1
|
Bailey AE, Chai SJ, Snyder RE, Bui DP, Lewis LS, Saadeh K, Bertumen JB, Epson E, Siegel JD. Healthcare personnel with laboratory-confirmed mpox in California during the 2022 outbreak. Infect Control Hosp Epidemiol 2024:1-3. [PMID: 38533591 DOI: 10.1017/ice.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
The California Department of Public Health (CDPH) reviewed 109 cases of healthcare personnel (HCP) with laboratory-confirmed mpox to understand transmission risk in healthcare settings. Overall, 90% of HCP with mpox had nonoccupational exposure risk factors. One occupationally acquired case was associated with sharps injury while unroofing a patient's lesion for diagnostic testing.
Collapse
Affiliation(s)
- Allison E Bailey
- California Department of Public Health, Richmond and Sacramento, California
| | - Shua J Chai
- California Department of Public Health, Richmond and Sacramento, California
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert E Snyder
- California Department of Public Health, Richmond and Sacramento, California
| | - David P Bui
- California Department of Public Health, Richmond and Sacramento, California
- Portland Oregon Veterans Affairs Medical Center, Oregon
| | - Linda S Lewis
- California Department of Public Health, Richmond and Sacramento, California
| | - Kayla Saadeh
- California Department of Public Health, Richmond and Sacramento, California
| | - J Bradford Bertumen
- California Department of Public Health, Richmond and Sacramento, California
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- California Department of Public Health, Richmond and Sacramento, California
| | - Jane D Siegel
- California Department of Public Health, Richmond and Sacramento, California
| |
Collapse
|
2
|
Li R, Beshearse E, Malden D, Truong H, Kraushaar V, Bonin BJ, Kim J, Kennedy I, McNary J, Han GS, Rudman SL, Perz JF, Perkins KM, Glowicz J, Epson E, Benowitz I, Villarino E. Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) outbreak investigation in a hospital emergency department-California, December 2020-January 2021. Infect Control Hosp Epidemiol 2023; 44:1187-1192. [PMID: 35591783 PMCID: PMC9411728 DOI: 10.1017/ice.2022.39] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/03/2022]
Abstract
We describe a large outbreak of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) involving an acute-care hospital emergency department during December 2020 and January 2021, in which 27 healthcare personnel worked while infectious, resulting in multiple opportunities for SARS-CoV-2 transmission to patients and other healthcare personnel. We provide recommendations for improving infection prevention and control.
Collapse
Affiliation(s)
- Ruoran Li
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elizabeth Beshearse
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Deborah Malden
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Holly Truong
- County of Santa Clara Public Health Department, San José, California
| | - Vit Kraushaar
- County of Santa Clara Public Health Department, San José, California
| | - Brandon J. Bonin
- County of Santa Clara Public Health Department, San José, California
| | - Janice Kim
- California Department of Public Health, Sacramento, California
| | - Idamae Kennedy
- California Department of Public Health, Sacramento, California
| | - Jennifer McNary
- California Department of Public Health, Sacramento, California
| | - George S. Han
- County of Santa Clara Public Health Department, San José, California
| | - Sarah L. Rudman
- County of Santa Clara Public Health Department, San José, California
| | - Joseph F. Perz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kiran M. Perkins
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet Glowicz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- California Department of Public Health, Sacramento, California
| | - Isaac Benowitz
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elsa Villarino
- County of Santa Clara Public Health Department, San José, California
| |
Collapse
|
3
|
Lutgring JD, Grass JE, Lonsway D, Yoo BB, Epson E, Crumpler M, Galliher K, O’Donnell K, Zahn M, Evans E, Jacob JT, Page A, Satola SW, Smith G, Kainer M, Muleta D, Wilson CD, Hayden MK, Reddy S, Elkins CA, Rasheed JK, Karlsson M, Magill SS, Guh AY. Development of a Broth Microdilution Method To Characterize Chlorhexidine MICs among Bacteria Collected from 2005 to 2019 at Three U.S. Sites. Microbiol Spectr 2023; 11:e0413422. [PMID: 37067448 PMCID: PMC10269762 DOI: 10.1128/spectrum.04134-22] [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: 10/11/2022] [Accepted: 03/29/2023] [Indexed: 04/18/2023] Open
Abstract
Chlorhexidine bathing to prevent transmission of multidrug-resistant organisms has been adopted by many U.S. hospitals, but increasing chlorhexidine use has raised concerns about possible emergence of resistance. We sought to establish a broth microdilution method for determining chlorhexidine MICs and then used the method to evaluate chlorhexidine MICs for bacteria that can cause health care-associated infections. We adapted a broth microdilution method for determining chlorhexidine MICs, poured panels, established quality control ranges, and tested Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae complex isolates collected at three U.S. sites. Chlorhexidine MICs were determined for 535 isolates including 129 S. aureus, 156 E. coli, 142 K. pneumoniae, and 108 E. cloacae complex isolates. The respective MIC distributions for each species ranged from 1 to 8 mg/L (MIC50 = 2 mg/L and MIC90 = 4 mg/L), 1 to 64 mg/L (MIC50 = 2 mg/L and MIC90 = 4 mg/L), 4 to 64 mg/L (MIC50 = 16 mg/L and MIC90 = 32 mg/L), and 1 to >64 mg/L (MIC50 = 16 mg/L and MIC90 = 64 mg/L). We successfully adapted a broth microdilution procedure that several laboratories were able to use to determine the chlorhexidine MICs of bacterial isolates. This method could be used to investigate whether chlorhexidine MICs are increasing. IMPORTANCE Chlorhexidine bathing to prevent transmission of multidrug-resistant organisms and reduce health care-associated infections has been adopted by many hospitals. There is concern about the possible unintended consequences of using this agent widely. One possible unintended consequence is decreased susceptibility to chlorhexidine, but there are not readily available methods to perform this evaluation. We developed a method for chlorhexidine MIC testing that can be used to evaluate for possible unintended consequences.
Collapse
Affiliation(s)
- Joseph D. Lutgring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julian E. Grass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David Lonsway
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brian B. Yoo
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin Epson
- California Department of Public Health, Richmond, California, USA
| | - Megan Crumpler
- Orange County Health Care Agency, Santa Ana, California, USA
| | - Karen Galliher
- Orange County Health Care Agency, Santa Ana, California, USA
| | | | - Matthew Zahn
- Orange County Health Care Agency, Santa Ana, California, USA
| | - Eric Evans
- Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
- Emory University, School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Jesse T. Jacob
- Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
- Emory University, School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Alexander Page
- Emory University, School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Sarah W. Satola
- Emory University, School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Gillian Smith
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA
- Foundation for Atlanta Veterans Education and Research, Decatur, Georgia, USA
| | - Marion Kainer
- Tennessee Department of Health, Nashville, Tennessee, USA
| | - Daniel Muleta
- Tennessee Department of Health, Nashville, Tennessee, USA
| | | | - Mary K. Hayden
- Rush University Medical Center, Division of Infectious Diseases, Chicago, Illinois, USA
| | - Sujan Reddy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christopher A. Elkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - J. Kamile Rasheed
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley S. Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alice Y. Guh
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
4
|
Engeda JC, Karmarkar EN, Mitsunaga TM, Raymond KL, Oh P, Epson E. Resident racial and ethnic composition, neighborhood-level socioeconomic status, and COVID-19 infections in California SNFs. J Am Geriatr Soc 2023; 71:157-166. [PMID: 36196970 PMCID: PMC9874461 DOI: 10.1111/jgs.18076] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/18/2022] [Accepted: 08/30/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND In California, >29,000 residents in skilled nursing facility (SNFs) were diagnosed with novel coronavirus disease 2019 (COVID-19) between March 2020 and November 2020. Prior research suggests that SNFs serving racially and ethnically minoritized residents often have fewer resources and lower quality of care. We performed a cross-sectional analysis of COVID-19 incidence among residents in California SNFs, assessing the association of SNF-level racial and ethnic compositions and facility- and neighborhood-level (census tract- and county-level) indicators of socioeconomic status (SES). METHODS SNFs were grouped based on racial and ethnic composition using data from the Centers for Medicare and Medicaid Services; categories included SNFs with ≥88% White residents, SNFs with ≥32% Black or Latinx residents, SNFs with ≥32% Asian residents, or SNFs not serving a high proportion of any racial and ethnic composition (mixed). SNF resident-level COVID-19 infection data were obtained from the National Healthcare Safety Network from May 25, 2020 to August 16, 2020. Multilevel mixed-effects negative binomial regressions were used to estimate incidence rate ratios (IRR) for confirmed COVID-19 infections among residents. RESULTS Among 971 SNFs included in our sample, 119 (12.3%) had ≥88% White residents; 215 (22.1%) had ≥32% Black or Latinx residents; 78 (8.0%) had ≥32% Asian residents; and 559 (57.6%) were racially and ethnically mixed. After adjusting for confounders, SNFs with ≥32% Black or Latinx residents (IRR = 2.40 [95% CI = 1.56, 3.68]) and SNFs with mixed racial and ethnic composition (IRR = 2.12 [95% CI = 1.49, 3.03]) both had higher COVID-19 incidence rates than SNFs with ≥88% White residents. COVID-19 incidence rates were also found to be higher in SNFs with low SES neighborhoods compared to those in high SES neighborhoods. CONCLUSION Public health personnel should consider SNF- and neighborhood-level factors when identifying facilities to prioritize for COVID-19 outbreak prevention and control.
Collapse
Affiliation(s)
- Joseph C. Engeda
- California Department of Public HealthHealthcare‐Associated Infections ProgramRichmondCaliforniaUSA,Public Health and Scientific ResearchSocial & Scientific SystemsDurhamNorth CarolinaUSA
| | - Ellora N. Karmarkar
- California Department of Public HealthHealthcare‐Associated Infections ProgramRichmondCaliforniaUSA
| | - Tisha M. Mitsunaga
- California Department of Public HealthHealthcare‐Associated Infections ProgramRichmondCaliforniaUSA
| | - Kristal L. Raymond
- California Department of Public HealthOffice of Health EquitySacramentoCaliforniaUSA
| | - Peter Oh
- California Department of Public HealthOffice of Health EquitySacramentoCaliforniaUSA
| | - Erin Epson
- California Department of Public HealthHealthcare‐Associated Infections ProgramRichmondCaliforniaUSA
| |
Collapse
|
5
|
Brenes L, Magro M, Mitsunaga T, Epson E. 2017. Comparison of California Acute Care Hospital Central Line-Associated Bloodstream Infection Incidence by Hospital Location Before and During the COVID-19 Pandemic. Open Forum Infect Dis 2022. [PMCID: PMC9752651 DOI: 10.1093/ofid/ofac492.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Central line-associated bloodstream infection (CLABSI) incidence among acute care hospitals (ACH) and in some patient care locations such as critical care (CC) units increased substantially nationwide during the COVID-19 pandemic. We compared California ACH CLABSI incidence by location before and during the pandemic to identify locations with high burden to inform targeted prevention efforts. Methods Using California ACH (n=327) CLABSI standardized infection ratio (SIR) data from the National Healthcare Safety Network, we compared incidence during the second halves of 2019 (2019H2) and 2020 (2020H2) to evaluate early pandemic changes, and during 2019 (pre-pandemic) and 2021 (pandemic) periods by hospital type, location type (e.g., CC), and patient care location (e.g., medical CC), excluding rehabilitation units. A mid-P exact test was applied to compare SIRs between study periods. Results ACH CLABSI SIR increased statewide from 2019H2 to 2020H2 by 50.8% (0.65 to 0.98) and from 2019 to 2021 by 34.3% (0.67 to 0.90). Community hospitals < 125 beds had the highest SIR and percentage increase in 2021 as well as 2020H2. Of 9 location types and 58 patient care locations, CC units and medical and medical-surgical CC had significantly higher SIR in both comparisons (2020H2 versus 2019H2 and 2021 versus 2019); wards and medical wards in 2020H2 only, and step-down units and adult step-down in 2021 only. Trauma CC SIR was significantly higher only in 2020H2 compared to 2019H2, while surgical CC SIR was significantly higher in 2021 compared to 2019. Respiratory CC had the highest SIR (2.99, 95%CI 2.14-4.08) in 2021, but was not significantly higher when compared to 2019 (1.06, 95%CI 0.21-3.41).
