Between 2016 and 2021, we retrospectively identified 42 patients receiving ≥1 dose of dalbavancin for osteomyelitis, skin and soft-tissue infection, endocarditis or bacteremia, or septic arthritis. Median antibiotic duration prior to dalbavancin administration was 7 days. Within 90 days, 93% achieved clinical cure, 12% were readmitted, 12% developed hepatotoxicity, and 5% died.

Mental fatigue and burnout are concerns for healthcare organizations, but their effects on leaders have not been thoroughly studied. Infectious diseases teams and leaders are at risk for mental fatigue and burnout due to the increased demands from the coronavirus disease 2019 (COVID-19) pandemic, additive effects of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (omicron) and δ (delta) variant surges, and unique pre-existing pressures. No single intervention can reduce stress and burnout in healthcare workers. Work-hour limitations may have the biggest impact in physician burnout mitigation. Institutional and individual programs focused on mindfulness may improve well-being in the workplace. Leading during times of stress requires a multimodal approach and an understanding of goals and priorities. Greater awareness of burnout and fatigue across the healthcare spectrum and continued research are required to advance healthcare worker well-being.

The climate crisis calls for urgent action from every level of the US healthcare sector, starting with an acknowledgment of our own outsized contribution to greenhouse gas emissions (at least 8.5% of carbon emissions). As the climate continues to become warmer and wetter, the medical establishment must deal with increasing rates of pulmonary and cardiovascular diseases, heat-related illness, and emerging infectious diseases among many other health harms. Additionally, extreme weather events are causing healthcare delivery breakdown due to physical infrastructure damage, slowed supply chains, and workforce burden. Pathways for healthcare systems to meet these challenges are emerging. They entail significant measures to mitigate our carbon footprint, embrace shared and equity-driven governance, develop new metrics of accountability, and build more resilience into our care delivery processes. We call upon SHEA to play a unique leadership role in the fight for sustainable, equitable, and efficient health care in a rapidly changing climate that immediately threatens human well-being.

Tackling antimicrobial resistance (AMR) through antimicrobial stewardship (AMS) interventions is a key objective within the World Health Organization (WHO)’s Global Action on AMR. We outline the reasons why global collaborations for AMS are needed. We provide examples of global collaborations, and we offer considerations when starting on a global health journey focused on AMS.

A multisite research team proposed a survey to assess burnout among healthcare epidemiologists. Anonymous surveys were disseminated to eligible staff at SRN facilities. Half of the respondents were experiencing burnout. Staffing shortages were a key stressor. Allowing healthcare epidemiologists to provide guidance without directly enforcing policies may improve burnout.

Background:Candida auris is an emerging multidrug-resistant yeast that is transmitted in healthcare facilities and is associated with substantial morbidity and mortality. Environmental contamination is suspected to play an important role in transmission but additional information is needed to inform environmental cleaning recommendations to prevent spread. Methods: We conducted a multiregional (Chicago, IL; Irvine, CA) prospective study of environmental contamination associated with C. auris colonization of patients and residents of 4 long-term care facilities and 1 acute-care hospital. Participants were identified by screening or clinical cultures. Samples were collected from participants’ body sites (eg, nares, axillae, inguinal creases, palms and fingertips, and perianal skin) and their environment before room cleaning. Daily room cleaning and disinfection by facility environmental service workers was followed by targeted cleaning of high-touch surfaces by research staff using hydrogen peroxide wipes (see EPA-approved product for C. auris, List P). Samples were collected immediately after cleaning from high-touch surfaces and repeated at 4-hour intervals up to 12 hours. A pilot phase (n = 12 patients) was conducted to identify the value of testing specific high-touch surfaces to assess environmental contamination. High-yield surfaces were included in the full evaluation phase (n = 20 patients) (Fig. 1). Samples were submitted for semiquantitative culture of C. auris and other multidrug-resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase–producing Enterobacterales (ESBLs), and carbapenem-resistant Enterobacterales (CRE). Times to room surface contamination with C. auris and other MDROs after effective cleaning were analyzed. Results:Candida auris colonization was most frequently detected in the nares (72%) and palms and fingertips (72%). Cocolonization of body sites with other MDROs was common (Fig. 2). Surfaces located close to the patient were commonly recontaminated with C. auris by 4 hours after cleaning, including the overbed table (24%), bed handrail (24%), and TV remote or call button (19%). Environmental cocontamination was more common with resistant gram-positive organisms (MRSA and, VRE) than resistant gram-negative organisms (Fig. 3). C. auris was rarely detected on surfaces located outside a patient’s room (1 of 120 swabs; <1%). Conclusions: Environmental surfaces near C. auris–colonized patients were rapidly recontaminated after cleaning and disinfection. Cocolonization of skin and environment with other MDROs was common, with resistant gram-positive organisms predominating over gram-negative organisms on environmental surfaces. Limitations include lack of organism sequencing or typing to confirm environmental contamination was from the room resident. Rapid recontamination of environmental surfaces after manual cleaning and disinfection suggests that alternate mitigation strategies should be evaluated.

