India is experiencing a second wave of COVID-19, with 28.2 million cases reported as of this writing, although this is likely an underestimate; the true toll is estimated at more than 500 million cases. The unprecedented increase in COVID-19 cases during this second wave exposed the crippled health care system. Oxygen supplies have dwindled, hospitals have turned away patients because of a lack of beds, and shortages of critical medicines have occurred. In the midst of this crisis, a “syndemic” of rhino-orbito-cerebral mucormycosis infections has arisen, with nearly 9000 cases reported so far from several states in India. A syndemic recognizes the interactions between social and biological factors that result in more adverse disease outcomes. Compounding the crises are reported shortages of amphotericin B, the main drug used to treat mucormycosis. Although COVID-19–associated mucormycosis is not unique to India, emerging data indicate that the extraordinarily high prevalence is multifactorial, with contributions from poorly controlled diabetes, excessive use of corticosteroids and possibly antibiotics, and environmental exposure.

We read with great interest the article by Martin et al published online in May 2018 in Infection Control and Hospital Epidemiology. We previously reported on the impact of elimination of contact precautions (CP) in methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) patients on noninfectious complications, although our analysis was limited to falls and pressure ulcers. Our findings differed from those of Martin et al; we observed no statistically significant difference in the rate of falls or pressure ulcers among MRSA/VRE patients in the years before and after eliminating CP.

Approximately 3% of Staphylococcus aureus strains that, according to results of conventional phenotypic methods, are highly susceptible to methicillin-like antibiotics also have polymerase chain reaction (PCR) results positive for mecA. The genetic nature of these mecA-positive methicillin-susceptible S. aureus (MSSA) strains has not been investigated. We report the first clearly defined case of reversion from methicillin susceptibility to methicillin resistance among mecA-positive MSSA within a patient during antibiotic therapy. We describe the mechanism of reversion for this strain and for a second clinical isolate that reverts at a similar frequency. The rates of reversion are of the same order of magnitude as spontaneous resistance to drugs like rifampicin. When mecA is detected by PCR in the clinical laboratory, current guidelines recommend that these strains be reported as resistant. Because combination therapy using both a beta-lactam and a second antibiotic suppressing the small revertant population may be superior to alternatives such as vancomycin, the benefits of distinguishing between mecA-positive MSSA and MRSA in clinical reports should be evaluated.

Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.

BACKGROUND: Hospitals use contact precautions to prevent the spread of meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). There is concern that contact precautions may have adverse effects on the safety of isolated patients. In November 2010, the infection control policy at an academic medical centre was modified, and contact precautions were discontinued for patients colonized or infected with MRSA or VRE (MRSA/VRE patients). AIM: To assess the rates of falls and pressure ulcers among MRSA/VRE patients and other adult medical-surgical patients, as well as changes in MRSA and VRE transmission before and after the policy change. METHODS: A single-centre retrospective hospital-wide cohort study was performed from 1st November 2009 to 31st October 2011. FINDINGS: Rates of falls and pressure ulcers were significantly higher among MRSA/VRE patients compared with other adult medical-surgical patients before the policy change (falls: 4.57 vs 2.04 per 1000 patient-days, P < 0.0001; pressure ulcers: 4.87 vs 1.22 per 1000 patient-days, P < 0.0001) and after the policy change (falls: 4.82 vs 2.10 per 1000 patient-days, P < 0.0001; pressure ulcers: 4.17 vs 1.19 per 1000 patient-days, P < 0.0001). No significant differences in the rates of falls and pressure ulcers among MRSA/VRE patients were found after the policy change compared with before the policy change. There was no overall change in MRSA or VRE hospital-acquired transmission. CONCLUSION: MRSA/VRE patients had higher rates of falls and pressure ulcers compared with other adult medical-surgical patients. Rates were not affected by removal of contact precautions, suggesting that other factors contribute to these complications. Further research is required among this population to prevent complications.

We read the article of Hayakawa et al with great interest. The report describes the growing prevalence of vancomycin-resistant Enterococcus faecalis in Michigan, a state that also has the most reports of vancomycin-resistant Staphylococcus aureus. Similar findings were reported in the tigecycline evaluation and surveillance trial (TEST). During the 2004–2009 period, 4.6% of 3,753 E. faecalis isolates were vancomycin resistant, with the highest rates of 7.6% in the East North Central region of United States. Here we report rates and trends of vancomycin-resistant E. faecalis in the East North Central region compared with national rates from 1999 to 2010.