Maryland Department of Health

The American Board of Emergency Medicine gathers extensive background information on Accreditation Council for Graduate Medical Education-accredited emergency medicine residency and fellowship programs, as well as the residents and fellows training in those programs. We present the 2026 annual report on the status of physicians training in Accreditation Council for Graduate Medical Education-accredited emergency medicine training programs in the United States.

Introduction: NDM-producing Carbapenem-resistant Acinetobacter baumannii (CRAB) is an emerging concern globally due to extensive antimicrobial resistance and high mortality, although less common in the United States. We describe the epidemiology of this pathogen at our academic medical center over a 5-year period. Methods: Observational study and epidemiologic investigation at two campuses (800-bed hospital (“A”) including 7 adult ICUs and 144-bed hospital (“B”) including 1 ICU and 1 long-term post-acute unit) with patient-sharing. Patients with CRAB in clinical or surveillance cultures from January 2021 to April 2025 were included. Active surveillance was conducted in select units using rectal swabs, and available isolates underwent genomic sequencing. Results: We identified 13 unique patients with 61 NDM-CRAB clinical (7 [11%]) or surveillance (54 [89%]) cultures. Two of 10 colonized patients subsequently developed clinical infection. NDM-CRAB constituted 25% of all sequenced CRAB isolates during this time. Among the 13 patients, median age was 62 years, 6 (46%) were female, all had prior healthcare exposure and 10 (77%) had colonization or infection with other multidrug-resistant organisms (MDROs). None reported international travel. Nine patients (69%) had prior exposure to carbapenems, 9 (69%) had central venous catheters, and 7 (54%) required mechanical ventilation. Sites of infection included pneumonia, urinary tract, and wound. Following sporadic cases from 2021-2023, a cluster of 2 cases occurred on the post-acute unit in 2024 followed by a prolonged outbreak (n=10) detected via weekly rectal surveillance cultures (Figure). With the exception of the index case, all other post-acute unit outbreak cases had a prior negative surveillance screen, suggesting transmission among long-stay patients. Observations revealed suboptimal environmental surface-cleaning and deficiencies in use of personal protective equipment. No additional cases were identified on other units including ICUs undergoing routine weekly surveillance. Twenty-five NDM-CRAB isolates underwent genomic sequencing. All belonged to the same A. baumannii multilocus sequencing typing (MLST) lineage (STPas2, STOxf 218/2164). Long-read sequencing of select isolates identified blaNDM-1 and blaOXA-23 integrated in the chromosome. Notably, one isolate additionally acquired blaOXA-72 on a r3-T60 Acinetobacter plasmid, suggesting continuing genetic evolution. Conclusion: Over a 5-year period, we found NDM-CRAB transmission in a post-acute care unit within an acute care hospital, among long-stay patients with invasive devices and antibiotic exposure. We did not observe sustained transmission in other parts of the hospital, underscoring the contribution of long-term acute care in MDRO dissemination. Genomic analysis helped distinguish this cluster from other non-NDM CRAB cases, supplementing epidemiologic findings.

Importance National organizations recommend antiviral treatment for hospitalized children with influenza; however, use in this setting has recently declined. Studies of oseltamivir effectiveness in children are limited by misclassification bias, unknown symptom onset date, and incomplete capture of antiviral use prior to admission. Objective To assess the association between oseltamivir receipt and intensive care unit (ICU) admission and hospital length of stay (LOS) among pediatric influenza-associated hospitalizations. Design, Setting, and Participants This cohort study used data that were obtained from the Influenza Hospitalization Surveillance Network (FluSurv-NET), which conducts US population-based surveillance for laboratory-confirmed influenza hospitalizations for all ages across 13 states. The study data include seasons 2014 to 2015 through 2022 to 2023, excluding 2020 to 2021. Participants included children aged younger than 18 years who were hospitalized with laboratory-confirmed influenza and for whom a respiratory symptom onset date was available. These data were analyzed from October 2024 through May 2026. Exposures Oseltamivir receipt as a time-dependent exposure. Main Outcome(s) and Measure(s) The primary outcome was time from symptom onset to ICU admission. Secondary outcome was time from admission to discharge (LOS). Adjusted Cox proportional hazard models (aHR) with oseltamivir receipt as a time-dependent exposure were used. Results After exclusions, 6044 influenza cases were included in the primary ICU analysis, of whom 4240 (70.2%) received oseltamivir, and 7103 cases were included in the secondary LOS analysis, of whom 5746 (80.9%) received oseltamivir. In the ICU analysis, the median (IQR) age was 3 (1-7) years, 3382 (56%) were male and 3721 (44%) were female, and 2937 (49%) had 1 or more medical comorbidity—the most common of which was asthma in 1547 children (26%). In adjusted models, compared with untreated children, oseltamivir treatment reduced the hazard of ICU admission (aHR, 0.69; 95% CI, 0.60-0.80) and shortened LOS (analyzed as hazard of hospital discharge; aHR, 1.13; 95% CI, 1.06-1.21). Conclusions and Relevance In this cohort of children hospitalized with influenza, oseltamivir treatment was significantly associated with a reduced risk of ICU admission by 31% and decreased hospital LOS. These findings demonstrate the benefits of oseltamivir receipt and support current national recommendations for oseltamivir treatment as soon as possible in children hospitalized with suspected or laboratory-confirmed influenza.