Funding: None

Disclosures: None

We interviewed 1,208 healthcare workers with positive SARS-CoV-2 tests between October 2020 and June 2021 to determine likely exposure sources. Overall, 689 (57.0%) had community exposures (479 from household members), 76 (6.3%) had hospital exposures (64 from other employees including 49 despite masking), 11 (0.9%) had community and hospital exposures, and 432 (35.8%) had no identifiable source of exposure.

We analyzed efficacy of a centralized surveillance infection prevention (CSIP) program in a healthcare system on healthcare-associated infection (HAI) rates amid the coronavirus disease 2019 (COVID-19) pandemic. HAI rates were variable in CSIP and non-CSIP facilities. Central-line–associated bloodstream infection (CLABSI), C. difficile infection (CSI), and surgical-site infection (SSI) rates were negatively correlated with COVID-19 intensity in CSIP facilities.

We compared patients with Staphylococcus aureus bacteremia enrolled in outpatient parenteral antibiotic therapy monitoring program (OPAT-MP) upon hospital discharge with patients not enrolled. OPAT-MP patients were more likely to attend infectious diseases follow-up appointments. OPAT-related emergency room visits and/or readmissions were more common among non–OPAT-MP patients, but differences were not statistically significant.

Chat Generative Pre-trained Transformer (ChatGPT), the flagship generative artificial intelligence (AI) chatbot by OpenAI, is transforming many things in medicine, from healthcare and research to medical education. It is anticipated to integrate in many aspects of the medical industry, and we should brace for this inevitability and use it to our advantage. Here are proposed ways you can use ChatGPT in medicine with some specific use cases in antimicrobial stewardship and hospital epidemiology.

Background: Diagnostic stewardship modifies the ordering, performing, and reporting of diagnostic tests to optimize clinical care and infection prevention while conserving healthcare resources. Timely and accurate diagnosis of respiratory virus infections can optimize the use of antibiotics, antivirals, ancillary tests, and inpatient beds. Influenza-like illnesses (ILIs) are frequently caused by viruses. However, before COVID-19, specific antiviral medication was commonly used only for the treatment of influenza virus infections. Methods: Eskenazi Health (EH) had 2 respiratory PCR assays: influenza/RSV ($58.18 per assay) and a 20-pathogen respiratory pathogens panel (RPP) ($129 per assay). An inpatient ILI algorithm was developed and implemented in the electronic health record (EHR) in October 2018 to guide the selection of the appropriate assay (Figure 1). Ambulatory testing defaulted to the influenza/RSV assay. Prescribers retained the ability to override recommendations. We performed a retrospective chart review of all orders for RPP and influenza/RSV assays before implementation of the ILI algorithm (October 1, 2017, to September 30, 2018) and after implementation (October 1, 2018, to September 30, 2019). The primary end point was the number of RPP assays ordered. The secondary end point was the appropriateness of RPP assays ordered (ie, met ≥1 criteria) and number of influenza/RSVs assays ordered with virus detected. Results: Before the implementation of the intervention, 1,882 orders were reviewed. After implementation 1,621 orders were reviewed. All influenza/RSV and RPP assays were included if they were ordered between October 1, 2017, and September 30, 2019, at EH. There were no exclusion criteria. After implementation, RPP assays decreased ~40% (Table 1), with associated cost savings of $35,368.68 (22.6% of total assay costs; $163,742.88 before implementation and $128,374.20 after implementation). Although some of this reduction could be attributed to the lower number of overall assays ordered, the 40% reduction in RPP assays exceeded the 14% decrease in overall orders, demonstrating improvement in utilization of RPP assays. A corresponding increase in influenza/RSV assay orders was not observed; both groups had similar total influenza/RSV orders. Both groups also had similar percentages of viruses detected with influenza/RSV and RPP (33% before vs 31% after). After implementation, 1,522 (94%) of 1,621 orders followed the recommendations of the ILI algorithm (Table 2). Several prescribers ordered influenza/RSV despite the patient meeting criteria for RPP assay; of these 26 assays, 4 (15%) resulted in virus detection. Of the 73 instances in which prescribers bypassed recommendations for the influenza/RSV assay and ordered an RPP assay, 14 (19%) of the assays resulted in virus detection; only 1 of 14 was a virus that would have been detected by the influenza/RSV. We were unable to identify any trends that would assist in developing additional order questions to capture these patients. Conclusions: Implementation of the ILI algorithm was associated with high adherence, improvement in the appropriateness of ordering, and significant cost savings.

