1
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Vaivoothpinyo S, Sathitakorn O, Jantarathaneewat K, Weber DJ, Apisarnthanarak P, Rutjanawech S, Tantiyavarong P, Apisarnthanarak A. The impact of environmental cleaning protocol featuring PX-UV in reducing the incidence of multidrug-resistant gram-negative healthcare-associated infection and colonization in intensive care units in Thailand. Infect Control Hosp Epidemiol 2024; 45:684-687. [PMID: 38088177 DOI: 10.1017/ice.2023.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
In this quasi-experimental study, implementing PX-UV to the standard environmental cleaning protocol was associated with a reduction in the overall incidence of multidrug-resistant (MDR) gram-negative organisms (P = .01) and MDR Acinetobacter baumannii (P = .001) in intervention intensive care units. However, the intervention did not reduce patient length of stay and 30-day mortality.
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Affiliation(s)
- Supavit Vaivoothpinyo
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Ornnicha Sathitakorn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Kittiya Jantarathaneewat
- Department of Pharmaceutical Care, Faculty of Pharmacy, Thammasat University, Pathum Thani, Thailand
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - David J Weber
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
| | - Piyaporn Apisarnthanarak
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasinuch Rutjanawech
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Pichaya Tantiyavarong
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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2
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Sweitzer SF, Sickbert-Bennett EE, Seidelman J, Anderson DJ, Lim MR, Weber DJ. The impact of minimally invasive surgical approaches on surgical-site infections. Infect Control Hosp Epidemiol 2024; 45:557-561. [PMID: 38167421 DOI: 10.1017/ice.2023.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
We performed a literature review to describe the risk of surgical-site infection (SSI) in minimally invasive surgery (MIS) compared to standard open surgery. Most studies reported decreased SSI rates among patients undergoing MIS compared to open procedures. However, many were observational studies and may have been affected by selection bias. MIS is associated with reduced risk of surgical-site infection compared to standard open surgery and should be considered when feasible.
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Affiliation(s)
- Stephanie F Sweitzer
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Jessica Seidelman
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Deverick J Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Moe R Lim
- Department of Orthopedics, University of North Carolina, Chapel Hill, North Carolina
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, University of North Carolina Hospitals, Chapel Hill, North Carolina
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3
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Buchanan MO, Sickbert-Bennett EE, Selimos A, Dean SM, Willis B, Boone WP, Mitchell AM, DiBiase LM, Shaheen NJ, Weber DJ. Strategies to maintain an N95 respirator supply during a pandemic supply-chain shortage. Infect Control Hosp Epidemiol 2024; 45:688-689. [PMID: 38087655 DOI: 10.1017/ice.2023.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Mark O Buchanan
- Department of Infection Prevention, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina
| | - Emily E Sickbert-Bennett
- Department of Infection Prevention, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, North Carolina
| | - Amy Selimos
- Department of Infection Prevention, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina
| | - Stephen M Dean
- Department of Operational Efficiency, UNC Health Shared Services, Morrisville, North Carolina
| | - Beth Willis
- Department of Operational Efficiency, UNC Health Shared Services, Morrisville, North Carolina
| | - William P Boone
- Department of Environmental Health and Safety, UNC Medical Center, Chapel Hill, North Carolina
| | - Ashley M Mitchell
- Supply Chain, UNC Health Shared Services Center, Durham, North Carolina
| | - Lauren M DiBiase
- Department of Infection Prevention, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, North Carolina
| | - Nicholas J Shaheen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Gastroenterology and Hepatology, UNC School of Medicine, Chapel Hill, North Carolina
| | - David J Weber
- Department of Infection Prevention, University of North Carolina (UNC) Medical Center, Chapel Hill, North Carolina
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, North Carolina
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4
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Samanta R, Zhuang X, Varney KM, Weber DJ, Matysiak S. Deciphering S100B Allosteric Signaling: The Role of a Peptide Target, TRTK-12, as an Ensemble Modulator. J Chem Inf Model 2024; 64:3477-3487. [PMID: 38605537 DOI: 10.1021/acs.jcim.4c00116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Allostery is an essential biological phenomenon in which perturbation at one site in a biomolecule elicits a functional response at a distal location(s). It is integral to biological processes, such as cellular signaling, metabolism, and transcription regulation. Understanding allostery is also crucial for rational drug discovery. In this work, we focus on an allosteric S100B protein that belongs to the S100 class of EF-hand Ca2+-binding proteins. The Ca2+-binding affinity of S100B is modulated allosterically by TRTK-12 peptide binding 25 Å away from the Ca2+-binding site. We investigated S100B allostery by carrying out nuclear magnetic resonance (NMR) measurements along with microsecond-long molecular dynamics (MD) simulations on S100B/Ca2+ with/without TRTK-12 at different NaCl salt concentrations. NMR HSQC results show that TRTK-12 reorganizes how S100B/Ca2+ responds to different salt concentrations at both orthosteric and allosteric sites. The MD data suggest that TRTK-12 breaks the dynamic aromatic and hydrogen-bond interactions (not observed in X-ray crystallographic structures) between the hinge/helix and Ca2+-binding EF-hand loop of the two subunits in the homodimeric protein. This triggers rearrangement in the protein network architectures and leads to allosteric communication. Finally, computational studies of S100B at distinct ionic strengths suggest that ligand-bound species are more robust to the changing environment relative to the S100B/Ca2+ complex.
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Affiliation(s)
- Riya Samanta
- Biophysics Graduate Program, University of Maryland, College Park, Maryland 20742, United States
| | - Xinhao Zhuang
- Department of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, United States
| | - Kristen M Varney
- Department of Biochemistry and Molecular Biology, University of Maryland, Baltimore, Maryland 20742, United States
| | - David J Weber
- IBBR, Department of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, United States
| | - Silvina Matysiak
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland 20742, United States
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5
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Kiernan MA, Garvey M, Norville P, Otter JA, Weber DJ. Is detergent-only cleaning paired with chlorine disinfection the best approach for cleaning. J Hosp Infect 2024:S0195-6701(24)00119-1. [PMID: 38649119 DOI: 10.1016/j.jhin.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Martin A Kiernan
- Richard Wells Research Centre, University of West, London, Brentford, UK.
| | - Mark Garvey
- Hospital Infection Research Laboratory, University Hospitals Birmingham NHS Foundation, Trust, Birmingham, UK
| | | | - Jonathon A Otter
- Directorate of Infection, Guy's and St. Thomas NHS Foundation Trust, London, UK; National Institute for Healthcare Research Health Protection Research Unit (NIHR HPRU), in HCAI and AMR, Imperial College London, London, UK
| | - David J Weber
- Department of Infection Prevention, UNC Medical Center, University of, North Carolina at Chapel Hill, Chapel Hill, USA
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6
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Haas EJ, Kelly-Reif K, Edirisooriya M, Reynolds L, Beatty Parker CN, Zhu D, Weber DJ, Sickbert-Bennett E, Boyce RM, Ciccone EJ, Aiello AE. Infection precaution adherence varies by potential exposure risks to SARS-CoV-2 and job role: Findings from a US medical center. Am J Infect Control 2024; 52:381-386. [PMID: 38069921 DOI: 10.1016/j.ajic.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 03/22/2024]
Abstract
BACKGROUND Infection precautions (IP) facilitate standardized and safe patient care. Research has demonstrated several barriers to IP adherence among health care personnel (HCP) but potential exposure risk to SARS-CoV-2 and job role has not been considered. METHODS Researchers used self-reported baseline surveys with 191 HCPs at a university medical center to examine factors that may have affected IP adherence (eg, personal protective equipment [PPE] and hand hygiene errors) over the 2 weeks prior to the survey. Chi-square tests were used to determine if differences existed first, among job role and IP adherence, and second, the potential risk of exposure to SARS-CoV-2 and IP adherence. A binary logistic regression estimated if PPE nonadherence was associated with COVID-19 stress, job role, and potential exposure risk to SARS-CoV-2. RESULTS PPE nonadherence varied by job role. Those in the Other group (ie, nonphysician/non-nursing HCP) reported significantly fewer errors (9.6%) compared to Physicians (26.5%) and Registered Nurses (33.3%). Hand/glove hygiene errors between COVID-19 patient rooms varied by job role. Respondents who had higher risks of exposure to SARS-CoV-2 were 5.74 times more likely to experience errors. CONCLUSIONS The results provide implications for adopting systems-level approaches to support worker knowledge and engagement across job roles to improve IP adherence.
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Affiliation(s)
- Emily J Haas
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA.
| | - Kaitlin Kelly-Reif
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Mihili Edirisooriya
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA
| | - Laura Reynolds
- Respiratory Health Division, National Institute for Occupational Safety and Health, Morgantown, WV
| | - Cherese N Beatty Parker
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Columbia University, New York, NY
| | - Deanna Zhu
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
| | - David J Weber
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emily Sickbert-Bennett
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Ross M Boyce
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emily J Ciccone
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Allison E Aiello
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Columbia University, New York, NY
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7
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Marx AH, Nowicki DN, Carlson RB, Schultz KM, Sickbert-Bennett E, Weber DJ. Bacille Calmette-Guérin preparation and intravesical administration to patients with bladder cancer: Risks to healthcare personnel and patients, and mitigation strategies. Infect Control Hosp Epidemiol 2024; 45:520-525. [PMID: 38073548 DOI: 10.1017/ice.2023.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Intravesical Bacillus Calmette-Guérin (BCG) is a standard therapy for non-muscle-invasive bladder cancer used in urology clinics and inpatient settings. We present a review of infection risks to patients receiving intravesical BCG, healthcare personnel who prepare and administer BCG, and other patients treated in facilities where BCG is prepared and administered. Knowledge of these risks and relevant regulations informs appropriate infection prevention measures.
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Affiliation(s)
- Ashley H Marx
- Department of Pharmacy, University of North Carolina Medical Center; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Diana N Nowicki
- Department of Pharmacy, University of North Carolina Medical Center; University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Rebecca B Carlson
- University of North Carolina Health Sciences Library, Chapel Hill, North Carolina
| | - Katherine M Schultz
- Department of Infection Prevention, UNC Medical Center; Chapel Hill, North Carolina
| | - Emily Sickbert-Bennett
- Department of Infection Prevention, UNC Medical Center; Chapel Hill, North Carolina
- Department of Epidemiology, University of North Carolina School of Public Health; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David J Weber
- Department of Infection Prevention, UNC Medical Center; Chapel Hill, North Carolina
- Department of Epidemiology, University of North Carolina School of Public Health; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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8
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Gravagna K, Thompson SC, Sickbert-Bennett E, Weber DJ. Testing residual chloramine levels in tap water across sink locations in a US academic hospital setting. Infect Control Hosp Epidemiol 2024:1-2. [PMID: 38505953 DOI: 10.1017/ice.2024.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Katie Gravagna
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sharon C Thompson
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Emily Sickbert-Bennett
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David J Weber
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC, USA
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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9
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Graves AM, Warren BG, Barrett A, Lewis SS, Smith B, Weber DJ, Sickbert-Bennett EE, Anderson DJ. Healthcare Provider N95 Respirator Contamination Worn Behind Face Shields With SARS-CoV-2 During Routine Clinical Care of Patients With COVID-19. Open Forum Infect Dis 2024; 11:ofae040. [PMID: 38449922 PMCID: PMC10917086 DOI: 10.1093/ofid/ofae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024] Open
Abstract
N95 respirator contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during clinical care of patients with coronavirus disease 2019 is poorly understood. We performed a prospective observational study on healthcare provider's (HCP's) N95 respirators' and face shields' SARS-CoV-2 contamination during aerosol-generating procedures on SARS-CoV-2-positive patients housed in a COVID-19-specific unit. Medical masks worn on top of HCP's N95 respirators, and under face shields, during study aerosol-generating procedures were used as surrogates to detect contamination to avoid waste. Thirty-three HCPs were studied, and a total of 33 mask and 27 face shields were sampled. Masks were cut into 9 pieces and face shields were sampled twice, front and back, to determine locality of contamination; however, no positive samples were identified using standard polymerase chain reaction techniques with a CT value up to 40. All 9 mask piece samples were then pooled, as were face shield samples, using centrifugal concentration with polyethersulfone membranes. Once pooled and concentrated, overall, 9 (15%) samples were positive via real-time polymerase chain reaction: 5 from masks (15.2%) and 4 from face shields (14.8%).
