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Objective: The true incidence and risk factors for secondary bacterial infections in coronavirus disease 2019 (COVID-19) remains poorly understood. Knowledge of risk factors for secondary infections in hospitalized patients with COVID-19 is necessary to optimally guide selective use of empiric antimicrobial therapy. Design: Single-center retrospective cohort study of symptomatic inpatients admitted for COVID-19 from April 15, 2020, through June 30, 2021. Setting: Academic quaternary-care referral center in Portland, Oregon. Patients: The study included patients who were 18 years or older with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR test up to 10 days prior to admission. Methods: Secondary infections were identified based on clinical, radiographic, and microbiologic data. Logistic regression was used to identify risk factors for secondary infection. We also assessed mortality, length of stay, and empiric antibiotics among those with and without secondary infections. Results: We identified 118 patients for inclusion; 31 (26.3%) had either culture-proven or possible secondary infections among hospitalized patients with COVID-19. Mortality was higher among patients with secondary infections (35.5%) compared to those without secondary infection (4.6%). Empiric antibiotic use on admission was high in both the secondary and no secondary infection groups at 71.0% and 48.3%, respectively. Conclusions: The incidence of secondary bacterial infection was moderate among hospitalized patients with COVID-19. However, a higher proportion of patients received empiric antibiotics regardless of an identifiable secondary infection. Transfer from an outside hospital, baseline immunosuppressant use, and corticosteroid treatment were independent risk factors for secondary infection. Additional studies are needed to validate risk factors and best guide antimicrobial stewardship efforts.

Antibiotics are among the most commonly prescribed medications, and there is evidence to guide the optimal use of these agents for most situations encountered in clinical medicine, including for both treatment and prophylaxis. Nevertheless, clinicians routinely prescribe antibiotics in ways that diverge from this evidence, such as prescribing them when not indicated, for durations longer than necessary, or selecting broad-spectrum antibiotics when a narrower-spectrum agent would suffice.1,2 This overuse of antibiotics contributes to the public health crisis of antibiotic resistance while exposing patients to potential antibiotic-related harms.

In this matched case–control study, we sought to determined the association between probiotic use and invasive infections caused by typical probiotic organisms. The odds of probiotic use in cases were 127 times the odds of probiotic use in controls (95% CI, 6.21–2600). Further research into these rare but severe complications is needed.

Objective:Current surveillance for healthcare-associated (HA) urinary tract infection (UTI) is focused on catheter-associated infection with hospital onset (HO-CAUTI), yet this surveillance does not represent the full burden of HA-UTI to patients. Our objective was to measure the incidence of potentially HA, community-onset (CO) UTI in a retrospective cohort of hospitalized patients.Design:Retrospective cohort study.Setting:Academic, quaternary care, referral center.Patients:Hospitalized adults at risk for HA-UTI from May 2009 to December 2011 were included.Methods:Patients who did not experience a UTI during the index hospitalization were followed for 30 days post discharge to identify cases of potentially HA-CO UTI.Results:We identified 3,273 patients at risk for potentially HA-CO UTI. The incidence of HA-CO UTI in the 30 days post discharge was 29.8 per 1,000 patients. Independent risk factors of HA-CO UTI included paraplegia or quadriplegia (adjusted odds ratio [aOR], 4.6; 95% confidence interval [CI], 1.2–18.0), indwelling catheter during index hospitalization (aOR, 1.5; 95% CI, 1.0–2.3), prior piperacillin-tazobactam prescription (aOR, 2.3; 95% CI, 1.1–4.5), prior penicillin class prescription (aOR, 1.7; 95% CI, 1.0–2.8), and private insurance (aOR, 0.6; 95% CI, 0.4–0.9).Conclusions:HA-CO UTI may be common within 30 days following hospital discharge. These data suggest that surveillance efforts may need to be expanded to capture the full burden to patients and better inform antibiotic prescribing decisions for patients with a history of hospitalization.

To assess the efficacy of an infection control program as measured by tuberculin skin-test (TST) conversion rates in medical house staff.Observational study.University-based hospital in New York City serving a large indigent population.Medical house staff.TST conversions were measured every 6 months in medical house staff from June 1992 to June 1994. Compliance with the isolation policy was measured by identifying room locations 24 hours after admission of patients who had Mycobacterium tuberculosis recovered from respiratory specimens.The TST conversion rate decreased from 5.8 to 0, 2.3, and 0 per 100 person years of exposure in successive 6-month periods. The estimated annual TST conversion rate among interns fell from 7 per 100 person years in June 1992 to 0 per 100 person years in June 1993 and 0 per 100 person years in June 1994 (P.029). The proportion of patients with pulmonary tuberculosis who were isolated in negative-pressure rooms increased from 38% to 75% over the study period (P.01).Development of a multifaceted infection control program can decrease the risk of nosocomial tuberculosis infection in medical house staff.

