Haemophilus parainfluenzae infective endocarditis complicated by multiorgan septic emboli.

Infective endocarditis (IE) caused by Haemophilus parainfluenzae is a rare but serious condition if not diagnosed and treated promptly. In this article, we describe a patient with H. parainfluenzae IE who initially presented with non-specific symptoms but subsequently developed multiple sequelae of IE. The diagnosis of IE was made based on clinical, echocardiographic, radiological and microbiological findings. He was treated successfully with a mitral valve replacement along with 4 weeks of intravenous antibiotic therapy. Our case highlights the importance of obtaining a thorough history and a complete physical examination to ensure an early diagnosis of IE.

Impact of stewardship intervention on antibiotic prescribing prior to dental procedures in a veteran population.

BACKGROUND: Dentists are an overlooked group of prescribers but are responsible for up to 10% of antibiotic prescriptions written in the United States annually, most of which are for prophylaxis. Dental prophylaxis in orthopedic patients has been an area of confusion, with discordance among societal guidelines. In 2020, an antimicrobial stewardship (AS) group spearheaded a collaborative effort among dental, orthopedic surgery, and infectious diseases specialties to develop a protocol for the use of dental antibiotic prophylaxis for patients with total joint replacements (TJRs) based on the most current American Dental Association-American Academy of Orthopaedic Surgeons statement. OBJECTIVE: This study aimed to assess antibiotic prescribing for dental prophylaxis before and after an AS intervention. METHODS: This study is an interventional, pre-post review of dental encounters with patients with a history of TJR before (October 2019 to July 2021) and after (August 2021 to April 2023) the intervention. Charts were reviewed to determine the frequency and appropriateness of dental procedure prophylactic antibiotics. RESULTS: A total of 1587 encounters from October 2019 to April 2023 were identified. Notably, 179 encounters in the pre- and 183 encounters in the postgroup were analyzed, 31 encounters (17%) in the pregroup versus 33 (18%) in the postgroup had a prophylactic antibiotic associated with it (P > 0.05), 26 of 31 antibiotics (84%) in the pregroup were prescribed for prosthetic joint infection prophylaxis compared with 18 of 33 (55%) in the postgroup (P > 0.05), and 151 of 179 encounters (84.3%) were guideline adherent in the preintervention group compared with 160 of 183 encounters (87.4%) in the postintervention group (P > 0.05). CONCLUSION: This study observed a shift in the distribution of antibiotic indications and a decreased rate of inappropriate prophylactic prescriptions in dental patients with a history of TJR after an AS-led, collaborative intervention. Although the overall rate of prophylactic antibiotic prescribing remained the same and the changes did not reach statistical significance, lessons learned through this process can help inform future interventions in our institution and for others.

Increasing Local Productivity Through a Regional Antimicrobial Stewardship Collaborative.

Background: Antimicrobial stewardship programs (ASPs) are vital to improving patient safety and ensuring quality of care but are often underresourced, limiting their effectiveness and reach. While barriers to ASP success have been well documented, approaches to address these barriers with limited resources are needed. Stewardship networks and collaboratives have emerged as possible solutions. In January 2020, 5 US Department of Veterans Affairs facilities created a regional ASP collaborative. In this article, we describe the impact of this collaborative on the productivity of the facilities' ASPs. Methods: ASP annual reports for each of the 5 facilities provided retrospective data. Reports from fiscal year (FY) 2019 and reports from FY 2020-2022 were reviewed. Staffing, inpatient and outpatient stewardship reporting, individual and collaborative initiatives, and publications data were collected to measure productivity. Yearly results were trended for each facility and for the region. Additionally, the COVID-19 antibiotic use dashboard and upper respiratory infection dashboard were used to review the impact of initiatives on antibiotic prescribing during the collaborative. Results: Regular reporting of outpatient metrics increased; 27% of measures showed improvement in 2019 and increased to 60% in 2022. For all 5 facilities, ASP initiatives increased from 33 in 2019 to 41 in 2022 (24% increase) with a corresponding increase in collaborative initiatives from 0 to 6. Likewise, publications increased from 2 in 2019 to 17 in 2022 (750% increase). Rates of reporting and improvement in inpatient metrics did not change significantly. Conclusions: The ASP collaborative aided in efficiency and productivity within the region by sharing improvement practices, distributing workload for initiatives, and increasing publications.