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Affiliation(s)
- Amanda M Graves
- Division of Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Division of Infectious Diseases, Disinfection, Resistance and Transmission Epidemiology (DiRTE) lab, Durham, North Carolina, USA
| | - Bobby G Warren
- Division of Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Division of Infectious Diseases, Disinfection, Resistance and Transmission Epidemiology (DiRTE) lab, Durham, North Carolina, USA
| | - Aaron Barrett
- Division of Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Division of Infectious Diseases, Disinfection, Resistance and Transmission Epidemiology (DiRTE) lab, Durham, North Carolina, USA
| | - Sarah S Lewis
- Division of Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - Becky Smith
- Division of Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
- Division of Infectious Diseases, Disinfection, Resistance and Transmission Epidemiology (DiRTE) lab, Durham, North Carolina, USA
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10
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Ciccone EJ, Zhu DR, Gunderson AK, Hawke S, Ajeen R, Lodge EK, Shook-Sa BE, Abernathy H, Garrett HE, King E, Alavian N, Reyes R, Taylor JL, Beatty C, Chung C, Mendoza CE, Weber DJ, Markmann AJ, Premkumar L, Juliano JJ, Boyce RM, Aiello AE. Magnitude and Durability of the Antibody Response to mRNA-Based Vaccination Among SARS-CoV-2 Seronegative and Seropositive Health Care Personnel. Open Forum Infect Dis 2024; 11:ofae009. [PMID: 38293246 PMCID: PMC10826795 DOI: 10.1093/ofid/ofae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
Few studies have described changes in SARS-CoV-2 antibody levels in response to infection and vaccination at frequent intervals and over extended follow-up periods. The purpose of this study was to assess changes in SARS-CoV-2-specific antibody responses among a prospective cohort of health care personnel over 18 months with up to 22 samples per person. Antibody levels and live virus neutralization were measured before and after mRNA-based vaccination with results stratified by (1) SARS-CoV-2 infection status prior to initial vaccination and (2) SARS-CoV-2 infection at any point during follow-up. We found that the antibody response to the first dose was almost 2-fold higher in individuals who were seropositive prior to vaccination, although neutralization titers were more variable. The antibody response induced by vaccination appeared to wane over time but generally persisted for 8 to 9 months, and those who were infected at any point during the study had slightly higher antibody levels over time vs those who remained uninfected. These findings underscore the need to account for SARS-CoV-2 natural infection as a modifier of vaccine responses, and they highlight the importance of frequent testing of longitudinal antibody titers over time. Together, our results provide a clearer understanding of the trajectories of antibody response among vaccinated individuals with and without prior SARS-CoV-2 infection.
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Affiliation(s)
| | - Deanna R Zhu
- Department of Epidemiology, Gillings School of Global Public Health
| | | | - Sam Hawke
- Department of Biostatistics, Gillings School of Global Public Health
| | - Rawan Ajeen
- Institute for Global Health and Infectious Diseases
| | - Evans K Lodge
- Department of Epidemiology, Gillings School of Global Public Health
| | - Bonnie E Shook-Sa
- Department of Biostatistics, Gillings School of Global Public Health
| | | | - Haley E Garrett
- Department of Epidemiology, Gillings School of Global Public Health
| | - Elise King
- Institute for Global Health and Infectious Diseases
| | - Naseem Alavian
- Division of Hospital Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Raquel Reyes
- Division of Hospital Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | | | - Cherese Beatty
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Carmen E Mendoza
- Department of Epidemiology, Gillings School of Global Public Health
| | - David J Weber
- Division of Infectious Diseases, School of Medicine
- Department of Epidemiology, Gillings School of Global Public Health
| | | | - Lakshmanane Premkumar
- Department of Microbiology and Immunology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Jonathan J Juliano
- Division of Infectious Diseases, School of Medicine
- Department of Epidemiology, Gillings School of Global Public Health
| | - Ross M Boyce
- Division of Infectious Diseases, School of Medicine
- Department of Epidemiology, Gillings School of Global Public Health
| | - Allison E Aiello
- Department of Epidemiology and Robert N. Butler Columbia Aging Center, Mailman School of Public Health, Columbia University, New York, New York
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11
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Fellner A, White S, Rockwell E, Giandomenico D, Diaz MM, Weber DJ, Miller MB, Boyce RM. The clinical epidemiology, management, and outcomes of patients diagnosed with encephalitis in North Carolina, 2015-2020. J Clin Microbiol 2023; 61:e0073123. [PMID: 38014985 PMCID: PMC10729753 DOI: 10.1128/jcm.00731-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE Despite the relatively high mortality and the difficulty in diagnosis, nearly one-third of patients hospitalized with a documented diagnosis of encephalitis did not undergo a lumbar puncture (LP). When an LP was performed, pathogen-specific testing was greatly underutilized. Infectious etiologies were most common, but over 40% of cases were idiopathic at discharge. These findings suggest that there is a substantial opportunity to improve the quality of care through more accurate and timely diagnosis.
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Affiliation(s)
- Anuva Fellner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel White
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emmanuel Rockwell
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dana Giandomenico
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David J. Weber
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa B. Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ross M. Boyce
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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12
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Lázaro-Gorines R, Pérez P, Heras-Murillo I, Adán-Barrientos I, Albericio G, Astorgano D, Flores S, Luczkowiak J, Labiod N, Harwood SL, Segura-Tudela A, Rubio-Pérez L, Nugraha Y, Shang X, Li Y, Alfonso C, Adipietro KA, Abeyawardhane DL, Navarro R, Compte M, Yu W, MacKerell AD, Sanz L, Weber DJ, Blanco FJ, Esteban M, Pozharski E, Godoy-Ruiz R, Muñoz IG, Delgado R, Sancho D, García-Arriaza J, Álvarez-Vallina L. Dendritic Cell-Mediated Cross-Priming by a Bispecific Neutralizing Antibody Boosts Cytotoxic T Cell Responses and Protects Mice against SARS-CoV-2. Adv Sci (Weinh) 2023; 10:e2304818. [PMID: 37863812 DOI: 10.1002/advs.202304818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/24/2023] [Indexed: 10/22/2023]
Abstract
Administration of neutralizing antibodies (nAbs) has proved to be effective by providing immediate protection against SARS-CoV-2. However, dual strategies combining virus neutralization and immune response stimulation to enhance specific cytotoxic T cell responses, such as dendritic cell (DC) cross-priming, represent a promising field but have not yet been explored. Here, a broadly nAb, TNT , are first generated by grafting an anti-RBD biparatopic tandem nanobody onto a trimerbody scaffold. Cryo-EM data show that the TNT structure allows simultaneous binding to all six RBD epitopes, demonstrating a high-avidity neutralizing interaction. Then, by C-terminal fusion of an anti-DNGR-1 scFv to TNT , the bispecific trimerbody TNT DNGR-1 is generated to target neutralized virions to type 1 conventional DCs (cDC1s) and promote T cell cross-priming. Therapeutic administration of TNT DNGR-1, but not TNT , protects K18-hACE2 mice from a lethal SARS-CoV-2 infection, boosting virus-specific humoral responses and CD8+ T cell responses. These results further strengthen the central role of interactions with immune cells in the virus-neutralizing antibody activity and demonstrate the therapeutic potential of the Fc-free strategy that can be used advantageously to provide both immediate and long-term protection against SARS-CoV-2 and other viral infections.
