To identify and present the pathogens and sources of contamination linked to outbreaks within hematopoietic stem cell transplant (HSCT) units.

Systematic review.

Inpatient HSCT units.

The PubMed/Medline databases were systematically searched as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, employing the search terms “stem cell”, “bone marrow”, “transplant”, “transplantation”, “outbreak” and “pseudo-outbreak” from inception until July 31, 2024. Data on the type of event, pathogen involved, and source of contamination were extracted from eligible publications.

In total, 39 studies including 387 patients were included in this review. The overall mortality rate was 23%. Pathogens identified included adenovirus, RSV, Pseudomonas aeruginosa, Aspergillus spp., and non-tuberculous mycobacteria (NTM). P. aeruginosa outbreaks were associated with contaminated sanitary fixtures (P = .007) and water (P = .039), outbreaks caused by NTM were associated with water (P = .009), while Aspergillus spp. outbreaks were associated with construction (P < .001). An index case was identified in 36.8% of viral outbreaks (P = .016). Other sources included inadequate disinfection and transmission from visitors.

Our study highlights several associations between pathogens involved in HSCT unit outbreaks and their respective sources. Establishing standardized guidelines for unit construction – particularly for ventilation and water safety – could further reduce the risk of pathogen transmission and enhance infection prevention in these high-risk settings.

A diagnostic flexible laryngoscopy using a flexible endoscope (FE) without a working channel can become contaminated when inserted through the nose to inspect the throat. Microbiological surveillance is necessary to ensure adequate reprocessing. A lack of knowledge exists about the most accurate way to assess microbiological contamination on the surface of FEs without a working channel. A scoping review of research on sampling techniques for FEs without a working channel was done to identify frequently used sampling techniques and to determine the best way to assess microbiological contamination.

PubMed, Embase, Cochrane Library, and CINAHL databases were searched. Data related to the sampling technique and bacterial contamination were extracted.

Twelve of the 378 studies met the inclusion criteria. None compared sampling techniques, most studies investigated the efficacy of several disinfection methods. Retrieved sampling techniques were immersion, swabbing, and wiping. Immersion and wiping could detect bacterial contamination on contaminated FEs without a working channel. Two out of six studies using a swabbing method found bacterial contamination on contaminated FEs without a working channel. Three studies using the swabbing method detected bacterial contamination after disinfection. One study did not retrieve microorganisms after disinfection using the swabbing method.

Three different sampling techniques were extracted: immersion, wiping, and swabbing, which could all detect microbiological contamination on contaminated FEs without a working channel. However, this scoping review identified significant gaps in literature. Additional research is needed to determine the best sampling technique(s) for FEs without a working channel to detect microbiological contamination.

To improve the understanding of appropriate antibiotic de-escalation and stewardship by consolidating the evidence on screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization of the nares to predict MRSA in acute skin and soft tissue infections (SSTIs).

This meta-analysis was performed according to PRISMA guidelines. Six databases were searched by two reviewers for articles on MRSA detection in the nares and acute SSTIs. The quality and risk of bias of the articles were then assessed. The primary outcomes of interest were pooled sensitivity and specificity. Sub-analyses were also performed to test for heterogeneity.

After screening 1040 records, 15 articles (n = 1,970) were included in the meta-analysis. Using MRSA nares screening to predict MRSA in acute SSTIs had an overall specificity of 0.949 and sensitivity of 0.474. With a prevalence of 29.1%, the calculated NPV was 0.815. There were sub-analyses on various study variables, such as study location, participant age, and detection by polymerase chain reaction versus culture. The only significant finding was an increased sensitivity for adults (0.543) compared to pediatric participants (0.285).

To our knowledge, this is the first meta-analysis that focuses on the performance of MRSA nares screening for predicting MRSA infection in patients presenting with acute SSTIs. The baseline prevalence of MRSA SSTIs is important for interpreting the screening results, and the prevalence is influenced by geography and patient factors. This clinical context must be considered before utilizing MRSA nares screening for acute SSTIs.

To evaluate the impact of a mobile-app-based central line-associated bloodstream infection (CLABSI) prevention program in oncology clinic patients with peripherally inserted central catheters (PICCs).

Pre-post prospective cohort study with baseline (July 2015–December 2016), phase-in (January 2017–April 2017), and intervention (May 2017–November 2018). Generalized linear mixed models compared intervention with baseline frequency of localized inflammation/infection and dressing peeling. Cox proportional hazards models compared days-to-removal of lines with localized inflammation/infection. Chi-square test compared bacteremia rates before and after intervention.