![]() Conclusion We observed an overall statewide increase in hospital CLABSI incidence, especially in CC locations, during the pandemic. Although the SIR increase relative to pre-pandemic was smaller in 2021 than in 2020H2, with some exceptions, most locations had persistently higher incidence. We will further assess associations between CLABSI incidence and antimicrobial resistance, device insertion dates, and hospital COVID-19 burden. We will use our findings to guide public health support for hospital infection prevention programs to reduce their CLABSI incidence. Disclosures All Authors: No reported disclosures.
Collapse
Affiliation(s)
- Lizette Brenes
- California Department of Public Health (CDPH), Richmond, California
| | - Monise Magro
- California Department of Public Health, Richmond, California
| | - Tisha Mitsunaga
- California Department of Public Health, Richmond, California
| | | |
Collapse
|
6
|
Holden D, Mitsunaga T, Ahanya S, Trausch K, Haridass V, Levit R, Velasquez K, Garcia E, Sardana N, Cabral A, Garcia EG, Schneider EC, Epson E. 1363. Moving from Public Health Outbreak Response to Mitigation for a Regional Outbreak of Highly-Resistant New Delhi Metallo-β-Lactamase-Producing Acinetobacter baumannii in California, May 2020 – April 2022. Open Forum Infect Dis 2022. [PMCID: PMC9752962 DOI: 10.1093/ofid/ofac492.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Since May 2020, the California Department of Public Health and 12 local health jurisdictions (LHJ) have responded to a regional outbreak of highly-resistant New Delhi metallo-β-lactamase-producing Acinetobacter baumannii (NDM AB). Starting in October 2021, public health shifted from outbreak response to resource-conscious long-term mitigation in affected healthcare facilities, and prevention of spread to interconnected facilities. Methods We defined a case as a patient identified with an NDM AB clinical isolate, or NDM positive colonization screening and epidemiologic linkage. In October 2021, we lengthened the screening interval and changed the screening population in outbreak skilled nursing facilities (SNF) and long-term acute care hospitals to only include high-risk patients (total dependence for activities of daily living, having wounds or indwelling devices, or ventilated); we continued to screen ventilator units in ventilator-equipped SNF, and epidemiologically-linked unit(s) in acute care hospitals. Concurrently, public health initiated a prevention collaborative focused on improving environmental services (EVS) practices in the most affected LHJ, including 3 outbreak and 4 non-outbreak SNF to promote sustainable EVS practice improvement and peer-to-peer learning.
![]() Results Whereas we identified 170 cases during the outbreak response period May 2020 – September 2021, since October 2021 we identified only 43 cases. Screening test percent positivity decreased from 3.0% (105/3542) through September 2021 to 1.4% (21/1505) since October 2021. During the outbreak response period, we completed 42 infection prevention and control (IPC) onsite assessments that identified poor adherence to core EVS practices; since October 2021, we completed 29 assessments, including 14 for the EVS prevention collaborative.
![]() ![]() Conclusion Long-term mitigation of regional, multifacility novel multidrug-resistant organism outbreaks is possible by implementing a coordinated package of interventions including proactive targeted IPC assessment and support at interconnected facilities, and continued routine public health follow-up at outbreak facilities. Disclosures All Authors: No reported disclosures.
Collapse
Affiliation(s)
- Diana Holden
- California Department of Public Health, Richmond, California
| | - Tisha Mitsunaga
- California Department of Public Health, Richmond, California
| | - Shantala Ahanya
- California Department of Public Health, Richmond, California
| | - Kristy Trausch
- California Department of Public Health, Richmond, California
| | - Vikram Haridass
- California Department of Public Health, Richmond, California
| | - Rachel Levit
- California Department of Public Health, Richmond, California
| | - Kiara Velasquez
- California Department of Public Health, Richmond, California
| | - Erin Garcia
- California Department of Public Health, Richmond, California
| | - Neha Sardana
- California Department of Public Health, Richmond, California
| | - Ashya Cabral
- California Department of Public Health, Richmond, California
| | | | | | | |
Collapse
|
7
|
Heinzerling A, Nguyen A, Frederick M, Chan E, Gibb K, Rodriguez A, Wong J, Epson E, Watt J, Materna B, Jain S. Workplaces Most Affected by COVID-19 Outbreaks in California, January 2020-August 2021. Am J Public Health 2022; 112:1180-1190. [PMID: 35830667 PMCID: PMC9342810 DOI: 10.2105/ajph.2022.306862] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 12/12/2022]
Abstract
Objectives. To describe which industries have the highest burden of COVID-19 outbreaks in California. Methods. We assigned US census industry codes to COVID-19 outbreaks reported to the California Department of Public Health (CDPH) from January 1, 2020, to August 31, 2021, and determined numbers of outbreaks, numbers of outbreak-associated cases, and outbreak incidence levels by industry. We determined characteristics of outbreak-associated cases using individual case data linked to COVID-19 outbreaks. Results. Local health departments reported 19 893 COVID-19 outbreaks and 300 379 outbreak-associated cases to CDPH. The most outbreaks (47.8%) and outbreak-associated cases (54.8%) occurred in the health care and social assistance sector, where outbreak incidence levels were highest in skilled nursing facilities and residential care facilities (1306 and 544 outbreaks per 1000 establishments, respectively). High proportions of outbreaks also occurred in the retail trade (8.6%) and manufacturing (7.9%) sectors. Demographics of outbreak-associated cases varied across industries. Conclusions. Certain California industries, particularly in the health care, manufacturing, and retail sectors, have experienced a high burden of COVID-19 outbreaks during the pandemic. Public Health Implications. Tracking COVID-19 outbreaks by industry may help target prevention efforts, including workforce vaccination. (Am J Public Health. 2022;112(8):1180-1190. https://doi.org/10.2105/AJPH.2022.306862).
Collapse
Affiliation(s)
- Amy Heinzerling
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Alyssa Nguyen
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Matt Frederick
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Elena Chan
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Kathryn Gibb
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Andrea Rodriguez
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Jessie Wong
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Erin Epson
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - James Watt
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Barbara Materna
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| | - Seema Jain
- The authors are with the California Department of Public Health, Richmond. Matt Frederick, Elena Chan, Kathryn Gibb, Andrea Rodriguez, and Jessie Wong are also with the Public Health Institute, Oakland, CA
| |
Collapse
|
8
|
Magro M, Parriott A, Mitsunaga T, Epson E. Estimating COVID-19 Vaccine Effectiveness for Skilled Nursing Facility Healthcare Personnel, California, USA. Emerg Infect Dis 2022; 28:1734-1736. [PMID: 35732196 PMCID: PMC9328913 DOI: 10.3201/eid2808.220650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We estimated real-world vaccine effectiveness among skilled nursing facility healthcare personnel who were regularly tested for SARS-CoV-2 infection in California, USA, during January‒March 2021. Vaccine effectiveness for fully vaccinated healthcare personnel was 73.3% (95% CI 57.5%-83.3%). We observed high real-world vaccine effectiveness in this population.
