Background Medication errors (MEs) and adverse drug events (ADEs) are both common and under-reported in the intensive care setting. The definitions of these terms vary substantially in the literature. Many methods have been used to estimate their incidence. Methods A systematic review was done to assess methods used for tracking unintended drug events in intensive care units (ICUs). Studies published up to 22 June 2007 were identified by searching eight online databases, including Medline. In total, 613 studies were evaluated for inclusion by two reviewers. Results The authors selected 29 papers to analyse; all studies took place in an ICU, were reproducible and reported ICU-specific rates of events. Rates of MEs varied from 8

C haracterizing mutations in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genome has led to the identifi cation of variants of concern (VOCs) on the basis of such criteria as increased transmissibility, clinical severity, effect on diagnostic testing, and reduced vaccine effi cacy (1-5). Globally, the B.1.1.7 (Alpha), B.1.351 (Beta), and P.1 (Gamma) lineages represented the 3 main actively circulating VOCs in late 2020 and early 2021 (6). B.1.1.7 was fi rst detected in England in September 2020 and progressed to become the dominant lineage in this setting within months (4,7). By early January 2021, >40 countries had documented B.1.1.7 cases, demonstrating rapid international spread (8). This lineage has been associated with an estimated 40%-90% increase in transmissibility (4,7), variable effects on clinical severity and mortality rates (5,9,10), and limited effect on vaccine effectiveness (11). In contrast, whereas B.1.351 and P.1 also emerged in fall 2020 and spread rapidly locally, initial evidence of international transmission beyond South Africa and Brazil was limited (8,12,13). The P.1 lineage poses concern given its associations with an estimated 70%-240% increase in transmissibility ( 12), decreased neutralization capacity by monoclonal and serum-derived polyclonal antibodies ( 14), and increased risk for reinfection (12). Limited evidence from Italy, where B.1.1.7 and P.1 lineages have cocirculated, has shown the potential for B.1.1.7 to surpass P.1 for dominant VOC status in a short timeframe (15; P. Stefanelli et al., unpub. data, https://www.medrxiv.org/content/10.1101/ 2021.04.06.21254923v1). However, recent evidence from the United States suggests that infection after vaccination might be attributed to variants characterized by such mutations as E484K, T95I, del142-144, and D614G (16). The SARS-CoV-2 spike E484K mutation, which is present in the P. 1 and B.1.351 lineages,

Medical leech therapy (MLT) with Hirudo medicinalis is well established as a treatment for venous congestion of tissue flaps, grafts, and replants. Unfortunately, this treatment is associated with surgical site infections with bacterial species, most commonly Aeromonas hydrophila, which is an obligate symbiot of H. medicinalis. For this reason, prophylactic antibiotics are recommended in the setting of MLT. After culturing Aeromonashydrophila resistant to ciprofloxacin from a tissue specimen from a patient with a failed replant of three digits post-MLT, we performed environmental surveillance cultures and antibiotic susceptibility testing on water collected from leech tanks. This surveillance was performed twice weekly for 2.5 months. Fourteen surveillance cultures demonstrated 21 isolates of Aeromonas species, 71.4% of which were ciprofloxacin susceptible. All isolates were sulfamethoxazole-trimethoprim (SXT) susceptible. The prophylactic antibiotic regimen of choice for leech therapy at our institution is SXT, with culture of tank water to refine antimicrobial choice if necessary. This study demonstrates the importance of regular surveillance to detect resistant Aeromonas species in medical leeches; however optimal practice has not been established.

ObjectivesOutbreaks of shigellosis have been documented in men who have sex with men (MSM), associated with interpersonal transmission and underlying HIV infection. We observed a rise in Shigella flexneri isolates identified in a downtown tertiary-care hospital laboratory located within the city centre community health area (CHA-1) of Vancouver, Canada. The objectives of this study were to evaluate clinical outcomes of shigellosis cases among MSM admitted to hospital and to evaluate trends in Shigella cases within Vancouver, Canada. MethodsAdult rates of shigellosis were analysed by gender and health region, from 2005 to 2011, followed by retrospective chart review of all hospital laboratory-identified S. flexneri cases from 2008 to 2012. Serotyping and pulsed-field gel electrophoresis (PFGE) were performed on these isolates. ResultsAlthough shigellosis rates in men within CHA-1 did not change from 2005 to 2011 (range 33.4-68.5 per 100 000; P = 0.74), they were significantly higher than in other regions within the city of Vancouver (P ≤ 0.001) and the province of British Columbia (P ≤ 0.001). Shigella flexneri rates in men within CHA-1 increased significantly (range 2.3-51.4 per 100 000; P < 0.001), starting in 2008, and were higher than in other regions within Vancouver (P ≤ 0.01). Seventy-nine isolates of S. flexneri from 72 patients were identified by a single hospital laboratory. All patients were male and predominantly MSM (91.7%) and HIV-infected (86.1%), with most (92.6%) demonstrating CD4 counts ≥ 200 cells/μL. In total, 38.0% required hospitalization. Most (87.3%) had S. flexneri serotype 1 infection, with 72.9% of these representing a single PFGE pattern. ConclusionsWe identified high levels of transmission of a primarily clonal strain of S. flexneri serotype 1 in our local MSM population, resulting in a substantial burden of illness and health care resource use secondary to hospital admissions. [3][4][5]. From 1970 to 1985, a significant demographic shift occurred in the USA with respect to S. flexneri infection, with a more than fivefold increase in the infection rate in men 30 to 39 years old, despite no change in women of comparable age [6]. MSM transmission was felt to be a likely explanation for this change, with acquisition thought to be related to sexual practices of oral−anal and oral−genital contact [6]. In 1996, HIV was also identified as an important risk factor for shigellosis, after higher rates of Shigella infection were noted in a population that was significantly more likely to be adult, male and HIV-infected [7]. A case−control study was performed in the San Francisco area during a nonoutbreak period from 1998 to 1999, with multivariate analysis demonstrating a significant association of shigellosis with MSM, HIV infection, direct oral−anal contact and foreign travel [8]. Shigella flexneri appeared to be the predominant species in MSM during that period and, compared with S. sonnei, was significantly associated with MSM, HIV infection, direct anal contact, and lack of foreign travel ...