Oncology clinic at a large medical center.

Oncology clinic adult patients with PICCs.

CLABSI prevention program consisting of an actionable scoring system for identifying insertion site infection/inflammation coupled with a mobile-app enabling photo-assessments and automated physician alerting for remote response.

We completed 5,343 assessments of 569 PICCs in 401 patients (baseline: 2,924 assessments, 300 PICCs, 216 patients; intervention: 2,419 assessments, 269 PICCs, 185 patients). The intervention was associated with a 92% lower likelihood of having a dressing with peeling (OR 0.08, 95%CI 0.04-0.17, P < 0.001), 53% lower local inflammation/infection (OR 0.47, 95%CI 0.27-0.84, P < 0.011), and 24% (non-significant) lower CLABSI rates (P = .63). Physician mobile-app alerting and response enabled 80% lower risk of lines remaining in place after inflammation/infection was identified (HR 0.20, 95%CI:0.14-0.30, P < 0.001) and 85% faster removal of infected lines from mean (SD) 11.1 (9.7) to 1.7 (2.4) days.

A mobile-app-based CLABSI prevention program decreased frequency of inflamed/infected central line insertion sites and increased speed of removal when inflammation/infection was found.

To identify risk factors for surgical site infections (SSIs) following C-sections in an underserved, urban population.

Retrospective case-control study and multivariable regression analyses.

Multicenter urban hospital system.

All women undergoing C-sections during 2023.

To identify risk factors for SSIs, patients suffering SSIs were compared to a propensity-matched control group (controlled for the following variables: age, body mass index, diabetes mellitus, American Society of Anesthesia (ASA) score, wound class, and duration of surgery). In addition, multivariable logistic regression analysis was performed to identify independent risks for SSIs.

Of 4,642 C-sections performed, 73 SSIs were identified; 90% were detected after hospital discharge. Compared to a propensity-matched group, more patients in the SSI cohort received gentamicin with clindamycin (vs a cefazolin-based regimen); gentamicin dosing was consistently below recommended levels. Also, significantly more patients in the SSI group were recent immigrants to the United States compared to the control group (20.5% vs 4.1%, P = .004). Multivariate regression analysis revealed 3 independent risk factors for SSIs: ASA score, surgery at a hospital without an Obstetrics-Gynecology residency program, and residence in the borough of the Bronx, NY.

For women living in areas of low socioeconomic status, most SSIs after C-sections are detected following hospital discharge. Women who are recent immigrants and living in areas of high poverty are particularly at higher risk. Addressing the broader social determinants of health, particularly in underserved areas, will be crucial in reducing SSIs and improving overall maternal health outcomes.

Antibiotic stewardship programs (ASPs) target hospitalized children, but most do not routinely review antibiotic prescriptions at discharge, despite 30% of discharged children receiving additional antibiotics. Our objective is to describe discharge antibiotic prescribing in children hospitalized for uncomplicated community-acquired pneumonia (CAP), skin/soft tissue infection (SSTI), and urinary tract infection (UTI).

Retrospective cohort study.

Four academic children’s hospitals with established ASPs.

ICD-10 codes identified 3,847 encounters for children <18 years admitted from January 1, 2021 to December 31, 2021 and prescribed antibiotics at discharge for uncomplicated CAP, SSTI, or UTI. After excluding children with medical complexity and encounters with concomitant infections, >7 days hospital stay, or intensive care unit stay, 1,206 encounters were included.

Primary outcomes were the percentage of subjects prescribed optimal (1) total (inpatient plus outpatient) duration of therapy (DOT) and (2) antibiotic choice based on current national guidelines and available evidence.

Of 226 encounters for CAP, 417 for UTI, and 563 for SSTI, the median age was 4 years, 52% were female, and the median DOT was 9 days (8 for CAP, 10 for UTI, and 9 for SSTI). Antibiotic choice was optimal for 77%, and DOT was optimal for 26%. Only 20% of antibiotic courses included both optimal DOT and antibiotic choice.

At 4 children’s hospitals with established ASPs, 80% of discharge antibiotic courses for CAP, UTI, and SSTI were suboptimal either by choice of antibiotic or DOT. Discharge antibiotic prescribing represents an opportunity to improve antibiotic use in children.

To identify Surgical Site Infection (SSI) risk factors for abdominal hysterectomy patients and report the results of a performance improvement initiative.

