A case report of Nocardia spp. infective endocarditis in an injection drug user.

BACKGROUND: Nocardia-related endocarditis is rare. Intravenous drug use with nonsterile injection practices is a potential risk factor for nocardia infection. Disseminated nocardiosis with endovascular involvement is rarely reported in immunocompetent individuals. CASE PRESENTATION: A 54-year-old male was diagnosed with infective endocarditis due to Nocardia asteroides with septic emboli in the brain and spleen. The use of a matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) rapid diagnostic system was beneficial in identifying the causative organism. He was empirically treated with combination therapy consisting of three antibiotics. Antimicrobial susceptibility testing indicated that all three antibiotics had favorable minimum inhibitory concentrations (MICs). Due to his clinical status, he was not a surgical candidate. Patient passed away after discharge to hospice. CONCLUSIONS: This case demonstrates unique challenges in the identification, diagnosis, and management of Nocardia-related infective endocarditis. A detailed history of injection practices should guide clinicians in assessing the risk for environmental pathogens. Valvular surgery and combination antibiotic therapy should be recommended for all eligible patients to improve the chances of survival.

Considerations for Intravenous Antibiotic Treatment of Prosthetic Joint Infections.

Intravenous antibiotic therapy remains necessary for many patients with prosthetic joint infections. Intravenous therapies may be used for short durations before switching to oral regimens or may be used for the entirety of therapy. Factors to consider intravenous antibiotic selection include pathogen factors such as resistance profiles, host factors such as allergies, and drug factors including how difficult the selected agent would be to administer in the outpatient setting. Monitoring of prolonged intravenous therapy in the outpatient setting requires weekly monitoring of labs with specific labs required to monitor certain antibiotics. This narrative review assesses the appropriate duration, antimicrobial selection by pathogen, and monitoring parameters for intravenous antibiotic treatment of prosthetic joint infections. (Journal of Surgical Orthopaedic Advances 30(4):243-248, 2021).

Uses of Procalcitonin as a Biomarker in Critical Care Medicine.

Procalcitonin is a commonly used biomarker for infection and severity in the intensive care unit. Although relatively specific for bacterial, as opposed to viral, infections, serum procalcitonin levels also correlate with disease severity and thus cannot reliably distinguish between bacterial and nonbacterial infections in the setting of critical illness, particularly in cases of severe influenza and coronavirus disease-2019. Baseline procalcitonin levels are insufficiently discriminative to permit the withholding of antibiotics in patients with critical illness and suspected sepsis. Trends in procalcitonin levels over time, however, give us the opportunity to individualize the duration of antibiotics without negative impacts on mortality.

Changing Attitudes toward the COVID-19 Vaccine among North Carolina Participants in the COVID-19 Community Research Partnership.

Coronavirus Disease-2019 (COVID-19) vaccine acceptance is variable. We surveyed participants in the COVID-19 Community Research Partnership from 17 December 2020 to 13 January 2021 to assess vaccine receptiveness. Vaccine uptake was then monitored until 15 May 2021; 20,232 participants responded to the receptiveness survey with vaccination status accessed in 18,874 participants via daily follow-up surveys (participants not completing daily surveys ≥30 days to 15 May 2021, were excluded). In the initial survey, 4802 (23.8%) were vaccine hesitant. Hesitancy was most apparent in women (Adjusted RR 0.93, p < 0.001), Black Americans (Adjusted RR 1.39, 1.41, 1.31 to non-Hispanic Whites, Other, and Hispanic or Latino, respectively p < 0.001), healthcare workers (Adjusted RR 0.93, p < 0.001), suburbanites (ref. Urban Adjusted RR 0.85, 0.90 to urban and rural dwellers, respectively, p < 0.01), and those previously diagnosed with COVID-19 (RR 1.20, p < 0.01). Those <50 years were also less accepting of vaccination. Subsequent vaccine uptake was 99% in non-hesitant participants. For those who were unsure, preferred not to answer, or answered "no", vaccination rates were 80% (Adjusted RR 0.86, p < 0.0001), 78% (Adjusted RR 0.83, p < 0.0001), and 52.7% (Adjusted RR 0.65, p < 0.0001), respectively. These findings suggest that initial intent did not correlate with vaccine uptake in our cohort.