022.

BACKGROUND: Candida auris is an emerging fungal pathogen increasingly recognized as a cause of healthcare-associated infections including outbreaks. METHODS: We performed a mixed-methods study to characterize the emergence of C. auris in the state of Maryland from 2019 to 2022, with a focus on socioeconomic vulnerability and infection prevention opportunities. We describe all case-patients of C. auris among Maryland residents from June 2019 to December 2021 detected by Maryland Department of Health. We compared neighborhood socioeconomic characteristics of skilled nursing facilities (SNFs) with and without C. auris transmission outbreaks using both the social vulnerability index (SVI) and the area deprivation index (ADI). The SVI and the ADI were obtained at the state level, with an SVI ≥ 75th percentile or an ADI ≥ 80th percentile considered severely disadvantaged. We summarized infection control assessments at SNFs with outbreaks using a qualitative analysis. RESULTS: A total of 140 individuals tested positive for C. auris in the study period in Maryland; 46 (33%) had a positive clinical culture. Sixty (43%) were associated with a SNF, 37 (26%) were ventilated, and 87 (62%) had a documented wound. Separate facility-level neighborhood analysis showed SNFs with likely C. auris transmission were disproportionately located in neighborhoods in the top quartile of deprivation by the SVI, characterized by low socioeconomic status and high proportion of racial/ethnic minorities. Multiple infection control deficiencies were noted at these SNFs. CONCLUSION: Neighborhood socioeconomic vulnerability may contribute to the emergence and transmission of C. auris in a community.

Changes in Peri-Implant Soft Tissue Thickness with Bone Grafting and Dermis Allograft. Part III: A Case Series Using a Novel, Hybrid Implant Design with a Subcrestal Angle Correction.

This comparative case series presents 16 consecutively placed and temporized immediate implants in the maxillary esthetic zone. The implants have a novel, inverted body-shift design, intended to achieve high levels of primary stability via the tapered apical portion. The coronal narrow cylinder provides greater space between the implant platform and facial socket wall and adjacent teeth/implants, allowing a greater opportunity for augmentation. The restorative platform also features a subcrestal angle correction, which facilitates screw retention. The wider, facial platform-shift thus creates more room for augmentation via dual-zone bone grafting and the application of a dermal allograft, which yields greater soft tissue thickness after initial healing. This case series aimed to evaluate soft tissue thickness and compare the results to two previously published cohorts where implant design served as the only variable between groups.

Efficacy of Removal of Residual Dental Cement by Laser, Ultrasonic Scalers, and Titanium Curette: An In Vitro Study.

The purpose of this study was to conduct an in vitro evaluation of the efficacy of six dental lasers, two ultrasonic scalers, and a titanium curette in the removal of dental cement from the surface of an implant. The study used a total of 39 dental implants, representing three different surface textures. The implants were divided into 13 groups with one of each of the three surface textures in a group. A standardized amount of modified resin dental cement was applied to the implant surface. Each test instrument was used as a monotherapy. Additionally, three of the lasers were used as part of a dual therapy in conjunction with the piezo ultrasonic scaler. Laser irradiation was limited to 2 minutes. Following treatment, implants were graded visually and by scanning electron microscopy (SEM) for the presence of unremoved cement and concomitant damage, if any, to the implant surface. The results showed that no treatment removed all residual cement from any of the three implant surfaces, although specific protocols appeared more effective than others. Implant surface damage was frequently observed, both visually and by SEM, and appeared to result from laser irradiation and the use of ultrasonic scaling instruments.

Stakeholder Engagement Significantly Decreased Colorectal Surgical Site Infections.

