Reliability and predictive validity of a hepatitis-related symptom inventory in HIV-infected individuals referred for Hepatitis C treatment

<p>Abstract</p> <p>Background</p> <p>We aimed to determine the reliability and validity of a hepatitis symptom inventory and to identify predictors of hepatitis C (HCV) treatment initiation in a cohort of HIV-infected patients.</p> <p>Methods</p> <p>Prospective clinic based study that enrolled patients referred for HCV therapy consideration. A hepatitis symptom inventory and the Center for Epidemiologic Studies Depression Scale (CES-D) were administered to HIV/HCV individuals. The symptom inventory was factor analyzed and subscale reliability estimated with Cronbach's alpha. Predictive validity was evaluated using generalized estimating equations (GEE). Predictors of HCV treatment were identified using logistic regression.</p> <p>Results</p> <p>Between April 2008 to July 2010, 126 HIV/HCV co-infected patients were enrolled in the study. Factor analysis using data from 126 patients yielded a three-factor structure explaining 60% of the variance for the inventory. Factor 1 (neuropsychiatric symptoms) had 14 items, factor 2 (somatic symptoms) had eleven items, and factor 3 (sleep symptoms) had two items, explaining 28%, 22% and 11% of the variance, respectively. The three factor subscales demonstrated high intrinsic consistency reliability. GEE modeling of the 32 patients who initiated HCV therapy showed that patients developed worsening neuropsychiatric and somatic symptoms following HCV therapy with stable sleep symptoms. Bivariate analyses identified the following as predictors of HCV therapy initiation: lower HIV log₁₀RNA, lower scores for neuropsychiatric, somatic and sleep symptoms, lower CES-D scores and white ethnicity. In stepwise multiple logistic regression analysis, low neuropsychiatric symptom score was the strongest independent predictor of HCV therapy initiation and HIV log₁₀RNA was inversely associated with a decision to initiate HCV treatment.</p> <p>Conclusions</p> <p>A 41-item hepatitis-related symptom inventory was found to have a clinically meaningful 3-factor structure with excellent internal consistency reliability and predictive validity. In adjusted analysis, low neuropsychiatric symptom scores and controlled HIV infection were independent predictors of HCV treatment initiation. The usefulness of the HCV symptom inventory in monitoring HCV treatment should be evaluated prospectively.</p

Sphingomonas paucimobilis Bloodstream Infections Associated with Contaminated Intravenous Fentanyl1

Compounding pharmacies should be required to follow good manufacturing practices, including end-product sterility testing

Updated guidance on the management of COVID-19:from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.status: Published onlin

Acute HIV infection presenting as fulminant meningoencephalitis with massive CSF viral replication

A 22-year-old man presented to the emergency department with 10 days of malaise, generalized rash, sore throat, oral ulcers, headache, nausea, and vomiting. On examination he had fever (101.5°F), hepatosplenomegaly, generalized maculopapular rash, and lymphadenopathy. He rapidly became obtunded, requiring intubation. Initial laboratory studies showed mild transaminitis, increased lactate dehydrogenase, and 4,600 leukocytes per μL with 61% bands and 18% lymphocytes. Bacterial and fungal blood cultures were negative as well as a rapid HIV test, additional serologies (including rapid plasma reagin and Treponema pallidum particle agglutination), quantitative PCRs (for viruses other than HIV), and urine and blood toxicology. CSF, on hospital day 4, showed a lymphocytic pleocytosis (total leukocytes: 100), high protein, borderline hypoglycorrhachia, and negative Gram stain and culture. Brain MRI revealed no meningeal enhancement or masses. EEG revealed no epileptiform activity. Flow cytometry on bone marrow biopsy and CSF found no evidence of malignancy; neither did an excisional lymph node biopsy (figure 1). An immunofluorescent assay test for HIV returned inconclusive and a Western blot detected HIV gp120/gp160 bands. Quantitative HIV RNA PCR was 1.4 × 10(6) copies/mL in plasma and in CSF exceeded the upper limit of quantitation (10(7) copies/mL) (figure 2)

816. Effectiveness of Aseptic Stethoscope Barriers in Allowing Clean Contact for Clostridioides Difficile-Contaminated Stethoscopes

