Assessment of the impact of centralized bioMérieux BACT/ALERT® VIRTUO® blood culture system (VIRTUO) implementation on outcomes in patients with gram-negative bacteremia.

BACKGROUND: We evaluated pre- and postimplementation of Virtuo on outcome in patients with gram-negative bacteremia using a quasiexperimental time-in-motion design. METHODS: Becton Dickinson BACTEC™ 9000 series (Bactec) (2018) and Virtuo system (2020) were utilized in a decentralized and centralized process, respectively. Data collected in August-December in 2018 and 2020 were analyzed with SPSS (ver 28). RESULTS: For 185 patients in each time period, patient age, gender, length of hospitalization were not different. However, blood culture (BC) volume was significantly lower in 2020 (7.1 ± 2.6 mL) compared to 2018 (8.9 ± 1.9 mL). Time from BC draw and time from pathogen identification (ID) to treatment change were both significantly faster in 2020 (52.9 ± 38.3 hours; 15.1 ± 27.4 hours), compared to 2018 (65.0 ± 46.3 hours; 23.8 ± 33.8), respectively. CONCLUSIONS: Replacement of decentralized Bactec with centralized Virtuo, resulted in significant improvement in management of patients gram-negative bacteremia.

Disseminated Coccidioidomycosis With Fungemia and Possible Strongyloides Co-infection.

INTRODUCTION: Coccidioidomycosis is most often an asymptomatic or mild self-limited respiratory infection, but in rare cases it can become disseminated and cause severe disease. CASE PRESENTATION: A 29-year-old man who was originally from Thailand and had been living in Arizona for 2 years presented with intermittent fevers, fatigue, and other nonspecific symptoms, including abdominal pain, nonbloody diarrhea, and pruritic rash. Initial laboratory values showed significant peripheral eosinophilia. Extensive evaluation revealed possible Strongyloides species infection. Shortly after, Coccidioidies species fungemia was found. Fevers and symptoms resolved after adequate treatment. DISCUSSION: Disseminated coccidioidomycosis with fungemia is very rare in immunocompetent individuals. Co-infection with Stronglyloides species is only reported in two other case reports. CONCLUSIONS: We report this case to raise awareness of a rare infection. In adequate epidemiological circumstances, co-infections Coccidioides and Strongyloides species should be considered in presence of fever and eosinophilia.

An Unusual Discovery of Multi-Opportunistic Organisms in Gastrointestinal Biopsies of a Patient With Acquired Immunodeficiency Syndrome and Infectious Colitis.

Patients with acquired immunodeficiency syndrome (AIDS) have an increased risk of infectious colitis. While individual cases of infectious colitis are not rare, co-infections involving multiple opportunistic organisms are uncommon. Here, we present an AIDS patient with concurrent opportunistic gastrointestinal infections resulting in symptomatic infectious colitis. A 56-year-old woman with AIDS presented to the hospital with diarrhea, abdominal pain, and sepsis. Initial imagining revealed thickening of the colonic wall suggestive of colitis. The initial workup identified the presence of Campylobacter and Cryptosporidium through the GI Pathogen Multiplex Polymerase Chain Reaction Panel (bioMérieux BioFire®, Salt Lake City, USA), and stool parasite examination also confirmed the presence of Cryptosporidium. Despite treatment for these infections, the patient's diarrhea persisted. The patient had a sigmoidoscopy performed, and the biopsy results revealed the presence of Histoplasma capsulatum, cytomegalovirus (CMV), Herpes simplex virus (HSV), Cryptosporidium, and Campylobacter. The patient subsequently received appropriate treatment for each infection, leading to the resolution of both colitis and bacteremia. This case emphasizes the importance of considering multiple pathogens in the management of infectious colitis in patients with AIDS. The presence of one infectious agent does not preclude the presence of additional agents, and a thorough investigation can ensure a definitive diagnosis and optimal treatment for patients.

Unusual Freshwater-Related Infections Caused by Haematospirillum jordaniae.

