Michael Mitchell

Methicillin-Resistant Staphylococcus intermedius Pneumonia Following Coronary Artery Bypass Grafting

virus DNA in cerebrospinal fluid from immunocompetent individuals with brain disorders. Microbiologica 1998;21:77–9. 8. Studahl M, Bergström T, Hagberg L. Acute viral encephalitis in adults— a prospective study. Scand J Infect Dis 1998;30:215–20. 9. Tang YW, Espy MJ, Persing DH, Smith TF. Molecular evidence and clinical significance of herpesvirus coinfection in the central nervous system. J Clin Microbiol 1997;35:2869–72.

Oropharyngeal flora in healthy infants: observations and implications for cystic fibrosis care

The purpose of this preliminary study was to determine normal oropharyngeal flora in healthy, non‐CF infants in order to help care givers better interpret culture results obtained from infants with CF.

Therapeutic apheresis using a mononuclear cell program to lower the microfilaria burden of a 23-year-old African woman with loiasis.

Apheresis has been used to lower the parasite burden of patients with Loa loa infection, but there are no reports regarding how to do this using modern, continuous flow equipment with a currently available program. A 23‐year‐old female refugee from Cameroon with known Loa loa infection presented to our Emergency Department with acute mental status changes and a picture of encephalitis. Lumbar puncture revealed Loa loa in her cerebrospinal fluid. Her midday blood microfilaria count was 15,000/mL. Because treatment with diethylcarbamazine was under consideration, we were asked to lower her parasite burden using apheresis. One single 2‐total blood volume apheresis using the mononuclear cell program (without hydroxyethyl starch) on a COBE® Spectra Apheresis System decreased the microfilarial load from 15,000/mL to 10,666/mL, a 29% reduction. J. Clin. Apheresis 32:200–202, 2017.

Recrudescence of Plasmodium falciparum in a Primigravida after Nearly 3 Years of Latency.

We present a case of a primigravid woman who presented with Plasmodium falciparum nearly 3 years after she last visited a malaria-endemic region. We review the literature to identify case reports of recrudescent P. falciparum malaria during pregnancy, including those with prolonged latency. Reports of recrudescence of P. falciparum during pregnancy are limited. Plasmodium falciparum infection can persist for years. Recrudescence can occur with waning of immunity following departure from endemic areas. Pregnancy, particularly the primigravid state, is a risk factor for severe infection.

A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center

Background The rates of central line‐associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital‐onset bacteremias in these units should also be expected. We report 10‐year trends for total hospital‐onset ICU‐associated bacteremias at a tertiary‐care academic medical center. Methods This was a retrospective analysis of all positive‐result blood cultures among patients admitted to seven adult ICUs for fiscal year 2005 (FY2005) through FY2014 according to Centers for Disease Control and Prevention National Healthcare Safety Network definitions. The rate of change for primary and secondary hospital‐onset BSIs was determined, as was the distribution of organisms responsible for these BSIs. Data from three medical, two general surgical, one combined neurosurgical/trauma, and one cardiac/cardiac surgery adult ICU were analyzed. Results Across all ICUs, the rates of primary BSIs progressively fell from 2.11/1,000 patient days in FY2005 to 0.32/1,000 patient days in FY2014; an 85.0% decrease (P < .0001). Secondary BSIs also progressively decreased from 3.56/1,000 to 0.66/1,000 patient days; an 81.4% decrease (P < .0001). The decrease in BSI rates remained significant after controlling for the number of blood cultures obtained and patient acuity. Conclusions An increased focus on reducing hospital‐onset infections at the academic medical center since 2005, including multimodal multidisciplinary efforts to prevent central line‐associated BSIs, pneumonia, Clostridium difficile disease, surgical site infections, and urinary tract infections, was associated with progressive and sustained decreases for both primary and secondary hospital‐onset BSIs.