Explore the vast range of titles available.

We describe a febrile adult returning to the U.S. from Nigeria. Malaria was diagnosed by rapid antigen testing, but recognition of invasive nontyphoidal Salmonella disease was delayed. While the moniker, “typhomalaria,” once used to describe an illness with features of malaria and typhoid fever, has fallen out of favor, it may nevertheless be a helpful reminder to clinicians that both infectious diseases can arise in the same patient. Blood cultures should be obtained routinely in febrile returning travelers from malaria-endemic regions, including those in whom the diagnosis of malaria has already been established.

We report the case of acute peritonitis caused by a rapidly growing mycobacterium in a chronic peritoneal dialysis patient, whose renal failure had been caused by diabetic glomerulosclerosis. The organism cultured from the peritoneal dialysis fluid was Mycobacterium wolinskyi . Peritonitis caused by M. wolinskyi in a chronic peritoneal dialysis patient has never been reported before.

Cutibacterium (formerly called Propionibacterium ) acnes is a human skin flora often implicated in orthopedic infections. The unique characteristics of this microorganism make the diagnosis of infection difficult. The diagnosis often is made based on clinical evidence, radiographic signs, and laboratory and/or surgical findings combined. Treatment often involves both pharmacologic and surgical methods. In addition, formation of biofilms and increased resistance to drugs exhibited by the microorganism can require combined antimicrobial therapy. Prophylactic measures are particularly important, but no single method has been shown to fully eliminate the risk of C acnes infections. Previous reports have focused on C acnes infections involving surgical implants or after certain orthopedic procedures, particularly in the shoulder and spine. This article reviews current clinical, diagnostic, and treatment principles for C acnes in orthopedics in general. [ Orthopedics . 2020; 43(1):52–61.]

Background In this study, we present our experience with community-acquired, culture-positive, non-tuberculous mycobacterial (NTM) infections of the hand and wrist and compare the clinical features, risk factors, diagnostic delays, and treatment outcomes among patients referred for surgical consultation at our institution over a five-year period. Methodology We retrospectively identified patients on chart review who were diagnosed with culture-positive, extrapulmonary, cutaneous NTM infections between January 1, 2014, and December 31, 2018. Only patients with community-acquired NTM infections of the hand and wrist were included. Patient demographics, risk factors, location, diagnostic delays, NTM species isolated, treatment modalities, and treatment outcomes were collected and analyzed. These variables were further compared between patients who participated in fishing-related activities and those who did not. Results A total of 10 patients were identified with community-acquired NTM infections of the hand or wrist. Of these patients, eight (80%) were male, and six (60%) had participated in fishing-related activities prior to the initial presentation. The majority of patients had isolates (n = 6, 60%) and involved the hand (n = 8, 80%).  isolates were associated with a significantly shorter time to diagnosis (p = 0.02). All patients underwent surgical management with a prolonged course of postoperative antibiotics and were cured of their infection at the end of their treatment course. Conclusions Proper risk factor documentation and heightened clinical awareness are essential to reduce delays in the diagnosis of NTM skin and soft tissue infections and provide the best chance for curative therapy.

We report the development of a collaborative relationship between antimicrobial stewardship and clinical microbiology that incorporates stewardship practices into daily laboratory rounds. Antimicrobial stewardship involvement on rounds was a welcomed and effective initiative with substantial rates of intervention. New opportunities to positively impact use of antimicrobials and laboratory resources were realized.

Ceftolozane/tazobactam (C/T) was tested and compared against 93 nonfermenting, Gram-negative clinical isolates from cystic fibrosis specimens. Based on current breakpoints for intra-abdominal and urinary tract infections (which may not be appropriate for pulmonary infections), C/T was found to be the most active agent against P. aeruginosa (95.7% susceptible), followed by piperacillin/tazobactam (89.4% susceptible). For other Gram-negative pathogens included, C/T had varying activity.

Microbial growth in heating ventilation and air-conditioning (HVAC) systems with the subsequent contamination of indoor air is of increasing concern. Microbes and the subsequent biofilms grow easily within heat exchangers. A comparative study where heat exchangers fabricated from antimicrobial copper were evaluated for their ability to limit microbial growth was conducted using a full-scale HVAC system under conditions of normal flow rates using single-pass outside air. Resident bacterial and fungal populations were quantitatively assessed by removing triplicate sets of coupons from each exchanger commencing the fourth week after their installation for the next 30 weeks. The intrinsic biofilm associated with each coupon was extracted and characterized using selective and differential media. The predominant organisms isolated from aluminum exchangers were species of Methylobacterium of which at least three colony morphologies and 11 distinct PFGE patterns we found; of the few bacteria isolated from the copper exchangers, the majority were species of Bacillus. The concentrations and type of bacteria recovered from the control, aluminum, exchangers were found to be dependent on the type of plating media used and were 11,411–47,257 CFU cm−2 per coupon surface. The concentration of fungi was found to average 378 CFU cm−2. Significantly lower concentrations of bacteria, 3 CFU cm−2, and fungi, 1 CFU cm−2, were recovered from copper exchangers regardless of the plating media used. Commonly used aluminum heat exchangers developed stable, mixed, bacterial/fungal biofilms in excess of 47,000 organisms per cm2 within 4 weeks of operation, whereas the antimicrobial properties of metallic copper were able to limit the microbial load affiliated with the copper heat exchangers to levels 99.97 % lower during the same time period.