Successful Development and Implementation of a Large Virtual Interprofessional Education Activity Applying the Social Determinants of Health.

Interprofessional education (IPE) activities provide students insight into healthcare teams, shared decision-making, and social determinants of health (SDOH). Virtual IPE activities with large student populations or across multicampus have not been evaluated. The study aimed to explore the interprofessional competency growth in students, across several disciplines, following participation in a large-scale, virtual IPE activity. Students from pharmacy, medicine, social work, and physician assistant programs across Tennessee participated in an IPE patient case and SDOH in fall 2020 and fall 2021. Pre- and postsurveys included Likert ranking of 16 statements based on the 2011 Interprofessional Education Collaborative (IPEC) framework. A total of 607 students completed surveys (overall response rate, 76%). Wilcoxon signed-rank tests were performed on the pre-/postsurvey data, in aggregate and by discipline. Significant increases in all IPEC competency statements were seen, both in aggregate (100% of statements with p < 0.001) and in pharmacy (100% of statements with p < 0.001) and medicine subgroups (94% of statements with p < 0.001). Implementing large virtual IPE activities involving a complex patient case and SDOH significantly increased student IPEC competency outcomes for participating students, whether in aggregate or on a discipline-specific basis.

Lyticase Facilitates Mycobiome Resolution Without Disrupting Microbiome Fidelity in Primates.

BACKGROUND: Microbiome research has expanded to consider contributions of microbial kingdoms beyond bacteria, including fungi (i.e., the mycobiome). However, optimal specimen handling protocols are varied, including uncertainty of how enzymes utilized to facilitate fungal DNA recovery may interfere with bacterial microbiome sequencing from the same samples. METHODS: With Institutional Animal Care and Use Committee approval, fecal samples were obtained from 20 rhesus macaques (10 males, 10 females; Macaca mulatta). DNA was extracted using commercially available kits, with or without lyticase enzyme treatment. 16S ribosomal RNA (bacterial) and Internal Transcribed Spacer (ITS; fungal) sequencing was performed on the Illumina MiSeq platform. Bioinformatics analysis was performed using Qiime and Calypso. RESULTS: Inclusion of lyticase in the sample preparation pipeline significantly increased usable fungal ITS reads, community alpha diversity, and enhanced detection of numerous fungal genera that were otherwise poorly or not detected in primate fecal samples. Bacterial 16S ribosomal RNA amplicons obtained from library preparation were statistically unchanged by the presence of lyticase. CONCLUSIONS: We demonstrate inclusion of the enzyme lyticase for fungal cell wall digestion markedly enhances mycobiota detection while maintaining fidelity of microbiome identification and community features in non-human primates. In restricted sample volumes, as are common in limited human samples, use of single sample DNA isolation will facilitate increased rigor and controlled approaches in future work.

Perceived significance of isolated HBcAb in patients with HIV: a survey of practitioners.

The prevalence of the isolated hepatitis B core Ab phenotype (hepatitis B surface antigen negative [HBsAg-] hepatitis B surface antibody negative [HBsAb-], and hepatitis B core antibody positive [HBcAb+] is particularly high among human HIV-positive patients. Controversy exists regarding both the significance of this phenotype and the risk of progressive liver disease as well as the need for hepatitis B vaccination in this population. A survey of 40 HIV primary care providers (PCPs) at an urban outpatient HIV clinic was conducted in 2005 regarding these two issues and a summary of the findings are presented in this report. Seventy-eight percent thought that these patients' infection had resolved and were immune, half thought they were at risk for progressive liver disease, and 6 (15%) routinely administered hepatitis B vaccine to patients with this phenotype. The wide variety in attitudes and practices among providers in a single clinic suggests the need for further research and development of management guidelines in this group of patients.

Gender differences in indices of opioid dependency and medical comorbidity in a population of hospitalized HIV-infected African-Americans.

We examined gender differences in drug use patterns and in medical presentation among 520 hospitalized, HIV-infected African-Americans. Substance abuse history was self-reported, and medical data were obtained by chart review. Overall, 321 (65%) reported ever having used heroin, with equivalent rates in men and women. Women were more likely to report current use, to have sought treatment, and tended to feel more dependent on heroin than men. Among heroin users, women were more likely to be admitted for conditions related to drug use, rather than AIDS, and to have CD4 counts > 200/mm3. These gender differences in opioid dependency and medical comorbidity may indicate a need for alternative treatment approaches for men and women.