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Affiliation(s)
- Rodrigo Lázaro-Gorines
- Cancer Immunotherapy Unit (UNICA), Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
- Immuno-Oncology and Immunotherapy Group, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, 28041, Spain
- H12O-CNIO Cancer Immunotherapy Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, 28029, Spain
| | - Patricia Pérez
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología (CNB), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28049, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, 28029, Spain
| | - Ignacio Heras-Murillo
- Immunobiology lab, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
| | - Irene Adán-Barrientos
- Immunobiology lab, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
| | - Guillermo Albericio
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología (CNB), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28049, Spain
| | - David Astorgano
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología (CNB), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28049, Spain
| | - Sara Flores
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología (CNB), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28049, Spain
| | - Joanna Luczkowiak
- Virology and HIV/AIDS Group, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, 28041, Spain
| | - Nuria Labiod
- Virology and HIV/AIDS Group, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, 28041, Spain
| | - Seandean L Harwood
- Department of Molecular Biology and Genetics - Protein Science, Aarhus University, Aarhus, 80000, Denmark
| | - Alejandro Segura-Tudela
- Cancer Immunotherapy Unit (UNICA), Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
- Immuno-Oncology and Immunotherapy Group, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, 28041, Spain
- H12O-CNIO Cancer Immunotherapy Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, 28029, Spain
| | - Laura Rubio-Pérez
- Cancer Immunotherapy Unit (UNICA), Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
- Immuno-Oncology and Immunotherapy Group, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, 28041, Spain
- H12O-CNIO Cancer Immunotherapy Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, 28029, Spain
- Chair for Immunology UFV/Merck, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, 28223, Spain
| | - Yudhi Nugraha
- Protein Crystallography Unit, Structural Biology Programme, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, 28029, Spain
| | - Xiaoran Shang
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD, 20850, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Yuxing Li
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD, 20850, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- The Center for Biomolecular Therapeutics, Rockville, MD, 20850, USA
| | - Carlos Alfonso
- Centro de Investigaciones Biológicas Margarita Salas (CIB), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28040, Spain
| | - Kaylin A Adipietro
- The Center for Biomolecular Therapeutics, Rockville, MD, 20850, USA
- Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Dinendra L Abeyawardhane
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD, 20850, USA
- The Center for Biomolecular Therapeutics, Rockville, MD, 20850, USA
- Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Rocío Navarro
- Department of Antibody Engineering, Leadartis SL, Tres Cantos, Madrid, 28002, Spain
| | - Marta Compte
- Department of Antibody Engineering, Leadartis SL, Tres Cantos, Madrid, 28002, Spain
| | - Wenbo Yu
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD, 20850, USA
| | - Alexander D MacKerell
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD, 20850, USA
- Computer Aided Drug Design Center, Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, 21201, USA
- Center for Biomolecular Therapeutics (CBT), University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Laura Sanz
- Molecular Immunology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Madrid, 28220, Spain
| | - David J Weber
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD, 20850, USA
- The Center for Biomolecular Therapeutics, Rockville, MD, 20850, USA
| | - Francisco J Blanco
- Centro de Investigaciones Biológicas Margarita Salas (CIB), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28040, Spain
| | - Mariano Esteban
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología (CNB), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28049, Spain
| | - Edwin Pozharski
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD, 20850, USA
- The Center for Biomolecular Therapeutics, Rockville, MD, 20850, USA
| | - Raquel Godoy-Ruiz
- Institute for Bioscience and Biotechnology Research, University of Maryland, Rockville, MD, 20850, USA
- The Center for Biomolecular Therapeutics, Rockville, MD, 20850, USA
| | - Inés G Muñoz
- Protein Crystallography Unit, Structural Biology Programme, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, 28029, Spain
| | - Rafael Delgado
- Virology and HIV/AIDS Group, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, 28041, Spain
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
- Department of Medicine, Universidad Complutense de Madrid, Madrid, 28040, Spain
| | - David Sancho
- Immunobiology lab, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, 28029, Spain
| | - Juan García-Arriaza
- Department of Molecular and Cellular Biology, Centro Nacional de Biotecnología (CNB), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, 28049, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Madrid, 28029, Spain
| | - Luis Álvarez-Vallina
- Cancer Immunotherapy Unit (UNICA), Department of Immunology, Hospital Universitario 12 de Octubre, Madrid, 28041, Spain
- Immuno-Oncology and Immunotherapy Group, Instituto de Investigación Sanitaria 12 de Octubre (imas12), Madrid, 28041, Spain
- H12O-CNIO Cancer Immunotherapy Clinical Research Unit, Centro Nacional de Investigaciones Oncológicas (CNIO), Madrid, 28029, Spain
- Chair for Immunology UFV/Merck, Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, 28223, Spain
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13
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Weber DJ, Rutala WA, Anderson DJ, Sickbert-Bennett EE. Biofilms on medical instruments and surfaces: Do they interfere with instrument reprocessing and surface disinfection. Am J Infect Control 2023; 51:A114-A119. [PMID: 37890940 DOI: 10.1016/j.ajic.2023.04.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Biofilms are surface-attached communities of bacteria embedded in an extracellular matrix. This matrix shields the resident cells from desiccation, chemical perturbation, invasion by other bacteria, and confers reduced susceptibility to antibiotics and disinfectants. There is growing evidence that biofilms on medical instruments (especially endoscopes) and environmental surfaces interfere with cleaning and disinfection. METHODS The English literature on the impact of biofilms in medicine was reviewed with a focus on the impact of biofilms on reusable semicritical medical instruments and hospital environmental surfaces. RESULTS Biofilms are frequently present on hospital environmental surfaces and reusable medical equipment. Important health care...associated pathogens that readily form biofilms on environmental surfaces include Staphylococcus aureus, Pseudomonas aeruginosa, and Candida auris. Evidence has demonstrated that biofilms interfere with cleaning and disinfection. DISCUSSION New technologies such as ..úself-disinfecting..Ñ surfaces or continuous room disinfection systems may reduce or disrupt biofilm formation and are under study to reduce the impact of the contaminated surface environment on health care...associated infections. CONCLUSIONS Future research is urgently needed to develop methods to reduce or eliminate biofilms from forming on implantable medical devices, reusable medical equipment, and hospital surfaces.
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Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Deverick J Anderson
- Division of Infectious Diseases, School of Medicine, Duke University, Durham, NC
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC
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14
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O'Grady NP, Alexander E, Alhazzani W, Alshamsi F, Cuellar-Rodriguez J, Jefferson BK, Kalil AC, Pastores SM, Patel R, van Duin D, Weber DJ, Deresinski S. Executive Summary: Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Med 2023; 51:1566-1569. [PMID: 37902339 DOI: 10.1097/ccm.0000000000006021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Affiliation(s)
- Naomi P O'Grady
- Internal Medicine Services, National Institutes of Health Clinical Center, Bethesda, MD
| | - Earnest Alexander
- Clinical Pharmacy Services, Department of Pharmacy, Tampa General Hospital, Tampa, FL
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jennifer Cuellar-Rodriguez
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Diseases, Bethesda, MD
| | - Brian K Jefferson
- Division of Hepatobiliary and Pancreatic Surgery, Department of Internal Medicine-Critical Care Services, Atrium Health Cabarrus, Concord, NC
| | - Andre C Kalil
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, and Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - Stanley Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA
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15
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Rutala WA, Weber DJ, Barbee SL, Gergen MF, Sobsey MD, Samsa GP, Sickbert-Bennett EE. Evaluation of antibiotic-resistant bacteria in home kitchens and bathrooms: Is there a link between home disinfectant use and antibiotic resistance? Am J Infect Control 2023; 51:A158-A163. [PMID: 37890947 DOI: 10.1016/j.ajic.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To determine the relationship between home disinfectant use and the prevalence of antibiotic resistance among environmental isolates of human pathogens. METHODS Bacteria were cultured from 5 kitchen and 5 bathroom sites using quantitative methods. Antibiotic susceptibility was determined by standard methods. Home disinfectant use was assessed via a questionnaire. RESULTS The overall total mean log10 counts (total CFU) for the kitchen and bathroom were 4.31 and 4.88, respectively. Gram-positive bacteria were more common in the bathroom (4.05) than in the kitchen (3.60), while Gram-negative bacilli were more common in the kitchen (4.23) than in the bathroom (3.86). The sink and bath drains were the most contaminated sites with 6.16-log10 of total CFU and 6.6-log10 in the kitchen and bathroom, respectively. Households reported cleaning frequency with a variety of commercial products. Most respondents used antibacterial products (eg, soaps, surface disinfectants) in the home. Antibiotic-resistant pathogens were infrequently isolated in the homes evaluated. CONCLUSIONS Compared to pathogens causing community-acquired clinical infections in the ICARE study, pathogens isolated from households are less likely to demonstrate antibiotic resistance. In addition, no relationship between antibacterial use or frequency of cleaning or disinfection and antibiotic resistance was revealed.
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Affiliation(s)
- William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; NC Statewide Program for Infection Control and Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Infection Prevention, University of North Carolina Health Care System, Chapel Hill, NC
| | - Susan L Barbee
- NC Statewide Program for Infection Control and Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Maria F Gergen
- Department of Infection Prevention, University of North Carolina Health Care System, Chapel Hill, NC
| | - Mark D Sobsey
- Department of Engineering and Environmental Sciences, University of North Carolina School of Public Health, Chapel Hill, NC
| | - Gregory P Samsa
- NC Statewide Program for Infection Control and Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; Department of Infection Prevention, University of North Carolina Health Care System, Chapel Hill, NC
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16
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Rutala WA, Weber DJ. Risk of disease transmission to patients from "contaminated" surgical instruments and immediate use steam sterilization. Am J Infect Control 2023; 51:A72-A81. [PMID: 37890956 DOI: 10.1016/j.ajic.2023.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND There are several sources of pathogens that cause surgical site infections (SSI) to include the patients endogenous microflora and exogenous sources (e.g., air, surfaces, staff, surgical equipment). METHODS We searched the published English literature (Google, Google Scholar, PubMed) for articles on reprocessing surgical instruments, effectiveness of sterilization methods, microbial load on surgical instruments, frequency of "contaminated" instruments, and the infection risk associated with "contaminated" surgical instruments and immediate use steam sterilization. RESULTS There is substantial redundancy in instrument reprocessing to include: even if a patient was exposed to a "contaminated" instrument, the decontamination and sterilization process would have removed and/or inactivated the contaminating pathogens due to the exceptional effectiveness of the manual and mechanical cleaning (i.e., washer-disinfector) and the remarkable robustness of sterilization technology; and the low-level of microorganisms on surgical instruments after use and before cleaning. CONCLUSIONS A critical review of the literature suggests that the risk of acquiring an SSI from instruments used in surgery is essentially zero if the sterilization cycle is validated.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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17
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Rutala WA, Donskey CJ, Weber DJ. Disinfection and sterilization: New technologies. Am J Infect Control 2023; 51:A13-A21. [PMID: 37890943 DOI: 10.1016/j.ajic.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Adherence to professional guidelines and/or manufacturer's instructions for use regarding proper disinfection and sterilization of medical devices is crucial to preventing cross transmission of pathogens between patients. Emerging pathogens (e.g., Candida auris) and complex medical devices provide new challenges. METHODS A search for published English articles on new disinfection and sterilization technologies was conducted by Google, Google scholar and PubMed. RESULTS Several new disinfection methods or products (e.g., electrostatic spraying, new sporicides, colorized disinfectants, "no touch" room decontamination, continuous room decontamination) and sterilization technologies (e.g., new sterilization technology for endoscopes) were identified. CONCLUSIONS These technologies should reduce patient risk.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - Curtis J Donskey
- Geriatric Research, Education and Clinical Care, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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18
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Kanamori H, Rutala WA, Sickbert-Bennett EE, Weber DJ. Role of the contaminated environment in transmission of multidrug-resistant organisms in nursing homes and infection prevention. Am J Infect Control 2023; 51:A151-A157. [PMID: 37890946 DOI: 10.1016/j.ajic.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND With aging of the population in the United States, there are more people in long-term care facilities than in hospitals. Nursing home residents have a high prevalence of colonization with multidrug-resistant organisms (MDROs). A shared environment with vulnerable patients can facilitate intra- and inter-facility transmission of MDROs. The aim of this paper is to examine the role of the nursing home environment in MDRO transmission and provide infection prevention strategies. METHODS We searched the published literature and reviewed selected articles on contamination, transmission, and infection associated with the nursing home environment. RESULTS Nursing home residents were frequently colonized with MDROs, leading to contamination of the surrounding environment with the same pathogen. Surface contamination with MDROs was common in nursing home patient rooms, and to a substantial but lesser frequency in common rooms. Shared rooms were a risk factor for MDRO transmission between patients. CONCLUSIONS Since outbreaks and infections via the environmental contamination cause substantial burden of morbidity and mortality in the nursing home residents, it is essential for healthcare personnel to recognize the role of the nursing home environment in infection transmission and adhere to the current infection prevention guidelines for cleaning and disinfection of environmental surfaces.
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Affiliation(s)
- Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; Infection Prevention Department, UNC Medical Center, Chapel Hill, NC
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC; Infection Prevention Department, UNC Medical Center, Chapel Hill, NC
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19
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Rutala WA, Weber DJ. Disinfection, sterilization and antisepsis: Principles, practices, current issues, new research and new technologies. Am J Infect Control 2023; 51:A1-A2. [PMID: 37890938 DOI: 10.1016/j.ajic.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/20/2023] [Indexed: 10/29/2023]
Affiliation(s)
- William A Rutala
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Hospitals, Chapel Hill, NC
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20
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Weber DJ, Rutala WA, Anderson DJ, Sickbert-Bennett EE. ..úNo touch..Ñ methods for health care room disinfection: Focus on clinical trials. Am J Infect Control 2023; 51:A134-A143. [PMID: 37890944 DOI: 10.1016/j.ajic.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Hospital patient room surfaces are frequently contaminated with multidrug-resistant organisms. Since studies have demonstrated that inadequate terminal room disinfection commonly occurs, ..úno touch..Ñ methods of terminal room disinfection have been developed such as ultraviolet light (UV) devices and hydrogen peroxide (HP) systems. METHODS This paper reviews published clinical trials of ..úno touch..Ñ methods and ..úself-disinfecting..Ñ surfaces. RESULTS Multiple papers were identified including clinical trials of UV room disinfection devices (N.ß=.ß20), HP room disinfection systems (N.ß=.ß8), handheld UV devices (N.ß=.ß1), and copper-impregnated or coated surfaces (N.ß=.ß5). Most but not all clinical trials of UV devices and HP systems for terminal disinfection demonstrated a reduction of colonization/infection in patients subsequently housed in the room. Copper-coated surfaces were the only ..úself-disinfecting..Ñ technology evaluated by clinical trials. Results of these clinical trials were mixed. DISCUSSION Almost all clinical trials reviewed used a ..úweak..Ñ design (eg, before-after) and failed to assess potential confounders (eg, compliance with hand hygiene and environmental cleaning). CONCLUSIONS The evidence is strong enough to recommend the use of a ..úno-touch..Ñ method as an adjunct for outbreak control, mitigation strategy for high-consequence pathogens (eg, Candida auris or Ebola), or when there are an excessive endemic rates of multidrug-resistant organisms.