Collapse
|
9
|
Mitsunaga T, Holden D, Karmarkar E, Kennedy I, Nelson T, Haridass V, Dratch A, O’Donnell K, Bhaurla S, OYong K, Clarke A, Takiguchi E, Baldwin L, Nguyen J, Bhurtyal K, Gomez A, Clark KA, Batres JR, Romo S, Kang G, Rauhauser M, Schneider EC, Chinn RY, Cole B, Sequeira M, Gustafson E, Holman E, Rubin Z, Zahn M, Epson E. 169. The Resurgence of Candida auris in California during the Novel Coronavirus (COVID-19) Pandemic, May 2020–May 2021. Open Forum Infect Dis 2021. [PMCID: PMC8644425 DOI: 10.1093/ofid/ofab466.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In February 2019, California (CA) experienced its first C. auris outbreak in Orange County (OC). The CA Department of Public Health (CDPH) and OC with the Centers for Disease Control and Prevention (CDC), mounted a successful containment response; by November 2019, cases were limited to low-level spread in OC long-term acute care hospitals (LTACH). In May 2020, C. auris cases began to surge in OC, followed by extensive spread in six other southern CA local health jurisdictions (LHJ). CDPH with LHJ and CDC, initiated an aggressive, interjurisdictional containment response. Methods We carried out response and preventive point prevalence surveys (PPS), onsite infection prevention and control (IPC) assessments, and in-service trainings at outbreak and interconnected hospitals and skilled nursing facilities in six LHJ. Other regional activities included: epidemiologic investigation, contact and discharge tracking and screening; increasing laboratory testing capacity; screening patients admitted to and from LTACH; statewide healthcare facility (HCF) education and outreach; sending regional outbreak HCF lists to all HCF; and biweekly state-LHJ coordination calls. The Antibiotic Resistance (AR) Lab Network supported testing. Results From May 2020—May 2021, we conducted screening at 226 HCF, and identified 1192 cases at 93 HCF, mostly through screening (n=1109, 93%) and at LTACH (n=906, 76%); we identified 113 (10%) cases at ACH, including 35 (31%) in COVID-19-burdened units. Cases peaked in August 2020 (n=93) and February 2021 (n=191) and have since declined, with C. auris resurgence mirroring COVID-19 incidence. We conducted 98 onsite IPC assessments, and identified multiple, improper IPC practices which had been implemented in response to COVID-19, including double-gloving and -gowning, extended use of gowns and gloves outside patient rooms, and cohorting according to COVID-19 status only. Figure 1. C. auris and COVID-19 Cases in California through May 2021, and C. auris Cases by Local Health Jurisdiction (LHJ) May 2020–May 2021 ![]()
Table 1. By Facility Type: Colonization Testing May 2020–May 2021, and Total Case Counts before and from May 2020 ![]()
Table 2. COVID-19-related Infection Control Practices Affecting C. auris Spread, and Associated Public Health Recommendations ![]()
Conclusion The C. auris resurgence in CA was likely a result of COVID-19-related practices and conditions. An aggressive, coordinated, interjurisdictional C. auris containment response, including proactive prevention activities at HCF interconnected with outbreak HCF, can help mitigate spread of C. auris and potentially other novel AR pathogens. Disclosures All Authors: No reported disclosures
Collapse
Affiliation(s)
| | - Diana Holden
- California Department of Public Health, Richmond, CA
| | | | | | - Teresa Nelson
- California Department of Public Health, Richmond, CA
| | | | - Alissa Dratch
- Orange County Health Care Agency, Santa Ana, California
| | | | - Sandeep Bhaurla
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Kelsey OYong
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Anthony Clarke
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Eric Takiguchi
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Leslie Baldwin
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Jennifer Nguyen
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Kiran Bhurtyal
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Alma Gomez
- Riverside University Health System – Public Health, Riverside, California
| | - Kelli A Clark
- San Bernardino County Department of Public Health, San Bernardino, California
| | - Jessica R Batres
- San Bernardino County Department of Public Health, San Bernardino, California
| | - Scarlett Romo
- San Bernardino County Department of Public Health, San Bernardino, California
| | - Grace Kang
- County of San Diego, Epidemiology & Immunization Services Branch, San Diego, California
| | - Mara Rauhauser
- San Diego County Health & Human Services Agency, San Diego, California
| | | | - Raymond Y Chinn
- County of San Diego, Health and Human Services Agency, San Diego, California
| | - Barbara Cole
- Riverside University Health System – Public Health, Riverside, California
| | - Michael Sequeira
- San Bernardino County Department of Public Health, San Bernardino, California
| | - Erin Gustafson
- San Bernardino County Department of Public Health, San Bernardino, California
| | - Emily Holman
- Long Beach Department of Health and Human Services, Long Beach, California
| | - Zachary Rubin
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Matthew Zahn
- Orange County Department of Health, Irvine, California
| | - Erin Epson
- California Department of Public Health, Richmond, CA
| |
Collapse
|
10
|
Holden D, Sylvester M, Crandall J, Xu F, Schneider EC, Watson HB, Zhang P, Bacud J, Mejia R, Epson E, Berrada Z, Mitsunaga T, Mukhopadhyay R. 179. Identification and Whole Genome Sequencing Analysis of an Oxacillinase (OXA)-48-like-producing Acinetobacter baumannii Outbreak in California, January-May 2021. Open Forum Infect Dis 2021. [PMCID: PMC8644873 DOI: 10.1093/ofid/ofab466.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background In January 2021, a California acute care hospital (ACH A), a sentinel site for Acinetobacter baumannii (AB) surveillance, identified OXA-48-like-carbapenemase producing (CP) AB in a patient admitted from a ventilator-equipped skilled nursing facility (vSNF A); OXA-48-like AB had not been previously reported in the United States. Methods Our investigation included onsite infection control (IC) assessments, contact tracing, and point prevalence surveys (PPS) at vSNF A. The Antibiotic Resistance (AR) Laboratory Network performed carbapenemase testing on AB isolates (including those from ACH A) and PPS swabs. A case was defined as a patient with an OXA-48-like AB isolate, or an epidemiologically-linked patient with an OXA-48-like gene detected via screening. We performed whole genome sequencing (WGS) of OXA-48-like AB and other CP organisms on the Illumina MiSeq and Oxford Nanopore MinION for short and long read sequencing, respectively. Results Since January 2021, we have identified five OXA-48-like AB cases (including the index), six OXA-48-like cases (no organism recovered), and six patients with other CP organisms at ACH A and vSNF A. Since August 2019, vSNF A has concurrently been experiencing an OXA-109 AB outbreak. A second vSNF A patient, Patient 2, who overlapped with the index patient, had OXA-48-like Klebsiella pneumoniae (KP) (November 2019) and OXA-109 AB (May 2020) isolates. WGS of the index patient’s AB and Patient 2’s KP isolates identified a rare OXA-48-like gene located on the AB chromosome and a KP plasmid. The OXA-48-like AB was also carrying an OXA-109 gene, and hqSNP analysis indicated it varied by 9-44 single-nucleotide polymorphisms (SNPs) from 14 OXA-109 AB isolates linked to that outbreak, and 0-3 SNPs from the other OXA-48-like AB case isolates. Figure 1. Phylogenetic Tree Comparison of OXA-109 AB and OXA-48-like AB Isolates ![]()
Figure 2. Epidemic Curve of OXA-109 AB, OXA-48-like AB, and Other CP Organism Cases, 2019-2021 ![]()
Conclusion The first reported case of OXA-48-like AB in the US was identified through public health sentinel laboratory surveillance, allowing prompt response to contain spread of a novel multidrug-resistant organism (MDRO). WGS detected a rare OXA-48-like gene in AB and KP and provides evidence for possible interspecies transfer of this gene from KP to AB through plasmid transfer followed by chromosomal integration. Disclosures All Authors: No reported disclosures
Collapse
Affiliation(s)
- Diana Holden
- California Department of Public Health, Richmond, CA
| | | | - John Crandall
- California Department of Public Health, Richmond, CA
| | - Fengfeng Xu
- California Department of Public Health, Richmond, CA
| | | | | | - Peng Zhang
- California Department of Public Health, Richmond, CA
| | - Jaclyn Bacud
- California Department of Public Health, Richmond, CA
| | - Rafael Mejia
- California Department of Public Health, Richmond, CA
| | - Erin Epson
- California Department of Public Health, Richmond, CA
| | - Zenda Berrada
- California Department of Public Health, Richmond, CA
| | | | | |
Collapse
|
11
|
Kim JJ, Turner NE, Holman E, Lefrak L, Youssef FA, Richardson P, Mukhopadhyay R, Crandall J, Su H, Epson E. 802. Corynebacterium striatum Outbreak Among Ventilated COVID-19 Patients in an Acute Care Hospital – California, 2021. Open Forum Infect Dis 2021. [PMCID: PMC8644052 DOI: 10.1093/ofid/ofab466.998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices.
Methods
A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq.
Results
Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated; 58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill; often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units; extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2).
Figure 1. Corynebacterium striatum Respiratory Cultures January 2020-February 2021
Figure 2. Phylogenetic Tree Corynebacterium striatum Isolates
Conclusion
A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients.
Disclosures
All Authors: No reported disclosures
Collapse
Affiliation(s)
- Janice J Kim
- California Department of Public Health, Richmond, California
| | - Nancy E Turner
- Memorialcare Long Beach Medical Center, Simi Valley, California
| | - Emily Holman
- Long Beach Department of Health and Human Services, Long Beach, California
| | - Linda Lefrak
- California Department of Public Health, Richmond, California
| | - Fady A Youssef
- Long Beach Memorial Medical Center, Long Beach, California
| | | | | | - John Crandall
- California Department of Public Health, Richmond, California
| | - Henry Su
- MemorialCare Long Beach Medical Center, Long Beach, California
| | - Erin Epson
- California Department of Public Health, Richmond, California
| |
Collapse
|
12
|
Karmarkar EN, O'Donnell K, Prestel C, Forsberg K, Gade L, Jain S, Schan D, Chow N, McDermott D, Rossow J, Toda M, Ruiz R, Hun S, Dale JL, Gross A, Maruca T, Glowicz J, Brooks R, Bagheri H, Nelson T, Gualandi N, Khwaja Z, Horwich-Scholefield S, Jacobs J, Cheung M, Walters M, Jacobs-Slifka K, Stone ND, Mikhail L, Chaturvedi S, Klein L, Vagnone PS, Schneider E, Berkow EL, Jackson BR, Vallabhaneni S, Zahn M, Epson E. Rapid Assessment and Containment of Candida auris Transmission in Postacute Care Settings-Orange County, California, 2019. Ann Intern Med 2021; 174:1554-1562. [PMID: 34487450 PMCID: PMC10984253 DOI: 10.7326/m21-2013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Candida auris, a multidrug-resistant yeast, can spread rapidly in ventilator-capable skilled-nursing facilities (vSNFs) and long-term acute care hospitals (LTACHs). In 2018, a laboratory serving LTACHs in southern California began identifying species of Candida that were detected in urine specimens to enhance surveillance of C auris, and C auris was identified in February 2019 in a patient in an Orange County (OC), California, LTACH. Further investigation identified C auris at 3 associated facilities. OBJECTIVE To assess the prevalence of C auris and infection prevention and control (IPC) practices in LTACHs and vSNFs in OC. DESIGN Point prevalence surveys (PPSs), postdischarge testing for C auris detection, and assessments of IPC were done from March to October 2019. SETTING All LTACHs (n = 3) and vSNFs (n = 14) serving adult patients in OC. PARTICIPANTS Current or recent patients in LTACHs and vSNFs in OC. INTERVENTION In facilities where C auris was detected, PPSs were repeated every 2 weeks. Ongoing IPC support was provided. MEASUREMENTS Antifungal susceptibility testing and whole-genome sequencing to assess isolate relatedness. RESULTS Initial PPSs at 17 facilities identified 44 additional patients with C auris in 3 (100%) LTACHs and 6 (43%) vSNFs, with the first bloodstream infection reported in May 2019. By October 2019, a total of 182 patients with C auris were identified by serial PPSs and discharge testing. Of 81 isolates that were sequenced, all were clade III and highly related. Assessments of IPC identified gaps in hand hygiene, transmission-based precautions, and environmental cleaning. The outbreak was contained to 2 facilities by October 2019. LIMITATION Acute care hospitals were not assessed, and IPC improvements over time could not be rigorously evaluated. CONCLUSION Enhanced laboratory surveillance and prompt investigation with IPC support enabled swift identification and containment of C auris. PRIMARY FUNDING SOURCE Centers for Disease Control and Prevention.
Collapse
Affiliation(s)
- Ellora N Karmarkar
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia, and the California Department of Public Health, Richmond, California (E.N.K.)
| | - Kathleen O'Donnell
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Christopher Prestel
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Kaitlin Forsberg
- Centers for Disease Control and Prevention and IHRC, Atlanta, Georgia (K.F.)
| | - Lalitha Gade
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Seema Jain
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Douglas Schan
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Nancy Chow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Darby McDermott
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - John Rossow
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Mitsuru Toda
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia (C.P., J.R., M.T.)
| | - Ryan Ruiz
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Sopheay Hun
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Jennifer L Dale
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Annastasia Gross
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Tyler Maruca
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Richard Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia, and the Maryland Department of Health, Infectious Disease Epidemiology and Outbreak Response Bureau, Baltimore, Maryland (R.B.)
| | - Hosniyeh Bagheri
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Teresa Nelson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Nicole Gualandi
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Zenith Khwaja
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Sam Horwich-Scholefield
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| | - Josh Jacobs
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Michele Cheung
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Maroya Walters
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Kara Jacobs-Slifka
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Nimalie D Stone
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Lydia Mikhail
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | | | - Liore Klein
- Maryland Department of Health Laboratories Administration, Baltimore, Maryland (T.M., L.K.)
| | - Paula Snippes Vagnone
- Minnesota Department of Health Public Health Laboratory, St. Paul, Minnesota (J.L.D., A.G., P.S.V.)
| | - Emily Schneider
- Washington State Public Health Laboratories, Shoreline, Washington (R.R., S.H., E.S.)
| | - Elizabeth L Berkow
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Brendan R Jackson
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Snigdha Vallabhaneni
- Centers for Disease Control and Prevention, Atlanta, Georgia (L.G., N.C., D.M., J.G., N.G., M.W., K.J., N.D.S., E.L.B., B.R.J., S.V.)
