Cases of hospital-onset bacteremia and fungemia (HOBF) are on the rise in Japanese hospitals, but little is known about their incidence in hospitals and how it relates to the availability of services provided by infectious diseases departments.

We herein investigated the monthly incidence density of HOBF per 1,000 patient days from 2013 through 2023 at a tertiary care hospital in Japan. The incidence of overall HOBF and pathogen-specific HOBF, including those caused by Enterobacterales, Staphylococcus aureus, coagulase-negative staphylococci (CNS), and Candida species, was tracked. Changes in the HOBF trend before and after the establishment of an infectious diseases department at the hospital were evaluated.

In total, 4,315 HOBF-related events were identified. The overall incidence density of HOBF increased by 2.4-fold from 0.58 per 1,000 PD in 2013 to 1.42 per 1,000 PD in 2023. Both the level and trend changes in the incidence density of overall HOBF (+0.3142 for change in level [P < .001]; +0.0085 for change in trend [P < .001]), HOBF caused by S. aureus (+0.0983 for change in level [P < .001]; +0.0016 for change in trend [P = 0.016]), and Candida spp. (+0.0466 for change in level [P = 0.030]; +0.0019 for change in trend [P = 0.002]) significantly increased after the establishment of the infectious diseases department.

The incidence density of overall HOBF and clinically important pathogen-specific HOBF increased over the last decade. The availability of services through the infectious diseases department was significantly associated with an increase in the HOBF incidence, likely suggesting improvement in the diagnosis of HOBF.

Resilience of the healthcare system has been described as the ability to absorb, adapt, and respond to stress while maintaining the provision of safe patient care. We quantified the impact that stressors associated with the COVID-19 pandemic had on patient safety, as measured by central line-associated bloodstream infections (CLABSIs) reported to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.

Acute care hospitals were mandated to report markers of resource availability (staffing and hospital occupancy with COVID-19 inpatients) to the federal government between July 2020 and June 2021. These data were used with community levels of COVID-19 to develop a statistical model to assess factors influencing rates of CLABSIs among inpatients during the pandemic.

After risk adjustment for hospital characteristics, measured stressors were associated with increased CLABSIs. Staff shortages for more than 10% of days per month were associated with a statistically significant increase of 2 CLABSIs per 10,000 central line days versus hospitals reporting staff shortages of less than 10% of days per month. CLABSIs increased with a higher inpatient COVID-19 occupancy rate; when COVID-19 occupancy was 20% or more, there were 5 more CLABSIs per 10,000 central line days versus the referent (less than 5%).

Reporting of data pertaining to hospital operations during the COVID-19 pandemic afforded an opportunity to evaluate resilience of US hospitals. We demonstrate how the stressors of staffing shortages and high numbers of patients with COVID-19 negatively impacted patient safety, demonstrating poor resilience. Understanding stress in hospitals may allow for the development of policies that support resilience and drive safe care.

To identify risk factors for methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) nasal carriage and surgical site infection (SSI) among patients undergoing fracture fixation procedures who were included in a quality improvement protocol involving screening patients for S. aureus nasal carriage and treating carriers with intranasal mupirocin and chlorhexidine bathing.

Retrospective cohort study.

Level 1 trauma center.

1,254 adults who underwent operative fixation of 1,298 extremity or pelvis fractures between 8/1/2014 – 7/31/2017.

We calculated rates of S. aureus nasal carriage and SSI. We used multivariable stepwise logistic regression and selected the final models based on Akaike information criterion.

Of the 1,040 screened first procedures, 262 (25.19%) were performed on S. aureus nasal carriers: 211 (20.29%) on MSSA carriers and 51 (4.90%) on MRSA carriers. Long-term care facility residence (odds ratio [OR] 3.38; 95% confidence interval [CI] 1.17–9.76) was associated with MRSA nasal carriage. After adjusting for statistically and clinically significant variables, MRSA carriage was significantly associated with any SSI (OR 4.58; 95% CI 1.63–12.88), S. aureus SSI (OR 10.11; 95% CI 3.25–31.42), and MRSA SSI (OR 27.25; 95% CI 5.33–139.24), whereas MSSA carriage was not. Among S. aureus carriers, any chlorhexidine use was documented for 232 (88.55%), and any intranasal mupirocin was documented for 85 (40.28%) MSSA carriers and 33 (64.71%) MRSA carriers.

