The Benefit of Influenza Vaccines: Beyond Prevention of Clinical Infection No abstract available

Highlights of Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America Asymptomatic bacteriuria is a common cause of unnecessary antimicrobial use. The Infectious Diseases Society of America has published an update of the clinical practice guideline for the management of asymptomatic bacteriuria. The guideline provides recommendations for avoidance of antimicrobial use for the great majority of patients with asymptomatic bacteriuria. Included in the recommendations is to refrain from screening with urinalysis and/or urine culture for older patients with cognitive impairment or fall and rather to look for alternative causes of altered mental status (eg, dehydration, metabolic causes, medication effects).

Dengue Fever in End-Stage Renal Failure Patient: Case Report and Updated Literature Review in the Diagnostic and Management Challenges Dengue viral infection is common in tropical and subtropical parts of the world and may lead to death. There are an estimated 390 million cases of dengue viral infections reported worldwide each year, putting 2.5 billion individuals at risk of this arthropod-borne viruses. The cornerstone of its management is prompt diagnosis, appropriate monitoring, and careful fluid replacement. This is particularly difficult in end-stage renal failure (ESRF) patients on maintenance dialysis, as there is a complex issue of the ability of making a prompt diagnosis, the presence of coagulopathy, and the risk of fluid overload due to constant evolving fluid dynamic as part of the dengue fever disease process. There is a serious lack of literature report in the area of dengue infection in ESRF patient. We report a case of a man with ESRF with a delayed diagnosis of dengue viral infection, who admitted at the critical phase of the illness. Despite that, he managed to recover uneventfully with tailored management in his fluid replacement, medication adjustment, and dialysis prescription. Hence, a high index of suspicion is needed when an ESRF patient presents with fever in a dengue-endemic area. A multidisciplinary approach with good collaboration between physician and nephrologist is needed to ensure the best outcome. Renal replacement therapy and medications should be individually tailored according to the patient's clinical condition. We hope that our reported clinical case will contribute to the understanding of the complex issue of management of dengue fever in ESRF patients.

Pacemaker Infections Caused by Rapidly Growing Mycobacteria: Presentation of 3 Cases and Review of the Literature There has been a steady rise in the use of cardiac pacemakers in the last 25 years and an associated increase in the number of device-related infections. Although Staphylococcus aureus and coagulase-negative staphylococci are the most common causes of these infections, rapidly growing mycobacteria have occasionally been implicated. We report 3 cases managed at our institution and review 21 cases found in the literature. Most patients underwent device removal and were managed with more than 1 antibiotic for at least 4 weeks. All but 2 patients achieved cure. It is important to recognize these organisms as potential etiologies of pacemaker infections and to request special culture media and stains. Furthermore, it is reasonable for antibiotic choice to be guided by susceptibility reports, and at least initially, more than 1 antibiotic is recommended.

Herpes Simplex Virus 1 Hepatitis Leading to Liver Failure and Hemophagocytic Lymphohistiocytosis: Case Report and Review of the Literature A 65-year-old immunocompetent adult presented with fever, fatigue, and laboratory evidence of acute liver failure. He was unable to undergo liver biopsy secondary to coagulopathy. His herpes simplex virus 1 (HSV-1) polymerase chain reaction level was elevated in the serum, leading to presumptive diagnosis of HSV-1–associated hepatitis. His course was complicated by rising ferritin, and workup revealed hemophagocytic lymphohistiocytosis suspected to be secondary to infection with HSV-1. He improved on intravenous acyclovir and completed a 21-day course. Review of the literature demonstrates that this is the fourth case of hemophagocytic lymphohistiocytosis associated with HSV-1 alone in an immunocompetent adult. Case reports have described treatment regimens including antivirals, antivirals in combination with immunosuppressant agents, and liver transplantation with immunosuppression with successful outcomes.

Acute Parotitis Due to Candida glabrata: A Case Report and Literature Review This report describes the case of a 60-year-old man who developed acute parotitis with abscess formation. The causative agent of the parotid abscess was Candida glabrata, which is an unusual cause of salivary gland pathology because it typically inhabits the oral cavity as a commensal microorganism. Acute parotitis occurs most often in elderly patients who are debilitated by systemic disease or as a postoperative complication. This case is interesting because the patient was immunocompetent and had no obvious risk factors for fungal parotitis other than poor dentition.

Impact of Vaccination on Morbidity and Mortality in Adults Hospitalized With Influenza A, 2014–2015 Background Influenza A is a significant cause of in-hospital morbidity and mortality in the United States. While vaccination has proven the most effective means of preventing infection, data examining its impact on patients hospitalized with influenza A are lacking. This is particularly true during seasons when there is poor vaccine matching, such as the 2014–2015 season. We hypothesize that vaccination is associated with less in-hospital morbidity and mortality among adults hospitalized with influenza A in a large tertiary hospital during the 2014–2015 season. Methods A retrospective chart review was conducted on all adults hospitalized with influenza A during the 2014–2015 season. Adjusting for confounders, multivariable logistic regression analyses were performed to examine the relationship between vaccination status and a variety of serious clinical outcomes. Results Of 217 adults hospitalized with influenza A, 118 were vaccinated (54%). Serious outcomes were frequent; 14 patients (7%) died, 31 (14%) required intensive care unit admission, and 27 (12%) required mechanical ventilation. Adjusting for sociodemographic and clinical confounders, we show that vaccinated patients were significantly less likely to die (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.09–0.99), require mechanical ventilation (OR, 0.35; 95% CI, 0.14–0.83), and suffer a severe outcome (intensive care unit admission or death) (OR, 0.41; 95% CI, 0.19–0.87). Discussion Vaccination during the 2014–2015 season was associated with reduced morbidity and mortality among adults hospitalized with influenza A, despite the poor vaccine matching recognized during that season. Our findings suggest that during seasons with poor vaccine matching vaccination may afford protection against poor outcomes in patients hospitalized with influenza A.

