In this manuscript, we discuss a systematic approach that healthcare facilities can adopt to prepare to identify, confirm, and safely manage highly pathogenic avian influenza in the healthcare setting.

In a cross-sectional study of 20 Massachusetts long-term care (LTC) facilities, 19% (n = 449) of residents received antibiotics, with approximately one-third having a documented penicillin allergy. This documented allergy decreased the likelihood of prescribing beta-lactam antibiotics for infections. Improved penicillin allergy assessments and delabeling could optimize antibiotic prescribing in LTC settings.

Background: While Outpatient Parenteral Antibiotic Therapy (OPAT) offers patient convenience and reduced healthcare costs, its increasing utilization has brought various complications to light, including antibiotics-related and line-related OPAT complications. In a large prospective study, 18% of the patients experienced adverse drug events. Another study showed 8.45% of patients had vascular complications. Our study aims to identify clinical predictors associated with OPAT complications. Identifying predictors for suboptimal OPAT outcomes provides an opportunity to intervene, thereby minimizing the risk of OPAT-related complications. Method: We conducted a retrospective cohort study at Tufts Medical Center of all adult patients aged ≥18 years discharged on OPAT from April 2022 to October 2022. Demographic, treatment, outcome, and complications data were extracted through chart review. The primary outcome was the proportion and predictors of OPAT complications. The secondary outcomes were OPAT completion rate, 30-day ED visit, and 30-day readmission rates related to OPAT complications. We used univariable and multivariable analyses using logistic regression models for the predictors of OPAT complications. Variables with p5 (OR, 0.281, 95% CI 0.101–0.784), but they were more likely to have received two antibiotics (OR, 2.265; 95% CI 1.155-4.442). However, no significant independent predictor OPAT complications was identified in multivariable regression analysis (Figure 2). OPAT completion rates were lower in patients with complications (59.1% versus 75.4%). The 30-day ED visit and 30-day readmission rates were significantly higher in the complication group (31.8% vs. 0 and 34.1% vs. 2.1%, respectively). Conclusion: Our study highlights the significant difference in treatment completion rates and higher incidence of ED visits and readmissions rates among those with OPAT complications. Although specific independent predictor was not identified, the association with multiple antibiotic therapies and telemedicine follow-ups suggests areas for further investigation.

Background: Outpatient parenteral antimicrobial therapy (OPAT) provides a safe and effective alternative to prolonged hospitalization for patients with infectious diseases requiring elongated antimicrobial therapy. One study found that 35.6% of OPAT episodes met the composite definition for treatment failure, with unplanned extension of OPAT as the most common reason for treatment failure. Our study sought to identify factors predicting higher likelihood of extension of OPAT due to slow clinical response to treatment and determine how therapy extension relates to complications. Method: This retrospective cohort study included all patients aged ≥18 years discharged on OPAT between April 2022 and October 2022. Demographic, treatment, outcome, and complications data were extracted through chart review. The primary outcome was the proportion and predictors of OPAT extension due to slow clinical response to treatment. The secondary outcomes were OPAT complication rate, 30-day ED visit and 30-day readmission rates related to OPAT complications. We used univariable and multivariable logistic regression models for the primary outcome of slow clinical response requiring OPAT extension. Variables with p < 0.1 in the univariable analyses were included in the multivariable model. Result: 231 patients received OPAT during the six-month study. Among them, 40 (17.3%) patients required an extension of therapy. In univariable analysis, patients who had slow clinical response requiring extension of OPAT were more likely to have intraabdominal infection (odds ratio [OR], 2.435; 95% confidence interval[CI], 1.053–5.628), receipt of metronidazole (OR, 3.729; 95% CI, 1.413–9.842), and were more likely to be followed up through office visit (OR, 5.033; 95%CI, 1.164–21.759) or combination of office visit and telemedicine (OR, 2.223; 95%CI 1.041–4.747). Other variable comparisons are detailed in Figure 1. In the multivariable regression analysis, the independent predictor associated with extended of OPAT was follow-up via office visit (adjusted OR, 4.630; 95% CI, 1.024-20.694). Rates of complications related to intravenous access and antibiotic were similar between patients with and without extension; 15% vs. 11% (p=0.430) and 7.5% vs. 7.3% (p=1.000), respectively. There were no significant differences in 30-day ED visits and readmission rates between the 2 groups: 7.5% vs. 5.8%(p=0.715) and 12.5% vs. 7.3% (p=0.338). Conclusion: Our study highlights patient’s office visit follow-up is associated with the OPAT extension due to slow clinical response. However, extended therapy did not result in a significant increase in complications or hospital readmissions. These findings suggest the importance of careful patient selection and monitoring for OPAT, potentially guiding more efficient and targeted healthcare practices.