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Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, NC
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC
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21
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Weber DJ, Rutala WA, Sickbert-Bennett E. Emerging infectious diseases, focus on infection prevention, environmental survival and germicide susceptibility: SARS-CoV-2, Mpox, and Candida auris. Am J Infect Control 2023; 51:A22-A34. [PMID: 37890950 DOI: 10.1016/j.ajic.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND New and emerging infectious diseases continue to represent a public health threat. Emerging infectious disease threats include pathogens increasing in range (eg, Mpox), zoonotic microbes jumping species lines to cause sustained infections in humans via person-to-person transmission (SARS-CoV-2) and multidrug-resistant pathogens (eg, Candida auris). MATERIALS AND METHODS We searched the published English literature and reviewed the selected articles on SARS-CoV-2, Mpox, and Candida auris with a focus on environmental survival, contamination of the patient's hospital environment, susceptibility of the pathogen to antiseptics and disinfectants and infection prevention recommendations. RESULTS All three pathogens (ie, SARS-CoV-2, Mpox, and Candida auris) can survive on surfaces for minutes to hours and for Mpox and C auris for days. Currently available antiseptics (eg, 70%-90% alcohol hand hygiene products) are active against SARS-CoV-2, Mpox and C auris. The U.S Environmental Protection Agency provides separate lists of surface disinfectants active against SARS-CoV-2, Mpox, and C auris. DISCUSSION The risk of environment-to-patient transmission of SARS-CoV-2, Mpox and Candida auris, is very low, low-moderate and high, respectively. In the absence of appropriate patient isolation and use of personal protection equipment, the risk of patient-to-health care provider transmission of SARS-CoV-2, Mpox, and C auris is high, moderate and low, respectively. CONCLUSIONS Appropriate patient isolation, use of personal protective equipment by health care personnel, hand hygiene, and surface disinfection can protect patients and health care personnel from acquiring SARS-CoV-2, Mpox, and C auris from infected patients.
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Affiliation(s)
- David J Weber
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
| | - William A Rutala
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Emily Sickbert-Bennett
- Division of Infectious Diseases, School of Medicine, University of North Carolina, Chapel Hill, NC; Department of Infection Prevention, UNC Medical Center, Chapel Hill, NC; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
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O'Grady NP, Alexander E, Alhazzani W, Alshamsi F, Cuellar-Rodriguez J, Jefferson BK, Kalil AC, Pastores SM, Patel R, van Duin D, Weber DJ, Deresinski S. Society of Critical Care Medicine and the Infectious Diseases Society of America Guidelines for Evaluating New Fever in Adult Patients in the ICU. Crit Care Med 2023; 51:1570-1586. [PMID: 37902340 DOI: 10.1097/ccm.0000000000006022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
RATIONALE Fever is frequently an early indicator of infection and often requires rigorous diagnostic evaluation. OBJECTIVES This is an update of the 2008 Infectious Diseases Society of America and Society (IDSA) and Society of Critical Care Medicine (SCCM) guideline for the evaluation of new-onset fever in adult ICU patients without severe immunocompromise, now using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. PANEL DESIGN The SCCM and IDSA convened a taskforce to update the 2008 version of the guideline for the evaluation of new fever in critically ill adult patients, which included expert clinicians as well as methodologists from the Guidelines in Intensive Care, Development and Evaluation Group. The guidelines committee consisted of 12 experts in critical care, infectious diseases, clinical microbiology, organ transplantation, public health, clinical research, and health policy and administration. All task force members followed all conflict-of-interest procedures as documented in the American College of Critical Care Medicine/SCCM Standard Operating Procedures Manual and the IDSA. There was no industry input or funding to produce this guideline. METHODS We conducted a systematic review for each population, intervention, comparison, and outcomes question to identify the best available evidence, statistically summarized the evidence, and then assessed the quality of evidence using the GRADE approach. We used the evidence-to-decision framework to formulate recommendations as strong or weak or as best-practice statements. RESULTS The panel issued 12 recommendations and 9 best practice statements. The panel recommended using central temperature monitoring methods, including thermistors for pulmonary artery catheters, bladder catheters, or esophageal balloon thermistors when these devices are in place or accurate temperature measurements are critical for diagnosis and management. For patients without these devices in place, oral or rectal temperatures over other temperature measurement methods that are less reliable such as axillary or tympanic membrane temperatures, noninvasive temporal artery thermometers, or chemical dot thermometers were recommended. Imaging studies including ultrasonography were recommended in addition to microbiological evaluation using rapid diagnostic testing strategies. Biomarkers were recommended to assist in guiding the discontinuation of antimicrobial therapy. All recommendations issued were weak based on the quality of data. CONCLUSIONS The guidelines panel was able to formulate several recommendations for the evaluation of new fever in a critically ill adult patient, acknowledging that most recommendations were based on weak evidence. This highlights the need for the rapid advancement of research in all aspects of this issue-including better noninvasive methods to measure core body temperature, the use of diagnostic imaging, advances in microbiology including molecular testing, and the use of biomarkers.
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Affiliation(s)
- Naomi P O'Grady
- Internal Medicine Services, National Institutes of Health Clinical Center, Bethesda, MD
| | - Earnest Alexander
- Clinical Pharmacy Services, Department of Pharmacy, Tampa General Hospital, Tampa, FL
| | - Waleed Alhazzani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Jennifer Cuellar-Rodriguez
- Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Diseases, Bethesda, MD
| | - Brian K Jefferson
- Division of Hepatobiliary and Pancreatic Surgery, Department of Internal Medicine-Critical Care Services, Atrium Health Cabarrus, Concord, NC
| | - Andre C Kalil
- Infectious Diseases Division, University of Nebraska Medical Center, Omaha, NE
| | - Stephen M Pastores
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robin Patel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Rochester, MN
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN
| | - David van Duin
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, NC
| | - Stanley Deresinski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA
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Rutala WA, Weber DJ. Reprocessing semicritical items: An overview and an update on the shift from HLD to sterilization for endoscopes. Am J Infect Control 2023; 51:A96-A106. [PMID: 37890958 DOI: 10.1016/j.ajic.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Semicritical medical devices are defined as items that come into contact with mucous membranes or nonintact skin (e.g., gastrointestinal endoscopes, endocavitary probes). Such medical devices require minimally high-level disinfection. METHODS Analyze the methods used to reprocess semicritical medical devices and identify methods and new technologies to reduce the risk of infection. RESULTS The reprocessing methods for semicritical medical devices is described as well as a shift from high-level disinfection to sterilization for lumened endoscopes. CONCLUSIONS Strict adherence to current guidelines and transition to sterilization for endoscopes is required as more outbreaks have been linked to inadequately disinfected endoscopes and other semicritical items than any other reusable medical devices.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Department of Infection Prevention, Hospital Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC
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Abstract
BACKGROUND Each year in the United States there are approximately 100,000,000 outpatient/inpatient surgical procedures. Each of these procedures involves contact by a medical device or surgical instrument with a patient's sterile tissue and/or mucous membrane. A major risk of all such procedures is the introduction of infection. METHODS We searched published literature for articles on the use and effectiveness of disinfectants, sterilization methods and antiseptics. RESULTS The level of disinfection is dependent on the intended use of the object: critical (items that contact sterile tissue such as surgical instruments), semicritical (items that contact mucous membrane such as endoscopes), and noncritical (devices that contact only intact skin such as stethoscopes) items require sterilization, high-level disinfection and low-level disinfection, respectively. Cleaning must always precede high-level disinfection and sterilization. Antiseptics are essential to infection prevention as part of a hand hygiene program as well as other uses such as surgical hand antisepsis and pre-operative patient skin preparation. CONCLUSIONS When properly used, disinfection and sterilization can ensure the safe use of invasive and non-invasive medical devices. Cleaning should always precede high-level disinfection and sterilization. Strict adherence to current disinfection and sterilization guidelines is essential to prevent patient infections and exposures to infectious agents.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - John M Boyce
- J.M. Boyce Consulting, Boyce Consulting, LLC, Middletown, CT
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, UNC School of Medicine, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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Rutala WA, Weber DJ. Sterilization of 20 billion medical devices by ethylene oxide (ETO): Consequences of ETO closures and alternative sterilization technologies/solutions. Am J Infect Control 2023; 51:A82-A95. [PMID: 37890957 DOI: 10.1016/j.ajic.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 01/31/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND To prevent healthcare-associated infections, it is essential that critical medical devices be sterilized before use. Although there are several sterilization technologies for medical devices, only ethylene oxide (ETO) sterilization has virtually universal material compatibility. METHODS We searched the published English literature (Google, Google scholar and PubMed) for articles on the sterilization of medical devices by ethylene oxide, the consequences of ETO closures, and alternative sterilization technologies/solutions. RESULTS ETO's compatibility and effectiveness with medical products allows for sterilization of many medical devices that would otherwise be rendered ineffective or unsafe if sterilized with an alternative method. CONCLUSIONS At present, there are no alternatives to ETO that provide the same sterility assurance and result in the same device performance as ETO; therefore, it is likely irreplaceable for years.
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Affiliation(s)
- William A Rutala
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC.
| | - David J Weber
- Statewide Program for Infection Control and Epidemiology, University of North Carolina Hospitals, Chapel Hill, NC; Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, NC; Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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Lee YS, Cheng IT, Raquel GR, Weber DJ, Scalea JR. Initial exploration of a novel fusion protein, IL-4/IL-34/IL-10, which promotes cardiac allograft survival mice through alloregulation. Innate Immun 2023; 29:150-158. [PMID: 37800911 PMCID: PMC10559875 DOI: 10.1177/17534259231186239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 10/07/2023] Open
Abstract
Immune mediated graft loss still represents a major risk to transplant recipients. Creative approaches to immunosuppression that exploit the recipient's own alloregulatory mechanisms could reduce the need for pharmacologic immunosuppression and potentially induce immune tolerance. In the process of studying recipient derived myeloid derived suppressor cells (MDSCs), we identified key alloregulatory MDSC mechanisms, mediated by isolatable proteins IL-4, IL-34, and IL-10. We sought to purify these proteins and fuse them for subsequent infusion into transplant recipients as a means of inducing an alloregulatory response. In this introductory investigation, we leveraged molecular engineering technology to create a fusion protein (FP) of three cytokine coding sequences of IL-4, IL-34, and IL-10 and demonstrated their expressions by Western Blot analysis. Following purification, we tested whether FP IL-4/IL-34/IL-10 (FP1) can protect heart transplant allografts. Injection of FP1 significantly prolonged allogeneic cardiac graft survival in a dose-dependent fashion and the increase of graft survival time exceeded survival attributable to IL-34 alone. In vitro, MDSCs cells were expanded by FP1 treatment. However, FP1 did not directly inhibit T cell proliferation in vitro. In conclusion, newly developed FP1 improves the graft survival in cardiac transplantation mouse model. Significant additional work to optimize FP1 or include other novel proteins could supplement current treatment options for transplant patients.