Impact of Peptide Nucleic Acid Fluorescence in Situ Hybridization Testing for Coagulase-Negative Staphylococci in a Pediatric Setting Background Coagulase-negative staphylococci (CoNS) are common blood culture contaminants, whereas Staphylococcus aureus is a pathogen with isolation from blood requiring therapy. Peptide nucleic acid fluorescence in situ hybridization (PNA-FISH) permits distinction of CoNS and S. aureus and has been demonstrated to decrease hospital costs, vancomycin use, and length of stay when paired with antimicrobial stewardship intervention. The impact of this testing in a children's hospital in the absence of stewardship intervention is unknown. The objective of this study was to determine the impact of PNA-FISH in a setting without an antimicrobial stewardship protocol for response to rapid testing. Methods This retrospective cohort study included pediatric patients with at least 1 CoNS-positive blood culture between January 1, 2012, and August 1, 2016. Patients were categorized based on the use of Staphylococcus QuickFISH, a rapid PNA-FISH method of identification. The primary outcome was hours of vancomycin exposure. Secondary outcomes included time-to-therapy change, time to culture result, and hospital length of stay. Results Of the 211 identified patients who had at least 1 blood culture bottle positive for CONS, 179 (85%) received vancomycin. Median hours of vancomycin exposure decreased between groups (63 rapid diagnostic testing group vs 81 conventional testing group; P = 0.019). Conclusions Despite an observed decrease in vancomycin exposure with use of rapid PNA-FISH testing, the full benefits of rapid diagnostic testing are unrealized in the absence of an appropriate stewardship protocol. Further studies may allow determination of the full impact of rapid diagnostic testing in pediatric settings.

Ceftolozane/Tazobactam for the Treatment of Osteomyelitis Due to Multidrug-Resistant Pseudomonas aeruginosa We conducted a retrospective study of 18 patients who were treated with ceftolozane/tazobactam (C/T) for greater than 48 hours for multidrug-resistant Pseudomonas aeruginosa (MDR-PA) osteomyelitis. Osteomyelitis was diagnosed by imaging, presence of systemic inflammatory signs and symptoms, elevated C-reactive protein, and positive culture for MDR-PA. Clinical cure was defined as complete or partial resolution of signs and symptoms of infection without need for escalation of antimicrobials during inpatient and outpatient therapy. The cohort was mostly male (81.2%) with a median age of 58.5 (53.5–68.5) years. The majority had polymicrobial osteomyelitis (77.8%) and a previous episode of osteomyelitis (83.3%). Clinical cure was achieved in 50% of patients, and C/T was well tolerated. These preliminary data suggest C/T maybe an option for treating patients with MDR-PA osteomyelitis, but more data are needed.

Epidemiology and Outcome of Hospitalized Infants With Pertussis Background Pertussis during infancy is associated with significant morbidity and mortality. The objective of this study was to review the epidemiology and outcome of infants with pertussis. Methods We identified infants with diagnosis of pertussis and compared demographic and outcome data with others who did not have pertussis. Infants with pertussis were matched 1:1 with correlative propensity score using sex, hospital region, income quartiles, race, ventilation status, and All Patients Refined Diagnosis Related Groups severity score. Results A total of 2920 pertussis cases were identified (prevalence: 4.7/1000 discharges). Females (49% vs 43%), Hispanics (35% vs 25%), and lower income quartile group (39% vs 36%) represented more frequently among pertussis cases (P < 0.001). Mechanical ventilation (6% vs 4.7%, P = 0.001), pulmonary hypertension (PHTN) (36% vs 1%, P < 0.001), and extracorporeal membrane oxygenation (ECMO) use (0.65% vs 0.08%, P < 0.001) were common among pertussis patients. In the intubated patients with pertussis, 50% had PHTN, 10% required ECMO, and 1 patient received leukapheresis. The mortality rate was significantly higher among ventilated (10.9% vs 0.04%, P < 0.001), PHTN (1.4% vs 0.3%, P < 0.001), and ECMO (60% vs 0.3%, P < 0.01) patients with pertussis. The mean length of stay was longer (5.96 ± 8.3 vs 4.53 ± 10.6 days, P < 0.01) among pertussis patients. Comparing with matched controls, the mortality rate was higher (0.72% vs 0.34%, P = 0.048), PHTN was common (36.4% vs 0.82%, P < 0.01), and ECMO usage was more frequent (0.65% vs 0%, P < 0.01) among pertussis cases. Conclusions Pertussis is more prevalent among females, Hispanics, and lower income quartile groups. This large sample study shows lower mortality than recent studies in infants with pertussis.