| | - Matthew Zahn
- Orange County Health Care Agency, Santa Ana, California (K.O., D.S., J.J., M.C., L.M., M.Z.)
| | - Erin Epson
- California Department of Public Health, Richmond, California (S.J., H.B., T.N., Z.K., S.H., E.E.)
| |
Collapse
|
13
|
Hartnett KP, Powell KM, Rankin D, Gable P, Kim JJ, Spoto S, Breaker E, Hunter R, Dotson N, McAllister G, Stevens V, Halpin AL, Houston H, Epson E, Malarkey M, Mendoza M, McNeill L, Perkins KM. Investigation of Bacterial Infections Among Patients Treated With Umbilical Cord Blood-Derived Products Marketed as Stem Cell Therapies. JAMA Netw Open 2021; 4:e2128615. [PMID: 34618037 PMCID: PMC8498849 DOI: 10.1001/jamanetworkopen.2021.28615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE The number of clinics marketing stem cell products for joint diseases, chronic pain, and most recently, COVID-19, has increased despite warnings from the US Food and Drug Administration that stem cell products for these and other indications have not been proven safe or effective. OBJECTIVE To examine bacterial infections in 20 patients who received umbilical cord blood-derived products marketed as stem cell treatment. DESIGN, SETTING, AND PARTICIPANTS This case series is a national public health investigation including case-finding, medical record review and abstraction, and laboratory investigation, including sterility testing of products and whole-genome sequencing of patient and product isolates. Participants included patients who developed bacterial infections following administration of umbilical cord blood-derived products marketed as stem cell treatment during August 2017 to September 2018. Data analysis was performed from March 2019 to September 2021. EXPOSURES Umbilical cord blood-derived products marketed as stem cell treatment. MAIN OUTCOMES AND MEASURES Data were collected on patient infections and exposures. The Centers for Disease Control and Prevention performed sterility testing on undistributed and distributed vials of product marketed as stem cell treatment and performed whole-genome sequencing to compare patient and product bacterial isolates. RESULTS Culture-confirmed bacterial infections were identified in 20 patients (median [range] age, 63 [2-89] years; 13 male patients [65%]) from 8 US states who sought stem cell treatment for conditions including pain, osteoarthritis, rheumatoid arthritis, and injury; all but 1 required hospitalization. The most frequently isolated bacteria from patients with infections were common enteric species, including Escherichia coli (14 patients) and Enterobacter cloacae (7 patients). Of unopened, undistributed products sampled for testing, 65% (22 of 34 vials) were contaminated with at least 1 of 16 bacterial species, mostly enteric. A patient isolate from Arizona matched isolates obtained from products administered to patients in Florida, and patient isolates from Texas matched undistributed product sent from the company in California. CONCLUSIONS AND RELEVANCE Unapproved stem cell products can expose patients to serious risks without proven benefit. Sequencing results suggest a common source of extensive contamination, likely occurring during the processing of cord blood into product. Patients and health care practitioners who are considering the use of unapproved products marketed as stem cell treatment should be aware of their unproven benefits and potential risks, including serious infections.
Collapse
Affiliation(s)
- Kathleen P. Hartnett
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krista M. Powell
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Erin Breaker
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie Stevens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hollis Houston
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- California Department of Public Health, Sacramento
| | - Mary Malarkey
- US Food and Drug Administration, Silver Spring, Maryland
| | | | - Lorrie McNeill
- US Food and Drug Administration, Silver Spring, Maryland
| | - Kiran M. Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
14
|
Tsay SV, Mu Y, Williams S, Epson E, Nadle J, Bamberg WM, Barter DM, Johnston HL, Farley MM, Harb S, Thomas S, Bonner LA, Harrison LH, Hollick R, Marceaux K, Mody RK, Pattee B, Shrum Davis S, Phipps EC, Tesini BL, Gellert AB, Zhang AY, Schaffner W, Hillis S, Ndi D, Graber CR, Jackson BR, Chiller T, Magill S, Vallabhaneni S. Burden of Candidemia in the United States, 2017. Clin Infect Dis 2021; 71:e449-e453. [PMID: 32107534 DOI: 10.1093/cid/ciaa193] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 11/26/2019] [Accepted: 02/24/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Candidemia is a common healthcare-associated bloodstream infection with high morbidity and mortality. There are no current estimates of candidemia burden in the United States (US). METHODS In 2017, the Centers for Disease Control and Prevention conducted active population-based surveillance for candidemia through the Emerging Infections Program in 45 counties in 9 states encompassing approximately 17 million persons (5% of the national population). Laboratories serving the catchment area population reported all blood cultures with Candida, and a standard case definition was applied to identify cases that occurred in surveillance area residents. Burden of cases and mortality were estimated by extrapolating surveillance area cases to national numbers using 2017 national census data. RESULTS We identified 1226 candidemia cases across 9 surveillance sites in 2017. Based on this, we estimated that 22 660 (95% confidence interval [CI], 20 210-25 110) cases of candidemia occurred in the US in 2017. Overall estimated incidence was 7.0 cases per 100 000 persons, with highest rates in adults aged ≥ 65 years (20.1/100 000), males (7.9/100 000), and those of black race (12.3/100 000). An estimated 3380 (95% CI, 1318-5442) deaths occurred within 7 days of a positive Candida blood culture, and 5628 (95% CI, 2465-8791) deaths occurred during the hospitalization with candidemia. CONCLUSIONS Our analysis highlights the substantial burden of candidemia in the US. Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida is higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions.
Collapse
Affiliation(s)
- Sharon V Tsay
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sabrina Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erin Epson
- California Emerging Infections Program, Oakland, California, USA
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California, USA
| | - Wendy M Bamberg
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Devra M Barter
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Helen L Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Monica M Farley
- Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Sasha Harb
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Stepy Thomas
- Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | | | - Lee H Harrison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rosemary Hollick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kaytlynn Marceaux
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rajal K Mody
- Minnesota Department of Health, St Paul, Minnesota, USA
| | | | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, Albuquerque, New Mexico, USA
- University of New Mexico, Albuquerque, New Mexico, USA
| | - Brenda L Tesini
- University of Rochester, Rochester, New York, USA
- New York Emerging Infections Program, Rochester, New York, USA
| | - Anita B Gellert
- New York Emerging Infections Program, Rochester, New York, USA
| | | | | | - Sherry Hillis
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Danielle Ndi
- Tennessee Emerging Infections Program, Nashville, Tennessee, USA
| | | | - Brendan R Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tom Chiller
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
15
|
Karmarkar E, Jain S, Higa J, Fontenot J, Bertolucci R, Huynh T, Hammer G, Brodkin A, Thao M, Brousseau B, Hopkins D, Kelly E, Sheffield M, Henley S, Whittaker H, Herrick RL, Pan CY, Chen A, Kim J, Schaumleffel L, Khwaja Z, Epson E, Chai SJ, Wadford D, Vugia D, Lewis L. Outbreak of Norovirus Illness Among Wildfire Evacuation Shelter Populations - Butte and Glenn Counties, California, November 2018. MMWR Morb Mortal Wkly Rep 2020; 69:613-617. [PMID: 32437337 PMCID: PMC7357343 DOI: 10.15585/mmwr.mm6920a1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Camp Fire, California's deadliest wildfire, began November 8, 2018, and was extinguished November 25 (1). Approximately 1,100 evacuees from the fire sought emergency shelter. On November 10, acute gastroenteritis (AGE) was reported in two evacuation shelters; norovirus illness was suspected, because it is commonly detected in shelter-associated AGE outbreaks. Norovirus is highly contagious and resistant to several disinfectants. Butte County Public Health Department (BCPHD), assisted by the California Department of Public Health (CDPH), initiated active surveillance to identify cases, confirm the etiology, and assess shelter infection prevention and control (IPC) practices to guide recommendations. During November 8-30, a total of 292 patients with AGE were identified among nine evacuation shelters; norovirus was detected in 16 of 17 unique patient stool specimens. Shelter IPC assessments revealed gaps in illness surveillance, isolation practices, cleaning, disinfection, and handwashing. CDPH and BCPHD collaborated with partner agencies to implement AGE screening, institute isolation protocols and 24-hour cleaning services, and promote proper hand hygiene. During disasters with limited resources, damaged infrastructure, and involvement of multiple organizations, establishing shelter disease surveillance and IPC is difficult. However, prioritizing effective surveillance and IPC at shelter activation is necessary to prevent, identify, and contain outbreaks.
Collapse
|
16
|
Heinzerling A, Stuckey MJ, Scheuer T, Xu K, Perkins KM, Resseger H, Magill S, Verani JR, Jain S, Acosta M, Epson E. Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient - Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep 2020; 69:472-476. [PMID: 32298249 PMCID: PMC7755059 DOI: 10.15585/mmwr.mm6915e5] [Citation(s) in RCA: 315] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|
17
|
Rizzo K, Horwich-Scholefield S, Epson E. Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA 1. Emerg Infect Dis 2019; 25:1389-1393. [PMID: 31211678 PMCID: PMC6590759 DOI: 10.3201/eid2507.181938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We analyzed antimicrobial susceptibility test results reported in healthcare-associated infections by California hospitals during 2014-2017. Approximately 3.2% of Enterobacteriaceae reported in healthcare-associated infections were resistant to carbapenems and 26.9% were resistant to cephalosporins. The proportion of cephalosporin-resistant Escherichia coli increased 7% (risk ratio 1.07, 95% CI 1.04-1.11) per year during 2014-2017.
Collapse
|
18
|
Thompson ND, Penna A, Eure TR, Bamberg WM, Barney G, Barter D, Clogher P, DeSilva MB, Dumyati G, Epson E, Frank L, Godine D, Irizarry L, Kainer MA, Li L, Lynfield R, Mahoehney JP, Nadle J, Ocampo V, Perry L, Ray SM, Davis SS, Sievers M, Wilson LE, Zhang AY, Stone ND, Magill SS. Epidemiology of Antibiotic Use for Urinary Tract Infection in Nursing Home Residents. J Am Med Dir Assoc 2019; 21:91-96. [PMID: 31822391 DOI: 10.1016/j.jamda.2019.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/09/2019] [Revised: 11/01/2019] [Accepted: 11/12/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Describe antibiotic use for urinary tract infection (UTI) among a large cohort of US nursing home residents. DESIGN Analysis of data from a multistate, 1-day point prevalence survey of antimicrobial use performed between April and October 2017. SETTING AND PARTICIPANTS Residents of 161 nursing homes in 10 US states of the Emerging Infections Program (EIP). METHODS EIP staff reviewed nursing home medical records to collect data on systemic antimicrobial drugs received by residents, including therapeutic site, rationale for use, and planned duration. For drugs with the therapeutic site documented as urinary tract, pooled mean and nursing home-specific prevalence rates were calculated per 100 nursing home residents, and proportion of drugs by selected characteristics were reported. Data were analyzed in SAS, version 9.4. RESULTS Among 15,276 residents, 407 received 424 antibiotics for UTI. The pooled mean prevalence rate of antibiotic use for UTI was 2.66 per 100 residents; nursing home-specific rates ranged from 0 to 13.6. One-quarter of antibiotics were prescribed for UTI prophylaxis, with a median planned duration of 111 days compared with 7 days when prescribed for UTI treatment (P < .001). Fluoroquinolones were the most common (18%) drug class used. CONCLUSIONS AND IMPLICATIONS One in 38 residents was receiving an antibiotic for UTI on a given day, and nursing home-specific prevalence rates varied by more than 10-fold. UTI prophylaxis was common with a long planned duration, despite limited evidence to support this practice among older persons in nursing homes. The planned duration was ≥7 days for half of antibiotics prescribed for treatment of a UTI. Fluoroquinolones were the most commonly used antibiotics, despite their association with significant adverse events, particularly in a frail and older adult population. These findings help to identify priority practices for nursing home antibiotic stewardship.