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Affiliation(s)
- Young S. Lee
- Department of Surgery, University of Maryland School of Medicine, Baltimore, USA
- Center for Vascular and Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, USA
| | - I-Ting Cheng
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, USA
- Institute for Bioscience and Biotechnology Research, Rockville, USA
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, Baltimore, USA
| | - Godoy-Ruiz Raquel
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, USA
- Institute for Bioscience and Biotechnology Research, Rockville, USA
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, Baltimore, USA
| | - David J. Weber
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, USA
- Institute for Bioscience and Biotechnology Research, Rockville, USA
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, Baltimore, USA
| | - Joseph R. Scalea
- Medical University of South Carolina, Department of Surgery and Immunology, Charleston, SC, USA
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27
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Stancill LB, Ponder MG, Kinlaw AC, Teal L, Sickbert-Bennett EE, Weber DJ, DiBiase LM. Methodologic challenges and lessons learned through conducting a hospital-based Salmonella Javiana case-control study. Am J Infect Control 2023; 51:1132-1138. [PMID: 36965777 DOI: 10.1016/j.ajic.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE Determine the food(s) most likely contaminated by Salmonella Javiana associated with a salmonellosis outbreak involving 2 hospitals in North Carolina that were within 50 miles of each other in November 2021. METHODS A 2:1 matched case-control study was conducted. Food histories were obtained from hospital food orders and potential confounder covariates were collected from patient medical records. Attack rates and conditional logistic regression odds ratios (OR) were estimated at the 80% confidence interval (CI) for each food exposure and salmonellosis. RESULTS There were 21 cases and 42 controls included. Fruit cups had the strongest association with salmonellosis (matched and adjusted OR = 7.9 80% CI: 2.7, 23.6). Hospital-specific ORs varied for several food items, but attack rates analyses provided additional evidence that fruit cups were a likely common source. CONCLUSION Our analyses implicated fruit cups in an outbreak of salmonellosis in 2 hospitals. Other methodologic challenges included selection of controls among sick patients, heterogeneity of food exposures, reliance on food orders rather than foods consumed, and retention of food history records. Understanding and anticipating these challenges through changes to policies and operational procedures is critical for conducting efficient and effective case-control studies in the hospital setting.
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Affiliation(s)
- Lisa B Stancill
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
| | - Madison G Ponder
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina School of Pharmacy, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lisa Teal
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
| | - Emily E Sickbert-Bennett
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC; Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - David J Weber
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
| | - Lauren M DiBiase
- Department of Infection Prevention, University of North Carolina Medical Center, Chapel Hill, NC
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28
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Thankan RS, Thomas E, Purushottamachar P, Weber DJ, Njar VCO. Salinization Dramatically Enhance the Anti-Prostate Cancer Efficacies of AR/AR-V7 and Mnk1/2 Molecular Glue Degraders, Galeterone and VNPP433-3β Which Outperform Docetaxel and Enzalutamide in CRPC CWR22Rv1 Xenograft Mouse Model. Bioorg Chem 2023; 139:106700. [PMID: 37392559 PMCID: PMC10528634 DOI: 10.1016/j.bioorg.2023.106700] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
Galeterone, 3β-(hydroxy)-17-(1H-benzimidazole-1-yl)androsta-5,16-diene (Gal, 1) and VNPP433-3β, 3β-(1H-imidazole-1-yl-17-(1H-benzimidazole-1-yl)androsta-5,16-diene (2) are potent molecular glue degrader modulators of AR/AR-V7 and Mnk1/2-eIF4E signaling pathways, and are promising Phase 3 and Phase 1 drug candidates, respectively. Because appropriate salts can be utilized to create new chemical entities with enhanced aqueous solubility, in vivo pharmacokinetics, and enhanced in vitro and in vivo efficacies, the monohydrochloride salt of Gal (3) and the mono- and di-hydrochlorides salts of compound 2, compounds 4 and 5, respectively, were synthesized. The salts were characterized using 1H NMR, 13C NMR and HRMS analyses. Compound 3 displayed enhanced in vitro antiproliferative activity (7.4-fold) against three prostate cancer cell lines but surprisingly decreased plasma exposure in the pharmacokinetics study. The antiproliferative activities of the compound 2 salts (4 and 5) were equivalent to that of compound 2, but their oral pharmacokinetic profiles were significantly enhanced. Finally, and most importantly, oral administration of the parent compounds (1 and 2) and their corresponding salts (3, 4 and 5) caused dose-dependent potent inhibition/regression of aggressive and difficult-to-treat CWR22Rv1 tumor xenografts growth, with no apparent host toxicities and were highly more efficacious than the blockbuster FDA-approved prostate cancer drugs, Enzalutamide (Xtandi) and Docetaxel (Taxotere). Thus, the HCl salts of Gal (3) and VNPP433-3β (4 and 5) are excellent orally bioavailable candidates for clinical development.
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Affiliation(s)
- Retheesh S Thankan
- Department of Pharmacology, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; Isoprene Pharmaceuticals, Inc. 801 West Baltimore Street, Suite 502J, Baltimore, MD 21201, USA.
| | - Elizabeth Thomas
- Department of Pharmacology, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Puranik Purushottamachar
- Department of Pharmacology, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; Isoprene Pharmaceuticals, Inc. 801 West Baltimore Street, Suite 502J, Baltimore, MD 21201, USA.
| | - David J Weber
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; Isoprene Pharmaceuticals, Inc. 801 West Baltimore Street, Suite 502J, Baltimore, MD 21201, USA.
| | - Vincent C O Njar
- Department of Pharmacology, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, USA; Isoprene Pharmaceuticals, Inc. 801 West Baltimore Street, Suite 502J, Baltimore, MD 21201, USA.
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29
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Abeyawardhane DL, Sevdalis SE, Adipietro KA, Godoy-Ruiz R, Varney KM, Nawaz IF, Spittel AX, Rustandi RR, Silin VI, des Georges A, Pozharski E, Weber DJ. Membrane binding and pore formation is Ca 2+ -dependent for the Clostridioides difficile binary toxin. bioRxiv 2023:2023.08.18.553786. [PMID: 37645845 PMCID: PMC10462154 DOI: 10.1101/2023.08.18.553786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The C. difficile binary toxin (CDT) enters host cells via endosomal delivery like many other 'AB'-type binary toxins. In this study, the cell-binding component of CDT, termed CDTb, was found to bind and form pores in lipid bilayers upon depleting free Ca 2+ ion concentrations, and not by lowering pH, as found for other binary toxins (i.e., anthrax). Cryoelectron microscopy, nuclear magnetic resonance spectroscopy, surface plasmon resonance, electrochemical impedance spectroscopy, CDT toxicity studies, and site directed mutagenesis show that dissociation of Ca 2+ from a single site in receptor binding domain 1 (RBD1) of CDTb is consistent with a molecular mechanism in which Ca 2+ dissociation from RBD1 induces a "trigger" via conformational exchange that enables CDTb to bind and form pores in endosomal membrane bilayers as free Ca 2+ concentrations decrease during CDT endosomal delivery.
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Thankan RS, Thomas E, Purushottamachar P, Weber DJ, Ramamurthy VP, Huang W, Kane MA, Njar VCO. VNLG-152R and its deuterated analogs potently inhibit/repress triple/quadruple negative breast cancer of diverse racial origins in vitro and in vivo by upregulating E3 Ligase Synoviolin 1 (SYVN1) and inducing proteasomal degradation of MNK1/2. Front Oncol 2023; 13:1240996. [PMID: 37766871 PMCID: PMC10520556 DOI: 10.3389/fonc.2023.1240996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
Triple-negative breast cancer (TNBC) and its recently identified subtype, quadruple negative breast cancer (QNBC), collectively account for approximately 13% of reported breast cancer cases in the United States. These aggressive forms of breast cancer are associated with poor prognoses, limited treatment options, and lower overall survival rates. In previous studies, our research demonstrated that VNLG-152R exhibits inhibitory effects on TNBC cells both in vitro and in vivo and the deuterated analogs were more potent inhibitors of TNBC cells in vitro. Building upon these findings, our current study delves into the molecular mechanisms underlying this inhibitory action. Through transcriptome and proteome analyses, we discovered that VNLG-152R upregulates the expression of E3 ligase Synoviolin 1 (SYVN1), also called 3-hydroxy-3-methylglutaryl reductase degradation (HRD1) in TNBC cells. Moreover, we provide genetic and pharmacological evidence to demonstrate that SYVN1 mediates the ubiquitination and subsequent proteasomal degradation of MNK1/2, the only known kinases responsible for phosphorylating eIF4E. Phosphorylation of eIF4E being a rate-limiting step in the formation of the eIF4F translation initiation complex, the degradation of MNK1/2 by VNLG-152R and its analogs impedes dysregulated translation in TNBC cells, resulting in the inhibition of tumor growth. Importantly, our findings were validated in vivo using TNBC xenograft models derived from MDA-MB-231, MDA-MB-468, and MDA-MB-453 cell lines, representing different racial origins and genetic backgrounds. These xenograft models, which encompass TNBCs with varying androgen receptor (AR) expression levels, were effectively inhibited by oral administration of VNLG-152R and its deuterated analogs in NRG mice. Importantly, in direct comparison, our compounds are more effective than enzalutamide and docetaxel in achieving tumor growth inhibition/repression in the AR+ MDA-MD-453 xenograft model in mice. Collectively, our study sheds light on the involvement of SYVN1 E3 ligase in the VNLG-152R-induced degradation of MNK1/2 and the therapeutic potential of VNLG-152R and its more potent deuterated analogs as promising agents for the treatment of TNBC across diverse patient populations.
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Affiliation(s)
- Retheesh S. Thankan
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, Baltimore, MD, United States
- Isoprene Pharmaceuticals, Inc., Baltimore, MD, United States
| | - Elizabeth Thomas
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Puranik Purushottamachar
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, Baltimore, MD, United States
| | - David J. Weber
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, Baltimore, MD, United States
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD, United States
| | | | - Weiliang Huang
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Maureen A. Kane
- Department of Pharmaceutical Sciences, University of Maryland School of Pharmacy, Baltimore, MD, United States
| | - Vincent C. O. Njar
- Department of Pharmacology, University of Maryland School of Medicine, Baltimore, MD, United States
- The Center for Biomolecular Therapeutics, University of Maryland School of Medicine, Baltimore, MD, United States
- Isoprene Pharmaceuticals, Inc., Baltimore, MD, United States
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, United States
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31
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Wiley ZE, Weber DJ. Approaching coronavirus disease 2019 (COVID-19) vaccine hesitancy among healthcare personnel: The importance of cultural competency. Infect Control Hosp Epidemiol 2023; 44:1371-1372. [PMID: 37462096 DOI: 10.1017/ice.2022.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
- Zanthia E Wiley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
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32
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Kalu IC, Henderson DK, Weber DJ, Haessler S. Back to the future: Redefining "universal precautions" to include masking for all patient encounters. Infect Control Hosp Epidemiol 2023; 44:1373-1374. [PMID: 36762631 DOI: 10.1017/ice.2023.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Despite recent guidance from the Centers for Disease Control and Prevention (CDC) allowing institutions to relax in-facility masking strategies and due to our evolving understanding of respiratory pathogen transmission during the coronavirus disease 2019 (COVID-19) pandemic, we propose an updated standard for universal precautions in healthcare settings: permanently including universal masking in routine patient-care interactions. Such a practice prioritizes safety for patients, healthcare providers (HCPs), and visitors.
