Multidrug-resistant (MDR) gram-negative bacilli are important nosocomial pathogens.
To determine the incidence of transmission of MDR Acinetobacter baumannii and Pseudomonas aeruginosa from patients ...to healthcare workers (HCWs) during routine patient care.
Prospective cohort study.
Medical and surgical intensive care units. Methods. We observed HCWs who entered the rooms of patients colonized with MDR A. baumannii or colonized with both MDR A. baumannii and MDR P. aeruginosa. We examined their hands before room entry, their disposable gloves and/or gowns upon completion of patient care, and their hands after removal of gloves and/or gowns and before hand hygiene.
Sixty-five interactions occurred with patients colonized with MDR A. baumannii and 134 with patients colonized with both MDR A. baumannii and MDR P. aeruginosa. Of 199 interactions between HCWs and patients colonized with MDR A. baumannii, 77 (38.7% 95% confidence interval {CI}, 31.9%-45.5%) resulted in HCW contamination of gloves and/or gowns, and 9 (4.5% 95% CI, 1.6%-7.4%) resulted in contamination of HCW hands after glove removal before hand hygiene. Of 134 interactions with patients colonized with MDR P. aeruginosa, 11 (8.2% 95% CI, 3.6%-12.9%) resulted in HCW contamination of gloves and/or gowns, and 1 resulted in HCW contamination of hands. Independent risk factors for contamination with MDR A. baumannii were manipulation of wound dressing (adjusted odds ratio aOR, 25.9 95% CI, 3.1-208.8), manipulation of artificial airway (aOR, 2.1 95% CI, 1.1-4.0), time in room longer than 5 minutes (aOR, 4.3 95% CI, 2.0-9.1), being a physician or nurse practitioner (aOR, 7.4 95% CI, 1.6-35.2), and being a nurse (aOR, 2.3 95% CI, 1.1-4.8).
Gowns, gloves, and unwashed hands of HCWs were frequently contaminated with MDR A. baumannii. MDR A. baumannii appears to be more easily transmitted than MDR P. aeruginosa and perhaps more easily transmitted than previously studied methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. This ease of transmission may help explain the emergence of MDR A. baumannii.
Urine cultures can provide information on the microbiological cause and
optimal treatment for patients diagnosed with acute pyelonephritis, but the need
for routine cultures for patients with simple, ...uncomplicated pyelonephritis is
unclear. In this Clinical Controversies series our pro and con discussants
present opposing viewpoints of the benefits and drawbacks of routine urine
cultures among patients with simple, uncomplicated pyelonephritis.
Article Note: The members of the Project COVERED Emergency Department Network are provided in the appendix. CDC disclaimer: The findings and conclusions in this article are those of the authors and ...do not necessarily represent the views of the Centers for Disease Control and Prevention. Supervising Editor: John H. Burton, MD. Funding information This project was funded by a cooperative agreement from the Centers for Disease Control and Prevention (U01CK000480) and was supported by the Institute for Clinical and Translational Science at the University of Iowa through a grant from the National Center for Advancing Translational Sciences at the National Institutes of Health (UL1TR002537). Byline: Walter A. Schrading, Stacy A. Trent, James H. Paxton, Robert M. Rodriguez, Morgan B. Swanson, Nicholas M. Mohr, David A. Talan,, Monica Bahamon, Jestin N Carlson, Makini Chisolm-Straker, Brian Driver, Brett Faine, James Galbraith, Philip A Giordano, John P Haran, Amanda Higgins, Jeremiah Hinson, Stacey House, Ahamed H Idris, Efrat Kean, Elizabeth Krebs, Michael C. Kurz, Lilly Lee, Stephen Y Liang, Stephen C Lim, Gregory Moran, Utsav Nandi, Kavitha Pathmarajah, Yesenia Perez, Richard Rothman, Jessica Shuck, Patricia Slev, Howard A. Smithline, Kimberly Souffront, Mark Steele, Michelle St. Romain, Amy Stubbs, Josh Tiao, Jesus R Torres, Lisandra Uribe, Arvind Venkat, Gregory Volturo, Kelli Wallace, Kurt D Weber
Ebolavirus, the causative agent of Ebola virus disease (EVD) has been responsible for sporadic outbreaks mainly in sub-Saharan Africa since 1976. EVD is associated with high risk of transmission, ...especially to healthcare workers during patient care.