Objective: To assess the efficacy of an infection control program as measured by tuberculin skin-test (TST) conversion rates in medical house staff. Design: Observational study. Setting: University-based hospital in New York City serving a large indigent population. Participants: Medical house staff. Interventions: TST conversions were measured every 6 months in medical house staff from June 1992 to June 1994. Compliance with the isolation policy was measured by identifying room locations 24 hours after admission of patients who had Mycobacterium tuberculosis recovered from respiratory specimens. Results: The TST conversion rate decreased from 5.8 to 0, 2.3, and 0 per 100 person years of exposure in successive 6-month periods. The estimated annual TST conversion rate among interns fell from 7 per 100 person years in June 1992 to 0 per 100 person years in June 1993 and 0 per 100 person years in June 1994 ( P =.029). The proportion of patients with pulmonary tuberculosis who were isolated in negative-pressure rooms increased from 38% to 75% over the study period ( P =.01). Conclusion: Development of a multifaceted infection control program can decrease the risk of nosocomial tuberculosis infection in medical house staff.

18, After years of discussion, hospitals in many countries are now being required to publicly report healthcare-associated infection rates. For example, in the United States, legislation to this effect is pending or has been approved in 32 states.1 The impetus for the public reporting movement is complex, but important driving goals are providing information to patients, health insurance carriers, and health maintenance organizations about hospital performance data and better informing consumers about healthcare services. Indeed, these efforts have been driven not only by consumers but also by entities as diverse as the Centers for Medicare and Medicaid Services, the Healthcare Infection Control Practices Advisory Committee, the Centers for Disease Control and Prevention, and state and federal legislators. However, for the reported data on healthcare-associated infection rates to be meaningful, the rates need to be properly risk adjusted to account for the differences in patient populations that lead to inherently different baseline risks. At present, many groups, including the Centers for Disease Control and Prevention and the Society for Healthcare Epidemiology of America, conclude that the use of infection rates for interhospital comparisons is crude, inaccurate, and potentially flawed because of the inability to effectively riskadjust rates using scientifically validated methods.2,3 Thus, the problem is that for most healthcare-associated infections, there are no validated and optimal methods of risk adjustment. We believe that properly risk-adjusted healthcare-associated infection rates can serve a number of very important purposes, and thus we are not against the reporting of these rates if they are properly risk adjusted. However, until validated methods of risk adjustment exist for each outcome measure, we favor the reporting of process measures. Properly risk-adjusted healthcare-associated infection rates are critical to the achievement of the following goals: (1) allowing consumers and healthcare maintenance orga

SynopsisThis paper considers the background, philosophy and desirability of the use of used automobile tyres in the construction of floating breakwaters for wave attenuation problems in general and their application to fish farm protection in particular. The method of construction and the assessment of performance are discussed.Model tests using one quarter scale tyres in a hydrodynamics laboratory towing tank are described. By computerised data collection and processing, the wave attenuation characteristics were deduced for twentyfive breakwater designs made up from the two most commonly used tyre groups or modules. Wave induced loads on the catenary mooring system were also analysed for extreme values. This data forms part of a systematic study of scrap tyre breakwater design parameters and some conclusions can be drawn.The implications of these model results are scaled to apply to the environmental requirements of fish farms and the relevance of the local topography is discussed.

The paper examines the results of an experiment which was designed to elucidate the manner in which wave characteristics, strut geometry and aspect ratio influence the angles at which struts ventilate. The experiment was conducted using small-scale models in a towing tank which allowed the wave parameters to be varied independently. The results indicate which parameters of a seaway are most hazardous to the operation of a hydrofoil ship in high seas and suggest design features which may extend the capability range of such craft.

ALMOST all archaeological work in the Southwest in the past several years has been an attempt to establish a series of events in their proper time and space context. This implies as the ultimate objective the building of a spacial series of chronologies, each one of which will give as complete an historical picture as is possible to obtain from archaeological data. The particular emphasis which has been, and is being, placed on chronology has directed attention to the methods by which this end is attained. The method has been set forth in 1931 by Leslie Spier in an article in "Methods in Social Science."'7 The list which Spier suggested is composed of the following methods: geology and paleontology, distribution, typology, stratigraphy, seriation, annual deposits, and documents. The writer agrees essentially with each one of these, as defined, with the exception of seriation, which it is felt might more profitably be re-defined as the correlation of series, and designating the relating of two or more chronologies built by one or more of the above methods. All serious scientific work attempts to check one group of data against another, as far as possible. Archaeology combines as many of the methods mentioned as are available by the process of seriation before an evaluation is attempted. If the preponderance of the data then points to one conclusion, after all questionable or doubtful indications are eliminated, this conclusion may be accepted as highly probable or a fact. This paper is a formal application of the seriation process to the determination of the date of the eruption of Sunset Crater, a prehistoric cinder cone near Flagstaff, Arizona, the eruptions of which created situations of considerable archaeological importance.l8 The primary methods of value in this undertaking are the following: geological, because of the phenomenon of the eruption itself, and the attendant scattering of ashes, or cinders, over a wide area; typological, of great importance in the building of a series of pottery designs, and the classification of other artifacts and remains; stratigraphical, in the recognition of certain sites lying beneath the cinders from the eruption; and most important of all dendrochronological, or tree-ring dating, as the means by which at least approximate dates may be assigned. For the past six years the Museum of Northern Arizona has been