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Altering the appearance of a computerized physician order entry (CPOE) interface reduces misuse of an HIV diagnostic test by 87%, demonstrating that CPOE design is a key component of diagnostic stewardship. Collaboration between infectious disease providers, clinical laboratorians, and information technology (IT) professionals can result in improved quality and decreased costs.
We assessed the prevalence of antibiotic prescriptions among ambulatory patients tested for coronavirus disease 2019 (COVID-19) in a large public US healthcare system and found a low overall rate of antibiotic prescriptions (6.7%). Only 3.8% of positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) tests were associated with an antibiotic prescription within 7 days.
The incidence of infections from extended-spectrum β-lactamase (ESBL)–producing Enterobacterales (ESBL-E) is increasing in the United States. We describe the epidemiology of ESBL-E at 5 Emerging Infections Program (EIP) sites.
During October–December 2017, we piloted active laboratory- and population-based (New York, New Mexico, Tennessee) or sentinel (Colorado, Georgia) ESBL-E surveillance. An incident case was the first isolation from normally sterile body sites or urine of Escherichia coli or Klebsiella pneumoniae/oxytoca resistant to ≥1 extended-spectrum cephalosporin and nonresistant to all carbapenems tested at a clinical laboratory from a surveillance area resident in a 30-day period. Demographic and clinical data were obtained from medical records. The Centers for Disease Control and Prevention (CDC) performed reference antimicrobial susceptibility testing and whole-genome sequencing on a convenience sample of case isolates.
We identified 884 incident cases. The estimated annual incidence in sites conducting population-based surveillance was 199.7 per 100,000 population. Overall, 800 isolates (96%) were from urine, and 790 (89%) were E. coli. Also, 393 cases (47%) were community-associated. Among 136 isolates (15%) tested at the CDC, 122 (90%) met the surveillance definition phenotype; 114 (93%) of 122 were shown to be ESBL producers by clavulanate testing. In total, 111 (97%) of confirmed ESBL producers harbored a blaCTX-M gene. Among ESBL-producing E. coli isolates, 52 (54%) were ST131; 44% of these cases were community associated.
The burden of ESBL-E was high across surveillance sites, with nearly half of cases acquired in the community. EIP has implemented ongoing ESBL-E surveillance to inform prevention efforts, particularly in the community and to watch for the emergence of new ESBL-E strains.
We performed an epidemiological investigation and genome sequencing of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to define the source and scope of an outbreak in a cluster of hospitalized patients. Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission to patients and healthcare workers during a single hemodialysis session, highlighting the importance of infection prevention precautions.
Pasteurella multocida (“killer of many species”) is a nonmotile, gram-negative, facultative coccobacillus best known for its association with soft-tissue infections after animal bites. However, this organism is also capable of causing invasive and life-threatening infections.
Pasteurella multocida is found worldwide. It commonly colonizes the upper respiratory tract of many animals, most notably cats (70% to 90%) and dogs (50% to 66%). Human infection is usually related to animal exposure. The most common mode of transmission to humans is by direct inoculation by a bite or scratch. Inoculation can also occur by nontraumatic animal contact, such as when a wound is licked by an animal. The second mode of transmission is by colonization of the human respiratory tract occurring with exposure to animals such as nuzzling or grooming of pets. Pasteurella has been cultured from the respiratory tract of healthy veterinary workers and animal handlers as well as from ill patients. Infections can occasionally occur in the absence of animal contact.
There are several species and subspecies of Pasteurella, with the most common ones causing human disease being P. multocida subsp. multocida, P. multocida subsp. septica, Pasteurella dagmatis, Pasteurella canis, and Pasteurella stomatis. These organisms can resemble Haemophilus and Neisseria species when visualized on Gram stain, grow well on sheep and chocolate agar, and appear as smooth, mucoid blue colonies.
Most of the virulence factors have been studied in animals. Pathogenesis of Pasteurella depends on the bacteria’s ability to adhere to the host’s respiratory epithelium, typically the tonsils, which can be mediated through fimbrae. Some species are capable of producing a leukotoxin that affects leukocytes and inhibits cellular immune responses. Differences between virulent strains of Pasteurella are identified according to capsular antigens A to F, which cause different animal diseases.
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