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Affiliation(s)
- Ibukunoluwa C Kalu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | | | - David J Weber
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sarah Haessler
- Division of Infectious Diseases, Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, Massachusetts
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Schaffzin JK, Sickbert-Bennett EE, Deloney VM, Weber DJ. Implementation should be a standard component of practice guidelines and guidance documents. Infect Control Hosp Epidemiol 2023; 44:1365-1368. [PMID: 36858810 DOI: 10.1017/ice.2022.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Joshua K Schaffzin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Emily E Sickbert-Bennett
- Division of Infectious Diseases, Department of Medicine, UNC- Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, UNC Medical Center, Chapel Hill, North Carolina
| | - Valerie M Deloney
- Society for Healthcare Epidemiology of America (SHEA), Arlington, Virginia
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, UNC- Chapel Hill, Chapel Hill, North Carolina
- Department of Infection Prevention, UNC Medical Center, Chapel Hill, North Carolina
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Chen X, Adhikary G, Newland JJ, Xu W, Keillor JW, Weber DJ, Eckert RL. Transglutaminase 2 Binds to the CD44v6 Cytoplasmic Domain to Stimulate CD44v6/ERK1/2 Signaling and Maintain an Aggressive Cancer Phenotype. Mol Cancer Res 2023; 21:922-932. [PMID: 37227250 DOI: 10.1158/1541-7786.mcr-23-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/08/2023] [Accepted: 05/24/2023] [Indexed: 05/26/2023]
Abstract
Transglutaminase 2 (TG2) is a key cancer cell survival protein in many cancer types. As such, efforts are underway to characterize the mechanism of TG2 action. In this study, we report that TG2 stimulates CD44v6 activity to enhance cancer cell survival via a mechanism that involves formation of a TG2/CD44v6/ERK1/2 complex that activates ERK1/2 signaling to drive an aggressive cancer phenotype. TG2 and ERK1/2 bind to the CD44v6 C-terminal intracellular cytoplasmic domain to activate ERK1/2 and stimulate cell proliferation and invasion. This is the same region that binds to ERM proteins and ankyrin to activate CD44v6-dependent cell proliferation, invasion, and migration. We further show that treatment with hyaluronan (HA), the physiologic CD44v6 ligand, stimulates CD44v6 activity, as measured by ERK1/2 activation, but that this response is severely attenuated in TG2 or CD44v6 knockdown or knockout cells. Moreover, treatment with TG2 inhibitor reduces tumor growth and that is associated with reduced CD44v6 level and ERK1/2 activity, and reduced stemness and epithelial-mesenchymal transition (EMT). These changes are replicated in CD44v6 knockout cells. These findings suggest that a unique TG2/CD44v6/ERK1/2 complex leads to increased ERK1/2 activity to stimulate an aggressive cancer phenotype and stimulate tumor growth. These findings have important implications for cancer stem cell maintenance and suggest that cotargeting of TG2 and CD44v6 with specific inhibitors may be an effective anticancer treatment strategy. IMPLICATIONS TG2 and CD44v6 are important procancer proteins. TG2 and ERK1/2 bind to the CD44v6 C-terminal domain to form a TG2/CD44v6/ERK1/2 complex that activates ERK1/2 to stimulate the cancer phenotype.
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Affiliation(s)
- Xi Chen
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gautam Adhikary
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John J Newland
- Department of Surgery Division of Thoracic Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Wen Xu
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jeffrey W Keillor
- Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - David J Weber
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, Maryland
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | - Richard L Eckert
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, Maryland
- Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
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35
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Thompson SC, Rutala WA, Sickbert-Bennett EE, DiBiase LM, Anderson DJ, Weber DJ. A comparison of methods for microbiologic environmental sampling. Infect Control Hosp Epidemiol 2023; 44:1502-1504. [PMID: 36453138 DOI: 10.1017/ice.2022.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
We compared the effectiveness of 4 sampling methods to recover Staphylococcus aureus, Klebsiella pneumoniae and Clostridioides difficile from contaminated environmental surfaces: cotton swabs, RODAC culture plates, sponge sticks with manual agitation, and sponge sticks with a stomacher. Organism type was the most important factor in bacterial recovery.
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Affiliation(s)
- Sharon C Thompson
- Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - William A Rutala
- Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Emily E Sickbert-Bennett
- Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
| | - Lauren M DiBiase
- Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, North Carolina
| | - David J Weber
- Infection Prevention, University of North Carolina Medical Center, Chapel Hill, North Carolina
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
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36
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Uthappa DM, Pak J, McGann KA, Brookhart MA, McKinzie K, Abdelbarr M, Cockrell J, Hickerson J, Armstrong S, D’Agostino EM, Weber DJ, Kalu IC, Benjamin DK, Zimmerman KO, Boutzoukas AE. In-Person Instruction and Educational Outcomes of K-8 Students During the COVID-19 Pandemic. Pediatrics 2023; 152:e2022060352L. [PMID: 37394499 PMCID: PMC10312276 DOI: 10.1542/peds.2022-060352l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Quantify the relationship between district policy permitting in-person instruction and educational outcomes during the 2020 to 2021 academic year for kindergarten through eighth grade students. METHODS An ecological, repeated cross-sectional analysis of grade-level proficiency of students enrolled in public school districts in North Carolina (n = 115 school districts) was conducted. Univariate and multivariate analyses were performed to evaluate the association between the proportion of the school year a district spent in-person and 2020 to 2021 end-of-year student proficiency in the district. We then fit a multivariable linear regression model, weighted by district size, and adjusted for district-level 2018 to 2019 proficiency and district-level factors (rural or urban, area deprivation). RESULTS Compared to 2018 to 2019, there was a 12.1% decrease (95% confidence interval [CI]: 16.8-19.3) in mathematics and an 18.1% decrease (95% CI: 10.8-13.4) in reading proficiency across the state at the end of 2020 to 2021. Compared to a district that remained entirely remote for the 2020 to 2021 school year, a district offering full in-person instruction had 12% (95% CI: 11%-12.9%) and 4.1% (95% CI: 3.5%-4.8%) more students achieve grade-level proficiency in mathematics and reading, respectively. In-person instruction was associated with greater increases in mathematics proficiency than reading, and greater increases in elementary-level students' proficiency than middle school-level. CONCLUSIONS The proportion of students achieving grade-level proficiency in 2020 to 2021 fell below prepandemic levels at each evaluated time point in the academic year. Increased time spent in-person by a school district was associated with an increased proportion of students achieving grade-level end-of-grade proficiency in both mathematics and reading.
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Affiliation(s)
| | - Joyce Pak
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | - Kaylee McKinzie
- Student, Trinity School of Arts & Sciences, Duke University, Durham, North Carolina
| | - Mariam Abdelbarr
- Student, North Carolina School of Science and Mathematics, Durham, North Carolina
| | - Jed Cockrell
- Yadkin County Schools, Yadkinville, North Carolina
| | | | | | - Emily M. D’Agostino
- Department of Family Medicine & Community Health, Duke University School of Medicine, Durham, North Carolina
| | - David J. Weber
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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37
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Sathitakorn O, Chansirikarnjana S, Jantarathaneewat K, Weber DJ, Warren DK, Apisarnthanarak P, Tantiyavarong P, Apisarnthanarak A. The role of procalcitonin and Clinical Pulmonary for Infection Score (CPIS) score to reduce inappropriate antibiotics use among moderate to severe coronavirus disease 2019 (COVID-19) pneumonia: A quasi-experimental multicenter study. Infect Control Hosp Epidemiol 2023; 44:1199-1203. [PMID: 35993305 DOI: 10.1017/ice.2022.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In this quasi-experimental study, implementing a procalcitonin and Clinical Pulmonary Infection Score (CPIS) successfully reduced inappropriate antibiotic use among severely-to-critically ill COVID-19 patients, multidrug-resistant organisms, and invasive fungal infections during the intervention period in 2 medical centers. However, this strategy did not improve inappropriate antibiotic use among mildly-to-moderately ill COVID-19 patients.
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Affiliation(s)
- Ornnicha Sathitakorn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Prathum Thani, Thailand
| | | | - Kittiya Jantarathaneewat
- Department of Pharmaceutical Care, Faculty of Pharmacy, Thammasat University, Prathum Thani, Thailand
- Research Group in Infectious Diseases, Epidemiology, and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - David J Weber
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
| | - David K Warren
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, United States
| | - Piyaporn Apisarnthanarak
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pichaya Tantiyavarong
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Prathum Thani, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Prathum Thani, Thailand
- Research Group in Infectious Diseases, Epidemiology, and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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38
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Apisarnthanarak A, Ling ML, Weber DJ. The role of environmental and healthcare-associated infections in Asia: Lessons learned from the coronavirus disease 2019 (COVID-19) pandemic. Antimicrob Steward Healthc Epidemiol 2023; 3:e100. [PMID: 37396196 PMCID: PMC10311687 DOI: 10.1017/ash.2023.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Anucha Apisarnthanarak
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Moi Lin Ling
- Infection Prevention & Epidemiology, Singapore General Hospital, Outram Road, Singapore, Singapore
| | - David J. Weber
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
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39
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Coburn KM, Roth B, Varney KM, Carrier F, Weber DJ. 1H, 13C, and 15N assignments of the mRNA binding protein hnRNP A18. Biomol NMR Assign 2023; 17:37-41. [PMID: 36539586 DOI: 10.1007/s12104-022-10117-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/08/2022] [Indexed: 06/02/2023]
Abstract
Heterogeneous ribonuclear protein A18 (hnRNP A18) is an RNA binding protein (RBP) involved in the hypoxic cellular stress response and regulation of cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) expression in melanoma, breast cancer, prostate cancer, and colon cancer solid tumors. hnRNP A18 is comprised of an N-terminal structured RNA recognition motif (RMM) and a C-terminal intrinsically disordered domain (IDD). Upon cellar stressors, such as UV and hypoxia, hnRNP A18 is phosphorylated by casein kinase 2 (CK2) and glycogen synthase kinase 3β (GSK-3β). After phosphorylation, hnRNP A18 translocates from the nucleus to the cytosol where it interacts with pro-survival mRNA transcripts for proteins such as hypoxia inducible factor 1α and CTLA-4. Both the hypoxic cellular response and modulation of immune checkpoints by cancer cells promote chemoradiation resistance and metastasis. In this study, the 1 H, 13 C, and 15 N backbone and sidechain resonances of the 172 amino acid hnRNP A18 were assigned sequence-specifically and provide a framework for future NMR-based drug discovery studies toward targeting hnRNP A18. These data will also enable the investigation of the dynamic structural changes within the IDD of hnRNP A18 upon phosphorylation by CK2 and GSK-3β to provide critical insight into the structure and function of IDDs.