Freshwater-related infections can be caused by a broad range of pathogens, potentially leading to skin and soft tissue, pulmonary, gastrointestinal, or even systemic diseases. Haematospirillum jordaniae (H. jordaniae),a gram-negative, aerobic organism previously regarded solely as an environmental microbe, has been classified as a pathogen capable of causing human infection in the United States. There has been only one other case reported in the literature of H. jordaniae infection, and little is known about the pathogenesis.The presentation and progression of clinical symptoms in our cases indicate freshwater cutaneous injury as the most likely route of H. jordaniae infection. We present two cases of H. jordaniae infection in elderly males. Both patients had freshwater exposure and skin injury resulting in sepsis, cellulitis at the site of injury, and bacteremia. Additionally, one patient presented with an acute deep venous thrombosis. The diagnosis of H. jordaniae was confirmed using Sanger sequencing 16s ribosomal RNA data. Antimicrobial therapy included piperacillin-tazobactam, ceftazidime, and levofloxacin. Both patients recovered successfully. While clinical cases and literature involving the newly classified human pathogen H. jordaniae are still rare, it is crucial to recognize the potential emergence of environmental organisms, previously believed to be harmless, as human pathogens. In cases of bacteremia and cellulitis with recent freshwater exposure and injury, H. jordaniae infection should be considered as part of the differential diagnosis.

Effect of antimicrobial stewardship with rapid MALDI-TOF identification and Vitek 2 antimicrobial susceptibility testing on hospitalization outcome.

We sought to evaluate time for bacterial culture and initiation of appropriate therapy for patients, from 2017 (without rapid diagnostic test (RDT) and Antimicrobial Stewardship Program (ASP)) and 2018 (with RDT and ASP). Time to identification (ID) was significantly faster in 2018 (2018 24.9 ±â€¯14.4, 2017 33.8 ±â€¯17 h, P = 0.001). Time to antimicrobial susceptibility test (AST) results was significantly faster for patients in 2018 compared to 2017 (18.2 ±â€¯14 h compared to 28.5 ±â€¯14.9 h, P < 0.001). Length of hospital stay for enrolled patients was significantly shorter in 2018 compared to 2017 (2018 10.7 ±â€¯11.1 days and 2017 15.5 ±â€¯18.1 days, P = 0.05). Length of antimicrobial therapy for enrolled patients was significantly shorter for 2018 (2018 6.7 ±â€¯3.8 d vs. 2017 8.8 ±â€¯7.8 d, P = 0.036). These results demonstrate MALDI-TOF/Vitek 2 leads to an average 21.5 h faster ID and AST results that can be acted upon by ASP for antimicrobial recommendations.

Clinical Utility of Advanced Microbiology Testing Tools.

Advanced microbiology technologies are rapidly changing our ability to diagnose infections, improve patient care, and enhance clinical workflow. These tools are increasing the breadth, depth, and speed of diagnostic data generated per patient, and testing is being moved closer to the patient through rapid diagnostic technologies, including point-of-care (POC) technologies. While select stakeholders have an appreciation of the value/importance of improvements in the microbial diagnostic field, there remains a disconnect between clinicians and some payers and hospital administrators in terms of understanding the potential clinical utility of these novel technologies. Therefore, a key challenge for the clinical microbiology community is to clearly articulate the value proposition of these technologies to encourage payers to cover and hospitals to adopt advanced microbiology tests. Specific guidance on how to define and demonstrate clinical utility would be valuable. Addressing this challenge will require alignment on this topic, not just by microbiologists but also by primary care and emergency room (ER) physicians, infectious disease specialists, pharmacists, hospital administrators, and government entities with an interest in public health. In this article, we discuss how to best conduct clinical studies to demonstrate and communicate clinical utility to payers and to set reasonable expectations for what diagnostic manufacturers should be required to demonstrate to support reimbursement from commercial payers and utilization by hospital systems.

Verification of Diagnosis in Tuberculosis: A Case Report and Discussion.