The use of face masks has been widely promoted and at times mandated to prevent coronavirus disease 2019 (COVID-19). The 2023 publication of an updated Cochrane review on mask effectiveness for respiratory viruses as well as the unfolding epidemiology of COVID-19 underscore the need for an unbiased assessment of the current scientific evidence. It appears that the widespread promotion, adoption, and mandating of masking for COVID-19 were based not primarily on the strength of evidence for effectiveness but more on the imperative of decision-makers to act in the face of a novel public health emergency, with seemingly few good alternatives. Randomized clinical trials of masking for prevention of COVID-19 and other respiratory viruses have so far shown no evidence of benefit (with the possible exception of continuous use of N95 respirators by hospital workers). Observational studies provide lower-quality evidence and do not convincingly demonstrate benefit from masking or mask mandates. Unless robust new evidence emerges showing the effectiveness of masks in reducing infection or transmission risks in either trials or real-world conditions, mandates are not warranted for future epidemics of respiratory viral infections.

Background: Throughout the COVID-19 pandemic, increased inappropriate antibiotic use (AU) drove concern for antimicrobial resistance. Antimicrobial stewardship efforts are critical for combatting antimicrobial resistance. Our objective was to compare AU between SARS-CoV-2 delta and omicron variant surge periods in COVID-19 patients hospitalized at Tufts Medical Center (TMC) in Boston. Infectious diseases consultation (IDC) was mandatory for patients diagnosed with COVID-19 throughout the SARS-CoV-2 delta variant surge. During the SARS-CoV-2 omicron variant surge, IDC was optional for certain patient populations. Instead, the antibiotic stewardship program (ASP) reviewed these patients for appropriate medical management. We hypothesized that AU would increase during the SARS-CoV-2 omicron variant surge compared to the delta variant surge due to optional IDC because IDC would reduce inappropriate AU for suspected viral pneumonia. Methods: Retrospective medical record review of patients hospitalized with COVID-19 during the SARS-CoV-2 delta and omicron variant surges was conducted. We collected data regarding vital signs, white blood cell count (WBC), length of stay (LOS), steroid use, IDC, and AU (defined as percentage of patients receiving at least 1 antibiotic dose), with a separate category for antibiotics commonly used for bacterial pneumonia (ampicillin-sulbactam, azithromycin, cefepime, cefpodoxime, ceftazidime, ceftriaxone, doxycycline, piperacillin-tazobactam, vancomycin). We determined that 71 patients from each group were needed to detect an absolute difference of 20% in AU between surges with 75% power, based on the CDC estimate that 80% of patients hospitalized with COVID-19 receive an antibiotic. Unpaired t tests and χ2 analyses were conducted on demographic data. Inferential statistics assessed for differences between the 2 SARS-CoV-2 variant surges in AU and days of therapy (DOT), supplemental oxygen (SaO2), steroid use, and IDC utilizing a Wilcoxon rank-sum test and logistic regression analyses. Results: Results showed no significant differences in AU between surges (38.0% during the SARS-CoV-2 delta variant surge vs 42.3% during the SARS-CoV-2 omicron variant surge; P = .131). Disease severity was not different between surges as measured by steroid use, initial WBC, and SaO2. WBC was a predictor for AU in both surges (delta surge, P = 0.007; omicron surge, P = .002). Average LOS was higher throughout the SARS-CoV-2 delta variant surge for all patients (11.58 days during the delta surge, vs 5.97 days during the omicron variant surge; P = .047) and those who received antibiotics (18.44 days during the delta variant surge vs 6.70 days dring the omicron variant surge; P = .210). Total DOT was significantly longer during the SARS-CoV-2 delta variant surge for all antibiotics (463 DOT during the delta variant surge vs 277 DOT during the omicron variant surge; P = .047) and antibiotics commonly used for bacterial pneumonia (315 DOT during the delta variant surge vs 202 DOT during the omicron variant surge; P = .021). Conclusions: Making IDC optional for certain patient populations diagnosed with COVID-19 did not affect AU in a large, urban academic medical center with a comprehensive ASP.