Collapse
Affiliation(s)
- Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Austin Penna
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Taniece R Eure
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Wendy M Bamberg
- Colorado Department of Public Health and Environment, Denver, CO
| | - Grant Barney
- New York Emerging Infections Program, Rochester, NY
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, CO
| | - Paula Clogher
- Connecticut Emerging Infections Program and the Yale School of Public Health, New Haven, CT
| | | | - Ghinwa Dumyati
- New York Emerging Infections Program, Rochester, NY; University of Rochester, Rochester, NY
| | - Erin Epson
- California Department of Health, Richmond, CA
| | - Linda Frank
- California Emerging Infections Program, Oakland, CA
| | | | | | | | - Linda Li
- Maryland Department of Health, Baltimore, MD
| | | | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, CA
| | | | - Lewis Perry
- Georgia Emerging Infections Program, Atlanta, GA
| | - Susan M Ray
- Georgia Emerging Infections Program, Atlanta, GA; Emory University, Atlanta, GA
| | | | | | | | | | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
19
|
Humphries RM, Hindler JA, Epson E, Horwich-Scholefield S, Miller LG, Mendez J, Martinez JB, Sinkowitz J, Sinkowtiz D, Hershey C, Marquez P, Bhaurla S, Moran M, Pandes L, Terashita D, McKinnell JA. Carbapenem-Resistant Enterobacteriaceae Detection Practices in California: What Are We Missing? Clin Infect Dis 2019; 66:1061-1067. [PMID: 29099915 DOI: 10.1093/cid/cix942] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/26/2017] [Indexed: 12/24/2022] Open
Abstract
Background The Clinical and Laboratory Standards Institute (CLSI) revised the carbapenem breakpoints for Enterobacteriaceae in 2010. The number of hospitals that adopted revised breakpoints and the clinical impact of delayed adoption has not been explored. Methods We performed a cross-sectional, voluntary survey of microbiology laboratories from California acute care hospitals and long-term acute care hospitals (LTAC) to determine use of revised CLSI breakpoints. Carbapenem-resistant Enterobacteriaceae (CRE) clinical isolates from a single tertiary-care hospital from 2013 to 2017 were examined. All isolates with an elevated minimum inhibitory concentration (MIC; ≥2 µg/mL) to imipenem or meropenem were tested for the presence of carbapenemase genes by polymerase chain reaction (PCR). Results We received responses from 128 laboratories that serve 264/393 (67%) of hospitals and LTACs. Current CLSI carbapenem breakpoints for Enterobacteriaceae were used by 92/128 (72%) laboratories. Among laboratories that used current breakpoints, time to implementation varied from 0 to 68 months (mean, 41 months; median, 55 months). Application of historical breakpoints to isolates with a carbapenemase gene detected by PCR resulted in susceptibility rates of 8.9%, 18.6%, and 18.6% to ertapenem, imipenem, and meropenem, respectively. By current breakpoints, <1% of these isolates were susceptible to ertapenem or imipenem and 2.6% to meropenem. Conclusion Clinicians and epidemiologists should be aware that use of outdated MIC breakpoints for Enterobacteriaceae remains common and can result in reports of false susceptibility to carbapenems and missed identification of carbapenemase producers. This misclassification could have consequences for patient care and infection control efforts to address carbapenemase-producing Enterobacteriaceae.
Collapse
Affiliation(s)
- Romney M Humphries
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California-Los Angeles, California
| | - Janet A Hindler
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at the University of California-Los Angeles, California
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, California
| | - Sam Horwich-Scholefield
- Healthcare-Associated Infections Program, California Department of Public Health, California
| | - Loren G Miller
- LA BioMed at Harbor-University of California-Los Angeles Medical Center, California.,David Geffen School of Medicine at the University of California-Los Angeles, California
| | - Job Mendez
- LA BioMed at Harbor-University of California-Los Angeles Medical Center, California
| | - Jeremias B Martinez
- LA BioMed at Harbor-University of California-Los Angeles Medical Center, California
| | - Jacob Sinkowitz
- LA BioMed at Harbor-University of California-Los Angeles Medical Center, California
| | - Darren Sinkowtiz
- David Geffen School of Medicine at the University of California-Los Angeles, California
| | - Christina Hershey
- David Geffen School of Medicine at the University of California-Los Angeles, California
| | - Patricia Marquez
- Acute Communicable Disease Control Program, Healthcare Outreach Unit, Los Angeles County Department of Public Health, California
| | - Sandeep Bhaurla
- Acute Communicable Disease Control Program, Healthcare Outreach Unit, Los Angeles County Department of Public Health, California
| | - Marcelo Moran
- Acute Communicable Disease Control Program, Healthcare Outreach Unit, Los Angeles County Department of Public Health, California
| | - Lindsey Pandes
- Acute Communicable Disease Control Program, Healthcare Outreach Unit, Los Angeles County Department of Public Health, California
| | - Dawn Terashita
- Acute Communicable Disease Control Program, Healthcare Outreach Unit, Los Angeles County Department of Public Health, California
| | - James A McKinnell
- LA BioMed at Harbor-University of California-Los Angeles Medical Center, California.,David Geffen School of Medicine at the University of California-Los Angeles, California.,Acute Communicable Disease Control Program, Healthcare Outreach Unit, Los Angeles County Department of Public Health, California
| |
Collapse
|
20
|
See I, Ansari U, Reses H, Grass JE, Epson E, Nadle J, Bamberg WM, Janelle SJ, Bower CW, Jacob JT, Vaeth E, Wilson LE, Lynfield R, VonBank B, Snippes Vagnone P, Hancock EB, Phipps EC, Dumyati G, Tsay R, Cassidy M, Kainer MA, Mounsey J, Muleta D, Bulens SN, Karlsson M, Duffy N, Lutgring J. 507. Epidemiology of Community-Associated Carbapenemase + Producing Carbapenem-Resistant Enterobacteriacae Identified from the Emerging Infections Program, 2012–2017. Open Forum Infect Dis 2019. [PMCID: PMC6811287 DOI: 10.1093/ofid/ofz360.576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Carbapenemase-producing (CP-) carbapenem-resistant Enterobacteriaceae (CRE) have been almost exclusively linked to extensive healthcare exposure and are of significant concern due to limited treatment options and potential for plasmid-mediated spread of resistance. We report on CP-CRE in community-dwelling individuals. Methods We used 2012–2017 active, laboratory and population-based surveillance data for CRE from CDC’s Emerging Infections Program sites (9 sites by 2017). Cases were the first isolation of Escherichia coli, Klebsiella spp., or Enterobacter spp. from a normally sterile body specimen or urine in a surveillance site resident meeting a CRE phenotype (figure) in a 30 day period. Epidemiologic data were obtained from chart review. Cases were community-associated (CA) if not isolated after the first three days of a hospital stay; without inpatient healthcare, dialysis, or surgery in the year prior; and without indwelling medical devices within two days prior to culture. A convenience sample of isolates was tested at CDC by real-time PCR to detect blaKPC, blaNDM, blaOXA-48-like, blaVIM, or blaIMP. Results Of 4023 CRE cases, 699 (17%) were CA, from which 297 isolates were tested; 20 (7%) were CP-CRE, from 18 patients (2 had repeat isolation of the same gene/species). The median age was 68 years (range: 33–91), and 14 (78%) were female. Patients were from 7 sites (range: 1–4/site). Their CP-CRE (10 blaKPC, 6 blaNDM, and 2 blaOXA-48-like) were from three species (10 K. pneumoniae, 6 E. coli, 2 E. cloacae) and isolated from urine (n = 16) and blood (n = 2). Among those with CP-CRE from urine, 12 (75%) had clinical diagnoses of urinary tract infections and the rest had no infection documented. Overall, 7 (39%) were admitted to a hospital within 30 days of culture; none died during hospitalization. Most (n = 13; 72%) had underlying medical comorbidities, most commonly urinary tract abnormalities (n = 5; 28%) and diabetes mellitus (n = 5; 28%). Three (17%) had international travel within two months prior to culture. Conclusion CA CP-CRE were found in most surveillance sites but are rare, occurring primarily in older patients with underlying medical conditions. Patient interviews are planned to determine whether CA CP-CRE may be associated with distant or undocumented healthcare exposures. ![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Isaac See
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Uzma Ansari
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hannah Reses
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julian E Grass
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- California Department Of Public Health, Richmond, California
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | - Wendy M Bamberg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Sarah J Janelle
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Chris W Bower
- Georgia Emerging Infections Program, Decatur, Georgia
| | | | | | - Lucy E Wilson
- University of Maryland Baltimore County, Baltimore, Maryland
| | - Ruth Lynfield
- Minnesota Department of Health, Saint Paul, Minnesota
| | | | | | | | | | - Ghinwa Dumyati
- New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
| | - Rebecca Tsay
- New York Rochester Emerging Infections Program at the University of Rochester Medical Center, Rochester, New York
| | | | | | | | - Daniel Muleta
- Tennessee Department of Health, Nashville, Tennessee
| | - Sandra N Bulens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria Karlsson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nadezhda Duffy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Lutgring
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
21
|
Vallabhaneni S, Zahn M, Epson E, ODonnell K, Horwich-Scholefield S, Brooks R, Vaeth E, Blood T, Shannon DJ, Feaster C, Leung V, Maloney M, Forsberg K, Kallen A, Jackson BR, Walters MS. 2449. Early Detection of Candida auris is Essential to Control Spread: Four Effective Active Surveillance Strategies. Open Forum Infect Dis 2019. [PMCID: PMC6809803 DOI: 10.1093/ofid/ofz360.2127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background C. auris has been identified from > 1600 US patients. Risk factors include high-acuity post-acute care admissions (e.g., long-term acute care hospitals (LTACHs)), hospitalization abroad, and carbapenemase-producing organism (CPO) colonization. Early detection of C. auris is key to controlling spread. We describe four active surveillance strategies that led to early C. auris identification. Methods Based on known risk factors, state health departments used active C. auris surveillance strategies: (1) species identification of yeast from urine cultures from LTACHs, (2) screening patients with a CPO and hospitalization abroad, (3) LTACH C. auris point prevalence surveys (PPS), or (4) admission screening in acute and long-term care settings. Results (1)A laboratory in Southern California serving 12 LTACHs began species identification for all Candida from urine cultures, which would have otherwise been discarded because they are assumed to be not clinically significant. Within 5 months, testing of 271 Candida urine isolates identified the region’s first C. auris case, prompting contact tracing and identification of additional cases and facilities. (2) When CPOs were identified in patients with recent hospitalizations outside of the United States, the Maryland Department of Health screened patients for C.auris colonization. Of four screened, one, who received care in Kenya, was C. auris colonized. (3) The Indiana State Department of Health implemented monthly PPS at an LTACH that frequently admits patients transferred from a high prevalence area. Of 38 patients screened, two were colonized. (4) The Connecticut Department of Public Health offers C. auris admission screening for patients who received inpatient care in high prevalence areas; of 12 screened, one C. auris colonized patient was found. Infection control assessments and implementation of infection control measures followed each detection. Conclusion Early detection of C. auris is important but is impacted by infrequent yeast species identification and a reservoir of asymptomatic colonized patients. Healthcare facilities and public health jurisdictions can consider adopting one or more of these strategies based on epidemiology and resource availability. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
| | - Matthew Zahn
- Orange County Department of Health, Irvine, California
| | - Erin Epson
- California Department Of Public Health, Richmond, California
| | | | | | - Richard Brooks
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Vivian Leung
- Connecticut Department of Public Health, Hartford, Connecticut
| | | | - Kaitlin Forsberg
- IHRC, Inc. and Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Maroya S Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
22
|
Karmarkar E, Karmarkar E, O’Donnell K, Prestel C, Forsberg K, Forsberg K, Schan DK, Chow NA, McDermott DS, Rossow JA, Toda M, Toda M, Glowicz J, Brooks R, Brooks R, Bagheri H, Nelson T, Gualandi N, Khwaja Z, Horwich-Scholefield S, Jacobs J, Cheung M, Mikhail L, Walters MS, Walters MS, Jacobs-Slifka K, Stone ND, Stone ND, Gade L, Berkow EL, Berkow EL, Jackson BR, Jackson BR, Vallabhaneni S, Vallabhaneni S, Zahn M, Epson E, Epson E. LB1. Regional Assessment and Containment of Candida auris Transmission in Post-Acute Care Settings—Orange County, California, 2019. Open Forum Infect Dis 2019. [PMCID: PMC6810421 DOI: 10.1093/ofid/ofz415.2484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Patients in long-term acute care hospitals (LTACHs) and skilled nursing facilities with ventilator units (VSNFs) are at high risk for Candida auris colonization; among patients colonized with this emerging pathogen, 5%–10% develop invasive disease with >45% mortality. In September 2018, a California LTACH-affiliated laboratory began enhanced C. auris surveillance by classifying species of Candida isolated from routine urine specimens. In February 2019, the first known Southern California case was detected in an Orange County (OC) LTACH; the patient had not traveled outside the region, indicating local acquisition. We performed point prevalence surveys (PPS) and infection prevention (IP) assessments at all OC LTACHs and VSNF subacute units to identify patients colonized with C. auris and control transmission.