The purpose of this review is to provide a concise review of EVD presentation, diagnosis, and management for emergency clinicians.
EVD is spread through direct contact, including blood, bodily fluids or contact with a contaminated object. Patients may present with non-specific symptoms such as fevers, myalgias, vomiting, or diarrhea that overlap with other viral illnesses, but rash, bruising, and bleeding may also occur. Laboratory analysis may reveal transaminitis, coagulopathy, and disseminated intravascular coagulation. The average clinical course is approximately 8–10 days with an average case fatality rate of 50%. The mainstay of treatment is supportive care, with two U.S. Food and Drug Administration-approved monoclonal antibody treatments (Ebanga and Inmazeb). Survivors of the disease may have a complicated recovery, marked by long-term symptoms.
EVD is a potentially deadly condition that can present with a wide range of signs and symptoms. Emergency clinicians must be aware of the presentation, evaluation, and management to optimize the care of these patients.
Bone and joint infections are potentially limb-threatening or even life-threatening diseases. Emergency physicians must consider infection when evaluating musculoskeletal complaints, as misdiagnosis ...can have significant consequences. Patients with bone and joint infections can have heterogeneous presentations with nonspecific signs and symptoms. Staphylococcus aureus is the most commonly implicated microorganism. Although diagnosis may be suggested by physical examination, laboratory testing, and imaging, tissue sampling for Gram stain and microbiologic culture is preferable, as pathogen identification and susceptibility testing help optimize long-term antibiotic therapy. A combination of medical and surgical interventions is often necessary to effectively manage these challenging infections.
Patients with cancer can be immunocompromised because of their underlying malignancy as well as the medical therapies with which they are treated. Infections frequently present atypically and can be ...challenging to diagnose. The spectrum of infectious diseases encountered in patients receiving chemotherapy, hematopoietic stem cell transplant, and immunotherapy is broad depending on the depth of immunosuppression. Early recognition of infectious processes followed by appropriate diagnostic testing, imaging, and empiric antibiotic therapy in the emergency department are critical to providing optimal care and improving survival in this complex patient population.
Sports venues foster community and support local economies. Due to their capacity to host hundreds to thousands of spectators, sports venues are vulnerable to becoming targets of terrorism. Types of ...venues targeted, regional trends, and methods of attack employed world-wide have not been well-described.
A search of the Global Terrorism Database (GTD) was conducted from 1970 through the end of 2019. Pre-coded variables for target type "business" and target subtype "entertainment/cultural/stadium/casino" were used to identify attacks involving venues where sports events might be viewed by spectators as part of an audience. Sports venues were specifically identified using the search terms "sport," "stadium," "arena," and "ring," as well as mention of any specific sport. Two authors then manually reviewed each entry for specific information to confirm appropriateness for inclusion, selecting preferentially for attacks against venues where watching a sports event was the primary focus for the majority of the attendees. Descriptive statistics were performed using R (3.6.1).
Seventy-four (74) terrorist attacks targeting sports venues were identified from January 1, 1970 through December 31, 2019. Thirty-three (33) attacks, or 44.6% of attacks, involved soccer stadiums or soccer venues, while 33.8% of attacks (25 attacks) involved unspecified sports venues. A bombing or explosion was the most frequent method of attack employed, comprising 87.8% of attacks. The highest number of attacks occurred in the Middle East & North Africa. In total, 213 persons died and 699 more were wounded in attacks against sports venues.
Although terrorist attacks against sports venues are uncommon, they carry the risk of mass casualties, especially when explosives are used. A greater understanding of the threat posed by terrorist attacks against sports venues can aid emergency preparedness planning and future medical responses.
The emergency department (ED) is an increasingly important site of care for patients who have undergone solid organ transplantation or hematopoietic cell transplantation. It is paramount for ...emergency physicians to recognize infections early on, obtain appropriate diagnostic testing, initiate empirical antimicrobial therapy, and consider specialty consultation and inpatient admission when caring for these patients. This review provides emergency physicians with an approach to the assessment of transplant patients' underlying risk for infection, formulation of a broad differential diagnosis, and initial management of transplant infectious disease emergencies in the ED.
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