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Most Read 2025

Read the most popular Clinician’s Newsletter articles published in 2025.

Number 1: Hepatitis B and shared glucometers
The image shows a vial of hepatitis B vaccine and a clinician using a blood glucose monitor to check a patient’s blood sugar. Text reads, “Hepatitis B virus (HBV) was transmitted in a nursing home through a shared glucometer. Nursing homes, protect residents who have diabetes: offer routine HVB vaccination; use a dedicated glucometer for each resident. If shared glucometers are used, they should be those designed for use in professional settings and cleaned and disinfected after every use.”

In May 2024, the North Carolina Division of Public Health was notified that a hospitalized patient with diabetes had received a diagnosis of acute hepatitis B virus (HBV) infection after being transferred from a skilled nursing facility. The patient’s diabetes management included regular blood glucose monitoring. The patient had no documented history of hepatitis B or hepatitis B vaccination. Investigation revealed that glucometers at the skilled nursing facility were shared among several residents and observed to be disinfected per manufacturer instructions between uses. No other gaps in infection control practices were observed. Hepatitis B testing identified one skilled nursing facility resident with a previously diagnosed and unreported chronic HBV infection who had also received daily assisted blood glucose monitoring during a period that overlapped with the estimated incubation period of the newly infected resident. The newly infected resident repeatedly underwent monitoring <1 minute following the resident with chronic HBV infection, an interval that might not have allowed for adequate disinfection. Whole genome sequencing analysis demonstrated that both residents were infected with a genetically identical HBV strain.

Bottom line:
  • Sharing glucometers, even when disinfection protocols are followed, can present a risk for HBV transmission.
  • CDC recommends assigning blood glucose monitors (glucometers) to one person.
  • CDC recommends universal hepatitis B vaccination for persons aged <60 years and, based on shared clinical decision making, also recommends hepatitis B vaccination for adults aged ≥60 years at higher risk for hepatitis B, such as those with diabetes.
Learn more:

MMWR: Notes from the Field: Hepatitis B Virus Transmission Associated with Assisted Blood Glucose Monitoring in a Skilled Nursing Facility — North Carolina, 2024

CDC: Considerations for Blood Glucose Monitoring and Insulin Administration
Universal Hepatitis B Vaccination in Adults Aged 19–59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2022

Other: Use of hepatitis B vaccination for adults with diabetes mellitus: recommendations of the Advisory Committee on Immunization Practices (ACIP) – PubMed

 

Number 2: Arboviral Diseases
The graphic shows a tick and a mosquito. Text reads: Cases of arboviral diseases more than doubled in 2023 compared to 2022. Top viruses reported: West Nile, Powassan, La Crosse, Jamestown Canyon. Consider testing patients with acute febrile or neurologic illnesses for arboviruses when mosquitoes and ticks are active.

(HBV) was transmitted in a nursing home through a shared glucometer. Nursing homes, protect residents who have diabetes: offer routine HBV vaccination; use a dedicated glucometer for each resident. If shared glucometers are used, they should be those designed for use in professional settings and cleaned and disinfected after every use.”

In 2023, arboviral disease cases were reported from all contiguous U.S. states; most occurred during April–December. West Nile virus (WNV) cases (n = 2,628) were most common, followed by Powassan virus disease cases (n = 49), which increased from the previous record high in 2022. Three WNV disease cases were reported among patients infected through organ transplantation from two donors. La Crosse virus was the most common cause of arboviral disease among children, with most cases classified as neuroinvasive.

Bottom Line:
  • Consider arboviral testing for patients with acute febrile or neurologic illnesses, including recipients of organ transplants or blood transfusions, particularly when ticks and mosquitoes are active.
  • Report positive test results to health departments.
  • Management is supportive because no prophylactic agents (e.g., human vaccines) or specific treatments (e.g., antiviral medications) are currently available to prevent or treat domestic arboviral infections.
  • Counsel patients to prevent insect bites by using EPA-registered insect repellent and wearing protective clothing.
Learn more:

MMWR: West Nile Virus and Other Nationally Notifiable Arboviral Diseases — United States, 2023

CDC: Guidelines for West Nile Virus Surveillance and Control
Preventing Mosquito Bites
Preventing Tick Bites
Blood Safety Basics

 

Number 3: 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.
Learn more:

MMWR: Population-Based Active Surveillance for Culture-Confirmed Candidemia — 10 Sites, United States, 2017–2021
Intravascular Catheter-related Infection (BSI) Prevention Guidelines

Other: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America

 

Number 4: Plague
The graphic shows an image of a veterinarian holding a cat and text that reads, “A pet cat with an abscess transmitted plague to its owner, who had a finger laceration. This case was reported earlier in the calendar year than any human plague case in Oregon in 90 years.”

Plague, caused by Yersinia pestis, is a rare but potentially life-threatening illness treatable with antibiotics if diagnosed early. Patients usually become infected through the bite of an infected rodent flea; however, Y. pestis can be transmitted to humans through exposure to ill pets, especially cats. An Oregon man sought care at an emergency department for signs and symptoms of plague on January 30, 2024, the earliest calendar date of plague recorded in the state’s history, possibly indicating a shift in the seasonality of plague incidence. The patient did not have direct contact with rodents, but did have contact with his infected cat, who had an abscess, after cutting his finger.

Bottom Line:
  • Maintain a high index of suspicion for Y. pestis infection in patients with a febrile illness associated with animal exposure in areas where Y. pestis is enzootic, regardless of season.
  • Initiate antibiotic therapy for plague based on risk factors (e.g., recent flea bite, exposure to areas with rodents, or contact with a sick or dead animal in endemic areas) and clinical signs and symptoms (including fever, headache, chills, weakness, one or more swollen and painful lymph nodes, shortness of breath, chest pain, and cough).
  • Gentamicin and fluoroquinolones are first-line antibiotic treatments for Y. pestis infection in the United States.
Learn more:

MMWR: Notes from the Field: Early-Season Human Plague Transmitted from an Infected Cat — Oregon, January 2024

CDC: Clinical Testing and Diagnosis for Plague
Clinical Care of Plague

 

Number 5: Candida auris and hemodialysis
The graphic shows a dialysis machine. Text reads, “Facilities caring for hemodialysis patients colonized with C. auris: Inform and educate staff; use appropriate PPE; minimize exposure to other patients; clean and disinfect reusable equipment; inform receiving facility of patient’s C. auris status.”

Candida auris, a frequently multidrug-resistant fungal pathogen, can spread within health care facilities. In five facilities providing dialysis in four states during 2020–2023, six patients infected or colonized with C. auris received dialysis for up to 4 months without transmission to other patients. Health care personnel at all five facilities had no knowledge of the patients’ C. auris status and had implemented standard dialysis infection prevention and control (IPC) only. Adherence to standard IPC practices appeared to enable safe provision of dialysis to patients with C. auris colonization or infection without transmission to other dialysis patients.

Bottom Line:
  • Improved interfacility communication regarding patients’ infection or colonization status with multidrug-resistant organisms is needed to ensure prompt implementation of all recommended IPC practices.
  • Dialysis-specific C. auris IPC measures, detailed in image above and including for those with asymptomatic colonization, remain an important component of prevention of transmission of multidrug-resistant organisms in health care settings.
Learn more:

MMWR: Candida auris Containment Responses in Health Care Facilities that Provide Hemodialysis Services — New Jersey, North Carolina, South Carolina, and Tennessee, 2020–2023

CDC: Guidelines, Recommendations and Resources
Infection Control Guidance: Candida auris

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