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Objective: To describe infection prevention and control (IPC) interventions implemented in response to an outbreak of New Delhi metallo-β-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) infections in a veterinary teaching hospital., Methods: A multimodal intervention was introduced that included environmental surveillance, point-prevalence surveillance of hospitalized dogs and cats, mandatory education/training about CRE, alterations in personal protective equipment protocols, increased environmental cleaning/disinfection, workflow modifications, and expert consultation., Results: The highest environmental point prevalence for all-type carbapenemase-producing CRE (CP-CRE) or NDM Escherichia coli samples was 59.4% (19 of 32) or 37.5% (12 of 32), respectively. The highest prevalence of patient colonization with all-type CP-CRE (4 of 13 [30.8%]) or NDM E coli (3 of 13 [23.1%]) occurred at the same time point. Following the interventions, NDM E coli and all-type CP-CRE in the environment rapidly declined, and no further clinical infections were documented in the subsequent 7 months. However, CP-CRE and NDM E coli patient colonization rates took several months to decline., Conclusions: Both clinical infections and patient colonization with CRE declined by use of a multimodal IPC strategy. However, inpatient colonization rates declined more slowly, suggesting ongoing intrafacility transmission and/or unidentified environmental reservoirs that took longer to resolve., Clinical Relevance: This study described feasible IPC interventions that can be applied to inpatient small animal settings to help mitigate acquisition of CRE infections and asymptomatic colonization. Monitoring for clinical infections alone is an insensitive indicator of intrafacility CRE transmission in hospitalized patients. Substantial expenses were associated with the outbreak. Improved IPC and early intervention are recommended to prevent CRE transmission within veterinary hospitals.

Background and Objectives: We created a multitude of initiatives that were in line with the principles of the BETA (Best Practices in the Evaluation and Treatment of Agitation) guidelines to determine if these initiatives would reduce the physical assault rate by patients on emergency medicine (EM) residents., Methods: We conducted three cross-sectional surveys of our EM residents (PGY-1 to -3) to determine the incidence of physical assaults by agitated patients at a large county hospital emergency department. These were primarily anonymous REDCap surveys and were administered at the following intervals: (1) pre-BETA initiative implementation, (2) approximately 12 months after implementation, and (3) 5 years postimplementation. Unfortunately, the in-person deescalation, self-defense, and simulation training were canceled 2 years prior to the last survey due to COVID-19. The second survey only looked at the incidence of physical assaults during the prior 6 months whereas the other two surveys evaluated the incidence of physical assaults since starting residency., Results: The survey response rates for the three REDCap surveys were 76% (50/66), 80% (53/66), and 71% (49/69), respectively. The percentage of EM residents who were physically assaulted per survey period were as follows: preimplementation cumulative assaults 28% (14/50), 12 months after implementation for 1 full academic year 11.3% (6/53), and postimplementation cumulative assaults during residency 5 years later 30.6% (15/49). The two independent-samples proportions tests comparing the number of physical assaults before and approximately 12 months after all of these initiatives were implemented was significant ( p  = 0.032)., Conclusions: An education and training curriculum designed to improve EM residents' ability to manage agitated patients may reduce the incidence of physical assaults on them by patients in their care. However, the decrease in physical assaults after these initiatives followed by the increase in physical assaults experienced after the COVID-19 pandemic are most likely multifactorial., Competing Interests: The authors declare no conflicts of interest., (© 2025 The Author(s). AEM Education and Training published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

In a cross-sectional study of 20 Massachusetts long-term care (LTC) facilities, 19% (n = 449) of residents received antibiotics, with approximately one-third having a documented penicillin allergy. This documented allergy decreased the likelihood of prescribing beta-lactam antibiotics for infections. Improved penicillin allergy assessments and delabeling could optimize antibiotic prescribing in LTC settings., Competing Interests: All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2024.)

Background: Antimicrobial resistance poses a significant global health challenge, particularly affecting older adults who are more susceptible to infections and their complications. Accurate diagnosis and documentation of antibiotic allergies are essential for effective antimicrobial stewardship. Despite the recognized overdiagnosis of antibiotic allergies, comprehensive studies on this subject in long-term care (LTC) settings are limited., Objective: To determine the point prevalence of antibiotic allergies and documentation quality in Massachusetts LTC facilities., Methods: We conducted a cross-sectional, 1-day point prevalence survey from July 1, 2023, to March 31, 2024, across 20 participating LTC facilities in Massachusetts in partnership with the Massachusetts Department of Public Health. The survey assessed the prevalence and documentation of antibiotic allergies among 2345 residents. Multivariable logistic regression was used to explore associations between documented penicillin allergy and demographic factors, including non-penicillin antibiotic allergies., Results: The overall point prevalence of documented antibiotic allergies was 39.1%, with the most frequently reported classes being penicillins at 23.1%, sulfonamides at 15.4%, and cephalosporins at 5.2%. Significant documentation gaps were identified, with up to 92.8% of the allergy records found to be incomplete. Factors associated with documented penicillin allergies included female sex (adjusted odds ratio [aOR], 1.50; 95% CI, 1.16-1.94), White race (aOR, 1.92; 95% CI, 1.25-2.94), having allergies to non-penicillin antibiotics (aOR, 2.89; 95% CI, 2.33-3.59), and receipt of antibiotic (aOR, 2.13; 95% CI, 1.68-2.71)., Conclusion: The high prevalence of documented antibiotic allergies and the notable deficiencies in their documentation underscore the urgent need for enhanced antibiotic evaluation, documentation practices, and penicillin delabeling in LTC facilities., Competing Interests: Disclosures All authors report no potential conflicts. All authors have submitted the International Committee of Medical Journal Editors Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (Copyright © 2024 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Angioedema is a histamine- or bradykinin-mediated response that can be acquired, hereditary, or idiopathic. Manifestations include nonpitting edema of the subcutaneous layer of the skin or submucosal layers of the respiratory or gastrointestinal tracts. While acute presentations are typically transient and localized, angioedema can result in acute airway compromise, requiring immediate stabilization. It can also result in abdominal pain that is commonly misdiagnosed, resulting in unnecessary and potentially harmful procedures. This review assesses current literature on the etiology and management of angioedema in the emergency department. An analysis of the most recent evidence on therapeutic options is provided, while addressing barriers to use.