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Central line...associated bloodstream infection rates increased during the Omicron surge at our rural academic medical center. To identify potential drivers of this increase, we investigated period- and patient-specific factors associated with the increase in central line...associated bloodstream infection. Increased central line utilization, decreased central line bundle compliance monitoring, increased proportion of traveling nurses, increased short-term venous catheter use in the internal jugular vein, increased multilumen catheter use, decreased port...associated infection, and increased patient acuity were significantly associated with the surge. Our results helped us target our local infection prevention efforts., (Copyright © 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

How immune dysregulation affects recovery from COVID-19 infection in patients with cancer remains unclear. We analyzed cellular and humoral immune responses in 103 patients with prior COVID-19 infection, more than 20% of whom had delayed viral clearance. Delayed clearance was associated with loss of antibodies to nucleocapsid and spike proteins with a compensatory increase in functional T cell responses. High-dimensional analysis of peripheral blood samples demonstrated increased CD8 + effector T cell differentiation and a broad but poorly converged COVID-specific T cell receptor (TCR) repertoire in patients with prolonged disease. Conversely, patients with a CD4 + dominant immunophenotype had a lower incidence of prolonged disease and exhibited a deep and highly select COVID-associated TCR repertoire, consistent with effective viral clearance and development of T cell memory. These results highlight the importance of B cells and CD4 + T cells in promoting durable SARS-CoV-2 clearance and the significance of coordinated cellular and humoral immunity for long-term disease control., Competing Interests: Declaration of interests S.A.V. is on the advisory board for Immunai and has received consulting fees from ADC Therapeutics. A.C.H. is a consultant for Immunai., (Copyright © 2022 Elsevier Inc. All rights reserved.)

We report a rare case of severe myopericarditis in a healthy man in his 20s after the third dose of an mRNA COVID-19 vaccine. His symptoms and troponinemia resolved with a beta-blocker in addition to standard anti-inflammatory therapy, highlighting the utility of multimodal therapy., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The COVID-19 pandemic has significantly impacted health care workers (HCW). Most research focused on the adverse mental health effects during the initial surge of cases; and yet little is known about approximately how workers are faring 1 year into the pandemic. The objective of this study is to examine stress, burnout, and risk perception in an academic medical system, 1 year after the start of the pandemic., Methods: HCW across care specialties participated in online surveys in Spring 2020 and Spring 2021. The surveys included questions related to workplace stress and risk perception related to COVID-19. Correlates of stress and burnout were explored using multivariable linear regression models. Professional Quality of Life Scale (PROQOL) questions were added to the second survey., Results: While HCW reported significantly fewer concerns about the risk of COVID-19 transmission to themselves and their families during the 2021 survey (compared with 2020), the percentage of workers who reported feeling excess stress at work or considered resigning stayed the same. One year into the pandemic, 57% of study participants met criteria for moderate or high levels of traumatic stress and 75% met criteria for moderate or high levels of burnout. As compared with participants who cared for no COVID-19 deaths, participants who cared for COVID-19 patients who died had significantly higher traumatic stress (1 to 10: Coef. = 2.7, P = .007 ; >10: Coef. = 6.7, P < .001 ) and burnout scores (1 to 10: Coef. = 2.7, P = .004 ; >10: Coef. = 2.6, P = .036 )., Conclusion: While Although perceptions of risk declined over the course of the year, levels of stress still remained high despite high vaccination rates. Those who witnessed more COVID-19 deaths were more likely to report increased burnout and post-traumatic stress. As our nation continues to grapple with the COVID-19 pandemic and new variants emerge it is imperative to focus on recovery strategies for high burnout groups to ensure the wellbeing of our health care workforce., Competing Interests: Conflict of interest: To the best of our knowledge, the named authors have no conflict of interest, financial or otherwise., (© Copyright 2022 by the American Board of Family Medicine.)

Infection with the SARS-CoV2 virus can vary from asymptomatic, or flu-like with moderate disease, up to critically severe. Severe disease, termed COVID-19, involves acute respiratory deterioration that is frequently fatal. To understand the highly variable presentation, and identify biomarkers for disease severity, blood RNA from COVID-19 patient in an intensive care unit was analyzed by whole transcriptome RNA sequencing. Both SARS-CoV2 infection and the severity of COVID-19 syndrome were associated with up to 25-fold increased expression of neutrophil-related transcripts, such as neutrophil defensin 1 (DEFA1), and 3-5-fold reductions in T cell related transcripts such as the T cell receptor (TCR). The DEFA1 RNA level detected SARS-CoV2 viremia with 95.5% sensitivity, when viremia was measured by ddPCR of whole blood RNA. Purified CD15+ neutrophils from COVID-19 patients were increased in abundance and showed striking increases in nuclear DNA staining by DAPI. Concurrently, they showed >10-fold higher elastase activity than normal controls, and correcting for their increased abundance, still showed 5-fold higher elastase activity per cell. Despite higher CD15+ neutrophil elastase activity, elastase activity was extremely low in plasma from the same patients. Collectively, the data supports the model that increased neutrophil and decreased T cell activity is associated with increased COVID-19 severity, and suggests that blood DEFA1 RNA levels and neutrophil elastase activity, both involved in neutrophil extracellular traps (NETs), may be informative biomarkers of host immune activity after viral infection., Competing Interests: TM and IT have an equity interest in True Bearing Diagnostics, Inc., a diagnostics company developing RNA biomarkers for various diseases, including coronary artery disease and internal infections. TM is seeking patent protection for technology related to the current studies. This does not alter our adherence to PLOS ONE policies on sharing data and materials. The other authors declare there are no competing interests.

