Tuberculosis has been entwined with humanity for millen…

For the first time, a map allows people to type in their ZIP code and determine the risk of measles in their area based on vaccination coverage.

From infestation to infection: a systematic review of arthropod-mediated microbial transmission in hospitals - Volume 6 Issue 1

Despite its classic association with HIV, modern cohorts of histoplasmosis are overwhelmingly in those with non-HIV-associated immunocompromise, such as biologic immunosuppression or solid organ transplantation. However, treatment guidelines are ...

Importance  Laboratory testing is necessary to distinguish blastomycosis, coccidioidomycosis, or histoplasmosis from other causes of community-acquired pneumonia (CAP). Robust data about testing for and diagnosis of these fungal diseases among patients with CAP throughout the US are lacking.Objective  To examine proportions and characteristics of (1) adult outpatients with CAP who underwent diagnostic testing for blastomycosis, coccidioidomycosis, or histoplasmosis; and (2) tested patients who received diagnoses of these diseases.Design, Setting, and Participants  This retrospective cohort study used 2017 to 2023 commercial health insurance claims data from the Merative MarketScan Commercial/Medicare Database. Adult outpatients with diagnosis codes for unspecified CAP were included.Main Outcomes and Measures  The primary outcome was the proportion of patients who underwent fungal diagnostic testing. The secondary outcomes were the proportions of tested patients who received diagnoses of blastomycosis, coccidioidomycosis, or histoplasmosis. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) for characteristics independently associated with receiving a diagnosis of coccidioidomycosis or histoplasmosis.Results  Among 573 994 patients (318 152 female [55%]; median [IQR] age, 54 [41-63] years) with unspecified CAP, 25 822 (5%) underwent fungal diagnostic testing, which occurred a median (IQR) of 3 (1-6) health care visits after the initial CAP diagnosis. Among tested patients, 755 (3%) received a blastomycosis, coccidioidomycosis, or histoplasmosis diagnosis code. Rash (aOR, 3.24; 95% CI, 2.27-4.63), lymphadenopathy (aOR, 1.74; 95% CI, 1.15-2.63), myalgia (aOR, 1.66; 95% CI, 1.11-2.49), chest pain (aOR, 1.65; 95% CI, 1.35-2.02), and receipt of antibiotics from multiple classes (aOR, 1.40; 95% CI, 1.17-1.67) were independently associated with increased odds of receiving a coccidioidomycosis diagnosis. Autoimmune inflammatory disease (aOR, 3.00; 95% CI, 1.72-5.21), chest pain (aOR, 1.84; 95% CI, 1.20-2.82), and abnormal weight loss (aOR, 5.15; 95% CI, 2.71-9.79) were associated with increased odds of receiving a histoplasmosis diagnosis.Conclusions and Relevance  In this cohort study of patients with unspecified CAP, testing rates for blastomycosis, coccidioidomycosis, and histoplasmosis were low in many locations. Increased awareness of these fungal infections may help increase timely testing for fungal diseases among patients with CAP, decrease health care utilization and inappropriate antibiotic use, and improve patient outcomes.

In what feels like the fastest-peaking influenza season in quite some time, I find myself returning to a familiar answer when asked questions about this miserable virus: “We just don’t know.” At least...

Invasive fungal diseases remain a major cause of morbidity and mortality in patients undergoing transplant, with shifting epidemiology, emerging resistance, and geographic variation underscoring the u...

What should infectious diseases clinicians know about pharmacy benefit managers and their impact on our patients? - Volume 6 Issue 1

Clinician perspectives of the impact of the 2024 National Blood Culture Bottle Shortage on Clinical Care: results of an Emerging Infection Network (EIN) online poll - Volume 5 Issue 1

In Vietnam, cefixime effectively treated rectal and urethral gonococcal infections but showed higher pharyngeal NAAT positivity at test of cure (TOC) compa

Invasive fungal diseases remain a major cause of morbidity and mortality in patients undergoing transplant, with shifting epidemiology, emerging resistance, and geographic variation underscoring the u...

Clinician perspectives of the impact of the 2024 National Blood Culture Bottle Shortage on Clinical Care: results of an Emerging Infection Network (EIN) online poll - Volume 5 Issue 1

An official journal of the Infectious Diseases Society of America. Publishes clinical, translational, and basic research findings focusing on the intersection of biomedical science and clinical practi...

Serious games like escape rooms (ER) offer immersive, interactive, and effective teaching through cooperative problem-solving and goal-oriented challenges. While ER have primarily been described in the context of medical conferences, their integration into routine medical education may serve as a novel strategy to foster early interest in infectious diseases (ID) and enhance long-term retention of medical knowledge.Figure 1.Escape room puzzle designTable 1.Escape room feedback via Likert-scaleMethodsWe designed an ID–themed ER for medical students and internal medicine residents (trainees) on the ID service, guided by Kern’s six-step approach to curriculum development. A general needs assessment was obtained via discussion with key stakeholders and literature review. A targeted needs assessment identified high yield board review exam topics and common errors in practical clinical knowledge. Eight learning objectives informed puzzle design covering key topics such as MRSA coverage, lab safety, molecular diagnostic interpretation, and empiric antibiotics (Figure 1).We used a complex game design with sequential and open puzzle structure to maximize the number of puzzles that could be engaged simultaneously and collaboratively by 4-6 team members. The game ended when the final meta-puzzle was completed; all preceding puzzles provided clues required for the meta-puzzle to be solved. No prior ID knowledge was required; all resources were available in-room.The 45-minute session served as the education strategy. Pre- and posttests assessments included questions across 3 categories: material introduced in ER only, lecture only, or both. A post-session Likert-scale survey measured engagement, perceived educational value and facilitating feedback for future improvements.Figure 2.Escape room trainee feedback quotesResultsER activity was implemented in April 2024 with 12 sessions occurring to date. Pilot data shows trainees find the activity a fun, beneficial learning experience based on survey (Table 1, Figure 2). Pre/posttest assessments ongoing.ConclusionEscape rooms are an engaging educational tool for introducing and reinforcing ID learning objectives. The integration of these innovative educational techniques reinforces trainee engagement and fosters more positive perceptions of the ID specialty, which is an important step in building and sustaining a robust ID workforce.DisclosuresAll Authors: No reported disclosures

