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Journal: Open forum infectious diseases


Multidrug-resistant organism (MDRO) infections are associated with high mortality and readmission rates. Infectious diseases (ID) consultation improves clinical outcomes for drug-resistantStaphylococcus aureusbloodstream infections. Our goal was to determine the association between ID consultation and mortality following various MDRO infections.

Concepts: Immune system, Medicine, Epidemiology, Disease, Infectious disease, Death, Infection, The Association


We report the case of a young patient treated with rituximab-containing chemotherapy who was infected with measles despite previous vaccination. Treatment with vitamin A, ribavirin, and immunoglobulins was started; nevertheless he developed severe pneumonitis and deceased. Broad vaccination coverage is crucial in protecting vulnerable subjects.


Directly observed therapy (DOT) remains an integral component of treatment support and adherence monitoring in tuberculosis care. In-person DOT is resource intensive and often burdensome for patients. Video DOT (vDOT) has been proposed as an alternative to increase treatment flexibility and better meet patient-specific needs.


Kindergarten-entry vaccination requirements have played an important role in controlling vaccine-preventable diseases in the United States. Forty-eight states and the District of Colombia offer nonmedical exemptions to vaccines, ranging in stringency.

Concepts: Vaccine, Vaccination, United States, Washington, D.C., Humid subtropical climate, Organization of American States


As more patients seek care in the outpatient setting, the opportunities for health care-acquired infections and associated outbreaks will increase. Without uptake of core infection prevention and control strategies through formal initiation of infection prevention programs, outbreaks and patient safety issues will surface. This review provides a step-wise approach for implementing an outpatient infection control program, highlighting some of the common pitfalls and high-priority areas.


We evaluated the operating characteristics of 2 comparably trained dogs as a “point-of-care” diagnostic tool to detect toxin gene-positive Clostridium difficile. Although each dog could detect toxin gene-positive C difficile in stool specimens with sensitivities of 77.6 and 92.6 and specificities of 85.1 and 84.5, respectively, interrater reliability is only modest (Cohen’s kappa 0.52), limiting widespread application.


With declining interest in infectious disease (ID) noted among internal medicine (IM) residents, national attention has been directed at methods to recruit more prospective ID applicants. The factors driving the recent decline in ID fellowship applications have thus far only been evaluated in survey studies. Since 2008 at our institution, all IM interns were required to complete a 4-week inpatient ID rotation. We evaluated this rotation to determine if any experiential factors could be linked to future ID interest.


Background.  Little is known about the American public’s perceptions or knowledge about antibiotic-resistant bacteria or antibiotic misuse. We hypothesized that although many people recognize antibiotic resistance as a problem, they may not understand the relationship between antibiotic consumption and selection of resistant bacteria. Methods.  We developed and tested a survey asking respondents about their perceptions and knowledge regarding appropriate antibiotic use. Respondents were recruited with the Amazon Mechanical Turk crowdsourcing platform. The survey, carefully designed to assess a crowd-sourced population, asked respondents to explain “antibiotic resistance” in their own words. Subsequent questions were multiple choice. Results.  Of 215 respondents, the vast majority agreed that inappropriate antibiotic use contributes to antibiotic resistance (92%), whereas a notable proportion (70%) responded neutrally or disagreed with the statement that antibiotic resistance is a problem. Over 40% of respondents indicated that antibiotics were the best choice to treat a fever or a runny nose and sore throat. Major themes from the free-text responses included that antibiotic resistance develops by bacteria, or by the infection, or the body (ie, an immune response). Minor themes included antibiotic overuse and antibiotic resistance caused by bacterial adaptation or an immune response. Conclusions.  Our findings indicate that the public is aware that antibiotic misuse contributes to antibiotic resistance, but many do not consider it to be an important problem. The free-text responses suggest specific educational targets, including the difference between an immune response and bacterial adaptation, to increase awareness and understanding of antibiotic resistance.

Concepts: Immune system, Bacteria, Understanding, Antibiotic resistance, Antibiotic, Microorganism, Penicillin, Antibiotics


We assessed the effectiveness of a Lactobacillus probiotic on rates of health care facility-onset Clostridium difficile infection (HO-CDI) in patients receiving antibiotics. A total of 1576 patients were evaluated. There was no difference in the HO-CDI incidence between those who received probiotics and those who did not (1.8% vs 0.9%; P = .16).


“Expected practice” is a recently described method to alter clinical behavior. We implemented an expected practice around short-course antibiotic therapy, which was associated with decreased antibiotic utilization for multiple bacterial infections. Thus, we describe this expected practice as a novel, simple, and inexpensive tool to enhance antibiotic stewardship.