Funding: No

Disclosures: None

Figure 1.

Table 1.

Table 2.

We evaluated barriers and facilitators to patient adherence with a bundled intervention including chlorhexidine gluconate (CHG) bathing and decolonizing Staphylococcus aureus nasal carriers in a real-world setting. Survey data identified 85.5% adherence with home use of CHG as directed and 52.9% adherence with home use of mupirocin as directed.

Efforts to improve antimicrobial prescribing are occurring within a changing healthcare landscape, which includes the expanded use of telehealth technology. The wider adoption of telehealth presents both challenges and opportunities for promoting antimicrobial stewardship. Telehealth provides 2 avenues for remote infectious disease (ID) specialists to improve inpatient antimicrobial prescribing: telehealth-supported antimicrobial stewardship and tele-ID consultations. Those 2 activities can work separately or synergistically. Studies on telehealth-supported antimicrobial stewardship have reported a reduction in inpatient antimicrobial prescribing, cost savings related to less antimicrobial use, a decrease in Clostridioides difficile infections, and improved antimicrobial susceptibility patterns for common organisms. Tele-ID consultation is associated with fewer hospital transfers, a shorter length of hospital stay, and decreased mortality. The implementation of these activities can be flexible depending on local needs and available resources, but several barriers may be encountered. Opportunities also exist to improve antimicrobial use in outpatient settings. Telehealth provides a more rapid mechanism for conducting outpatient ID consultations, and increasing use of telehealth for routine and urgent outpatient visits present new challenges for antimicrobial stewardship. In primary care, urgent care, and emergency care settings, unnecessary antimicrobial use for viral acute respiratory tract infections is common during telehealth encounters, as is the case for fact-to-face encounters. For some diagnoses, such as otitis media and pharyngitis, antimicrobials are further overprescribed via telehealth. Evidence is still lacking on the optimal stewardship strategies to improve antimicrobial prescribing during telehealth encounters in ambulatory care, but conventional outpatient stewardship strategies are likely transferable. Further work is warranted to fill this knowledge gap.

Current guidelines do not address a recommended duration of parenteral therapy for uncomplicated urinary tract infection (uUTI) treatment in the inpatient setting. We compared a 3-day course of ceftriaxone with longer antibiotic durations for inpatients with a uUTI. Our findings indicate that a 3-day course of ceftriaxone was as efficacious as longer antibiotic courses.

Contact precautions are used to prevent the spread of extended-spectrum β-lactamase (ESBL)–producing organisms in acute-care hospitals, but supporting data are lacking. We discontinued such precautions for ESBL Escherichia coli and Klebsiella spp and found no increased prevalence of these organisms with our change in practice.

Our surveys of nurses modeled after the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) revealed that opportunity and motivation factors heavily influence urine-culture practices (behavior), in addition to knowledge (capability). Understanding these barriers is a critical step towards implementing targeted interventions to improving urine-culture practices.