Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies

Throughout human history, infection has been the leading cause of morbidity and mortality, with pain being one of the cardinal warning signs. However, in a substantial percentage of cases, pain can persist after resolution of acute illness, manifesting as neuropathic, nociplastic (eg, fibromyalgia, irritable bowel syndrome), or nociceptive pain. Mechanisms by which acute infectious pain becomes chronic are variable and can include immunological phenomena (eg, bystander activation, molecular mimicry), direct microbe invasion, central sensitization from physical or psychological triggers, and complications from treatment. Microbes resulting in a high incidence of chronic pain include bacteria such as the Borrelia species and Mycobacterium leprae, as well as viruses such as HIV, SARS-CoV-2 and herpeses. Emerging evidence also supports an infectious cause in a subset of patients with discogenic low back pain and inflammatory bowel disease. Although antimicrobial treatment might have a role in treating chronic pain states that involve active infectious inflammatory processes, their use in chronic pain conditions resulting from autoimmune mechanisms, central sensitization and irrevocable tissue (eg, arthropathy, vasculitis) or nerve injury, are likely to cause more harm than benefit. This review focuses on the relation between infection and chronic pain, with an emphasis on common viral and bacterial causes.

Adoption and Utilization of Social Media Among Adult and Pediatric Infectious Diseases Divisions and Fellowship Programs in the United States.

Background: Social media (SoMe) is ubiquitous, but its adoption and utilization by infectious diseases (ID) divisions are poorly characterized in the United States. Methods: A systematic search of US ID fellowship/division Twitter, Facebook, and Instagram accounts occurred in November-December 2021. Social media account and program characteristics, post frequency and content, and other measures of SoMe adoption and utilization were recorded and compared between adult and pediatric programs. Posts were thematically categorized as social, promotional, educational, recruitment, or other. Results: Of 222 ID programs identified, 158 (71.2%) were adult and 64 (28.8%) pediatric. Seventy (31.5%) Twitter, 14 (6.3%) Facebook, and 14 (6.3%) Instagram accounts were identified from US programs. Twitter accounts were associated with larger programs and higher match rates. More adult than pediatric programs had Twitter accounts (37.3% vs 17.2%, P = .004); utilization was similar between adult and pediatric programs. Most Twitter posts were educational (1653 of 2859, 57.8%); most Facebook posts were promotional (68 of 128, 53.1%); and most Instagram posts were social (34 of 79, 43%). Facebook was the earliest adopted SoMe platform, but Twitter and Instagram have more recent growth. Rate of Twitter account creation increased from 1.33 accounts/month in the year before March 2020 (coronavirus disease [COVID] pandemic declaration) to 2.58 accounts/month in the year after March 2020 (P = .18). Conclusions: Social media remains underutilized across ID divisions, but COVID-19 and virtual recruiting may have influenced recent account creation. Twitter was the most frequently used ID program SoMe platform. Social media may benefit ID programs in recruitment and amplification of their trainees, faculty, and specialty.

Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update.

The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

Preparing the Intensive Care Unit for a Lethal Viral Respiratory Pandemic.

Future pandemics will certainly arise and continue to have a profound impact on health care, including management within the intensive care unit. Robust preparedness plans require specific attention to detail as it pertains to incident management, surge capacity, infection control practices, and the health care workforce. The COVID-19 pandemic highlighted many gaps in prior preparedness efforts, and those lessons learned must be integrated into updated preparedness work. Additionally, ensuring health care workforce wellness, decreasing health care disparities, strengthening networks for rapid research and response, and active roles in dispelling misinformation within the media should be integrated into pandemic preparedness plans.

#SoMe the Money! Value, Strategy, and Implementation of Social Media Engagement for Infectious Diseases Trainees, Clinicians, and Divisions.

Social media platforms have revolutionized how we consume information, along with how to effectively present communication, education, and advocacy efforts. There is profound value in leveraging social media within these aspects for the field of infectious diseases, for divisions and individual clinicians. Herein, we provide the rationale to incorporate social media as a key competency for infectious diseases training and specific guidance on aspects of education and strategic development of new accounts critical for success.

Prevention of Central-Line Associated Bloodstream Infections: 2021 Update.

Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.

Perioperative Coronavirus Vaccination-Timing and Implications: A Guidance Document.

EXECUTIVE SUMMARY: Cardiothoracic surgical patients are at risk of increased coronavirus disease severity. Several important factors influence the administration of the coronavirus disease vaccine in the perioperative period. This guidance statement outlines current information regarding vaccine types, summarizes recommendations regarding appropriate timing of administration, and provides information regarding side effects in the perioperative period for cardiac and thoracic surgical patients.

Evaluation of cycle threshold values at deisolation.

The decision to discontinue isolation in hospitalized patients with persistently positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) molecular testing is nuanced. Improvement in clinical status should be evaluated with expert consultation when considering whether discontinuation of isolation is appropriate. The cycle threshold value may serve as a useful adjunct to this decision-making process.