Acceptability of proposed stewardship interventions to reduce preoperative screening and treatment of asymptomatic bacteriuria.

Background: The Infectious Diseases Society of America Clinical Practice guidelines do not recommend screening patients for asymptomatic bacteriuria (ASB) before nonurological surgeries.

Methods: We conducted semistructured interviews at 5 Veterans Affairs hospitals about the acceptability of 4 prospectively identified potential interventions to deimplement routine preoperative urine testing for ASB: substitution of another infection prevention intervention, laboratory restrictions on ordering urine tests, audit and feedback on guideline concordance, and interactive workshops. We coded responses as acceptable, not acceptable, or possibly acceptable and noted recommendations for modifications.

Implementation of Diagnostic Stewardship to Improve Urinary Tract Infection Antibiotic Use Across Three Medical Centers.

Background: Overdiagnosis of urinary tract infections (UTIs) and unnecessary antibiotics are common. This is particularly true in older adult populations such as Veterans. Diagnostic stewardship can decrease overdiagnosis and overtreatment, but optimal implementation of such interventions has not been fully studied.

Impact of low-amplitude pulse interspersed with histotripsy treatment of Staphylococcus aureus biofilms on surgical mesh.

Ultrasound histotripsy has shown great potential for destroying bacteria biofilms on hernia mesh. The therapy could be further enhanced by reducing the necessary treatment times. In this study, we evaluated the inclusion of a low-amplitude pulse spaced between each of the high-amplitude histotripsy pulses on the effectiveness of the therapy for different treatment durations.

Urinary tract infection in adults: gaps in current guidelines - opinions from an international multidisciplinary panel and relevance to clinical practice.

Purpose: Although urinary tract infections (UTIs) are one of the most common infections encountered in clinical practice, many challenges remain with respect to classification and management. The purpose of this report is to discuss key issues in the management of UTIs and identify gaps in current knowledge and guidelines, as well as future research needs.

Design: A multidisciplinary panel of 13 experts from 6 European countries and the United States met on April 27, 2024.

Pivmecillinam for Treatment of Uncomplicated Urinary Tract Infection: New Efficacy Analysis.

Background: In April 2024-over 40 years after its first approval in Europe-pivmecillinam received approval from the United States Food and Drug Administration (FDA) for the treatment of uncomplicated urinary tract infection (uUTI) in women aged ≥18 years, caused by susceptible isolates of Escherichia coli, Proteus mirabilis, and Staphylococcus saprophyticus. Herein, we describe the reanalysis from previously published clinical trials, conducted in accordance with current FDA efficacy criteria, which formed the basis for this regulatory approval.

Methods: Of 14 studies reviewed, 3 randomized, controlled trials offered suitable subject-level data from patients with uUTI treated with 185 mg pivmecillinam 3 times daily for 3-7 days.

Sulopenem versus Amoxicillin/Clavulanate for the Treatment of Uncomplicated Urinary Tract Infection.

Background: Existing antibiotics for uncomplicated urinary tract infections are becoming less reliably effective owing to increasing antimicrobial resistance. Our objective was to evaluate the safety and efficacy of sulopenem/probenecid for uncomplicated urinary tract infections.

Methods: We conducted a double-blind, randomized, controlled, noninferiority trial of 5 days of sulopenem versus amoxicillin/clavulanate for women with uncomplicated urinary tract infection.

Does Routine Urine Culture Testing Before Endoscopic Prostate Surgery Decrease Postoperative Urinary Tract Infection? An Analysis of the Veteran Affairs Surgical Quality Improvement Program.

Introduction: Endoscopic prostate surgery increases septic morbidity and mortality. While urology guidelines recommend preoperative urine testing, surgeons determine what test to obtain. It remains unknown whether preoperative urine culture (UCX) decreases postoperative UTIs in these patients.

Incidence of COVID-19 Symptom Rebound After Treatment with Remdesivir.

Background/objectives: Recent in vitro data suggest that remdesivir might be less likely than nirmatrelvir-ritonavir to be associated with COVID-19 rebound. We compared the incidence of symptom rebound in our remdesivir-treated cohort with rates reported in the literature for nirmatrelvir-ritonavir.

Methods: We performed a retrospective cohort study of VA Boston Healthcare System patients who were nursing home residents or inpatients treated with remdesivir for mild to moderate COVID-19 that met clinical criteria for nirmatrelvir-ritonavir treatment between 05/2022 and 10/2024.

Nutritional Status and Dietary Diversity: A Community-based Assessment among Elderly Residents of Budge Budge II Block, West Bengal.

Background: Aging makes elderly people vulnerable to malnutrition; factors such as feeding difficulty, reduced mobility, psychological distress, being widowed, illiteracy, poverty, and poor access to health and social services further aggravate the condition. Decreased nutrition is one of the major factors that often go undiagnosed; hence, the diet must include a variety of foods for proper nutrition. The objectives of the study were to determine the nutritional status of elderly residents and to assess the dietary diversity among them.

Recurrent UTI in Women-Risk Factors and Management.

Urinary tract infections (UTIs) are common in women; more than 50% of women will be diagnosed with a UTI in her lifetime. Many of these women will go on to develop recurrent UTI. Nevertheless, evidence-based prevention of recurrent UTI is under-utilized.

