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To analyze the frequency and rates of community respiratory virus infections detected in patients at the National Institutes of Health Clinical Center (NIHCC) between January 2015 and March 2021, comparing the trends before and during the coronavirus disease 2019 (COVID-19) pandemic.
We conducted a retrospective study comparing frequency and rates of community respiratory viruses detected in NIHCC patients between January 2015 and March 2021. Test results from nasopharyngeal swabs and washes, bronchoalveolar lavages, and bronchial washes were included in this study. Results from viral-challenge studies and repeated positives were excluded. A quantitative data analysis was completed using cross tabulations. Comparisons were performed using mixed models, applying the Dunnett correction for multiplicity.
Frequency of all respiratory pathogens declined from an annual range of 0.88%–1.97% between January 2015 and March 2020 to 0.29% between April 2020 and March 2021. Individual viral pathogens declined sharply in frequency during the same period, with no cases of influenza A/B orparainfluenza and 1 case of respiratory syncytial virus (RSV). Rhino/enterovirusdetection continued, but with a substantially lower frequency of 4.27% between April 2020 and March 2021, compared with an annual range of 8.65%–18.28% between January 2015 and March 2020.
The decrease in viral respiratory infections detected in NIHCC patients during the pandemic was likely due to the layered COVID-19 prevention and mitigation measures implemented in the community and the hospital. Hospitals should consider continuing the use of nonpharmaceutical interventions in the future to prevent nosocomial transmission of respiratory viruses during times of high community viral load.
Voluntary asymptomatic severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing was provided by the NIH Clinical Center over 1 year. Among 105,927 tests, 0.2% were positive. Among eligible staff, 79% participated with variable frequency and 61% of positive individuals had symptoms at the time of testing. Saliva specimen collection was chosen as an option less frequently than midturbinate collection.
This consensus statement by the Society for Healthcare Epidemiology of America (SHEA) and the Society for Post-Acute and Long-Term Care Medicine (AMDA), the Association for Professionals in Epidemiology and Infection Control (APIC), the HIV Medicine Association (HIVMA), the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) recommends that coronavirus disease 2019 (COVID-19) vaccination should be a condition of employment for all healthcare personnel in facilities in the United States. Exemptions from this policy apply to those with medical contraindications to all COVID-19 vaccines available in the United States and other exemptions as specified by federal or state law. The consensus statement also supports COVID-19 vaccination of nonemployees functioning at a healthcare facility (eg, students, contract workers, volunteers, etc).
We used a survey to characterize contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities, and we compared these findings to those of a similar 2013 survey. Notable findings include decreased frequency of active surveillance for methicillin-resistant Staphylococcus aureus, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.
In the National Institutes of Health (NIH) Clinical Center, patients colonized or infected with vancomycin-resistant Enterococcus (VRE) are placed in contact isolation until they are deemed “decolonized,” defined as having 3 consecutive perirectal swabs negative for VRE. Some decolonized patients later develop recurrent growth of VRE from surveillance or clinical cultures (ie, “recolonized”), although that finding may represent recrudescence or new acquisition of VRE. We describe the dynamics of VRE colonization and infection and their relationship to receipt of antibiotics.
In this retrospective cohort study of patients at the National Institutes of Health Clinical Center, baseline characteristics were collected via chart review. Antibiotic exposure and hospital days were calculated as proportions of VRE decolonized days. Using survival analysis, we assessed the relationship between antibiotic exposure and time to VRE recolonization in a subcohort analysis of 72 decolonized patients.
In total, 350 patients were either colonized or infected with VRE. Among polymerase chain reaction (PCR)-positive, culture (Cx)-negative (PCR+/Cx−) patients, PCR had a 39% positive predictive value for colonization. Colonization with VRE was significantly associated with VRE infection. Among 72 patients who met decolonization criteria, 21 (29%) subsequently became recolonized. VRE recolonization was 4.3 (P = .001) and 2.0 (P = .22) times higher in patients with proportions of antibiotic days and antianaerobic antibiotic days above the median, respectively.
Colonization is associated with clinical VRE infection and increased mortality. Despite negative perirectal cultures, re-exposure to antibiotics increases the risk of VRE recolonization.
Diagnosis and treatment of vascular infections is complex and depends on a variety of factors, including the location of the infected tissue, the microbiology of the infection, and patient-specific factors, such as anatomy and immune status. Purulent or suppurative thrombophlebitis is inflammation of a peripheral or central venous wall because of the presence of microorganisms. Endarteritis (or infective arteritis) and mycotic aneurysms are infections of the arterial walls; arterial aneurysms or pseudoaneurysms are usually present because endarteritis may be difficult to diagnose unless an aneurysm is present. The term mycotic aneurysm is a misnomer that refers to any arterial aneurysm of infectious cause, fungal or bacterial, and may also include secondary infections of pre-existing aneurysms or pseudoaneurysms. Vascular graft infections present an even wider spectrum of disease that depends on the type and location of the graft. Management of infections located on vascular prostheses is further complicated by the fact that prosthesis excision can jeopardize a patient's life and organ function, and alternative grafting techniques, including ex situ bypass, autologous reconstruction, and a variety of other graft materials, must be considered. Finally, endovascular repair of aneurysms has resulted in a variety of infectious complications of endovascular stents, stent-grafts, and other intra-arterial devices.
Pathogenesis and diagnosis
Septic thrombophlebitis is characterized by inflammation with suppuration of the vein wall. The various anatomic sites of this serious condition determine the clinical significance and manifestations. Superficial suppurative thrombophlebitis is most often a complication of indwelling intravenous catheters or intravenous substance use. Suppurative thrombophlebitis due to intravenous catheters occurs more commonly with plastic than with steel cannulas. Irritation of the vein wall and subsequent development of purulent thrombophlebitis occurs more often with polyethylene catheters than with Teflon or Silastic catheters and is higher in lower extremity cannulation. Central vein thrombosis is a relatively common complication of central venous catheterization, occurring in as many as one-third of patients in some autopsy and clinical series. Peripherally inserted central venous catheters are also associated with increased risk of symptomatic thrombosis. Suppurative thrombophlebitis of the thoracic central veins results from the bacterial or fungal contamination (sepsis) of these often asymptomatic thrombi. The second major type of septic thrombophlebitis occurs by invasion from adjacent primary nonvascular infections and includes Lemierre's syndrome (internal jugular vein septic thrombophlebitis) as well as other entities discussed elsewhere. Lemierre's syndrome, although rare, usually follows an oropharyngeal infection and occurs most often in previously healthy patients aged 16 to 25 years.