Patients with cancer have high mortality from coronavirus disease 2019 (COVID-19), and the immune parameters that dictate clinical outcomes remain unknown. In a cohort of 100 patients with cancer who were hospitalized for COVID-19, patients with hematologic cancer had higher mortality relative to patients with solid cancer. In two additional cohorts, flow cytometric and serologic analyses demonstrated that patients with solid cancer and patients without cancer had a similar immune phenotype during acute COVID-19, whereas patients with hematologic cancer had impairment of B cells and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody responses. Despite the impaired humoral immunity and high mortality in patients with hematologic cancer who also have COVID-19, those with a greater number of CD8 T cells had improved survival, including those treated with anti-CD20 therapy. Furthermore, 77% of patients with hematologic cancer had detectable SARS-CoV-2-specific T cell responses. Thus, CD8 T cells might influence recovery from COVID-19 when humoral immunity is deficient. These observations suggest that CD8 T cell responses to vaccination might provide protection in patients with hematologic cancer even in the setting of limited humoral responses., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread within the human population. Although SARS-CoV-2 is a novel coronavirus, most humans had been previously exposed to other antigenically distinct common seasonal human coronaviruses (hCoVs) before the coronavirus disease 2019 (COVID-19) pandemic. Here, we quantified levels of SARS-CoV-2-reactive antibodies and hCoV-reactive antibodies in serum samples collected from 431 humans before the COVID-19 pandemic. We then quantified pre-pandemic antibody levels in serum from a separate cohort of 251 individuals who became PCR-confirmed infected with SARS-CoV-2. Finally, we longitudinally measured hCoV and SARS-CoV-2 antibodies in the serum of hospitalized COVID-19 patients. Our studies indicate that most individuals possessed hCoV-reactive antibodies before the COVID-19 pandemic. We determined that ∼20% of these individuals possessed non-neutralizing antibodies that cross-reacted with SARS-CoV-2 spike and nucleocapsid proteins. These antibodies were not associated with protection against SARS-CoV-2 infections or hospitalizations, but they were boosted upon SARS-CoV-2 infection., Competing Interests: Declaration of interests A.C.H. is a consultant for Immunai. E.J.W. has consulting agreements with and/or is on the scientific advisory board for Merck, Elstar, Janssen, Related Sciences, Synthekine, and Surface Oncology. E.J.W. is a founder of Surface Oncology and Arsenal Biosciences. E.J.W. is an inventor on a patent (U.S. patent number 10,370,446) submitted by Emory University that covers the use of PD-1 blockade to treat infections and cancer. D.J.R. is on scientific advisory boards for Alnylam, Metrea, Novartis, Pfizer, and Verve; is a consultant for and receives research support from Regeneron for work unrelated to this report; and is a founder of Vascular Strategies and Staten Biotechnologies. S.E.H. has received consultancy fee from Sanofi Pasteur, Lumen, Novavax, and Merck for work unrelated to this report., (Copyright © 2021 Elsevier Inc. All rights reserved.)

At the beginning of the COVID-19 pandemic, some nursing homes (NHs) in Maryland suffered larger outbreaks than others. This study examined how facility characteristics influenced outbreak size. We conducted a retrospective analysis of secondary data from Maryland NHs to identify characteristics associated with large outbreaks, defined as when total resident cases exceeded 10% of licensed beds, from January 1, 2020, through July 1, 2020. Our dataset was unique in its inclusion of short-stay residents as a measure of resident type and family satisfaction as a measure of quality. Facility characteristics were collected prior to 2020. Like other studies, we found that large outbreaks were more likely to occur in counties with high cumulative incidence of COVID-19, and in NHs with more licensed beds or fewer daily certified nursing assistant (CNA) hours. We also found that NHs with a greater proportion of short-stay residents were more likely to have large outbreaks, even after adjustment for other facility characteristics. Lower family satisfaction was not significantly associated with large outbreaks after adjusting for CNA hours. Understanding the characteristics of NHs with large COVID-19 outbreaks can guide facility re-structuring to prevent the spread of respiratory infections in future pandemics. [ABSTRACT FROM AUTHOR]

B Background: b The COVID-19 pandemic has psychological impacts on healthcare workers (HCW), especially those in the intensive care unit (ICU). We hypothesized that HCWs in the ICU treating COVID-19 patients would have high levels of risk perception, stress, and burnout one year into the pandemic. [Extracted from the article]

Questions evaluated workplace stress, burnout, and risk perception related to COVID; vaccination status and Professional Quality of Life Scale (PROQOL) were added in 2021. B Background: b The COVID-19 pandemic has killed more than 600,000 people in the United States. We aimed to compare levels of stress, burnout, and risk perception one year into the pandemic for APPs. [Extracted from the article]

Using both microarrays and RNA sequencing, Defensin alpha 1 (DEFA1) was identified as a sensitive biomarker of neutrophil activation. DEFA1 levels measured by ddPCR may provide a quick novel test to discriminate outcomes, severity and need for ICU admission in COVID19+ patients. B Methods: b Whole blood was collected in RNA stabilizing "Tempus" tubes from COVID19+ ICU patients, floor patients incidentally COVID19+, and a healthy COVID19 negative control group from 30 Oct 2020 - 14 Apr 2021. [Extracted from the article]