Abstract Background Healthcare-associated infections (HAIs), such as C. difficile colitis, pose a significant health risk. C. difficile is a spore-forming gram-positive anaerobic bacillus capable of surviving on various surfaces. While a strong emphasis has been placed on hand-washing and environmental cleaning with bleach products to limit the spread of C. difficile, stethoscope contamination has been poorly addressed. Studies have demonstrated that the stethoscope diaphragm harbors similar levels and type of contamination to one’s hands. While a non-alcohol-based solution is recommended for stethoscope hygiene in settings at risk for C. difficile, the use of an aseptic stethoscope diaphragm barrier has not been evaluated. Our purpose is to evaluate whether C. difficile-contaminated stethoscope diaphragms remain aseptic by the placement of an aseptic diaphragm barrier. Methods Fresh cultures of C. difficile were diluted to 107 CFU/mL. After inoculating 16 stethoscope diaphragms with C. difficile, 8 had an aseptic diaphragm barrier applied, and 8 served as non-barrier controls. Contaminated stethoscopes were placed in an anaerobic incubator, then swabbed at 15 and 30 minutes, 2 and 4 hours, and 1, 2, 3, and 7 days after inoculation, and subsequently plated onto blood, chocolate, and cycloserine-cefoxitin fructose agar. These plates were incubated for 48 hours, and resulting colonies were manually counted. Statistical analysis was performed (RStudio version 1.0.153) by ANOVA (Analysis of Variance) with post-hoc Tukey HSD (Honestly Significant Difference). Results Overall, mean colony count was 33 CFU on the 8 stethoscope diaphragms without barriers, vs zero on those with barriers (p≤ 0.05). Growth rates were greatest at 48 hours, with colony counts as high as 160. While stethoscope diaphragms without barriers had increasing rates of C. difficile culture growth, the presence of the barrier resulted in no growth in 100% of stethoscope diaphragms for up to 1 week after contamination (Figure 1). C. difficile colony counts from stethoscope diaphragms at time-points up to 1 week. Conclusion Aseptic barriers allow C. difficile-contaminated stethoscope diaphragms to remain without bacterial growth for up to a week. Disposable aseptic diaphragm barriers may be effective in preventing the spread of C. difficile. Disclosures William F. Peacock, MD, AseptiScope Inc. (Board Member

Annual N95 respirator fit-testing: an unnecessary burden on healthcare.

US regulations mandate annual N95 mask fit testing for healthcare workers, but the optimal testing interval is unknown. In our study using data from 12,565 healthcare workers, the probability of survival free from fit-test failure after 3 years was 99.4%, suggesting that less frequent fit testing every 3 years would be safe

The Impact of an Inpatient Nurse-Triggered Sepsis Alert on Antimicrobial Utilization

IntroductionA nurse-triggered sepsis alert called "Code Sepsis" was implemented for early recognition and management of sepsis. The researchers analyzed its impact on antimicrobial use and identified factors associated with infection as source of Code Sepsis.MethodsThe medical records of hospitalized patients with Code Sepsis between January 1 and June 30, 2018, were reviewed. Patients were classified as "Infection" when probable or definitive infection was identified or "No Infection" when a probable or definitive noninfectious source was identified. Patients were categorized as "Escalation" with addition or change to broader-spectrum antimicrobials or "No Escalation" with no change or change to narrower-spectrum antimicrobials. Escalation was classified as "Indicated" with appropriate escalation or "Not Indicated" with inappropriate escalation. Logistic regression model was used to identify factors associated with Infection as Code Sepsis trigger.ResultsCode Sepsis was activated in 529 patients, with Escalation in 246 (46.5%) and No Escalation in 283 (53.5%) patients. Escalation was Indicated in 157 (63.8%) and Not Indicated in 89 (36.2%) patients. Infection was identified in 356 (67.3%) and No Infection in 173 (32.7%) patients. History of HIV (odds ratio [OR] = 2.75, p = 0.03), temperature &gt; 38.3°C or &lt; 36°C (OR = 2.63, p &lt; 0.01), and respiratory rate &gt; 20/minute (OR = 1.56, p = 0.02) were associated with Infection, while surgery within 3 days (OR = 0.30, p &lt; 0.01) was associated with No Infection.ConclusionOne hospital system's Code Sepsis inadvertently identified patients without infections and led to antimicrobial overuse. By refocusing Code Sepsis on early recognition of severe sepsis and septic shock only, the organization hopes to optimize resource utilization and improve patient outcomes