Methods
During March–August 2019, we conducted PPS at facilities by collecting composite axilla and groin swabs for C. auris polymerase chain reaction testing and reflex culture from all patients who assented. Facilities with ≥1 C. auris-colonized patient repeated a PPS every 2 weeks to assess for new transmission. Isolate relatedness was assessed by whole-genome sequencing (WGS). We evaluated hand hygiene (HH) adherence, access to alcohol-based hand rubs (ABHR), and cleaning of high-touch surfaces to guide IP recommendations.
Results
The first PPS at all OC LTACHs (n = 3) and adult VSNFs (n = 14) identified 45 C. auris-colonized patients in 3 (100%) LTACHs and 6 (43%) VSNFs; after repeated PPS, the total count reached 124. Most patients (70%) were at 2 facilities (Table 1). Three of 124 patients developed candidemia. To date, isolates from 48 patients have completed WGS; all were highly related (<11 single-nucleotide polymorphisms) in the African clade. Of 9 facilities with C. auris, 5 had HH adherence < 50%, 3 had limited ABHR, and at 2, <60% of assessed high-touch surfaces were clean. We recommended regular HH and cleaning audits, and increased ABHR.
Conclusion
Our investigation, prompted by enhanced surveillance, identified C. auris at 9 OC facilities. WGS indicated a single introduction and local transmission. Early detection, followed by rapid county-wide investigation and IP support, enabled containment efforts for C. auris in OC.
Disclosures
All authors: No reported disclosures.
Collapse
Affiliation(s)
- Ellora Karmarkar
- Centers for Disease Control and Prevention, Richmond, California
| | - Ellora Karmarkar
- Centers for Disease Control and Prevention, Richmond, California
| | | | | | - Kaitlin Forsberg
- Centers for Disease Control and Prevention; IHRC, Inc., Atlanta, Georgia
| | - Kaitlin Forsberg
- Centers for Disease Control and Prevention; IHRC, Inc., Atlanta, Georgia
| | | | | | | | - John A Rossow
- Centers for Disease Control and Prevention, Richmond, California
| | - Mitsuru Toda
- Centers for Disease Control and Prevention, Richmond, California
| | - Mitsuru Toda
- Centers for Disease Control and Prevention, Richmond, California
| | - Janet Glowicz
- Centers for Disease Control and Prevention, Richmond, California
| | - Richard Brooks
- Centers for Disease Control and Prevention, Richmond, California
| | - Richard Brooks
- Centers for Disease Control and Prevention, Richmond, California
| | - Hosniyeh Bagheri
- California Department of Public Health (CDPH), Rancho Santa Margarita, California
| | - Teresa Nelson
- California Department of Public Health, Redlands, California
| | | | | | | | - Joshua Jacobs
- Orange County Health Care Agency, Los Angeles, California
| | - Michele Cheung
- Orange County Health Care Agency, Los Angeles, California
| | - Lydia Mikhail
- Orange County Health Care Agency, Los Angeles, California
| | - Maroya S Walters
- Centers for Disease Control and Prevention, Richmond, California
| | - Maroya S Walters
- Centers for Disease Control and Prevention, Richmond, California
| | | | - Nimalie D Stone
- CDC Division of Healthcare Quality and Promotion, Atlanta, Georgia
| | - Nimalie D Stone
- CDC Division of Healthcare Quality and Promotion, Atlanta, Georgia
| | | | | | | | | | | | | | | | - Matt Zahn
- Orange County Health Care Agency, Los Angeles, California
| | - Erin Epson
- California Department of Public Health, Redlands, California
| | - Erin Epson
- California Department of Public Health, Redlands, California
| |
Collapse
|
23
|
Kourtis AP, Hatfield K, Baggs J, Mu Y, See I, Epson E, Nadle J, Kainer MA, Dumyati G, Petit S, Ray SM, Ham D, Capers C, Ewing H, Coffin N, McDonald LC, Jernigan J, Cardo D. Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections - United States. MMWR Morb Mortal Wkly Rep 2019; 68:214-219. [PMID: 30845118 PMCID: PMC6421967 DOI: 10.15585/mmwr.mm6809e1] [Citation(s) in RCA: 401] [Impact Index Per Article: 80.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction Staphylococcus aureus is one of the most common pathogens in health care facilities and in the community, and can cause invasive infections, sepsis, and death. Despite progress in preventing methicillin-resistant S. aureus (MRSA) infections in health care settings, assessment of the problem in both health care and community settings is needed. Further, the epidemiology of methicillin-susceptible S. aureus (MSSA) infections is not well described at the national level. Methods Data from the Emerging Infections Program (EIP) MRSA population surveillance (2005–2016) and from the Premier and Cerner Electronic Health Record databases (2012–2017) were analyzed to describe trends in incidence of hospital-onset and community-onset MRSA and MSSA bloodstream infections and to estimate the overall incidence of S. aureus bloodstream infections in the United States and associated in-hospital mortality. Results In 2017, an estimated 119,247 S. aureus bloodstream infections with 19,832 associated deaths occurred. During 2005–2012 rates of hospital-onset MRSA bloodstream infection decreased by 17.1% annually, but the decline slowed during 2013–2016. Community-onset MRSA declined less markedly (6.9% annually during 2005–2016), mostly related to declines in health care–associated infections. Hospital-onset MSSA has not significantly changed (p = 0.11), and community-onset MSSA infections have slightly increased (3.9% per year, p<0.0001) from 2012 to 2017. Conclusions and Implications for Public Health Practice Despite reductions in incidence of MRSA bloodstream infections since 2005, S. aureus infections account for significant morbidity and mortality in the United States. To reduce the incidence of these infections further, health care facilities should take steps to fully implement CDC recommendations for prevention of device- and procedure-associated infections and for interruption of transmission. New and novel prevention strategies are also needed.
