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Background and Objectives The coronavirus disease 2019 pandemic placed unprecedented stress on older adults. Resiliency could mitigate deleterious effects of pandemic stressors. We described trends in resilience among U.S. adults aged 50–80 years approximately one and a half years after the onset of the pandemic, compared with before the pandemic, and evaluated associations between relationships and resilience. Research Design and Methods Data were from the National Poll on Healthy Aging (N = 2,100) in August 2021. Respondents rated their resiliency as compared with before the pandemic (more, about the same, or less) and different types of relationships (spouse/partner, friends, and neighbors) as sources of joy and/or stress during the pandemic (a lot, some, very little, and not at all). Multinomial logistic regressions (complete-case analysis) estimated the relationships between each joyful and stressful relationships and resiliency. Results Most participants reported feeling as resilient as before the pandemic (70.6%) with 14.5% feeling less resilient. More women than men felt less resilient than before the pandemic (16.7% vs 12.8%, p =.006). Feeling a lot of stress from one's spouse or neighbors was associated with increased likelihood of feeling less resilient than before the pandemic (odds ratio [OR] = 3.7; 95% confidence interval [CI]: 1.8, 7.7 and OR = 4.5; 95% CI: 1.5, 13.9, respectively), which was stronger among women (OR = 15.1; 95% CI: 4.8, 45.6) than men (OR = 1.03; 95% CI: 0.4, 2.7). Discussion and Implications Social relationships may have been more important for women than for men in supporting resiliency during the pandemic. Understanding patterns of resiliency can help to inform policymaking and support the well-being of older adults. [ABSTRACT FROM AUTHOR]

Background Polypharmacy is highly prevalent among older adults. This study's purpose was to provide nationally representative estimates of self-reported comprehensive medication review (CMR) receipt among older adults and describe factors associated with their receipt, as CMRs are available through the Medicare Part D program. Methods This cross-sectional study used data from the National Poll on Healthy Aging (NPHA), a nationally representative online survey of community-dwelling adults aged 50–80, administered in December 2019. Participants included older adults aged 65-80 with any health insurance (n = 960). Outcomes were self-reported CMR receipt, awareness of CMR insurance coverage, and interest in a future CMR with a pharmacist. Sociodemographic and health-related variables were included. Descriptive statistics and multivariable logistic regression with NPHA population sampling weights were used. Results Among older adults on 2 or more prescription medications, only 20.8% had received a CMR while 34.3% were interested in a future CMR. Among individuals who had not received a CMR, most (83.4%) were unaware their insurance might cover a CMR. Factors associated with higher odds of receiving a CMR included taking 5 or more prescription medications (adjusted odds ratio [AOR] = 2.6, 95% CI: 1.59–4.38) and reporting food insecurity (AOR = 2.9, 95% CI: 1.07–7.93). Having fair or poor self-reported physical health was associated with lower odds of receiving a CMR (AOR = 0.49, 95% CI: 0.25–0.97). Conclusions Most older adults on 2 or more prescription medications with health insurance had not received a CMR and many were interested in one. Targeted strategies to increase older adults' awareness and receipt of CMRs are warranted. [ABSTRACT FROM AUTHOR]

Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic poses new challenges for caregivers of adults with chronic or disabling conditions. This study uses nationally representative data to examine the prevalence of pandemic care challenges and supports and their associations with caregiver mental health and interpersonal well-being. Research Design and Methods Participants include 311 caregivers aged 50–80 in the United States who were providing care for an adult with a chronic or disabling condition from the June 2020 National Poll on Healthy Aging. Five care challenges (e.g. confusion on public health guidelines) and 2 supports (e.g. physician offered information on care during COVID-19) are treated as predictors of caregiver mental health (care-related stress, self-reported mental health, and depressive symptoms) and interpersonal well-being (interpersonal conflicts, lack of companionship, and isolation). Results Each care challenge/support was endorsed by 13%–23% of caregivers. In adjusted models, difficulty getting needed medical care was associated with greater caregiver stress, depressive symptoms, and lower interpersonal well-being. All care challenges universally predicted greater caregiver stress. Caregiving supports were not independently associated with caregiver' mental health and interpersonal well-being. Discussion and Implications Care challenges were associated with caregivers' mental health and interpersonal well-being during the early months of the pandemic. Some of these challenges may be attributed to changing public health guidelines and practices as the pandemic unfolded, whereas others are relevant to all care contexts (e.g. less support from family). Tools and supports for caregivers must consider both changing policies and care needs. [ABSTRACT FROM AUTHOR]

Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. The panel included clinicians and investigators representing internal medicine, emergency medicine, microbiology, critical care, surgery, epidemiology, pharmacy, and adult and pediatric infectious diseases specialties. These recommendations address the best approaches for antibiotic stewardship programs to influence the optimal use of antibiotics. [ABSTRACT FROM AUTHOR]

