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We compared outcomes at 3 community hospitals before and after switching from in-person to a Tele-ID group from an academic medical center. Compared to in-person, Tele-ID received significantly more consultations with similar outcomes for length of hospital stay, transfers, readmission, and mortality. Tele-ID is a suitable alternative for community settings. [ABSTRACT FROM AUTHOR]

Antimicrobial overuse and multidrug‐resistant pathogens are growing problems throughout the United States, yet most counties in the United States lack access to infectious diseases (ID) expertise. Developing an effective antimicrobial stewardship program (ASP) is challenging for many health care institutions, especially rural, community, and critical access hospitals with limited access to specialty care. Pharmacists are instrumental for the success of ASPs and pharmacy expertise is a requirement to meet federal ASP standards. Antimicrobial stewardship guidelines suggest telehealth consultation as an acceptable alternative to in‐person availability of an ID physician‐pharmacist team and encourage facilities to consider creative solutions for optimizing antimicrobial use. As a result, an understanding of successful telemedicine and tele‐ASP (TASP) models as a sustainable option is crucial. Data on existing TASP models, the role of clinical pharmacy services in TASPs, and future directions are herein described. Existing data on TASP are organized into three main categories of fully remote, integrated, or collaborative TASP models. TASPs may be led by remote ID physicians and/or ID‐trained clinical pharmacists within an affiliated health system or from an unaffiliated private practice, health system, or private telehealth entity. The on‐site stewardship pharmacist champion has a vital role in the success of many of the TASP models described by building trusting relationships with prescribers and key stakeholders, facilitating uptake of interventions and acceptance of the TASP, and ensuring timely therapy changes for patients. Future targets for TASP research should include TASP efforts in critical access hospitals and nonacute settings, the specific role of technology and clinical decision support software tools in TASP to improve and enhance pharmacist impact, and further descriptions of TASP models that improve patient‐centered outcomes. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has revolutionized the practice of ambulatory medicine, triggering rapid dissemination of digital healthcare modalities, including synchronous video visits. However, social determinants of health, such as age, race, income, and others, predict readiness for telemedicine and individuals who are not able to connect virtually may become lost to care. This is particularly relevant to the practice of infectious diseases (ID) and human immunodeficiency virus (HIV) medicine, as we care for high proportions of individuals whose health outcomes are affected by such factors. Furthermore, delivering high-quality clinical care in ID and HIV practice necessitates discussion of sensitive topics, which is challenging over video without proper preparation. We describe the "digital divide," emphasize the relevance to ID and HIV practice, underscore the need to study the issue and develop interventions to mitigate its impact, and provide suggestions for optimizing telemedicine in ID and HIV clinics. [ABSTRACT FROM AUTHOR]

Between 2000 and 2011, proven or probable invasive aspergillosis (IA) was diagnosed in 1.7% (8/455) of heart transplant (HTx) recipients at our center, in the absence of antifungal prophylaxis. All patients had invasive pulmonary infections and 75% (6/8) were diagnosed during 2 separate 3-month periods. Cases were notable for their association with septic shock and multiple organ dysfunction syndrome (MODS) (75%, 6/8 each), non-specific clinical and radiographic findings, and rapid mortality despite mould-active antifungal therapy (88%, 7/8; occuring at a median 11 days after diagnosis). All patients had predisposing conditions known to be risk factors for IA. For patients with early IA (within 90 days of HTx), conditions included hemodialysis, thoracic re-operation, and the presence of another case in the institution within the preceding 3 months. For late-onset IA, conditions included hemodialysis and receipt of augmented immunosuppression. Clinicians should suspect IA in HTx recipients with risk factors who present with non-specific and unexplained respiratory syndromes, including those in septic shock and MODS, and institute prompt antifungal therapy without waiting for the results of cultures or other diagnostic tests. [ABSTRACT FROM AUTHOR]

BACKGROUND: Staphylococcus aureus infections among lung transplant recipients are poorly studied. METHODS: We conducted a 5-year retrospective study of the epidemiology, clinical manifestations, risk factors, and outcomes of patients infected with S aureus within the first 90 days after lung transplantation. RESULTS: An S aureus infection developed in 109 of 596 lung transplant (18%) recipients. Methicillin-susceptible S aureus (MSSA; 62%) was more common than methicillin-resistant S aureus (MRSA; 38%); however, the proportion of infections caused by MRSA increased over time. Pneumonia (48%) was the most common infection, followed by tracheobronchitis (26%), bacteremia (12%), intrathoracic infections (7%), and skin/soft tissue infections (7%). Risk factors included mechanical ventilation for >5 days and isolation of S aureus from recipients’ sterility cultures. Patients with MRSA cultured from the nares or respiratory tract at the time of transplant were at an increased risk for MRSA infection (p<0.0001 and p=0.02, respectively). Infected patients required longer hospital and intensive care unit stays (p<0.0001 for both), but the 30- and 90-day mortality rates from the onset of infection were only 7% and 12%, respectively. However, infected patients had higher rates of acute and chronic rejection at 1 (p=0.048) and 3 years (p=0.002), and higher rates of mortality at 1 (p=0.058) and 3 years (p=0.009). Conclusions: S aureus infections within the first 90 days of lung transplant were associated with low short-term mortality but increased long-term rates of mortality and acute and chronic rejection. Future studies are needed to explore the utility of S aureus eradication strategies in reducing disease burden and improving outcomes. [ABSTRACT FROM AUTHOR]

Background: Lack of on-site antimicrobial stewardship expertise is a barrier to establishing successful programs. Tele-antimicrobial stewardship programs (TASPs) utilizing a clinical decision support system (CDSS) can address these challenges., Methods: This interrupted time series study reports the impact of CDSS implementation (February 2020) within an existing TASP on antimicrobial usage in a community hospital. Segmented regression analysis was used to assess differences in antimicrobial usage from January 2018 through December 2021. Pre- and post-CDSS frequencies of intravenous vs oral antimicrobials, time to optimal therapy (TTOT), pharmacist efficiency (number of documented interventions per month), and percentage of hospitalized patients receiving antimicrobials were compared with descriptive statistics., Results: Implementation of a CDSS into an existing TASP was associated with an immediate 11% reduction in antimicrobial usage (level change, P  < .0001). Antimicrobial usage was already trending down by 0.25% per month (pre-CDSS slope, P  < .0001) and continued to trend down at a similar rate after implementation (post-CDSS slope, P  = .0129). Frequency of use of select oral agents increased from 38% to 57%. Median TTOT was 1 day faster (2.9 days pre-CDSS vs 1.9 days post-CDSS). On average, pharmacists documented 2.2-fold more interventions per month (198 vs 90) and patients received 1.03 fewer days of antimicrobials per admission post-CDSS., Conclusions: Implementation of a CDSS within an established TASP at a community hospital resulted in decreased antimicrobial usage, higher rates of oral usage, faster TTOT, and improved pharmacist efficiency., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)