Tuberculosis (TB), caused by strains of Mycobacterium tuberculosis complex (M. tuberculosis), is a pulmonary infection that is spread by airborne droplet transmission. The development and spread of drug-resistant strains of M. tuberculosisgreatly jeopardize TB control efforts. We report the case of a previously healthy 43-year-old male, visiting from China, who presented to the emergency department complaining of hemoptysis of 10 days' duration. Cultures were positive for acid fast bacteria and negative for fungi. M. tuberculosis infection was confirmed by a deoxyribonucleic acid (DNA) probe. The patient was initially started on first-line therapy of isoniazid, rifampin, pyrazinamide, and ethambutol, with pyridoxine. His country of origin, China, increased suspicion for drug-resistant tuberculosis. Two weeks later, susceptibility testing of the M. tuberculosis isolate showed resistance to isoniazid, pyrazinamide, and ethambutol. Therapy was subsequently changed to amikacin, linezolid, moxifloxacin, and rifampin. The isolate was subsequently sent to the Center for Disease Control (CDC) for evaluation. Repeat testing showed that the isolate was susceptible to rifampin, pyrazinamide, and ethambutol. The patient was then restarted on his initial anti-TB regimen and was able to return to China. The main goals for the treatment of TB are to treat the individual patient and to minimize transmission. Clues that point to the possibility of multiple drug resistant tuberculosis (MDR-TB) include contact with a patient with MDR-TB, origin from an endemic region, or failure of therapy with documented supervision. Collaboration with experts was imperative in ensuring appropriate patient care.

Evaluation of Staphylococcus aureus Bacteremia: Academic and Community-Based Management Within the Same Health System.

A nonrandomized, retrospective comparison of Staphylococcus aureus bacteremia between an academic hospital setting (n=53) and a community hospital setting (n=245) within a single healthcare system was performed. Despite infectious disease consultations, S. aureus bacteremia management recommendations based on Infectious Diseases Society of America (IDSA) guidelines were not followed as closely in the community hospital setting. The community hospital setting requires management standardization for patients with S. aureus bacteremia. Infect Control Hosp Epidemiol 2017;38:740-742.

Whole genome mapping of the first reported case of KPC-2-positive Klebsiella pneumoniae ST258 in Nebraska.

Three ertapenem-resistant Klebsiella pneumoniae carrying bla(KPC-2) were isolated from a single patient in Nebraska over a span of 5 months. A comparative analysis of the genetic relatedness of these isolates was investigated using pulsed-field gel electrophoresis, multilocus sequence typing, and whole genome mapping.

Comparison of DiaSorin and Bio-Rad test kits for the detection of hepatitis B virus total core and surface antibodies on the Bio-Rad Evolis.

The new MONOLISA Bio-Rad kits were compared to DiaSorin kits for the detection of hepatitis B virus (HBV) total core (HBcTAb) and surface (HBsAb) antibodies on the Bio-Rad Evolis immunoanalyzer. The resolved sensitivities, specificities, positive and negative predictive values, and overall accuracy were 91%, 100%, 100%, 96%, and 97%, respectively, for HBcTAb and 99%, 95%, 96%, 99%, and 97%, respectively, for HBsAb. Whereas accuracy and reagent cost were comparable between the kits, Bio-Rad kits required less specimen volume and less instrument processing time to results than the DiaSorin kits.

Impact of lifestyle intervention on lost productivity and disability: improving control with activity and nutrition.

OBJECTIVE: To evaluate the effectiveness of a lifestyle intervention (LI) in reducing work loss and disability days. METHODS: One year randomized controlled trial of health plan members (n = 147) with type 2 diabetes and obesity. Members were randomized to modest-cost LI or usual care (UC). Outcomes were group differences in cumulative days either missed at work or with disability using Mann-Whitney U-tests and Poisson regression models. RESULTS: LI reduced the risk of workdays lost by 64.3% (P

Surveillance of community-based reservoirs reveals the presence of CTX-M, imported AmpC, and OXA-30 beta-lactamases in urine isolates of Klebsiella pneumoniae and Escherichia coli in a U.S. community.

beta-Lactamases produced by urine isolates from patients in long-term care facilities (LTCFs), outpatient, clinics, and one hospital in a U.S. community were characterized. A total of 1.3% of all Escherichia coli and Klebsiella pneumoniae isolates collected from patients in 30 LTCFs and various outpatient clinics produced extended-spectrum beta-lactamases (ESBLs) and/or imported AmpC beta-lactamases.