The association between hypervirulent ribotype and severe Clostridium difficile infection was nonsignificant after adjustment for microbiologic, epidemiologic, and laboratory variables. This nonsignificant association was further validated using an independent data set.Background. Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. A growing number of studies challenge the validity of this hypothesis.Methods. We conducted a cross-sectional study of C. difficile infection (CDI) to test whether ribotype predicted clinical severity when adjusted for the influence of other predictors. Toxigenic C. difficile isolates were cultured from stool samples, screened for genes encoding virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined their individual and cumulative influence on the association between C. difficile ribotype and severe disease. We then validated this influence using an independent data set.Results. A total of 34 severe CDI cases were identified among 310 independent cases of disease (11.0%). Eleven covariates, including C. difficile ribotype, were significant predictors of severe CDI in unadjusted analysis. However, the association between ribotypes 027 and 078 and severe CDI was not significant after adjustment for any of the other covariates. After full adjustment, severe cases were significantly predicted only by patients' white blood cell count and albumin level. This result was supported by analysis of a validation data set containing 433 independent CDI cases (45 severe cases; 10.4%).Conclusions. Ribotype is not a significant predictor of severe CDI when adjusted for the influence of any other variables separately or in combination. White blood cell count and albumin level are the most clinically relevant predictors of severe CDI cases. [ABSTRACT FROM AUTHOR]

Background. Vancomycin-resistant enterococcal (VRE) infections cause significant morbidity and mortality among patients undergoing liver transplantation. We performed a prospective study among patients awaiting transplantation to assess rates, risk factors, and outcomes associated with VRE colonization before and after transplantation. Methods. All adults on the transplantation waiting list from 2000-2003 were eligible. Demographic, historical, and laboratory data, as well as stool samples to be analyzed for VIRE, were collected at enrollment and every 4- 6 months thereafter until transplantation. After transplantation, samples were obtained every 3 days during hospitalization and were analyzed for VRE; outcomes were assessed at 90 days. Results. Overall, 375 patients were enrolled in our study, and 142 received transplants. VIRE colonization occurred in 50 (13%) of 375 patients before transplantation and was independently associated with treatment with antian aerobic antimicrobials, third-generation cephalosporins, proton pump inhibitors, or neomycin; having a recent endoscopic retrograde cholangiopancreatogram or paracentesis procedure; and admission to the liver unit. Of these 50 patients, 22 (44%) received a transplant, and 7 (32%) of 22 developed a VIRE infection after transplantation. An additional 22 patients (18%) who were not colonized before transplantation acquired VRE after transplantation; VIRE infection developed in 5 (23%) of these patients. Patients colonized with VIRE either before or after transplantation had longer stays in the intensive care unit and the hospital. Mortality at 90 days was significantly greater among those who acquired VRE after transplantation (5 [23%] of 22), compared with those who had V"RE colonization before transplantation (2 [9%] of 22). Conclusions. Liver transplantation candidates with VIRE colonization before transplantation experience greater morbidity but not greater mortality, compared with noncolonized candidates. Transplant recipients who acquire VIRE after transplantation have a higher mortality rate than noncolonized recipients. Strategies should be implemented to reduce nosocomial VRE acquisition after transplantation among this vulnerable group. [ABSTRACT FROM AUTHOR]

Eleven patients developed deep sternal wound infections due to Candida albicans after undergoing coronary artery bypass grafting (CABG) and were assessed. Six had sternal osteomyelitis, 1 had osteomyelitis and mediastinitis, and 4 had deep wound infections that probably involved bone. Seven patients experienced onset of infection within 28 days of CABG, but 4 experienced onset 48-150 days after CABG. Infections were characterized by a chronic, indolent course requiring prolonged treatment with an antifungal agent. Delay in initiating antifungal therapy was common. All patients were treated with fluconazole, and 1 also received amphotericin B. Six patients underwent incision and drainage, with or without wire removal, and 3 underwent sternectomy with placement of a muscle flap. Of 10 patients for whom follow-up data were available, 7 were cured after initial therapy (median duration of treatment, 6 months), and 3 experienced a relapse and required a second course of fluconazole. [ABSTRACT FROM AUTHOR]

Presents a study of nosocomial infections in left ventricular assist device recipients. Use of mechanical circulatory devices as bridges to transplantation; Role of transplantation as a definitive therapy for end-stage heart disease; Methodology and results.

Presents a study which found that several patients who underwent median sternotomy developed infections with Pseudomonas aeruginosa. Methods; Results; Discussion.

We evaluated the molecular relatedness of 47 clinical isolates of vancomycin-resistant Enterococcus faecalis collected from 15 Michigan hospitals from 1991 to 2000. There were 17 PFGE strain types for the 47 isolates. Ten of 15 hospitals demonstrated interhospital, and three of 15 intrahospital, dissemination of some isolates. Forty-two isolates (89.4%) demonstrated vanB resistance. All vanA isolates comprised unique PFGE groups, suggesting transposon dissemination or the presence of a similar plasmid. The results of this study suggest inter- and intrahospital dissemination of strains of vancomycin-resistant E. faecalis during a 10 year period in Michigan. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Clostridium difficile ribotype does not predict severe infection" in the 2012 issue is presented.