Evidence from whole genome sequencing of aerosol transmission of SARS-CoV-2 almost 5 hours after hospital room turnover.

Experimental evidence suggests that Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) remains viable within aerosols with a half-life of approximately 3 hours; however, it remains unclear how long airborne SARS-CoV-2 can transmit infection. Whole genome sequencing during an outbreak suggested in-room transmission of SARS-CoV-2 to two patients admitted nearly 2 and 5 hours, respectively, after discharge of an asymptomatic infected patient. These findings suggest that airborne SARS-CoV-2 may transmit infection for over 4 hours, even in a hospital setting.

Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture.

Importance: Although recent guidelines recommend against performance of preoperative urine culture before nongenitourinary surgery, many clinicians still order preoperative urine cultures and prescribe antibiotics for treatment of asymptomatic bacteriuria in an effort to reduce infection risk.

Objective: To assess the association between preoperative urine culture testing and postoperative urinary tract infection (UTI) or surgical site infection (SSI), independent of baseline patient characteristics or type of surgery.

Design, Setting, And Participants: This cohort study analyzed surgical procedures performed from January 1, 2017, to December 31, 2019, at any of 112 US Department of Veterans Affairs (VA) medical centers.

Participants With Acquired Brain Injury Realized They "Could Still Do Things" After a Yoga Intervention: A Qualitative Descriptive Study.

Importance: Occupational therapy practitioners use yoga in practice to achieve holistic care, and the American Occupational Therapy Association has provided guidance on the use of yoga in occupational therapy. For people with acquired brain injury (ABI), however, it is unknown whether yoga affects occupational performance.

Objective: To explore the perceived impact of an adapted yoga intervention on occupational performance using the Occupational Therapy Practice Framework: Domain and Process (4th ed.

Alpha-Synuclein Pre-Formed Fibrils Injected into Prefrontal Cortex Primarily Spread to Cortical and Subcortical Structures.

Background: Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) are characterized by diffuse spread of alpha-synuclein (α-syn) throughout the brain. Patients with PDD and DLB have a neuropsychological pattern of deficits that include executive dysfunction, such as abnormalities in planning, timing, working memory, and behavioral flexibility. The prefrontal cortex (PFC) plays a major role in normal executive function and often develops α-syn aggregates in DLB and PDD.

Predicting Antibiotic Susceptibility Among Patients With Recurrent Urinary Tract Infection Using a Prior Culture.

Purpose: Recurrent cystitis guidelines recommend relying on a local antibiogram or prior urine culture to guide empirical prescribing, yet little data exist to quantify the predictive value of a prior culture. We constructed a urinary antibiogram and evaluated test metrics (sensitivity, specificity, and Bayes' positive and negative predictive values) of a prior gram-negative organism on predicting subsequent resistance or susceptibility among patients with uncomplicated, recurrent cystitis.

Materials And Methods: We performed a retrospective database study of adults with recurrent, uncomplicated cystitis (cystitis occurring 2 times in 6 months or 3 times in 12 months) from urology or primary care clinics between November 1, 2016, and December 31, 2018.

Implementation of a Prevention Bundle to Decrease Rates of Staphylococcus aureus Surgical Site Infection at 11 Veterans Affairs Hospitals.

Importance: While current evidence has demonstrated a surgical site infection (SSI) prevention bundle consisting of preoperative Staphylococcus aureus screening, nasal and skin decolonization, and use of appropriate perioperative antibiotic based on screening results can decrease rates of SSI caused by S aureus, it is well known that interventions may need to be modified to address facility-level factors.

Objective: To assess the association between implementation of an SSI prevention bundle allowing for facility discretion regarding specific component interventions and S aureus deep incisional or organ space SSI rates.

Design, Setting, And Participants: This quality improvement study was conducted among all patients who underwent coronary artery bypass grafting, cardiac valve replacement, or total joint arthroplasty (TJA) at 11 Veterans Administration hospitals.

Facilitators and Barriers to Verifying Penicillin Allergies in a Veteran Nursing Home Population.

Background: Unconfirmed penicillin allergies are common and may contribute to adverse outcomes, especially in frail older patients. Evidence-based clinical pathways for evaluating penicillin allergies have been effectively and safely applied in selected settings, but not in nursing home populations.

Objective: To identify potential facilitators and barriers to implementing a strategy to verify penicillin allergies in Veterans Health Administration nursing homes, known as Community Living Centers (CLCs).

Sickness presenteeism in healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic: An observational cohort study.

Sickness presenteeism among healthcare workers (HCW) risks nosocomial infection, but its prevalence among HCW with COVID-19 is unknown. Contemporaneous interviews revealed a sickness presenteeism prevalence of 49.8% among 255 HCW with symptomatic COVID-19.

Prophylaxis against spontaneous bacterial peritonitis: Too much or too little?

Prophylaxis against spontaneous bacterial peritonitis (SBP) is recommended for select patients with cirrhosis, but long-term antibiotic therapy has risks. We evaluated concordance with guideline recommendations in 179 veterans with cirrhosis; 55% received guideline-concordant management of SBP prophylaxis. Despite stable guideline recommendations since 2012, guideline adherence remains low.