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Nocardiosis is an infection caused by the gram-positive bacterium Nocardia, which typically manifests as an isolated pulmonary or systemic disease. Of note, Nocardia has a predilection for the central nervous system (CNS) involvement, which is more commonly seen in systemic nocardiosis rather than as an isolated CNS infection. According to the Centers for Disease Control and Prevention, the estimated incidence of nocardiosis is only 500 to1000 cases in the USA every year, with cases mostly found in immunocompromised people, although infection in the immunocompetent may also occur. Here, we present a case of an immunocompromised patient who presented with neurologic symptoms and intracranial lesions initially concerning metastatic disease. Upon further investigation, the patient was found to have CNS nocardiosis with bacteremia. This is an extremely rare presentation given the lack of concurrent pulmonary and cutaneous involvement. The insidious onset and rarity of nocardiosis can result in a delayed or missed diagnosis. Early recognition is crucial as this is a potentially lifethreatening illness. After obtaining adequate culture specimens, empiric treatment must be started expeditiously, keeping in mind the diversity of the Nocardia species and their antimicrobial resistance patterns.

Introduction: Endoscopic management of Zenker diverticuli (ZD) has traditionally been via septotomy technique. The recent development of tunneling technique has shown to be both efficacious and safe. The aim of this study is to evaluate the tunneling technique using per oral endoscopic myotomy (Z-POEM) versus septotomy.Methods: Patients who underwent endoscopic management of ZD either by Z-POEM or septotomy from March 2017 until November 2020 from 9 international academic centers were included. Demographics, clinical data preprocedure and postprocedure, procedure time, adverse events, and hospital length of stay were analyzed.Results: A total of 101 patients (mean age 74.9 y old, 55.4% male) were included: septotomy (n = 49), Z-POEM (n = 52). Preprocedure Functional Oral Intake Scale score and Eckardt score was 5.3 and 5.4 for the septotomy group and 5.9 and 5.15 for the Z-POEM group. Technical success was achieved in 98% of the Z-POEM group and 100% of the septotomy group. Clinical success was achieved in 84% and 92% in the septotomy versus Z-POEM groups. Adverse events occurred in 30.6% (n = 15) in septotomy group versus 9.6% (n = 5) in the Z-POEM group (P = 0.017). Reintervention for ongoing symptoms occurred in 7 patients in the septotomy group and 3 patients in the Z-POEM group. Mean hospital length of stay was shorter for the Z-POEM group, at 1.5 versus 1.9 days. Conclusions:A tunneling technique via the Z-POEM procedure is an efficacious and safe endoscopic treatment for ZD. Z-POEM is a safer procedure with a statistically significant reduction in adverse events compared with traditional septotomy technique.

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INTRODUCTION:A study was conducted to evaluate the efficacy of antibiotic prophylaxis for early onset pneumonia in cardiac arrest patients who achieve return of spontaneous circulation (ROSC) and receive targeted temperature management (TTM). METHODS:A single-center, retrospective review was conducted using data collected from electronic medical records and pharmacy surveillance system at a 532-bed community medical center in adult cardiac arrest patients admitted to a critical care unit after ROSC and initiated on TTM between January 1, 2018 to July 31, 2020. The primary outcome was the incidence of early onset pneumonia defined as pneumonia occurring within the first seven days after cardiac arrest. Secondary outcomes include length of ICU stay, length of hospital stay, ventilator days, mortality at day 28, and incidence of subsequent C. difficile and other infections.