Monitoring Ceftazidime-Avibactam and Aztreonam Concentrations in the Treatment of a Bloodstream Infection Caused by a Multidrug-Resistant Enterobacter sp. Carrying Both Klebsiella pneumoniae Carbapenemase-4 and New Delhi Metallo-ß-Lactamase-1.

In an infection with an Enterobacter sp. isolate producing Klebsiella pneumoniae Carbapenemase-4 and New Delhi Metallo-ß-Lactamase-1 in the United States, recognition of the molecular basis of carbapenem resistance allowed for successful treatment by combining ceftazidime-avibactam and aztreonam. Antimicrobial synergy testing and therapeutic drug monitoring assessed treatment adequacy.

Microbial bioburden of inpatient and outpatient areas beyond patient hospital rooms.

OBJECTIVE: To investigate the frequency of environmental contamination in hospital areas outside patient rooms and in outpatient healthcare facilities. DESIGN: Culture survey. SETTING: This study was conducted across 4 hospitals, 4 outpatient clinics, and 1 surgery center. METHODS: We conducted 3 point-prevalence culture surveys for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridioides difficile, Candida spp, and gram-negative bacilli including Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumanii, and Stenotrophomonas maltophilia in each facility. In hospitals, high-touch surfaces were sampled from radiology, physical therapy, and mobile equipment and in emergency departments, waiting rooms, clinics, and endoscopy facilities. In outpatient facilities, surfaces were sampled in exam rooms including patient and provider areas, patient bathrooms, and waiting rooms and from portable equipment. Fluorescent markers were placed on high-touch surfaces and removal was assessed 1 day later. RESULTS: In the hospitals, 110 (9.4%) of 1,195 sites were positive for 1 or more bacterial pathogens (range, 5.3%-13.7% for the 4 hospitals) and 70 (5.9%) were positive for Candida spp (range, 3.7%-5.9%). In outpatient facilities, 31 of 485 (6.4%) sites were positive for 1 or more bacterial pathogens (range, 2% to 14.4% for the 5 outpatient facilities) and 50 (10.3%) were positive for Candida spp (range, 3.9%-23.3%). Fluorescent markers had been removed from 33% of sites in hospitals (range, 28.4%-39.7%) and 46.3% of sites in outpatient clinics (range, 7.4%-82.8%). CONCLUSIONS: Surfaces in hospitals outside patient rooms and in outpatient facilities are frequently contaminated with healthcare-associated pathogens. Improvements in cleaning and disinfection practices are needed to reduce contamination.

Evaluation of No-Touch Technologies for Decontamination of Toys in Pediatric Healthcare Settings.

No-touch technologies could be useful to decontaminate shared toys in healthcare settings. A high-level disinfection cabinet and electrostatic sprayer were effective against methicillin-resistant Staphylococcus aureus (MRSA), bacteriophage MS2, and Clostridioides difficile spores on toys. An ultraviolet-C light box was less effective but reduced MRSA and bacteriophage MS2 by >2 log10.

Pediatric Case of Severe COVID-19 With Shock and Multisystem Inflammation.

While the majority of pediatric coronavirus disease 2019 (COVID-19) cases have not been critical, occurrences of a multisystem inflammatory syndrome in children (MIS-C) have been emerging as the pandemic progresses. Herein, we report our experience with a pediatric COVID-19 case that presented with shock and multisystem inflammation. Our patient notably had multiple negative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription polymerase chain reaction (RT-PCR) assays but tested positive for SARS-CoV-2 IgG antibody. This case not only highlights the utility of SARS-CoV-2 IgG in the diagnosis of COVID-19 when RT-PCR is negative but suggests MIS-C may be a post-infectious immune-mediated process.