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June 2025

Candidemia
The image displays text that says, “IDSA guidelines recommend echinocandins as preferred initial therapy for most candidemia patients given increasing frequency of non-C albicans species and concern about fluconazole resistance.”

Candidemia, a bloodstream infection caused by Candida spp., is a common cause of health care–associated bloodstream infections in the United States. Laboratory surveillance of candidemia at 10 U.S. sites during 2017–2021 found an incidence of 7.4 cases per 100,000 population. Incidence within demographic groups was generally stable or increased slightly over time. Older adults, males, and Black patients were disproportionately affected. In addition, 63.7% of cases occurred in patients who had a central venous catheter, and 36.2% occurred in patients with diabetes. The all-cause in-hospital mortality rate was 32.6%. Among 6,576 Candida isolates, 5.6% were fluconazole-resistant, and <1% were echinocandin-resistant. Antifungal resistance was stable for all antifungals tested across years.

Bottom Line:
  • Strictly implement measures to reduce health care–associated bloodstream infections (e.g., ensure proper hand hygiene, use recommended catheter site dressings, and conduct thorough cleansing when managing central venous catheters) to prevent candidemia.
  • The Infectious Diseases Society of America guidelines recommend echinocandins as the preferred initial therapy for most patients with candidemia.
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Medetomidine
The image shows an IV bag labeled “Dexmedetomidine

Medetomidine, a nonopioid sedative not approved for use in humans, has been detected as an adulterant in illegally manufactured opioids across North America since 2022 and can cause both overdose and withdrawal syndromes.

During May 11–17, 2024, medetomidine overdose complicated the treatment of fentanyl overdoses in Chicago; bradycardia and lack of response to naloxone were defining clinical features.

During September 2024–January 2025, medetomidine also complicated the treatment of opioid withdrawal. A total of 165 patients at three Philadelphia health systems were hospitalized for fentanyl withdrawal complicated by profound autonomic dysfunction, including severe hypertension and tachycardia. This syndrome was resistant to medications that had previously been effective in managing fentanyl and xylazine withdrawal but was responsive to the sedative dexmedetomidine. During October 2024–March 2025, 10 patients in Pittsburgh who used illegally manufactured opioids also exhibited a withdrawal syndrome characterized by severe autonomic hyperactivity with rapid symptom onset often requiring dexmedetomidine administration and ICU admission.

Bottom Line:
  • The use of naloxone and other opioid overdose reversal medications is recommended for suspected opioid overdose.
  • Consider medetomidine overdose or withdrawal if patients are unresponsive to typical overdose management and manifest autonomic instability.
  • Dexmedetomidine infusion with subsequent controlled weaning is effective for managing autonomic hyperactivity from medetomidine withdrawal.
  • Connecting persons at risk for overdose to evidence-based treatment, services, and support can save lives.
  • In addition, clinicians should have a low threshold for contacting their local health department about clusters of overdoses with atypical, similar toxidromes.
Learn more:

MMWRs:

 

Infant RSV Hospitalizations
The graphic shows a chart demonstrating monthly hospitalizations among infants in the 2024-25 RSV season. Text reads, “RSV Hospitalizations Among Infants Were Significantly Lower in the 2024-25 Season When RSV Prevention Products Became Available.”

Maternal respiratory syncytial virus (RSV) vaccine and nirsevimab, a long-acting monoclonal antibody, became widely available in the United States during the 2024–25 RSV season. An ecological analysis compared RSV-associated hospitalization rates among children aged <5 years during 2024–25 with those during 2018–2020 before product introduction in two surveillance networks. Rates among infants aged 0–7 months who were eligible for protection by either maternal RSV vaccine or nirsevimab during 2024–25 were lower by an estimated 28% and 43% in the two networks compared to seasons before product introduction. Estimated reductions in RSV-associated hospitalization rates among infants aged 0–2 months were 52% and 45%. Rates were not lower in 2024–25 among older children aged 8–19 months and 20–59 months, who were largely ineligible for RSV prevention products.

Bottom Line:
  • Discuss maternal RSV vaccination or nirsevimab with pregnant women and new parents to protect against severe RSV disease in infants.
  • Highlight the importance of implementing the recommendations to protect infants as early in the RSV season as possible, before peak transmission, and for infants born during the RSV season, within the first week of life, ideally during the birth hospitalization.
Learn more:

 

SUID and Nursing Pillows
The image is of a blue nursing pillow with text that reads, “To Keep Babies Safe, Use Nursing Pillows Only For Feeding, Not For Sleep.”

Sudden unexpected infant deaths (SUIDs) most often occur in spaces where infants sleep. Analysis of the National Center for Fatality Review and Prevention’s Child Death Review data found that among 1,685 SUIDs in Georgia during 2013–2022, a nursing pillow was in the infant’s sleep space in 84 (5%) cases. Eighty percent of these deaths were in infants aged <4 months, 56% occurred in an adult bed, and all but one involved bed sharing.

Bottom Line:
  • Counsel parents and caregivers to keep soft items, including nursing pillows, out of infant sleep spaces.
Learn more:

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