Background: Coronavirus disease 2019 (COVID-19) has become a global pandemic. Clinical characteristics regarding secondary infections in patients with COVID-19 have been reported, but detailed microbiology, risk factors, and outcomes of secondary bloodstream infections (sBSIs) in patients with severe COVID-19 have not been well described.Methods: We performed a multicenter case-control study including all hospitalized patients diagnosed with severe COVID-19 and blood cultures drawn from 1 March 2020 to 7 May 2020 at 3 academic medical centers in New Jersey. Data collection included demographics, clinical and microbiologic variables, and patient outcomes. Risk factors and outcomes were compared between cases (sBSI) and controls (no sBSI).Results: A total of 375 hospitalized patients were included. There were 128 sBSIs during the hospitalization. For the first set of positive blood cultures, 117 (91.4%) were bacterial and 7 (5.5%) were fungal. Those with sBSI were more likely to have altered mental status, lower mean percentage oxygen saturation on room air, have septic shock, and be admitted to the intensive care unit compared with controls. In-hospital mortality was higher in those with an sBSI versus controls (53.1% vs 32.8%, P = .0001).Conclusions: We observed that hospitalized adult patients with severe COVID-19 and sBSI had a more severe initial presentation, prolonged hospital course, and worse clinical outcomes. To maintain antimicrobial stewardship principles, further prospective studies are necessary to better characterize risk factors and prediction modeling to better understand when to suspect and empirically treat for sBSIs in severe COVID-19.

Antimicrobial stewardship programs play a critical role in optimizing the use of antimicrobials against pathogens in the era of growing multi-drug resistance. However, implementation of antimicrobial stewardship programs among the hematopoietic stem cell transplant and oncology populations has posed challenges due to multiple risk factors in the host populations and the infections that affect them. The consideration of underlying immunosuppression and a higher risk for poor outcomes have shaped therapeutic decisions for these patients. In this multidisciplinary perspective piece, we provide a summary of the current landscape of antimicrobial stewardship, unique challenges, and opportunities for unmet needs in these patient populations.

Purpose of review: Infections can result in serious complications in solid organ transplant (SOT) patients. The need to remain up to date on recommendations on screening, vaccinations, and chemoprophylaxis is paramount in the management of SOT patients. The goal of this review is to provide an overview of current recommendations for the prevention of infections and optimization of vaccinations from the pretransplant through posttransplant periods. Recent findings: There is an emphasis on thorough pretransplant evaluation to guide clinicians and pretransplant testing based on epidemiological and endemic risk factors. Additionally, recent studies on vaccine safety and efficacy of newer vaccine formulations in SOT recipients are addressed. Summary: This review provides insight on updated recommendations for pretransplant screening, new data on vaccine optimization in SOT recipients and posttransplant prophylaxis. Further research is needed in order to improve preventive measures including screening tests, vaccines, and chemoprophylaxis.

Background: Cytomegalovirus (CMV) infection is a common and serious complication following renal transplantation. It is associated with significant morbidity and mortality. The introduction of preventive measures with antiviral prophylaxis has reduced the incidence in the immediate posttransplant period, but CMV infection continues to be a prominent complication, especially once antiviral prophylaxis is discontinued. A particularly rare entity is “very late‐onset” CMV disease, which we defined as occurring 10 or more years after transplantation. Methods: We report a case of very late‐onset CMV disease presenting 17 years post–renal transplant, complicated by concurrent Pneumocystis jirovecii pneumonia (PJP). We performed a focused narrative review using PubMed for cases of very late‐onset CMV disease to document potential risk factors for very late‐onset CMV disease. Results: Our narrative review did not show a consistent pattern between the traditional risk factors such as prior rejection, impaired renal function, or changes in immunosuppressive therapy and the development of very late‐onset CMV disease. However, an absolute lymphocyte count below 610/μL was present in our patient and may represent an area for further investigation as a potential risk factor for very late‐onset CMV disease. Conclusion: Early recognition is crucial, as complications such as CMV–PJP coinfection carry high mortality rates and adversely affect long‐term graft and patient outcomes. Clinicians should maintain a high index of suspicion for CMV in transplant recipients regardless of the time elapsed since transplantation.