Background: Patients and care providers raised concerns about the increased incidence of colorectal surgical site infection (SSI) at a community hospital in Baltimore compared with peer institutions. Patients and Methods: A preliminary analysis was performed that identified several modifiable targets for interventions to reduce SSIs in this patient population. The intervention focused on wide engagement of all stakeholder groups across the spectrum of care including physicians, pharmacists, nurses, administrators, and patients. The engagement process involved hospital-wide educational sessions, adoption and implementation of the best clinical guidelines, and utilization of the electronic medical record system to reinforce compliance and ensure quality control. Data for SSIs in colorectal surgical procedures were collected prior to the intervention (January 1, 2017 to March 31, 2018) and after implementation (April 1, 2018 to October 31, 2018). Results: A total of 355 cases (229 pre-intervention group, 126 post-intervention group) met the inclusion criteria; the two groups were comparable with respect to all the key parameters except the procedure type and use of endoscopy. Multivariable logistic regression modeling was utilized to evaluate the effects of the stakeholder engagement intervention while adjusting for potential confounders. The incidence of colorectal SSIs was substantially lower after the intervention (2.78% vs. 8.73%, p = 0.02). This reduction was robust to adjustment for covariates in regression modeling (p = 0.04). Conclusions: Informed stakeholder engagement helped bring cohesion to the inherently fragmented elements of the care delivery model and was associated with decreased incidence of colorectal SSIs.

A cell-laden microfluidic hydrogel.

The encapsulation of mammalian cells within the bulk material of microfluidic channels may be beneficial for applications ranging from tissue engineering to cell-based diagnostic assays. In this work, we present a technique for fabricating microfluidic channels from cell-laden agarose hydrogels. Using standard soft lithographic techniques, molten agarose was molded against a SU-8 patterned silicon wafer. To generate sealed and water-tight microfluidic channels, the surface of the molded agarose was heated at 71 degrees C for 3 s and sealed to another surface-heated slab of agarose. Channels of different dimensions were generated and it was shown that agarose, though highly porous, is a suitable material for performing microfluidics. Cells embedded within the microfluidic molds were well distributed and media pumped through the channels allowed the exchange of nutrients and waste products. While most cells were found to be viable upon initial device fabrication, only those cells near the microfluidic channels remained viable after 3 days, demonstrating the importance of a perfused network of microchannels for delivering nutrients and oxygen to maintain cell viability in large hydrogels. Further development of this technique may lead to the generation of biomimetic synthetic vasculature for tissue engineering, diagnostics, and drug screening applications.

The Role of Sugammadex in Symptomatic Transient Neonatal Myasthenia Gravis: A Case Report.

We describe the case of a 3-week-old boy with pyloric stenosis who presented for laparoscopic pyloromyotomy in the setting of symptomatic transient neonatal myasthenia gravis. The patient received muscle relaxation with rocuronium, and neuromuscular blockade was successfully reversed with sugammadex with recovery guided by train-of-four monitoring. He was extubated uneventfully without complications. Because sugammadex binds directly to rocuronium rather than interfering with acetylcholine metabolism, it might provide a good option for reversal of neuromuscular blockade in transient neonatal myasthenia gravis.

Whitesnake/sfpq is required for cell survival and neuronal development in the zebrafish.

Organogenesis involves both the development of specific cell types and their organization into a functional three-dimensional structure. We are using the zebrafish to assess the genetic basis for brain organogenesis. We show that the whitesnake mutant corresponds to the sfpq (splicing factor, proline/glutamine rich) gene, encoding the PSF protein (polypyrimidine tract-binding protein-associated splicing factor). In vitro studies have shown that PSF is important for RNA splicing and transcription and is a candidate brain-specific splicing factor, however, the in vivo function of this gene is unclear. sfpq is expressed throughout development and in the adult zebrafish, with strong expression in the developing brain, particularly in regions enriched for neuronal progenitors. In the whitesnake mutant, a brain phenotype is visible by 28 hr after fertilization, when it becomes apparent that the midbrain and hindbrain are abnormally shaped. Neural crest, heart, and muscle development or function is also abnormal. sfpq function appears to be required in two distinct phases during development. First, loss of sfpq gene function leads to increased cell death throughout the early embryo, suggesting that cell survival requires functional PSF protein. Second, sfpq function is required for differentiation, but not for determination, of specific classes of brain neurons. These data indicate that, in vertebrates, sfpq plays a key role in neuronal development and is essential for normal brain development.