Collapse
|
24
|
Thompson ND, Brown CJ, Eure T, Penna A, Bamberg W, Barney G, Barter D, Clogher P, Desilva M, Dumyati G, Epson E, Frank L, Godine D, Irizarry L, Kainer MA, Lynfield R, Mahoehney JP, Maloney M, Morabit S, Nadle J, Ocampo VLS, Pierce R, Ray SM, Shrum S, Sievers M, Wilson LE, Stone ND, Magill SS. 1831. Point Prevalence and Epidemiology of Antimicrobial Use in US Nursing Homes, 2017. Open Forum Infect Dis 2018. [PMCID: PMC6252607 DOI: 10.1093/ofid/ofy210.1487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The role of nursing homes (NH) in transmission of antimicrobial-resistant (AR) organisms is of growing concern. AR control requires evidence-based NH stewardship interventions; however, data on antimicrobial use (AU) from US NHs are scant. In the absence of other AU surveillance approaches, NH prevalence surveys can generate essential data, including rationale and indication. In 2017, an AU prevalence survey was conducted through the CDC’s Emerging Infections Program (EIP) to determine the prevalence and epidemiology of AU in NH residents. Methods NHs from California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee were randomly selected to participate in a 1-day AU point prevalence survey; participation was voluntary. For NH residents receiving antimicrobial drugs (AD) at the time of the survey, EIP staff reviewed available medical records to collect the AD route, rationale, and infection site(s). AD were categorized using the World Health Organization Anatomical Therapeutic Chemical classification system. Data were analyzed in SAS 9.4. Results Of 15,295 residents in 161 NHs, 1,261 (prevalence 8.2%, 95% confidence interval 7.8%-8.7%) received ≥1 AD at the time of the survey (AD range 1–4/resident). Of 1,452 total ADs, 77% were administered for treatment of an active infection, 19% for prophylaxis, 3% for noninfectious reasons, and no rationale documented in 1%. Most AD (80%) were administered by the oral/enteral route and most (87%) were antibacterials. The three most common infection sites were urinary tract (29%, of which 1/4 was for prophylaxis); wound, cellulitis or soft tissue (20%); and respiratory tract (14%). Among the 1,268 antibacterials (figure), fluoroquinolones (15%), combination penicillins (8%), third-generation cephalosporins (8%), and glycopepetides (5%) ranked among the top 10 classes in use. Conclusion This large-scale prevalence survey provides insight into AU in US NHs. On a given day, approximately 1 in 12 NH residents was receiving ≥1 AD. Notably, 30% of AD were administered for UTI, and AD in classes recommended for stewardship intervention were common. These findings highlight areas for evaluation to identify unnecessary use in NH. Prevalence survey data are important to inform and track the impact of stewardship interventions. ![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cedric J Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taniece Eure
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Austin Penna
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Wendy Bamberg
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Grant Barney
- NY Emerging Infections Program, Center for Community Health, University of Rochester Medical Center, Rochester, New York
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | | | - Malini Desilva
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota
| | - Ghinwa Dumyati
- NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Linda Frank
- California Emerging Infections Program, Oakland, California
| | - Deborah Godine
- California Emerging Infections Program, Oakland, California
| | | | - Marion A Kainer
- Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, Tennessee
| | - Ruth Lynfield
- State Epidemiologist and Medical Director for Infectious Diseases, Epidemiology and Community Health, Minnesota Department of Health, St. Paul, Minnesota
| | - J P Mahoehney
- Minnesota EIP/Department of Health, Minneapolis, Minnesota
| | - Meghan Maloney
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Susan Morabit
- Georgia Emerging Infections Program, Decatur, Georgia
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | - Valerie L S Ocampo
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, Oregon
| | - Rebecca Pierce
- Public Health Division, Oregon Health Authority, Portland, Oregon
| | - Susan M Ray
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah Shrum
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Marla Sievers
- New Mexico EIP/Department of Health, Santa Fe, New Mexico
| | | | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
25
|
Thompson ND, Brown C, Eure T, Penna A, Barney G, Barter D, Buhr N, Clogher P, Dumyati G, Epson E, Frank L, Godine D, Irizarry L, Johnston H, Kainer MA, Lynfield R, Mahoehney JP, Maloney M, Morabit S, Nadle J, Pierce R, Ray SM, Shrum S, Sievers M, Wilson LE, Stone ND, Magill SS. 1836. Characteristics of Nursing Homes Associated With Self-reported Implementation of Centers for Disease Control and Prevention (CDC) Core Elements of Antibiotic Stewardship. Open Forum Infect Dis 2018. [PMCID: PMC6252518 DOI: 10.1093/ofid/ofy210.1492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
Collapse
Affiliation(s)
- Nicola D Thompson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cedric Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Taniece Eure
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Austin Penna
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Grant Barney
- NY Emerging Infections Program, Center for Community Health, University of Rochester Medical Center, Rochester, New York
| | - Devra Barter
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Nicolai Buhr
- Office of Infectious Disease Epidemiology and Outbreak Response, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland
| | | | - Ghinwa Dumyati
- NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Linda Frank
- California Emerging Infections Program, Oakland, California
| | - Deborah Godine
- California Emerging Infections Program, Oakland, California
| | | | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Marion A Kainer
- Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Public Health, Nashville, Tennessee
| | - Ruth Lynfield
- State Epidemiologist and Medical Director for Infectious Diseases, Epidemiology and Community Health, Minnesota Department of Health, St. Paul, Minnesota
| | - J P Mahoehney
- Minnesota EIP/Department of Health, Minneapolis, Minnesota
| | - Meghan Maloney
- Connecticut Department of Public Health, Hartford, Connecticut
| | - Susan Morabit
- Georgia Emerging Infections Program, Decatur, Georgia
| | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | - Rebecca Pierce
- Acute and Communicable Disease Prevention, Oregon Health Authority, Portland, Oregon
| | - Susan M Ray
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Sarah Shrum
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Marla Sievers
- New Mexico EIP/Department of Health, Santa Fe, New Mexico
| | | | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shelley S Magill
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
26
|
Rizzo K, Garcia E, Zahn M, Yi SH, Epson E. 480. Reduction in Clostridium difficile Infection Rates Following a Prevention Collaborative in Orange County, California, 2014–2017. Open Forum Infect Dis 2018. [PMCID: PMC6253487 DOI: 10.1093/ofid/ofy210.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background The California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program and Orange County Health Care Agency convened a Clostridium difficile infection (CDI) prevention collaborative with health care facilities in Orange County (OC) to reduce CDI incidence in the region. Methods We invited all 34 hospitals and 76 skilled nursing facilities (SNF) in OC to participate from June 2015 to June 2016. Participants received onsite infection control and antimicrobial stewardship assessments, trainings, and an interfacility transfer communication improvement initiative. We used an interrupted time-series design and segmented regression analysis to evaluate monthly hospital-onset (HO) and community-onset (CO) CDI rates for acute care hospitals (ACH) reporting HAI data to CDPH via the National Healthcare Safety Network. The baseline period included 17 months (January 2014–June 2015) and the collaborative period 28 months (September 2015–December 2017). All OC acute care hospitals were included in the CO-CDI model to account for direct and indirect effects of the collaborative. We included only participating ACH in the HO-CDI model. For informal comparisons, we assessed changes in CO-CDI for ACH in three San Francisco Bay Area counties and HO-CDI rates in nonparticipant OC acute care hospitals. Results Collaborative participants comprised 15 ACH, three long-term acute care hospitals, one children’s hospital, and 20 SNF; all but two SNF received an onsite assessment. Unadjusted, baseline pooled mean HO-CDI rates were 8.5 cases per 10,000 patient days for participant ACH, and CO-CDI rates were 4.9 cases per 1,000 admissions in OC acute care hospitals. During the collaborative period, HO-CDI rates in OC participant ACH decreased 2% per month (incidence rate ratio [IRR]: 0.98, 95% CI: 0.96, 0.99; P < 0.001). HO-CDI rates among OC nonparticipant ACH (N = 10) did not change during the same timeframe (IRR: 0.99, 0.96, 1.02; P = 0.37). During the collaborative period, Orange County CO-CDI rates also declined 2% per month (IRR: 0.98, 0.97, 0.99; P < 0.001); no changes in CO-CDI were observed among ACH (N = 27) in the comparison counties (IRR: 1.00, 0.99, 1.01; P = 0.78). Conclusion Our analysis of acute care hospitals in Orange County provides evidence that coordinated, regional multifacility initiatives can reduce CDI incidence. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Kyle Rizzo
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Erin Garcia
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Matthew Zahn
- Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California
| | - Sarah H Yi
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| |
Collapse
|
27
|
Rizzo K, Horwich-Scholefield S, Epson E. 1169. Surveillance of Antibiotic-Resistant Bacteria Reported Among Healthcare-Associated Infections, California, 2011–2017. Open Forum Infect Dis 2018. [PMCID: PMC6252808 DOI: 10.1093/ofid/ofy210.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Antibiotic-resistant healthcare-associated infections (HAI) threaten patient safety and public health. HAI reported by California hospitals to the National Healthcare Safety Network include pathogen and antibiotic susceptibility information. We analyzed HAI data to measure regional changes in antibiotic resistance (AR) over time among select bacteria. Methods We analyzed central line-associated bloodstream infection (CLABSI) data using log binomial regression models to estimate annual change in the proportion of pathogens resistant to carbapenems, extended-spectrum cephalosporins, methicillin/oxacillin, and multidrug (MDR) combinations for the reporting years 2011–2017. We aggregated HAI CLABSI, catheter-associated urinary tract infection (CAUTI), and surgical site infection (SSI) data in 2-year increments (i.e., 2014–2015, 2016–2017) to assess changes in percent resistance by county when data for 30 or more pathogens were available. Results Among CLABSI reported from 2011 to 2017, there were no significant changes in the proportion of carbapenem-resistant Enterobacteriaceae (CRE) (Figure 1; risk ratio [RR]: 0.97, 95% CI: 0.92, 1.03; P = 0.32), methicillin/oxacillin-resistant S. aureus (MRSA) isolates (RR: 0.98, 95% CI: 0.96, 1.00; P = 0.06) or Pseudomonas aeruginosa with an MDR phenotype (RR: 1.02, 95% CI: 0.95, 1.10; P = 0.54). The proportion of E. coli with MDR and extended-spectrum β-lactamase (ESBL) phenotypes increased by 7% (RR: 1.07, 95% CI: 1.02, 1.12; P < 0.01) and 4% (RR: 1.04, 95% CI: 1.01, 1.08; P = 0.02) per year, respectively. Percentages of AR among aggregated CAUTI, CLABSI and SSI pathogens varied by county and time period (Figures 2 and 3). Conclusion Increases in antibiotic resistant phenotypes among E. coli, and unchanged prevalence of MDR Pseudomonas aeruginosa, CRE, and MRSA among reported HAI underscore the need for continued infection prevention and antibiotic stewardship efforts in California. Local public health departments can use these analyses to target coordinated AR prevention initiatives with healthcare facilities in their regions. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Kyle Rizzo
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Sam Horwich-Scholefield
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| |
Collapse
|
28
|
Magro M, Kealey M, Epson E. 466. Use of Administrative Data to Characterize Clostridium difficile Infections (CDI) Reported by California Hospitals to the California Department of Public Health (CDPH) via the National Healthcare Safety Network (NHSN): 2014–2015. Open Forum Infect Dis 2018. [PMCID: PMC6255594 DOI: 10.1093/ofid/ofy210.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
Collapse
Affiliation(s)
- Monise Magro
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Melissa Kealey
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| |
Collapse
|
29
|
Kabbani S, Jackson K, Epstein L, Gellert A, Bernu C, Overton R, Nadle J, Dumyati G, Lynfield R, Ray SM, Epson E, See I. 1059. Staphylococcus aureus Bacteremia Treatment: Results From Pilot Surveillance in Four US States. Open Forum Infect Dis 2018. [PMCID: PMC6254689 DOI: 10.1093/ofid/ofy210.896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Staphylococcus aureus treatment guidelines are being revised to include proposed quality measures for evaluation of patients with S. aureus bacteremia (SAB) (e.g., infectious disease [ID] consultation, echocardiogram, and documenting clearance of bacteremia). We describe current management practices of SAB to identify opportunities for quality improvement. Methods We conducted a pilot assessment of SAB cases reported to CDC’s Emerging Infections Program active, laboratory- and population-based surveillance from 24 hospitals in four states during 1–2 months in 2017 or 2018. An SAB case was the isolation of S. aureus from a blood culture among adults (≥18 years) in the catchment area. We collected clinical and demographic information and performed a descriptive analysis of management of SAB cases. Results Among 109 SAB cases identified, 50 (46%) were methicillin-resistant S. aureus (MRSA). While hospitalized, 87 (80%) patients were evaluated by ID consultation, 90 (83%) underwent an echocardiogram (26 were transesophageal), and 92 (84%) had documented clearance of bacteremia. During the hospitalization, 15 (14%) died and 12 (11%) left against medical advice (AMA). Of those who survived and did not leave AMA, median duration of hospitalization after initial culture was 10.5 days (interquartile range 7–18). In total, 10 survivors (9% of cases) completed at least 2 weeks of antibiotics while hospitalized, and 65 (60% of cases) were discharged on antibiotic therapy. Among the 25 MRSA patients discharged on antibiotics, common treatments were vancomycin (64%), daptomycin (8%), ceftaroline (8%), and linezolid (4%). Among the 40 methicillin-susceptible SAB patients discharged on antibiotics, cefazolin (56%), ceftriaxone (13%), cefepime (5%), linezolid (5%), nafcillin (3%), and vancomycin (3%) were most common. The remainder of outpatient treatments included oral β-lactams, clindamycin, doxycycline, levofloxacin, and erythromycin. Conclusion Overall, the majority of patients with SAB underwent evaluation according to the proposed quality measures and received therapy with targeted anti-staphylococcal agents, although opportunities to optimize treatment remain. Hospitalized patients who leave AMA represent a particular challenge for effective SAB therapy. Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Sarah Kabbani
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly Jackson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Epstein
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anita Gellert
- NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
| | - Carmen Bernu
- Minnesota Department of Health, St. Paul, Minnesota
| | | | - Joelle Nadle
- California Emerging Infections Program, Oakland, California
| | - Ghinwa Dumyati
- University of Rochester Medical Center, Rochester, New York
| | | | - Susan M Ray
- Emory University School of Medicine, Atlanta, Georgia
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
30
|
Tsay S, Williams S, Mu Y, Epson E, Johnston H, Farley MM, Harrison LH, Vonbank B, Shrum S, Dumyati G, Zhang A, Schaffner W, Magill S, Vallabhaneni S. 363. National Burden of Candidemia, United States, 2017. Open Forum Infect Dis 2018. [PMCID: PMC6255127 DOI: 10.1093/ofid/ofy210.374] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Candidemia is a common healthcare-associated bloodstream infection associated with high morbidity and mortality. No current estimates exist for understanding its burden in the United States. Methods In 2017, CDC’s Emerging Infections Program (EIP) performed laboratory- and active population-based candidemia surveillance in 45 counties in nine states (California, Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, Tennessee), encompassing ~17 million persons. A case was defined as Candida species isolated from blood in a surveillance area resident. EIP site staff reviewed medical records to collect demographic and clinical data. Using 2016 US census data, we created weighted estimates of national and regional incidence rates and mortality in persons with candidemia (defined as death from any cause within 7 days of incident candidemia). Results A total of 1,226 candidemia cases were identified in 2017. We estimated 23,000 candidemia cases (95% CI 20,000–25,000) occurred in the United States in 2017. Overall estimated incidence was 7.0/100,000 persons, with elevated rates in adults ≥65 years (20.3/100,000), males (8.0/100,000), and people of Black race (12.6/100,000) (table). Incidence was highest in the South Atlantic region (8.0/100,000) and lowest in the Pacific (6.0/100,000). Estimated number of deaths was 3,000 (1,000–5,000). Conclusion Our analysis highlights the substantial burden of candidemia in the US Because candidemia is only one form of invasive candidiasis, the true burden of invasive infections due to Candida species is likely higher. Ongoing surveillance can support future burden estimates and help assess the impact of prevention interventions. ![]()
Disclosures All authors: No reported disclosures.