Blood culture contamination rates, like many other indicators, suffered over the course of the COVID-19 Pandemic. In 2022, a renewed focus was placed on reducing contamination rates. A diversion device was deployed, and contamination rates were tracked with passive lab-based criteria. Each contamination event required chart abstraction to gather details and provide feedback.Dashboard FiltersEnd users can use these fields to get the data most applicable to them.Data PointsFor users with access to PHI, all of these details are made available.MethodsA process was created in the EHR which allowed Infection Preventionists to classify blood culture contamination events. By completing this process within the EHR all the key details associated with each blood culture collection were captured. A report was also created to generate the total denominator of all blood cultures collected. This data was then mapped to an analytics dashboard allowing us to share real time contamination rates. The dashboard allows drilling down to the hospital, department, and staff member levels, identifying the organism, distinguishing between pediatric and adult patients, and differentiating between phlebotomy and nursing data.Contamination Rate GraphThe graph provides a quick visual for identifying trends in the data.ResultsSince the rollout, our dashboard has been viewed ∼1400 times by senior leadership, quality representatives, unit leaders and educators. Awareness and utilization of the dashboard has improved since its roll out and so too has the overall contamination rate.Pre dashboard (January 2023- April 2024) contamination totals 2,121 contamination out of 77,812 Cultures = 2.73% average contamination rate.Post Dashboard (May 2024 – April 2025) contamination totals 1,369 contaminations out of 58,434 Cultures = 2.34% average contamination rate.This reduction is also statistically significant. A two-proportion Z-test was used to determine that it’s very unlikely to be due to random chance (Z-value=4.51). For a two tailed test, the p-value is then calculated as 0.000006 or p < 0.00001.ConclusionWith continued growth of our network, actionable data is critical to assist with quality care delivery. Front line staff want to be active participants in these types of metric based goals. Creating a self-service platform has proven to be a staff satisfier as it allows for more individuals to champion the issue of blood culture contamination. Colleague engagement has been key to the early success of our intervention.DisclosuresAll Authors: No reported disclosures

Podcast Episode · ID:IOTS - Infectious Disease Insight Of Two Specialists · 12/01/2026 · 56m

We implemented mitigation measures to decrease blood culture (BCx) usage due to a national shortage and sought to explore the association between the blood culture shortage and antibiotic use, contamination rates, and sepsis core measures.Image 1:Box plots of total number of blood cultures drawn for the compared time periodsImage 2:Box plots of antibiotic use in the emergency department for the compared time periodsMethodsA retrospective pre-/post- study compared parameters pre-shortage (7/2023-6/2024) to the shortage period (7/2024-11/2024) at a large academic medical center. Shortage mitigation included: electronic clinical decision support (CDS) offered soft stops on repeat blood cultures and notified clinicians of the shortage via a best practice advisory, requiring acknowledgement of repeat BCx done within 48 h and offering alternative cultures. Extensive education was conducted, with specific outreach to high use departments such as the emergency department (ED) and Oncology floors. The primary outcome was days of antibiotic therapy (DOT) per 1000 patient-days using National Healthcare Safety Network data. Secondary outcomes included BCx utilization, SEP-1 compliance, length of stay (LOS), inpatient mortality, and BCx contamination rate. The Wilcoxon rank sum test was used to compare the median values between pre-shortage and shortage.Image 3:Box plots of percent blood culture contamination rate for the compared time periodsTable 1:Results summary with comparison of time periods for number of cultures obtained, antibiotic use, contamination rates, length of stay, inpatient mortality, and core sepsis measuresAbbreviations: BSHO: broad-spectrum antibacterial agents for hospital-onset infections; BSCA: broad-spectrum antibacterial agents for community-acquired infections; DOT: days of therapy; ED: emergency department; Gram-Pos: antibacterial agents for resistance gram-positive infections; ICU: intensive care unit; IQR: interquartile range; LOS: length of stay; SEP-1: Severe Sepsis and Septic Shock Management BundleResultsComparison of the time periods is shown in Table 1. BCx utilization decreased during the shortage from a median of 1846 to 1205 (p=0.002), visualized by box plot in image 1. Overall antibacterial (Abx) use did not change nor did use by NHSN category. When evaluated by location, ED vancomycin use declined from a median of 17.53 to 11.70 DOT/1000 patient days (p=0.005), cefepime from 10.04 to 6.24 (p=0.005), and ceftriaxone from 38.27 to 32.63 (p=0.018), visualized in Image 2. Mortality did not change, but length of stay decreased mildly from 7.01 to 6.71 mean days observed (p=0.013). Contamination rates decreased from 1.96 to 1.66 (p=0.02), visualized in Image 3.ConclusionWhile concern existed that decreased BCx use may result in increased empiric antibiotic use, we found no change in antibiotic use during the shortage. Interestingly, significant decreases in some antibiotics were noted in the ED. These findings suggest that while the shortage influenced certain aspects of antibiotic prescribing and contamination rates, it did not adversely affect overall sepsis management and patient outcomes.DisclosuresTrevor C. Van Schooneveld, MD, FSHEA, FIDSA, Mannki: Grant/Research Support

AbstractBackground. Histoplasmosis is a potentially fatal fungal infection if not diagnosed promptly and treated. The literature remains unclear regarding