MRSA carriage was associated with a significant risk of SSI after operative fracture fixation. Many carriers did not undergo decolonization, suggesting that a simplified decolonization protocol is needed.

We introduced a urinary tract infection (UTI) panel requiring symptom documentation and identification of special populations linked to reflex urine culturing and evaluated its impact on catheter-associated UTI (CAUTI) including during the COVID-19 pandemic.

Quasi-experimental encompassing 3 periods: pre-panel (January 2014–March 2015), post-panel (April 2015–March 2020), and post-panel COVID (April 2020–June 2022).

Tertiary care center inpatients.

Poisson regression and interrupted time series (ITS) analysis evaluated changes in catheter days (CD), urine cultures (UC), and CAUTI measured by 1,000 CD and patient days (PD). National Health Safety Network standardized infection ratio (SIR) and standardized utilization ratio (SUR) data were analyzed.

UC per 1,000 PD decreased after implementation (pre-panel 36.9 vs 16.6 post-panel vs 14.4 post-panel COVID, all P < .001). CD declined pre-panel versus post-panel (RR 0.37, P < .001) but not from post-panel to post-panel COVID (RR 0.94, P = .88). UTI panel implementation was associated with a 40% decrease in CAUTI rates per 1,000 CD (P < .001). During the COVID-19 pandemic (post-panel COVID), a nonsignificant increase of 13% (P = .61) in CAUTI was noted but remained 32% lower than pre-panel (P = .02). The slope of change using ITS changed from negative to positive but was nonsignificant (P = .26). CAUTI rates per 1,000 PD demonstrated greater reductions (pre- vs post-panel (RR 0.37; 95% CI, 0.29–0.47) and pre- vs post-panel COVID (RR 0.35; 95% CI, 0.26–0.46)). SIRs were unavailable before 2016, but median SIRs post-panel compared to post-panel COVID were similar (1.05 vs 1.56, respectively, P = .067).

Implementation of the UTI panel was associated with a reduction in both UC and CAUTI with the impact maintained despite the COVID-19 pandemic.

To enumerate and describe the effect of whole genome sequencing (WGS) on epidemiological investigations of healthcare-associated transmission of nontuberculous mycobacteria (NTM).

Systematic review.

We performed a literature search using targeted search terms to identify articles meeting inclusion criteria. Data extraction of study characteristics and outcomes was performed by two independent researchers. The primary outcome was the author interpretation of WGS utility in the investigation of suspected healthcare-associated transmission of NTM. The secondary outcome was whether a transmission route was identified through WGS.

Thirty-one studies were included in the final analysis with 28 (90%) concluding that WGS was helpful in transmission investigations and in 19 of these 28 (68%) WGS aided in identifying a transmission route. The most common identified transmission routes were water-borne point sources (10), heater-cooler units (6), patient-to-patient (4), and a healthcare worker (1).

WGS is an informative tool in investigating healthcare transmission of NTM.

To describe the real-world clinical impact of a commercially available plasma cell-free DNA metagenomic next-generation sequencing assay, the Karius test (KT).

We retrospectively evaluated the clinical impact of KT by clinical panel adjudication. Descriptive statistics were used to study associations of diagnostic indications, host characteristics, and KT-generated microbiologic patterns with the clinical impact of KT. Multivariable logistic regression modeling was used to further characterize predictors of higher positive clinical impact.

We evaluated 1000 unique clinical cases of KT from 941 patients between January 1, 2017–August 31, 2023. The cohort included adult (70%) and pediatric (30%) patients. The overall clinical impact of KT was positive in 16%, negative in 2%, and no clinical impact in 82% of the cases. Among adult patients, multivariable logistic regression modeling showed that culture-negative endocarditis (OR 2.3; 95% CI, 1.11–4.53; P .022) and concern for fastidious/zoonotic/vector-borne pathogens (OR 2.1; 95% CI, 1.11–3.76; P .019) were associated with positive clinical impact of KT. Host immunocompromised status was not reliably associated with a positive clinical impact of KT (OR 1.03; 95% CI, 0.83–1.29; P .7806). No significant predictors of KT clinical impact were found in pediatric patients. Microbiologic result pattern was also a significant predictor of impact.

Our study highlights that despite the positive clinical impact of KT in select situations, most testing results had no clinical impact. We also confirm diagnostic indications where KT may have the highest yield, thereby generating tools for diagnostic stewardship.