Pneumonia remains a leading cause of mortality internationally, making it an intense area of study for new tools for diagnosis and treatment. In this review, we evaluate the potential of recently emerging syndromic panels in promoting rapid diagnosis and improved antibiotic stewardship. We will also examine emerging treatments, including new antibiotics in a world of worsening antimicrobial resistance, in addition to new methods of delivery and non-antibiotic paths of treatment.

Mucormycosis is a rare fungal infection caused by fungi of the order Mucorales. The rhino-cerebral form of mucormycosis is most commonly seen in patients with diabetes mellitus, whereas pulmonary mucormycosis is a rare manifestation in patients with hematological malignancy and transplant recipients. We report a case of a 40-year-old male, with history of poorly controlled diabetes, who presented to the emergency room with a one-week history of hemoptysis. Computed Tomography (CT) of the chest was concerning for a lung mass or abscess. Flexible bronchoscopy revealed an endobronchial lesion that was biopsied with a cryoprobe. Histopathologic examination showed non-septate right-angle branching hyphae, typical of mucormycosis. He underwent surgical resection of the right middle and lower lobes and treatment with antimycotic agents with a complete recovery. This case highlights the importance of early histopathological diagnosis of pulmonary mucormycosis in preventing a fatal outcome.

Objective: Identify incidence of enterococcal bacteremia and associated risk factors in ICU patients with SARS-CoV-2 infection. Design: Retrospective cohort study. Setting: Veterans Affairs Medical Center, Oklahoma City, Oklahoma. Patients: Adult ICU patients with SARS-CoV-2 and positive blood cultures for Enterococcus species between March 1, 2020 and February 28, 2022. Methods: Durations of hospitalization, ICU stay, ventilation, site and duration of central line, receipt of steroids, tocilizumab, and antimicrobials were gathered by chart review. Patient location during a surge of bacteremia was noted and strains were identified by multilocus sequencing typing (MLST). Results: There were 70 episodes of enterococcal bacteremia in ICU patients with COVID-19 during a 2-year period. Patients had a median age of 72 years and 97% were male. Onset of bacteremia was 12 and 14 days after mechanical ventilation and central line placement, respectively. The median number of days to bacteremia diagnosis was 13 from admission to the ICU and 90-day mortality was 66.7% among patients admitted October to December of 2020. A large proportion of ICU patients developed enterococcal bacteremia during a COVID-19 surge (P < .00001) and an increased incidence of enterococcal bacteremia was seen September 2020—February 2021 (P < .0001) in hospitalized patients. A total of 5 unique Enterococcal strains among 13 bacteremia episodes were identified in patients with ICU beds in close proximity. Conclusions: A high incidence of enterococcal bacteremia was observed in critically ill patients with SARS-CoV-2, especially during surges. Contributing factors may include environmental contamination, patient colonization, nonadherence to infection control practices, resource limitations, ICU design and use of mechanical ventilation, central lines and immunosuppressants. MLST can be used to identify clusters to address these contributing factors.

Right heart thrombus represents medical emergency as it is associated with acute pulmonary embolism. Right heart thrombus can manifest acutely in a dramatic fashion as cardiac arrest. Bedside echocardiography is a key to rapid diagnosis and allow early intervention. We report a case of elderly female who was admitted to our hospital after a mechanical fall and found to have hip fracture. Despite an initial uncomplicated course, she experienced cardiopulmonary arrest with right heart clot in transit identified on transesophageal echocardiography (TEE). We highlight the utility of point-of-care ultrasound as well as use of TEE to establish cause of cardiopulmonary arrest.