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Affiliation(s)
- Katherine M Coburn
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, 21201, Baltimore, MD, USA
| | - Braden Roth
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, 21201, Baltimore, MD, USA
| | - Kristen M Varney
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, 21201, Baltimore, MD, USA
- Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene St, 21201, Baltimore Maryland, USA
| | - France Carrier
- Department of Radiation Oncology, University of Maryland School of Medicine, 655 West Baltimore, Street, 21201, Baltimore, MD, USA
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, 21201, Baltimore, MD, USA
| | - David J Weber
- Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene Street, 21201, Baltimore, MD, USA.
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, 21201, Baltimore, MD, USA.
- Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, 108 N. Greene St, 21201, Baltimore Maryland, USA.
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40
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Yu W, Weber DJ, MacKerell AD. Integrated Covalent Drug Design Workflow Using Site Identification by Ligand Competitive Saturation. J Chem Theory Comput 2023; 19:3007-3021. [PMID: 37115781 PMCID: PMC10205696 DOI: 10.1021/acs.jctc.3c00232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Covalent drug design is an important component in drug discovery. Traditional drugs interact with their target in a reversible equilibrium, while irreversible covalent drugs increase the drug-target interaction duration by forming a covalent bond with targeted residues and thus may offer a more effective therapeutic approach. To facilitate the design of this class of ligands, computational methods can be used to help identify reactive nucleophilic residues, frequently cysteines, on a target protein for covalent binding, to test various warhead groups for their potential reactivities, and to predict noncovalent contributions to binding that can facilitate drug-target interactions that are important for binding specificity. To further aid covalent drug design, we extended a functional group mapping approach based on explicit solvent all-atom molecular simulations (SILCS: site identification by ligand competitive saturation) that intrinsically considers protein flexibility, functional group, and protein desolvation along with functional group-protein interactions. Through docking of a library of representative warhead fragments using SILCS-Monte Carlo (SILCS-MC), reactive cysteines can be correctly identified for proteins being tested. Furthermore, a machine learning model was trained to quantify the effectiveness of various warhead groups for proteins using metrics from SILCS-MC as well as experimental model compound warhead reactivity data. The ability to rank covalent molecular binders with similar warheads using SILCS ligand grid free energy (LGFE) ranking was also tested for several proteins. Based on these tools, an integrated SILCS-based workflow was developed, named SILCS-Covalent, which can both qualitatively and quantitatively inform covalent drug discovery.
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Affiliation(s)
- Wenbo Yu
- Computer-Aided Drug Design Center, Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland 21201, United States
- Institute for Bioscience and Biotechnology Research (IBBR), Rockville, Maryland 20850, United States
- Center for Biomolecular Therapeutics (CBT), School of Medicine, University of Maryland Baltimore, Baltimore, Maryland 21201, United States
| | - David J. Weber
- Institute for Bioscience and Biotechnology Research (IBBR), Rockville, Maryland 20850, United States
- Center for Biomolecular Therapeutics (CBT), School of Medicine, University of Maryland Baltimore, Baltimore, Maryland 21201, United States
| | - Alexander D. MacKerell
- Computer-Aided Drug Design Center, Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland Baltimore, Baltimore, Maryland 21201, United States
- Institute for Bioscience and Biotechnology Research (IBBR), Rockville, Maryland 20850, United States
- Center for Biomolecular Therapeutics (CBT), School of Medicine, University of Maryland Baltimore, Baltimore, Maryland 21201, United States
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41
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Kociolek LK, Gerding DN, Carrico R, Carling P, Donskey CJ, Dumyati G, Kuhar DT, Loo VG, Maragakis LL, Pogorzelska-Maziarz M, Sandora TJ, Weber DJ, Yokoe D, Dubberke ER. Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:527-549. [PMID: 37042243 PMCID: PMC10917144 DOI: 10.1017/ice.2023.18] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Larry K. Kociolek
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States
| | - Dale N. Gerding
- Edward Hines Jr. Veterans’ Affairs (VA) Hospital, Hines, Illinois, United States
| | - Ruth Carrico
- Norton Healthcare, Louisville, Kentucky, United States
| | - Philip Carling
- Boston University School of Medicine, Boston, Massachusetts, United States
| | - Curtis J. Donskey
- Case Western Reserve University School of Medicine, Cleveland VA Medical Center, Cleveland, Ohio, United States
| | - Ghinwa Dumyati
- University of Rochester Medical Center, Rochester, New York, United States
| | - David T. Kuhar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Vivian G. Loo
- McGill University, McGill University Health Centre, Montréal, Québec, Canada
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | | | - Thomas J. Sandora
- Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - David J. Weber
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Deborah Yokoe
- University of California San Francisco, UCSF Health-UCSF Medical Center, San Francisco, California, United States and
| | - Erik R. Dubberke
- Washington University School of Medicine, St. Louis, Missouri, United States
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42
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Karade SS, Franco EJ, Rojas AC, Hanrahan KC, Kolesnikov A, Yu W, MacKerell AD, Hill DC, Weber DJ, Brown AN, Treston AM, Mariuzza RA. Structure-Based Design of Potent Iminosugar Inhibitors of Endoplasmic Reticulum α-Glucosidase I with Anti-SARS-CoV-2 Activity. J Med Chem 2023; 66:2744-2760. [PMID: 36762932 PMCID: PMC10278443 DOI: 10.1021/acs.jmedchem.2c01750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Enveloped viruses depend on the host endoplasmic reticulum (ER) quality control (QC) machinery for proper glycoprotein folding. The endoplasmic reticulum quality control (ERQC) enzyme α-glucosidase I (α-GluI) is an attractive target for developing broad-spectrum antivirals. We synthesized 28 inhibitors designed to interact with all four subsites of the α-GluI active site. These inhibitors are derivatives of the iminosugars 1-deoxynojirimycin (1-DNJ) and valiolamine. Crystal structures of ER α-GluI bound to 25 1-DNJ and three valiolamine derivatives revealed the basis for inhibitory potency. We established the structure-activity relationship (SAR) and used the Site Identification by Ligand Competitive Saturation (SILCS) method to develop a model for predicting α-GluI inhibition. We screened the compounds against SARS-CoV-2 in vitro to identify those with greater antiviral activity than the benchmark α-glucosidase inhibitor UV-4. These host-targeting compounds are candidates for investigation in animal models of SARS-CoV-2 and for testing against other viruses that rely on ERQC for correct glycoprotein folding.
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Affiliation(s)
- Sharanbasappa S. Karade
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD 20850, USA
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD 20742, USA
| | - Evelyn J. Franco
- Institute for Therapeutic Innovation, Department of Medicine, College of Medicine, University of Florida, Orlando, FL 32827, USA
| | - Ana C. Rojas
- Institute for Therapeutic Innovation, Department of Medicine, College of Medicine, University of Florida, Orlando, FL 32827, USA
| | - Kaley C. Hanrahan
- Institute for Therapeutic Innovation, Department of Medicine, College of Medicine, University of Florida, Orlando, FL 32827, USA
| | - Alexander Kolesnikov
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD 20850, USA
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD 20742, USA
| | - Wenbo Yu
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD 20850, USA
- Computer-Aided Drug Design Center, Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA
- Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Alexander D. MacKerell
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD 20850, USA
- Computer-Aided Drug Design Center, Department of Pharmaceutical Sciences, School of Pharmacy, University of Maryland, Baltimore, MD 21201, USA
- Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | | | - David J. Weber
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD 20850, USA
- Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, School of Medicine, University of Maryland, Baltimore, MD 21201, USA
| | - Ashley N. Brown
- Institute for Therapeutic Innovation, Department of Medicine, College of Medicine, University of Florida, Orlando, FL 32827, USA
| | - Anthony M. Treston
- Emergent BioSolutions, Gaithersburg, MD 20879, USA
- Current address: Treadwell Therapeutics, Toronto M5G 2M9, Canada
| | - Roy A. Mariuzza
- University of Maryland Institute for Bioscience and Biotechnology Research, Rockville, MD 20850, USA
- Department of Cell Biology and Molecular Genetics, University of Maryland, College Park, MD 20742, USA
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43
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Rodino KG, Babady NE, Bearman G, Binnicker MJ, Isaacs SN, Pinsky BA, Weber DJ. Laboratory Preparedness for the Current Monkeypox Outbreak. Clin Chem 2023; 69:118-124. [PMID: 36544358 DOI: 10.1093/clinchem/hvac198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Kyle G Rodino
- Assistant Director of Clinical Microbiology, Director of the Rittenhouse Molecular Laboratory, and Assistant Professor of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - N Esther Babady
- Chief of Clinical Microbiology Service and Member, Department of Pathology and Laboratory Medicine and Department of Medicine (Infectious Disease Service), Memorial Sloan Kettering Cancer Center, New York, USA
| | - Gonzalo Bearman
- Chief of Infectious Diseases, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Matthew J Binnicker
- Director of Clinical Virology and Professor of Laboratory Medicine and Pathology, Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Stuart N Isaacs
- Associate Professor of Medicine, Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Benjamin A Pinsky
- Director of Clinical Virology at Stanford Health Care and Stanford Childrens Health and Professor, Departments of Pathology and Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - David J Weber
- Director of Infection Prevention, University of North Carolina Medical Center and Professor, Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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44
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Yu W, Weber DJ, MacKerell AD. Computer-Aided Drug Design: An Update. Methods Mol Biol 2023; 2601:123-152. [PMID: 36445582 PMCID: PMC9838881 DOI: 10.1007/978-1-0716-2855-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Computer-aided drug design (CADD) approaches are playing an increasingly important role in understanding the fundamentals of ligand-receptor interactions and helping medicinal chemists design therapeutics. About 5 years ago, we presented a chapter devoted to an overview of CADD methods and covered typical CADD protocols including structure-based drug design (SBDD) and ligand-based drug design (LBDD) approaches that were frequently used in the antibiotic drug design process. Advances in computational hardware and algorithms and emerging CADD methods are enhancing the accuracy and ability of CADD in drug design and development. In this chapter, an update to our previous chapter is provided with a focus on new CADD approaches from our laboratory and other peers that can be employed to facilitate the development of antibiotic therapeutics.
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Affiliation(s)
- Wenbo Yu
- Department of Pharmaceutical Sciences, Computer-Aided Drug Design Center, School of Pharmacy, University of Maryland, Baltimore, MD, USA.
- Institute for Bioscience and Biotechnology Research (IBBR), Rockville, MD, USA.
- Center for Biomolecular Therapeutics (CBT), School of Medicine, University of Maryland, Baltimore, MD, USA.
| | - David J Weber
- Institute for Bioscience and Biotechnology Research (IBBR), Rockville, MD, USA
- Center for Biomolecular Therapeutics (CBT), School of Medicine, University of Maryland, Baltimore, MD, USA
| | - Alexander D MacKerell
- Department of Pharmaceutical Sciences, Computer-Aided Drug Design Center, School of Pharmacy, University of Maryland, Baltimore, MD, USA.
- Institute for Bioscience and Biotechnology Research (IBBR), Rockville, MD, USA.
- Center for Biomolecular Therapeutics (CBT), School of Medicine, University of Maryland, Baltimore, MD, USA.