Abstract Background Acute infectious diarrhea is a leading cause of hospitalizations, outpatient visits, and lost quality of life in the United States. Rapid diagnostic technology may provide an opportunity to quickly optimize ABX therapy for acute infectious diarrhea. The GIP is a multiplex PCR test that detects 13 bacteria, 5 viruses, and 4 parasites in approximately 1 hour of run time. Our objective was to determine the frequency of alterations in empiric ABX therapy for acute diarrhea within 48 hours of reporting of GIP results. Methods Patients that had the GIP performed on diarrheagenic stool while in our emergency department or an inpatient location from January 1 to June 30, 2016 were identified. Patient data, including gender, race, age, ABX use and duration, and the results of non-stool bacterial cultures (if obtained) were collated with GIP results. Results Complete patient information and GIP results were available on 517 patients. At least 1 positive result occurred in 220 patients; 45 patients (8.7%) had ≥ 2 positive results. There were 161, 73, and 2 positive results for bacteria, viruses, and parasites, respectively. Clostridium difficile (n = 99) was most commonly identified and it was the only organism identified in 80 patients. Within 48 hours of result availability in the medical record, ABX were added in 47.3% of patients with any positive result and 24.2% of patients with negative results. Empiric ABX were stopped in 42.9 and 48.6% of patients with positive or negative results, respectively. ABX were altered (ie, start, stop, dose change) in 55.9 and 38.4% of patients with positive or negative results, respectively. Conclusion GIP results appear to impact changes in ABX therapy, though these may not have been the sole driver of change in all cases. That there may be room for improvement suggests an opportunity for antimicrobial stewardship (AST) initiatives, such as prospective auditing of GIP results by AST staff who make recommendations to the treatment team, or an expansion of our current gastroenteritis guidelines to include a clinical pathway for all organisms on the GIP to decrease inappropriate ABX use. Disclosures All authors: No reported disclosures.

Background Fungal PJIs are rare and often associated with poor outcome. Risk factors are not well described and thus, we sought to determine such risks among patients cared for at two large academic hospitals. Methods This was a retrospective case–control study among patients with PJI from 2006 to 2016. Each fungal PJI case was matched 1:1 with a bacterial PJI control for joint location (hip, knee, and shoulder) and year of diagnosis. We compared demographics (age, sex, and race), co-morbid conditions (BMI, diabetes, immunosuppression, renal disease, and antibiotic use), and clinical characteristics (joint age, wound factors, laboratory data, previous joint surgeries, and previous PJI) between fungal and bacterial PJI groups using chi square/Fisher’s exact or Wilcoxon rank-sum test. Risk factors statistically (P < 0.05) or clinically significant were included in a multivariable logistic regression (MVR) model in stepwise fashion (SAS 9.4, Cary, North Carolina). Results Forty-one fungal PJI occurred over the study period and 61% were due to Candida albicans. Median age was 64.7 years, 51% were females, and 87% were White. The hip was involved in 51.2%, followed by the knee (46.3%), and shoulder (2.4%). There were no significant differences in joint age or co-morbid conditions. Compared with bacterial PJI, those with fungal PJI were more likely to have received antibiotics within the past 3 months (70.7% vs. 34%, P = 0.001), had wound drainage lasting more than 5 days (48% vs. 9%, P = 0.0002), had a lower median CRP (2.95 mg/dL vs. 5.99, P = 0.013) and synovial fluid wbc count (13,953 cells/mm3 vs. 33,198, P = 0.007), and a higher proportion of prior two-stage exchanges (82.9% vs. 53.6%, P = 0.008). After MVR, controlling for the center, presence of wound drainage for more than 5 days (OR, 7.3; 95% confidence interval [CI], 2.02–26.95) and receipt of antibiotics within the past 3 months (OR, 3.4; 95% CI, 1.2–9.3) were factors significantly associated with fungal PJI. Conclusion In our study, Candida albicans was the most common species in fungal PJIs. The presence of wound drainage for more than 5 days and receipt of antibiotics within the past 3 months were independent risk factors for fungal PJI among a cohort of PJI patients. Disclosures All authors: No reported disclosures.