RESUMEN
Antibiotic stewardship interventions are urgently needed to reduce antibiotic overuse in hospitalized COVID-19 patients, particularly in small community hospitals (SCHs), who often lack access to infectious diseases (ID) and stewardship resources. We implemented multidisciplinary tele-COVID rounds plus tele-antibiotic stewardship surveillance in 17 SCHs to standardize COVID management and evaluate concurrent antibiotics for discontinuation. Antibiotic use was compared in the 4 months preintervention versus 10 months postintervention. Interrupted time-series analysis demonstrated an immediate decrease in antibiotic use by 339 days of therapy/1000 COVID-19 patient days (p < .001), and an estimated 5258 antibiotic days avoided during the postintervention period. Thirty-day mortality was not significantly different, and a significant reduction in transfers was observed following the intervention (23.3% vs. 7.8%, p < .001). A novel tele-ID and tele-stewardship intervention significantly decreased antibiotic use and transfers among COVID-19 patients at 17 SCHs, demonstrating that telehealth is a feasible way to provide ID expertise in community and rural settings.
Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , COVID-19 , Humanos , Antibacterianos/uso terapéutico , Hospitales Comunitarios , HospitalizaciónRESUMEN
Cryptococcal infection is relatively uncommon, except among immunocompromised individuals. The most common human pathogenic species is Cryptococcus neoformans. Virtually all organs can be affected, particularly the central nervous and pulmonary systems. The prototypical manifestations of cutaneous cryptococcal infection include generalized papules, periorificial acneiform pustules, and molluscumlike vesicles on the upper body. We describe an unusual case of Cryptococcus albidus infection presenting atypically with generalized hemorrhagic plaques. Furthermore, we review the literature on diagnostic evaluation and treatment.