Achromobacter cluster related to COVID-19 supply chain issues.

Isolation of an unusual organism, Achromobacter xylosoxidans, from 2 cardiac surgical patients on the same day prompted an investigation to search for cases and cause. An extensive review demonstrated a pseudo-outbreak related to practices to conserve laboratory saline due to short supply resulting from supply chain shortage from the coronavirus disease 2019 pandemic.

Monitored COVID-19 mRNA vaccine second doses for people with adverse reactions after the first dose.

Background: After Emergency Use Authorization of the coronavirus disease 2019 (COVID-19) vaccines, guidance was provided by the Centers for Disease Control and Prevention that persons with an immediate allergic reaction to a messenger RNA (mRNA) COVID-19 vaccine should be evaluated by an allergist/immunologist before receipt of the second dose. Methods: In vaccinating health-care personnel, we referred those with significant reactions to allergy/immunology specialists so that they could safely receive the second dose. Results: We found that many reactions after the first dose were nonallergic but could be debilitating and a barrier to the second dose. We created a protocol of premedications to allow health-care personnel to safely receive their second mRNA COVID-19 vaccine dose. Conclusion: This protocol is adaptable and can be used in settings where allergy/immunology referral is not immediately available.

Influenza Vaccination and Healthcare Personnel Compliance.

PURPOSE OF REVIEW: We reviewed the benefit of influenza vaccination in healthcare personnel (HCP), rates of vaccine coverage, and practices used to try to boost vaccine coverage among HCP. RECENT FINDINGS: Influenza vaccination in HCP provides benefits to both HCP and patients, including reductions in patient morbidity and mortality and decreases in HCP absenteeism. Despite these benefits, influenza vaccine coverage among HCP still falls short of the Healthy People 2020 goal of 90%. As a result, healthcare institutions have used various practices to boost vaccination, including mandatory vaccine policies and requiring non-immunized HCP to wear masks during the influenza season. All of these efforts have been successful at increasing vaccination rates, and employer vaccination requirements have led to rates that meet the Healthy People 2020 goal. Rates of mandatory vaccine policies have increased over time, and several states now have influenza vaccine requirements. However, additional study into how these policies improve patient outcomes is needed. SUMMARY: Continued effort is needed to boost influenza vaccination rates among HCP, and mandatory vaccine policies may be used if other methods have not been effective in adequately raising vaccination rates. Future research should focus on how mandatory vaccine policies can improve patient outcomes.

The effect of preoperative penicillin allergy testing on perioperative non-beta-lactam antibiotic use: A systematic review and meta-analysis.

Background: The majority of patients for elective surgery and with a history of penicillin allergy are placed on alternative prophylactic antibiotic therapies, which have been associated with the emergence of multidrug-resistant pathogens and increased morbidity and mortality rates. However, self-reporting of penicillin allergy alone may overestimate the prevalence of penicillin allergy in the population. Objective: To assess the effects of preoperative antibiotic allergy testing protocols in reducing the use of non-beta-lactam antibiotics. Methods: We searched medical literature data bases through July of 2018. Two reviewers independently extracted data from published studies and assessed the risk of bias in cohort studies by using the Newcastle-Ottawa Scale. We collected information related to study design, methodology, demographics, interventions, and outcomes. We pooled odds ratios for the rate of prescribing non-beta-lactam antibiotics by using a fixed-effects model. Results: Of 905 citations screened for eligibility, nine studies met inclusion criteria for qualitative analysis. Studies reported that the rates of non-beta-lactam use after preoperative skin testing ranged from 6 to 30%. In addition, four of the nine studies had sufficient control data to be included in a meta-analysis. These four studies found that preoperative testing protocols significantly decreased the rates of prescribing non-beta-lactam antibiotics compared with usual care (odds ratio 3.64 [95% confidence interval, 2.67-4.98]; p < 0.0001). Seven studies reported on adverse drug reactions after preoperative skin testing and found that the rate of such reactions was rare. Conclusion: Preoperative antibiotic allergy testing protocols seemed to be a safe and effective tool in reducing the use of non-beta-lactam antibiotics during surgery.

Postdischarge Outcomes of Pyogenic Liver Abscesses: Single-Center Experience 2007-2012.

BACKGROUND: Pyogenic liver abscesses (PLA) are increasingly managed by percutaneous treatment instead of surgery, but there are limited data about postdischarge outcomes. Postdischarge services and factors predicting poor outcomes have not been described. METHODS: We performed a retrospective, descriptive case series at a single center assessing treatment and outpatient follow-up for patients treated for PLA from 2007 to 2012. We reviewed the electronic medical record for patient characteristics and outcomes. Data for care received at other facilities were not available. In our analysis, we compared patients with malignancy with those without and attempted to determine predictors of emergency department (ED) visits and hospital readmissions. RESULTS: Of 125 patients identified with PLA, 12 had surgical drainage, 23 had percutaneous aspiration, 78 had percutaneous drainage (PD), 11 had no drainage, and 1 was made comfort measures only. Seventy (60%) were discharged with a drain, and 31 (25%) were discharged on intravenous (IV) antibiotics. After discharge, 46 (38%) had ED visits and 36 (30%) were readmitted within 30 days of discharge. Fourteen (12%) had complications from antibiotics, and 4 (13%) had complications from peripherally inserted center catheter lines. A total of 8 patients, 5 in-hospital and 3 postdischarge, died. In our analysis of risk factors for 90-day postdischarge ED visit/readmission, only malignancy was a predictor. CONCLUSIONS: Pyogenic liver abscess patients have intense postdischarge needs (drain management, IV antibiotics) and a high rate of ED visits and readmissions. Although PD provides source control without surgery, ambulatory needs are now more complex, requiring multidisciplinary collaboration.