Objective:From 2023-2024, the Maryland Statewide Prevention & Reduction Collaborative (SPARC) led an intervention targeting broad-spectrum antibiotic use for sepsis, aiming to identify the factors that influence the success of collaborative quality improvement (QI) programs. Design:Evaluation of a state collaborative run QI intervention. Participants:Acute-care facilities in Maryland. Methods:Participating sites developed and implemented sepsis-focused interventions with SPARC support, including tailored guidance and bimonthly office hours. Following the implementation of site-level interventions, sites participated in a mixed-methods assessment guided by the RE-AIM framework including brief qualitative interviews and a 6-month follow-up. Results:Eight hospitals implemented multi-component, multi-disciplinary sepsis-focused interventions. Facilities involved staff from up to six departments in the implementation of interventions. All sites noted the effectiveness of SPARC in supporting sites' intervention activities, as well as the effectiveness of the site's interventions in creating change. Sites identified barriers impacting the implementation of their interventions including lack of resources, administrative red-tape, and challenges changing culture. Facilitators included leadership support, having a structured intervention plan, and opportunities for peer-to-peer learning. Most sites were positive about SPARC's role identifying interventions and support, utilized information from SPARC as part of their interventions, and found it useful to hear how other institutions implement antibiotic stewardship. Six months post-assessment, all sites were continuing intervention activities. Conclusions:This evaluation highlights how statewide QI collaboratives can be effective in promoting hospital-based antibiotic stewardship. Sites identified several facilitators and challenges that contributed to intervention implementation and highlighted the contributions of the SPARC team.

BACKGROUND:Hepatocellular carcinoma (HCC) risk is elevated among people with human immunodeficiency virus (HIV) (PWH), but survival disparities are poorly understood. METHODS:We used data from the HIV/AIDS Cancer Match Study, a U.S. population-based linkage of 12 HIV and cancer registries during 2001-2019. Multivariable-adjusted Cox regression was used to estimate adjusted hazard ratios (aHRs) for HIV and HCC-specific and all-cause mortality among people with HCC, and to estimate aHRs for factors associated with HCC-specific and all-cause mortality among PWH. RESULTS:A total of 71 516 cases of HCC including 1610 PWH occurred during 2001-2019. Compared to people with HCC without HIV, a higher proportion of PWH were men, younger at time of cancer diagnosis, and were Black or Hispanic. Overall, 1279 deaths occurred among PWH (62.5% of deaths from HCC). HIV was associated with 34% higher all-cause mortality (aHR 1.34; 95% confidence interval, 1.27-1.41), and slightly increased HCC-specific mortality (aHR 1.08; 95% confidence interval, 1.01-1.16). Male sex, older age at HCC diagnosis, and nonreceipt of cancer treatment modalities were associated with increased all-cause and HCC-specific mortality among PWH. Increased HCC-specific mortality was also observed among men who have sex with men, compared to people who inject drugs. All-cause and HCC-specific mortality declined across calendar periods from 2001-2003 to 2016-2019 (Ptrends & .0002 and .06, respectively). CONCLUSIONS:HIV is associated with 34% higher all-cause and 8% higher HCC-specific mortality among PWH with HCC compared to those without HIV. As PWH are now living longer, and are at higher risk of HCC, research should prioritize opportunities for HCC prevention, screening, diagnosis, and treatment.