The Utilization of Low Dose Naltrexone for Chronic Pain

Naltrexone is a mu-opioid receptor antagonist with a long half-life compared with naloxone. Both of these drugs, along with others, were developed with the intention of reversing the effects of opioid abuse or toxicity. Evidence has also shown that naltrexone has a benefit in preventing relapse by reducing opioid cravings and reducing symptoms of opioid withdrawal. The benefits of this drug were not only shown with opioid abuse. In 1984 this drug was also approved for alcohol abuse. Naltrexone has been proven to decrease alcohol relapse by decreasing the craving. Apart from these approved indications for the use of naltrexone, with time, it has been seen that this drug has a benefit in treating chronic pain. A number of studies have shown the benefits of this drug with inflammatory bowel disease, fibromyalgia, multiple sclerosis, diabetic neuropathy, and complex regional pain syndrome, among others. More studies are needed to approve this medication for specific chronic pain conditions.

What If We Don't? A Retrospective Review of Standard Precautions for MRSA

BACKGROUND

There are conflicting data in the literature about the need for contact isolation for active methicillin-resistant Staphylococcus aureus (MRSA) infections.

METHODS

In this retrospective review, we compared the MRSA bloodstream standardized infection ratio for 1 year while contact precautions were in place for MRSA infections and for 1 year after routine contact precautions for MRSA were no longer in place.

RESULTS

There was no change in the MRSA bloodstream standardized infection ratio between the two time periods.

DISCUSSION

With cessation of contact precautions for MRSA infections, there was no change in bloodstream MRSA standardized infection ratios across a large health system. While standardized infection ratios would not detect asymptomatic horizontal transmission of a pathogen, it is reassuring that bloodstream infections - a known complication of MRSA colonization status - did not rise with cessation of contact precautions.

Diffuse Large B-cell Lymphoma Presenting as a Primary Pleural Mass: A Case Report and Literature Review

Primary pleural lymphoma is a rare type of lymphoma that accounts for only ​​0.3% of all non-Hodgkin's lymphomas. The rarity and nonspecific clinical presentation of primary pleural lymphomas pose a diagnostic challenge for clinicians. We present an atypical case of primary pleural lymphoma in an elderly patient without any associated pleuro-pulmonary disease, immunosuppression, or history of lymphoma. To our knowledge, this is one of the first described cases of a primary pleural lymphoma with such a presentation.

774. Outbreak of Central-Line-Associated Bloodstream Infections (CLABSI) amid the COVID-19 Pandemic Associated with Changes in Central Line Dressing Care Accompanying Changes in Nursing Education, Nursing Documentation, and Dressing Supply Kits

Background

National Healthcare Safety Network (NHSN) data have revealed an increase in CLABSI associated with the COVID-19 pandemic, but data on factors mediating the increase are limited. Our hospital had been free of CLABSI for 18 months, but we encountered an outbreak of 7 CLABSI over a 5-month period beginning in November 2020. This led to an investigation that revealed that some underlying issues were related to COVID-19.

Methods

Infection prevention staff at Omaha’s Veterans Affairs Medical Center interviewed hospital staff and performed a retrospective chart review of patients with CLABSI (based on the NHSN definition) amid the COVID-19 pandemic.

Results

The first case of CLABSI in the outbreak was detected in November 2020. Prior to that, there was no case of CLABSI since April 2019, as shown in the graph. Each case of CLABSI was associated with a different microorganism. Further investigation revealed deviations from our usual practices in central line dressing care. Our response to COVID-19 had included alterations in periodic competency training (including dressing care) for nursing staff as well as the rapid introduction of streamlined inpatient nursing documentation. Previously, dressing kits included chlorhexidine-impregnated dressings; in November, a kit without these dressings was introduced. A weekly audit of dressing care was begun in March 2021. No CLABSI was identified in April 2021.

Types of Microorganisms identified

Conclusion

We encountered a CLABSI outbreak associated with deviations from usual central line dressing care. Using the concept of the Swiss cheese model of error prevention, we recognized alterations in three barriers: competency training; thorough documentation; and complete supply kits. The first two of these factors were directly related to our COVID-19 response. Our findings illustrate the relevance of the Swiss cheese model for maintaining a safe healthcare environment.

Disclosures

Marvin J. Bittner, MD, Merck (Advisor or Review Panel member)Sanofi Pasteur (Speaker's Bureau)

Assessment of NAD+metabolism in human cell cultures, erythrocytes, cerebrospinal fluid and primate skeletal muscle

The reduction-oxidation state of NAD⁺/NADH is critical for cellular health with NAD⁺ and its metabolites playing critical roles in aging and pathologies. Given the inherent autooxidation of reduced dinucleotides (i.e. NADH/NADPH), and the well-established differential stability, the accurate measurement of NAD⁺ and its metabolites is technically challenging. Moreover, sample processing, normalization and measurement strategies can profoundly alter results. Here we developed a rapid and sensitive liquid chromatography mass spectrometry-based method to quantify the NAD⁺ metabolome with careful consideration of these intrinsic chemical instabilities. Utilizing this method we assess NAD⁺ metabolite stabilities and determine the presence and concentrations of NAD⁺ metabolites in clinically relevant human samples including cerebrospinal fluid, erythrocytes, and primate skeletal muscle.