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Background: Infection prevention (IP) behaviors such as hand hygiene (HH) and mobile device disinfection are important to reduce the risk of infection transmission from both family members and hospital staff to critically ill neonates. Purpose: To inform the design of educational interventions to improve both patient family and staff IP behaviors, we engaged separate groups of nurses and family members to understand perceptions about the spread of infection and barriers to implementing effective IP strategies. Methods: This was a qualitative study using focus groups to gather data from neonatal nurses and patient family members. Data were triangulated with hospital-wide survey data and analyzed using inductive content analysis. Results: Twelve nurses and 4 patient family members participated. Themes related to communication about IP between staff and family members emerged: stakeholders expressed discomfort with the timing and nature of just-in-time HH education. These communication challenges contributed to stress levels within the neonatal intensive care unit. This finding was reflected in the hospital-wide survey. Implications for Practice and Research: Steps should be taken to improve communication about IP behaviors between patient family members and frontline staff. Reducing nurse burden of providing just-in-time HH reminders to patient family members through increased IP education may decrease stress and facilitate IP behaviors. This has the potential to decrease infection spread and improve patient outcomes. The development of interventions targeting stakeholder communication is therefore warranted, but additional research is needed to understand the timing and process for delivery of the educational material. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://www.w3.org/1999/xlink). [ABSTRACT FROM AUTHOR]

Sepsis is a leading cause of pediatric mortality and timely antibiotic administration has been shown to improve outcomes. In this retrospective review of a single center sepsis dataset, we identified younger age and female sex as more likely to have delays in antibiotics. [ABSTRACT FROM AUTHOR]

Repeat blood cultures are common in children after an initial positive culture. However, in contrast to adults, there are little data to help guide clinicians when a repeat culture is necessary to assess for persistent bacteremia. This study identifies factors associated with persistent bloodstream infections (BSI) in children to inform diagnostic stewardship. This cross-sectional study of children less than 18 years with at least one positive blood culture over a 5-year period utilized a generalized linear equation model to predict patient and microbial factors associated with persistent BSI defined as a positive blood culture with the same organism >48 hours after the index culture. Four hundred and five patients had 502 positive blood cultures yielding 556 organisms. Sixty-seven (13.2%) cultures were persistently positive. Anaerobic organisms (0/37) and Streptococcus species (0/104) were never recovered from repeat cultures. Staphylococcus aureus (OR 9.45, CI 5.15-17.35) and yeast (OR 78.18, CI 9.45-646.6) were statistically associated with persistent BSI. Patients with prior positive cultures (OR 1.44, CI 1.12-1.84) or a central venous catheter (OR 2.20, 95% CI 1.04-3.92) were also at risk for persistence. Immune dysfunction and elevated inflammatory markers at the time of the index blood culture were not significantly associated with persistence. Yeast or S. aureus were associated with persistent BSI, while anaerobes and Streptococcus species were never persistent. Patient characteristics at the time of blood draw did not predict persistence other than having previous positive blood cultures or a central venous catheter. These data can inform when repeat blood cultures have clinical value and reduce the risk of unnecessary blood draws in children., Importance: We identify factors associated with bloodstream infection persistence in children. Our findings can help guide blood culture stewardship efforts in pediatric patients, especially in light of blood culture supply shortages., Competing Interests: D.R.P. has received research funding from Hologic, Inc.. and honoraria from Beckton Dickinson.

Extravasation of CCR2-positive monocytes into tissue and to the site of injury is a fundamental immunological response to infections. Nevertheless, exuberant recruitment and/or activity of these monocytes and monocyte-derived macrophages can propagate tissue damage, especially in chronic inflammatory disease conditions. We have previously shown that inhibiting the recruitment of CCR2-positive monocytes ameliorates lung tissue damage caused by chronic neutrophilic inflammation in cystic fibrosis (CF) mouse models. A potential concern with targeting monocyte recruitment for therapeutic benefit in CF, however, is whether they are essential for eradicating infections such as Pseudomonas aeruginosa (PA), a pathogen that commonly colonizes and damages the lungs of patients with CF. In this study, we investigated the role of CCR2-positive monocytes in the immune response to acute pulmonary PA infection. Our data show that the altered host immune response caused by the lack of monocyte recruitment to the lungs does not impact PA lung colonization, clearance, and the severity of the infection. These results also hold up in a CF mouse background, which have a hyper-inflammatory immune response, yet exhibit reduced bactericidal activity. Thus, we lay the groundwork for future studies to investigate the use of CCR2 inhibitors as a potential therapy to ameliorate lung tissue damage in CF. This could be given alone or as an adjunct therapy with CFTR modulators that significantly improve clinical outcomes for eligible patients, but do not completely resolve the persistent infection and inflammation that drive lung tissue damage., (© The Author(s) 2024. Published by Oxford University Press on behalf of Society for Leukocyte Biology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Despite advancements in cystic fibrosis (CF) therapeutics, the persistence of chronic infections necessitates continued use of nebulized therapies. Though the Cystic Fibrosis Foundation recommends well-defined cleaning and disinfection of nebulizers to mitigate pathogen exposure risks, discrepancies between Cystic Fibrosis Foundation guidelines, manufacturers' instructions, and variability in center recommendations contribute to confusion and non-standardized practices., Methods: A digital survey was distributed to directors, associate directors, and care coordinators of CF centers across the United States to investigate the methods, frequency, and educational practices surrounding nebulizer care they provide patients. Responses were analyzed using descriptive techniques and chi-square analyses., Results: Of 855 distributed surveys, 129 respondents provided insights into nebulizer care recommendations. Discrepancies in disinfection frequency were notable, with 18% of respondents recommending disinfecting nebulizers less than daily. Approximately 20% of respondents were unsure if their recommendations aligned with Cystic Fibrosis Foundation guidelines while 73% reported that their recommendations strictly adhered to the published guidelines. Of this 73%, all recommended at least daily cleaning, with 69% specifying cleaning before reuse; and 88% recommended disinfection at least daily, with 36% specifying disinfection before reuse. Only 10% recommended both cleaning and disinfection after every use. Disinfection less than daily was recommended by 11% of the respondents who felt they were strictly following the guidelines. We also highlight respondents who cited barriers to strict adhesion to the published guidelines., Conclusions: The highlighted variations in CF centers' recommendations for nebulizer care with deviations from Cystic Fibrosis Foundation guidelines underscore the necessity for developing clear and practical guidelines that consider both efficacy and the realities of patient adherence. Collaboration among CF care centers, patients, guideline committees, and other stakeholders is essential to develop recommendations that effectively address the challenges faced by the CF community, ensuring the safe and effective nebulizer use., (Copyright © 2024 by Daedalus Enterprises.)