Journal of Clinical Sleep Medicine is dedicated to advancing the science of clinical sleep medicine. In order to provide subscribers with access to new scientific developments as early as possible, accepted papers are posted prior to their final publication in an issue. These papers are posted as received-without copyediting or formatting by the publisher. In some instances, substantial changes are made during the copyediting and formatting processes; therefore, the final version of the paper may differ significantly from this version. Unless indicated otherwise, all papers are copyright of the American Academy of Sleep Medicine. No paper in whole or in part may be used in any form without written permission from the American Academy of Sleep Medicine.

Leclercia adecarboxylata is a motile, gram negative bacillus in the Enterobacteriaceae family that is a rarely isolated cause of disease, despite being ubiquitous in nature. A 2019 review article identified only 74 reported cases, most often in immunocompromised patients [ 1 ]. The organism is generally susceptible to most antibiotics although multiantibiotic resistant strains have been reported. We report a case of a 62-year-old Caucasian man with multiple co-morbidities treated for L. adecarboxylata endocarditis with intravenous ceftriaxone.

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Introduction Pandemics such as COVID-19 create population-wide stressors that create a natural laboratory for acute insomnia research. This study investigated risk factors and estimated rates of acute insomnia disorder in health care workers at the onset of the COVID-19 pandemic. Methods A Qualtrics survey of more than 2300 health care providers was conducted in a single academic health system on May 15th 2020, comprised of practicing attending physicians, residents and fellows in training, advanced practice providers, and nurses. Six hundred and sixty eight responded (29% response rate). The Research Diagnostic Criteria for Insomnia Disorder was used to diagnose Acute Insomnia Disorder. Results 573 respondent had no missing data pertaining to sleep, with a mean age of 43.4 + 12.5 years and 72% women. The rate of Insomnia Disorder before COVID-19 was 44.5%, while after COVID-19 it was 64.0% - a statistically significant increase. 10.2% of persons with Insomnia Disorder before COVID-19 stated it had resolved during COVID-19, while 43.4% of persons who did not have Insomnia Disorder before COVID-19 developed Acute Insomnia Disorder during COVID-19 (χ2=145.2; df=1; P<0.0001). New cases of Acute Insomnia Disorder increased with female gender, advancing age, and less time spent in direct patient care. Conclusion Insomnia Disorder showed high baseline prevalence before COVID-19, followed by a striking increase in incidence in this sample of tertiary care health care workers. The effects of gender and age were similar to what has been previously published as risk factors for insomnia. The surprising finding that less time spent in direct patient care was associated with more cases of Acute Insomnia Disorder might be related to the poorly understood stresses of working from home during COVID-19. Support (if any):

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