Antimicrobial Stewardship Meets Transitions of Care: Defining Length of Therapy for Community-Acquired Pneumonia (CAP)

Introduction: Hospital-based antimicrobial stewardship efforts have traditionally focused on inpatient settings. Antibiotic prescribing at discharge is often an overlooked area of focus for antimicrobial stewardship programs. Discharge prescribing optimization is necessary to combat antibiotic overuse. Methods: This was an observational, retrospective cohort study at a four–adult community hospital system. Four hundred adult patients admitted with community-acquired pneumonia and discharged with antibiotics were included. The primary outcome was overall (inpatient and discharge) antibiotic length of therapy. The secondary outcome was percentage of patients discharged on a fluoroquinolone who had not received one in the hospital. Descriptive statistics were utilized. Results: The median total antibiotic length of therapy was 9.5 days (IQR 8, 11). The median inpatient and discharge antibiotic lengths of therapy were 4 days (IQR 3, 5) and 5 days (IQR 5, 7), respectively. Of the 108 patients prescribed a fluoroquinolone at discharge, 43% (46/108) had not previously received a fluoroquinolone while hospitalized. Conclusion: Both length of therapy and fluoroquinolone stewardship at discharge may represent possible antimicrobial stewardship targets in community-acquired pneumonia patients

Concomitant invasive pneumococcal disease in a patient with COVID-19 – A case report from the Louisville Epidemiology Study

A 60-year-old male presented to the Emergency Department (ED) with a one-two day history of confusion, headache, and subjective fever. Because he had met with a contact two days prior to admission who had recently traveled from the Bahamas, a COVID-19 nasopharyngeal (NP) and oropharyngeal (OP) polymerase chain reaction (PCR) test was ordered. He was diagnosed with bacterial meningitis based on presenting neurologic symptoms and the identification of Streptococcus pneumoniae from blood cultures. The COVID-19 NP and OP test returned positive, although he never developed shortness of breath, cough, other respiratory symptoms, diarrhea, abdominal pain, nausea, vomiting, or any change in sense of smell or taste. On day three of admission, the patient had improved clinically on intravenous (IV) antibiotics and was discharged home with instructions to self-quarantine. This case demonstrates the possibility of co-infections with COVID-19 and raises the possibility of an association between COVID-19 and patient susceptibility to invasive pneumococcal disease (IPD)

The Incidence of Common Respiratory Viruses During the COVID-19 Pandemic: Results From the Louisville COVID-19 Epidemiology Study

Introduction: Social distancing has been utilized during the COVID-19 pandemic to reduce the spread of SARS-CoV-2, which is also expected to reduce the spread of common respiratory viruses. Methods: This retrospective, descriptive study assessed the rate of positivity of common respiratory viruses from commercially available respiratory pathogen panel, across a five-hospital health-system, during four-week periods within March to April of 2019 and 2020. Results: During the four-week period in 2019, the percent positivity of common respiratory viruses from week one to week four decreased from 6 to 32% among the four included viruses. In the comparator period in 2020, a decrease ranging from 74 to 100% was observed from week one to week four. Conclusions: These data indicate that the social distancing efforts implemented in Louisville, Kentucky, may be associated with a decrease in incidence of common respiratory viruses. This decrease in positivity of common respiratory viruses may serve as a surrogate marker for the effect of social distancing on the transmission of SARS-CoV-2

False-negative SARS-CoV-2 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) is an Important Consideration for Patient Management and Infection Prevention: A Case Report from The Louisville COVID-19 Epidemiology Study

We report a case of false negative SARS-CoV-2 RT-PCR on nasopharyngeal swab. Treating clinicians and infection preventionists should maintain a high suspicion for COVID-19 in the appropriate clinical setting despite negative test results. Utilization of chest CT should be strongly considered in the diagnostic work-up for suspected COVID-19, particularly in areas with limited RT-PCR availability

A Patient with Escherichia coli Bacteremia and COVID-19 Co-Infection: A Case Report for the Louisville COVID-19 Epidemiology Study

Patients with COVID-19 may have co-infections with other microorganisms. Here we report a case of a patient with an E. coli bacteremia secondary to a urinary tract infection, who experienced fevers while on active antimicrobial therapy. The patient was eventually tested for COVID-19 and found to be positive. This case emphasizes the need to suspect COVID-19 even in patients with documented bacterial infection