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45
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Young BD, Cook ME, Costabile BK, Samanta R, Zhuang X, Sevdalis SE, Varney KM, Mancia F, Matysiak S, Lattman E, Weber DJ. Binding and Functional Folding (BFF): A Physiological Framework for Studying Biomolecular Interactions and Allostery. J Mol Biol 2022; 434:167872. [PMID: 36354074 PMCID: PMC10871162 DOI: 10.1016/j.jmb.2022.167872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/20/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
EF-hand Ca2+-binding proteins (CBPs), such as S100 proteins (S100s) and calmodulin (CaM), are signaling proteins that undergo conformational changes upon increasing intracellular Ca2+. Upon binding Ca2+, S100 proteins and CaM interact with protein targets and induce important biological responses. The Ca2+-binding affinity of CaM and most S100s in the absence of target is weak (CaKD > 1 μM). However, upon effector protein binding, the Ca2+ affinity of these proteins increases via heterotropic allostery (CaKD < 1 μM). Because of the high number and micromolar concentrations of EF-hand CBPs in a cell, at any given time, allostery is required physiologically, allowing for (i) proper Ca2+ homeostasis and (ii) strict maintenance of Ca2+-signaling within a narrow dynamic range of free Ca2+ ion concentrations, [Ca2+]free. In this review, mechanisms of allostery are coalesced into an empirical "binding and functional folding (BFF)" physiological framework. At the molecular level, folding (F), binding and folding (BF), and BFF events include all atoms in the biomolecular complex under study. The BFF framework is introduced with two straightforward BFF types for proteins (type 1, concerted; type 2, stepwise) and considers how homologous and nonhomologous amino acid residues of CBPs and their effector protein(s) evolved to provide allosteric tightening of Ca2+ and simultaneously determine how specific and relatively promiscuous CBP-target complexes form as both are needed for proper cellular function.
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Affiliation(s)
- Brianna D Young
- The Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mary E Cook
- The Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Brianna K Costabile
- Department of Physiology and Cellular Biophysics, Columbia University, New York, NY 10032, USA
| | - Riya Samanta
- Biophysics Graduate Program, University of Maryland, College Park, MD 20742, USA; Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA
| | - Xinhao Zhuang
- The Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Spiridon E Sevdalis
- The Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Kristen M Varney
- The Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Filippo Mancia
- Department of Physiology and Cellular Biophysics, Columbia University, New York, NY 10032, USA
| | - Silvina Matysiak
- Biophysics Graduate Program, University of Maryland, College Park, MD 20742, USA; Fischell Department of Bioengineering, University of Maryland, College Park, MD 20742, USA
| | - Eaton Lattman
- The Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; Department of Physics, Arizona State University, Tempe, AZ 85287, USA
| | - David J Weber
- The Center for Biomolecular Therapeutics (CBT), Department of Biochemistry and Molecular Biology, University of Maryland School of Medicine, Baltimore, MD 21201, USA; The Institute of Bioscience and Biotechnology Research (IBBR), Rockville, MD 20850, USA.
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Sarojvisut P, Apisarnthanarak A, Jantarathaneewat K, Sathitakorn O, Pienthong T, Mingmalairak C, Warren DK, Weber DJ. An Open Label Randomized Controlled Trial of Ivermectin Plus Favipiravir-Based Standard of Care versus Favipiravir-Based Standard of Care for Treatment of Moderate COVID-19 in Thailand. Infect Chemother 2022; 55:50-58. [PMID: 36603821 PMCID: PMC10079435 DOI: 10.3947/ic.2022.0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of ivermectin in the treatment of moderate coronavirus disease 2019 (COVID-19) is controversial. We performed an open label randomized controlled trial to evaluate the role of ivermectin plus favipiravir-based standard of care versus favipiravir-based standard of care for the treatment of moderate COVID-19 infection. MATERIALS AND METHODS An open-label randomized control trial was performed at Thammasat Field Hospital and Thammasat University Hospital from October 1st, 2021 to May 31st, 2022. Patients with moderate COVID-19 infections were randomized to the intervention (ivermectin plus favipiravir-based standard of care) or control group (favipiravir-based standard of care alone). Patients were followed up to 21 days. The primary outcome was the improvement in World Health Organization (WHO) category ordinal scale by 2 points. Secondary outcomes included duration of illness, development of severe COVID-19, and adverse reactions. RESULTS There were 157 patients in the intervention and 160 patients in the control group. Characteristics, underlying diseases, and risk factors for severe COVID-19 were comparable in both groups. Improvement in the WHO-category ordinal scale by 2 points was achieved in 98.7% of the intervention group and in 99.4% of the control group (relative risk [RR]: 0.487; 95% confidence interval [CI]: 0.044-5.430). The median illness duration was 5.0 days (range, 3 - 28 days) in intervention group versus 5.2 days (range, 3 - 28 days) in control group (P = 0.630). Severe COVID-19 that required intensive care occurred in 2 patients (1.3%) in the intervention group and 1 patient (0.6%) in the control group (RR: 2.052; 95% CI: 0.184 - 22.857). No significant difference in serious drug adverse events was seen. CONCLUSION In this study ivermectin plus standard of care was not associated with improvement in the WHO-category ordinal scale, reduced illness duration, or development of severe COVID-19 in moderately ill COVID-19 patients. TRIAL REGISTRATION Clinicaltrials.gov Identifier: TCTR20220427005.
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Affiliation(s)
- Phahol Sarojvisut
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Anucha Apisarnthanarak
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.,Research group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Kittiya Jantarathaneewat
- Research group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.,Center of Excellence in Pharmacy Practice and Management Research, Faculty of Pharmacy, Thammasat University, Pathum Thani, Thailand
| | - Ornnicha Sathitakorn
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Thanus Pienthong
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Chatchai Mingmalairak
- Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - David K Warren
- Division of Infectious Diseases, Washington University School of Medicine, St.Louis, MO, USA
| | - David J Weber
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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Pineau L, Radix C, Weber DJ. Comparison of the sporicidal activity of a UV disinfection process with three FDA cleared sterilants. Am J Infect Control 2022; 50:1316-1321. [PMID: 35263613 DOI: 10.1016/j.ajic.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Endocavitary probes are semi-critical devices and must undergo, at least, high level disinfection (HLD) between uses. Therefore, they should be high level disinfected between uses (i.e., with a product/process that kills all forms of microbial life; bacteria, fungi, mycobacteria, and virus, and in some countries, a demonstrated potential for sporicidal activity). In this study, the sporicidal activity of three common Food and Drug Administration cleared sterilants (CIDEX OPA Solution, SPOROX II Sterilizing and Disinfection Solution and CIDEX Activated Dialdehyde Solution) was compared with the sporicidal activity of an ultraviolet disinfection technology (Hypernova Chronos, Germitec) against Bacillus subtilis ATCC 19659 spores spread on silicone flat carriers in the presence of inorganic and organic soil. RESULTS The results indicate that the UV disinfection process presented within a 35 seconds exposure time a sporicidal efficacy substantially higher than the chemical sterilants used according to manufacturer instructions for HLD. CONCLUSIONS This study demonstrated that even if it cannot be tested/approved as a sterilant according to AOAC 966.04, the UV unit is much more effective than usual Food and Drug Administration approved chemical HLD products to kill spores in real use conditions. This finding questions the relevancy of evaluating product efficacy within extended conditions giving results that could mislead users to select the most effective HLD product/process for the reprocessing of their medical devices.
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Affiliation(s)
- Lionel Pineau
- Division of Medical Device Testing, Eurofins Biotech Germande, Aix-en-Provence, France.
| | - Caroline Radix
- Division of Medical Device Testing, Eurofins Biotech Germande, Aix-en-Provence, France
| | - David J Weber
- Division of Infectious Diseases, Department of Hospital Epidemiology, University of North Carolina School of Medicine, University of North Carolina Hospitals, Chapel Hill, NC, USA
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Weber DJ. 63. Patient safety comes first through implementing rigorous infection prevention standards when using endocavity probes for ultrasonography. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Assimon MM, Pun PH, Wang L, Al-Khatib SM, Brookhart MA, Weber DJ, Winkelmayer WC, Flythe JE. letter to the editor. Kidney Int 2022; 102:1191-1192. [PMID: 36272744 PMCID: PMC10906980 DOI: 10.1016/j.kint.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Magdalene M Assimon
- Department of Medicine, Division of Nephrology and Hypertension, UNC School of Medicine, University of North Carolina Kidney Center, Chapel Hill, North Carolina, USA
| | - Patrick H Pun
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Lily Wang
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | - M Alan Brookhart
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - David J Weber
- Department of Medicine, Division of Infectious Diseases, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer E Flythe
- Department of Medicine, Division of Nephrology and Hypertension, UNC School of Medicine, University of North Carolina Kidney Center, Chapel Hill, North Carolina, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.
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50
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Campbell MM, Benjamin DK, Mann TK, Fist A, Blakemore A, Diaz KS, Kim H, Edwards LJ, Rak Z, Brookhart MA, Moore Z, Tilson EC, Kalu I, Boutzoukas AE, Moorthy GS, Uthappa D, Scott Z, Weber DJ, Shane AL, Bryant KA, Zimmerman KO. Test-to-Stay After SARS-CoV-2 Exposure: A Mitigation Strategy for Optionally Masked K-12 Schools. Pediatrics 2022; 150:e2022058200. [PMID: 35971240 PMCID: PMC9647593 DOI: 10.1542/peds.2022-058200] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES We evaluated the impact of a test-to-stay (TTS) program on within-school transmission and missed school days in optionally masked kindergarten through 12th grade schools during a period of high community severe acute respiratory syndrome coronavirus 2 transmission. METHODS Close contacts of those with confirmed severe acute respiratory syndrome coronavirus 2 infection were eligible for enrollment in the TTS program if exposure to a nonhousehold contact occurred between November 11, 2021 and January 28, 2022. Consented participants avoided school exclusion if they remained asymptomatic and rapid antigen testing at prespecified intervals remained negative. Primary outcomes included within-school tertiary attack rate (test positivity among close contacts of positive TTS participants) and school days saved among TTS participants. We estimated the number of additional school-acquired cases resulting from TTS and eliminating school exclusion. RESULTS A total of 1675 participants tested positive or received at least 1 negative test between days 5 and 7 and completed follow-up; 92% were students and 91% were exposed to an unmasked primary case. We identified 201 positive cases. We observed a tertiary attack rate of 10% (95% confidence interval: 6%-19%), and 7272 (89%) of potentially missed days were saved through TTS implementation. We estimated 1 additional school-acquired case for every 21 TTS participants remaining in school buildings during the entire study period. CONCLUSIONS Even in the setting of high community transmission, a TTS strategy resulted in substantial reduction in missed school days in optionally masked schools.
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Affiliation(s)
| | - Daniel K. Benjamin
- Duke Clinical Research Institute
- Department of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
| | | | | | | | | | | | | | | | | | - Zack Moore
- North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | | | - Ibukun Kalu
- Duke Clinical Research Institute
- Department of Pediatrics
| | | | | | - Diya Uthappa
- Doctor of Medicine Program, Duke University School of Medicine, Durham, North Carolina
| | | | - David J. Weber
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Kristina A. Bryant
- University of Louisville and Norton Children’s Hospital, Louisville, Kentucky
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute
- Department of Pediatrics
- Co-Chair, The ABC Science Collaborative, Durham, North Carolina
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