Disclosures: None

Early in the pandemic, pre-print servers sped rapid evidence sharing. A collaborative of major medical journals supported their use to ensure equitable access to scientific advancements. In the intervening three years, we have made major advancements in the prevention and treatment of COVID-19 and learned about the benefits and limitations of pre-prints as a mechanism for sharing and disseminating scientific knowledge.

Pre-prints increase attention, citations, and ultimately impact policy, often before findings are verified. Evidence suggests that pre-prints have more spin relative to peer-reviewed publications. Clinical trial findings posted on pre-print servers do not change substantially following peer-review, but other study types (e.g., modeling and observational studies) often undergo substantial revision or are never published.

Nuanced policies about sharing results are needed to balance rapid implementation of true and important advancements with accuracy. Policies recommending immediate posting of COVID-19-related research should be re-evaluated, and standards for evaluation and sharing of unverified studies should be developed. These may include specifications about what information is included in pre-prints and requirements for certain data quality standards (e.g., automated review of images and tables); requirements for code release and sharing; and limiting early postings to methods, results, and limitations sections.

Academic publishing needs to innovate and improve, but assessments of evidence quality remains a critical part of the scientific discovery and dissemination process.

Optimizing antibiotic prescribing is a crucial element of the fight against antibiotic resistance. Antibiotic prescribing patterns in jails have not been studied. We established a baseline of antibiotic prescribing between Massachusetts jails. We detected heterogeneity in quantity and duration of antibiotic prescriptions, revealing an opportunity for improved practice.

We report an outbreak of dermatitis associated with Ornithonysus bacoti and Liponyssoides sanguineus infestation in an acute ambulatory care setting. Healthcare workers developed dermatitis prior to the identification of the outbreak. A collaborative team effort resulted in complete eradication.

The national influenza pandemic response plan includes short-term school closures as an infection mitigation measure, based on modeling data regarding the role of pediatric populations and schools as drivers of disease spread. Modeled estimates regarding the role of children and their in-school contacts as drivers of community transmission of endemic respiratory viruses were used in part to justify prolonged school closures throughout the United States. However, disease transmission models extrapolated from endemic pathogens to novel ones may underestimate the degree to which spread is driven by population immunity and overestimate the impact of school closures as a means of reducing child contacts, particularly in the longer-term. These errors, in turn, may have caused incorrect estimations about the potential benefits of closing schools on a society level while simultaneously failing to account for the significant harms of long-term educational disruption.

Pandemic response plans need to be updated to include nuances regarding drivers of transmission such as pathogen type, population immunity, and contact patterns, and disease severity in different groups. Expected duration of impact also needs to be considered, recognizing that effectiveness of different interventions, particularly those focused on limiting social interactions, are short-lived. Additionally, future iterations should include risk–benefit assessments. Interventions that are particularly harmful to certain groups, such as school closures are on children, should be de-emphasized and time limited. Finally, pandemic responses should include ongoing and continuous policy re-evaluation and should include a clear plan for de-implementation and de-escalation.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the lack of agreement regarding the definition of aerosol-generating procedures and potential risk to healthcare personnel. We convened a group of Massachusetts healthcare epidemiologists to develop consensus through expert opinion in an area where broader guidance was lacking at the time.

Transmission of bacteria between animals and humans in domestic households is increasingly recognized. We evaluated the presence of antimicrobial-resistant fecal bacteria in 8 dog-owner–dog pairs before and after the dog received amoxicillin-clavulanate. The study identified shared flora in the humans and dogs that were affected by antimicrobial administration.