Retrospective case-control.

Parkland Hospital, an 882-bed academic, safety-net, tertiary referral center and a level 1 trauma center serving a diverse population of primarily uninsured patients in North Texas.

Patients over 18 who underwent abdominal hysterectomy and were diagnosed with SSIs within 30 days of surgery between 2019 and 2021.

Cases were matched to controls from the same or closest calendar month in a 1:2 ratio. Chart review of electronic medical records (EMR) was performed comparing variables using Pearson’s χ2 test for categorical variables and Student’s t-test for continuous variables followed by logistic regression for multivariate analysis. Upon identifying vaginal preparation technique as an area of improvement while investigating SSI bundle compliance, we implemented an OR staff training intervention.

Diabetes was identified as a significant risk factor while Hispanic or Latino ethnicity was associated with significantly lower rates of infection. Most organisms identified were enteric pathogens. Following the intervention, Parkland’s deep and organ-space Standardized Infection Ratio (SIR) decreased from 1.46 in 2021 to 0.519 for the rolling 12 months as of June 2024.

Our multidisciplinary intervention improving the quality and consistency of pre-operative vaginal preparation was associated with a reduction in abdominal hysterectomy SSI.

Patients with Opioid Use Disorder (OUD) are prone to Multidrug-Resistant Organism (MDRO) colonization and infections, thus at risk for worse outcomes during critical illness. Understanding the prevalence and predictors of MDRO infections is essential to optimize interventions and treatments.

Retrospective cohort study.

The study evaluated the prevalence of MDRO isolation among adults with OUD admitted to an intensive care unit (ICU) between January 1, 2018, and July 31, 2023. It included adults admitted to an ICU with bacterial infections and positive cultures obtained within 48 hours of admission. Demographics, clinical traits, and MDRO isolation rates were analyzed using descriptive statistics, univariate methods, and Least Absolute Shrinkage and Selection Operator (LASSO) regression.

MDRO isolation occurred in 178 of 790 patients (22.5%), with methicillin-resistant Staphylococcus aureus as the most frequently isolated organism. LASSO regression identified housing insecurity (OR: 1.79, 95% CI 1.09–2.93, P = .022), no receipt of medications for OUD treatment (OR: 1.56, 95% CI 1.06–2.29, P = .023), positive hepatitis C virus (HCV) status (OR: 2.19, 95% CI 1.19–4.03, P = .012), and intravenous antibiotic use in the prior 90 days (OR: 1.04 per 24 h, 95% CI 1.01–1.07, P = .007) as significant predictors of MDRO isolation.

The study highlights a high prevalence of MDRO isolation in critically ill OUD patients admitted for infection-related issues with positive cultures obtained within 48 hours of admission, influenced by factors like housing insecurity, no receipt of medications for OUD treatment, HCV status, and prior antibiotic use.

Medicare claims are frequently used to study Clostridioides difficile infection (CDI) epidemiology. However, they lack specimen collection and diagnosis dates to assign location of onset. Algorithms to classify CDI onset location using claims data have been published, but the degree of misclassification is unknown.

We linked patients with laboratory-confirmed CDI reported to four Emerging Infections Program (EIP) sites from 2016–2021 to Medicare beneficiaries with fee-for-service Part A/B coverage. We calculated sensitivity of ICD-10-CM codes in claims within ±28 days of EIP specimen collection. CDI was categorized as hospital, long-term care facility, or community-onset using three different Medicare claims-based algorithms based on claim type, ICD-10-CM code position, duration of hospitalization, and ICD-10-CM diagnosis code presence-on-admission indicators. We assessed concordance of EIP case classifications, based on chart review and specimen collection date, with claims case classifications using Cohen’s kappa statistic.

Of 12,671 CDI cases eligible for linkage, 9,032 (71%) were linked to a single, unique Medicare beneficiary. Compared to EIP, sensitivity of CDI ICD-10-CM codes was 81%; codes were more likely to be present for hospitalized patients (93.0%) than those who were not (56.2%). Concordance between EIP and Medicare claims algorithms ranged from 68% to 75%, depending on the algorithm used (κ = 0.56–0.66).

ICD-10-CM codes in Medicare claims data had high sensitivity compared to laboratory-confirmed CDI reported to EIP. Claims-based epidemiologic classification algorithms had moderate concordance with EIP classification of onset location. Misclassification of CDI onset location using Medicare algorithms may bias findings of claims-based CDI studies.