An emergency department intervention to improve earlier detection of community-onset bloodstream infection among hospitalized patients.

BACKGROUND: Blood cultures (BCs) are essential microbiologic tests, but blood culturing diagnostic stewardship is frequently poor. We aimed to study the process-related failures and to evaluate the effect of an emergency department (ED) intervention on BCs collection practices and yield. METHODS: We implemented an ED-quality improvement intervention including educational sessions, phlebotomists addition, promoting single-site strategy for BC-collection and preanalytical data feedback. BC-bottles collected, positive BCs, blood volumes and documentation of collection times were measured, before (December 2021-August 2022) and after (September 2022-July 2023) intervention. Results were corrected to hospitalizations admissions or days. We used interrupted-time series analyses for comparisons. RESULTS: A total of 64,295 BC bottles were evaluated, 26,261 before and 38,034 postintervention. The median ED-BCs collected per week increased from 88 to 105 BCs (P < .0001), resulting from increased early sampling (P = .0001). Solitary BCs decreased (95%-28%), documented times increased (2.8%-25%), and average blood volume increased (3 mL to 4.5 mL) postintervention. Community-onset Bloodstream infections (BSIs) increased (39.6-52 bottles/1,000 admissions, P = .0001), while Health care-associated BSIs decreased (39-27 bottles/10,000 days, P = .0042). Contamination rates did not change. CONCLUSIONS: An ED-focused intervention based on the education sessions and single-site strategy improved culturing stewardship and facilitated the early identification of BSI without an increase in contamination.

Myocarditis following COVID-19 mRNA vaccination.

BACKGROUND: Clinical trials of the BNT162b2 vaccine, revealed efficacy and safety. We report six cases of myocarditis, which occurred shortly after BNT162b2 vaccination. METHODS: Patients were identified upon presentation to the emergency department with symptoms of chest pain/discomfort. In all study patients, we excluded past and current COVID-19. Routine clinical and laboratory investigations for common etiologies of myocarditis were performed. Laboratory tests also included troponin and C-reactive protein levels. The diagnosis of myocarditis was established after cardiac MRI. FINDINGS: Five patients presented after the second and one after the first dose of the vaccine. All patients were males with a median age of 23 years. Myocarditis was diagnosed in all patients, there was no evidence of COVID-19 infection. Laboratory assays excluded concomitant infection; autoimmune disorder was considered unlikely. All patients responded to the BNT162b2 vaccine. The clinical course was mild in all six patients. INTERPRETATION: Our report of myocarditis after BNT162b2 vaccination may be possibly considered as an adverse reaction following immunization. We believe our information should be interpreted with caution and further surveillance is warranted.

The association between red cell distribution width and poor outcomes in hospitalized patients with influenza.

PURPOSE: To examine an association between red blood cell distribution width (RDW) and the prognosis of influenza patients. METHODS: We conducted a retrospective analysis of patients hospitalized with influenza during 2012-2015 in the internal medicine wards of one medical center. RDW measurements during hospitalization were analyzed. Primary outcome was complicated hospitalization (defined as at least one of: length of stay ≥7days, need for mechanical ventilation, septic shock, transfer to intensive-care, or 30-day mortality). Secondary outcome was 30-day mortality. RESULTS: 153 patients were included, mean age: 62.5±1, 82 (54%) male; 84 (55%) had a high RDW value (>14.5%) during hospitalization. Patients with high and low RDW (≤14.5%) had similar age and comorbidity profiles, but those with high RDW had lower hemoglobin and higher creatinine levels. Patients with high RDW had a higher rate of complicated hospitalization (32.5% vs. 10.3%, p<0.01) and a trend for increased 30-day mortality. In a multivariate regression model, high RDW was a predictor of complicated hospitalization (OR 5.03, 95% CI 1.81-13.93, p<0.01). Each 1-point increase in RDW was associated with a 29% increase in the risk for the primary outcome. CONCLUSION: RDW>14.5% was a predictor of severe hospital complications in patients with influenza.