Collapse
Affiliation(s)
- Sharon Tsay
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sabrina Williams
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yi Mu
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Helen Johnston
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Monica M Farley
- Department of Medicine, Emory University School of Medicine and Atlanta VA Medical Center, Atlanta, Georgia
| | - Lee H Harrison
- Maryland Emerging Infections Program, Pittsburg, Pennsylvania
| | | | - Sarah Shrum
- New Mexico Department of Health, Santa Fe, New Mexico
| | - Ghinwa Dumyati
- NY Emerging Infections Program, Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York
| | - Alexia Zhang
- Oregion Emerging Infections Program, Portlant, Oregon
| | | | - Shelley Magill
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Snigdha Vallabhaneni
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
31
|
Glowicz J, Crist M, Gould C, Moulton-Meissner H, Noble-Wang J, de Man TJ, Perry KA, Miller Z, Yang WC, Langille S, Ross J, Garcia B, Kim J, Epson E, Black S, Pacilli M, LiPuma JJ, Fagan R. A multistate investigation of health care-associated Burkholderia cepacia complex infections related to liquid docusate sodium contamination, January-October 2016. Am J Infect Control 2018; 46:649-655. [PMID: 29329922 DOI: 10.1016/j.ajic.2017.11.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Outbreaks of health care-associated infections (HAIs) caused by Burkholderia cepacia complex (Bcc) have been associated with medical devices and water-based products. Water is the most common raw ingredient in nonsterile liquid drugs, and the significance of organisms recovered from microbiologic testing during manufacturing is assessed using a risk-based approach. This incident demonstrates that lapses in manufacturing practices and quality control of nonsterile liquid drugs can have serious unintended consequences. METHODS An epidemiologic and laboratory investigation of clusters of Bcc HAIs that occurred among critically ill, hospitalized, adult and pediatric patients was performed between January 1, 2016, and October 31, 2016. RESULTS One hundred and eight case patients with Bcc infections at a variety of body sites were identified in 12 states. Two distinct strains of Bcc were obtained from patient clinical cultures. These strains were found to be indistinguishable or closely related to 2 strains of Bcc obtained from cultures of water used in the production of liquid docusate, and product that had been released to the market by manufacturer X. CONCLUSIONS This investigation highlights the ability of bacteria present in nonsterile, liquid drugs to cause infections or colonization among susceptible patients. Prompt reporting and thorough investigation of potentially related infections may assist public health officials in identifying and removing contaminated products from the market when lapses in manufacturing occur.
Collapse
|
32
|
Rizzo K, Horwich-Scholefield S, Epson E. Prevalence and Geographic Distribution of Select Antibiotic-Resistant Bacteria Reported among Healthcare-Associated Infections, California, 2014–2015. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.250] [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: 11/13/2022] Open
|
33
|
Blum L, Garcia E, Epson E. Assessment of Healthcare Facility Network Analysis to Inform Facility Enrollment into Regional Antimicrobial Resistance Prevention Collaboratives. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.287] [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: 11/13/2022] Open
|
34
|
Edens C, Wong J, Lyman M, Rizzo K, Nguyen D, Blain M, Horwich-Scholefield S, Moulton-Meissner H, Epson E, Rosenberg J, Patel PR. Hemodialyzer Reuse and Gram-Negative Bloodstream Infections. Am J Kidney Dis 2016; 69:726-733. [PMID: 27940061 DOI: 10.1053/j.ajkd.2016.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 05/27/2016] [Accepted: 09/19/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Clusters of bloodstream infections caused by Burkholderia cepacia and Stenotrophomonas maltophilia are uncommon, but have been previously identified in hemodialysis centers that reprocessed dialyzers for reuse on patients. We investigated an outbreak of bloodstream infections caused by B cepacia and S maltophilia among hemodialysis patients in clinics of a dialysis organization. STUDY DESIGN Outbreak investigation, including matched case-control study. SETTING & PARTICIPANTS Hemodialysis patients treated in multiple outpatient clinics owned by a dialysis organization. PREDICTORS Main predictors were dialyzer reuse, dialyzer model, and dialyzer reprocessing practice. OUTCOMES Case patients had a bloodstream infection caused by B cepacia or S maltophilia; controls were patients without infection dialyzed at the same clinic on the same day as a case; results of environmental cultures and organism typing. RESULTS 17 cases (9 B cepacia and 8 S maltophilia bloodstream infections) occurred in 5 clinics owned by the same dialysis organization. Case patients were more likely to have received hemodialysis with a dialyzer that had been used more than 6 times (matched OR, 7.03; 95% CI, 1.38-69.76) and to have been dialyzed with a specific reusable dialyzer (Model R) with sealed ends (OR, 22.87; 95% CI, 4.49-∞). No major lapses during dialyzer reprocessing were identified that could explain the outbreak. B cepacia was isolated from samples collected from a dialyzer header-cleaning machine from a clinic with cases and was indistinguishable from a patient isolate collected from the same clinic, by pulsed-field gel electrophoresis. Gram-negative bacteria were isolated from 2 reused Model R dialyzers that had undergone the facility's reprocessing procedure. LIMITATIONS Limited statistical power and overmatching; few patient isolates and dialyzers available for testing. CONCLUSIONS This outbreak was likely caused by contamination during reprocessing of reused dialyzers. Results of this and previous investigations demonstrate that exposing patients to reused dialyzers increases the risk for bloodstream infections. To reduce infection risk, providers should consider implementing single dialyzer use whenever possible.
Collapse
Affiliation(s)
- Chris Edens
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Jacklyn Wong
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA; California Department of Public Health, Richmond, CA
| | - Meghan Lyman
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kyle Rizzo
- California Department of Public Health, Richmond, CA
| | - Duc Nguyen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Michela Blain
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Heather Moulton-Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Erin Epson
- California Department of Public Health, Richmond, CA
| | - Jon Rosenberg
- California Department of Public Health, Richmond, CA
| | - Priti R Patel
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
35
|
Epson E, Horwich-Scholefield S, Humphries R, Hindler J, Hershey C, Miller L, Mendez J, Martinez J, Terashita D, Marquez P, Bhaurla S, Moran M, Pandes L, Mckinnell JA. Capacity Building within the Microbiology Laboratory Is Needed to Ensure Implementation of Strategies to Control the Spread of CRE. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1192] [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: 11/13/2022] Open
Affiliation(s)
- Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, CA
| | - Sam Horwich-Scholefield
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, CA
| | - Romney Humphries
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA
| | - Janet Hindler
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, CA
| | | | - Loren Miller
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA
| | - Job Mendez
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA
| | - Jeremias Martinez
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA
| | - Dawn Terashita
- Los Angeles County Department of Public Health, Los Angeles, CA
| | | | - Sandeep Bhaurla
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Marcelo Moran
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - Lindsey Pandes
- Los Angeles County Department of Public Health, Los Angeles, CA
| | - James a. Mckinnell
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA
| |
Collapse
|
36
|
A.Mckinnell J, Hindler J, Epson E, Horwich-Scholefield S, Miller L, Mendez J, Martinez J, Sinkowitz J, Terashita D, Marquez P, Bhaurla S, Moran M, Pandes L, Hershey C, Humphries R. Incomplete Adoption of Clinical Laboratory Standards Institute Breakpoints to Detect Carbapenem-Resistant Organisms. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.221] [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: 11/14/2022] Open
Affiliation(s)
- James A.Mckinnell
- Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Janet Hindler
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Sam Horwich-Scholefield
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Loren Miller
- Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Job Mendez
- Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Jeremias Martinez
- Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Jacob Sinkowitz
- Infectious Disease Clinical Outcomes Research, LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Dawn Terashita
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Patricia Marquez
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Sandeep Bhaurla
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Marcelo Moran
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Lindsey Pandes
- Los Angeles County Department of Public Health, Los Angeles, California
| | | | - Romney Humphries
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California
| |
Collapse
|
37
|
Mckinnell JA, Epson E, Horwich-Scholefield S, Humphries R, Hindler J, Miller L, Mendez J, Terashita D, Marquez P, Bhaurla S, Hershey C, Martinez J, Moran M, Pandes L, Thrupp L. The Microbiology Laboratory Is a Valuable, but Largely Underutilized Partner in Antimicrobial Stewardship and Antimicrobial Resistance Monitoring. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- James A. Mckinnell
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Erin Epson
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Sam Horwich-Scholefield
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, California
| | - Romney Humphries
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California
| | - Janet Hindler
- Department of Pathology and Laboratory Medicine, UCLA, Los Angeles, California
| | - Loren Miller
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Job Mendez
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Dawn Terashita
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Patricia Marquez
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Sandeep Bhaurla
- Los Angeles County Department of Public Health, Los Angeles, California
| | | | - Jeremias Martinez
- Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California
| | - Marcelo Moran
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Lindsey Pandes
- Los Angeles County Department of Public Health, Los Angeles, California
| | - Lauri Thrupp
- Medicine, University of California Irvine Health, Orange, California
| |
Collapse
|
38
|
Goldstein EJC, Goff DA, Reeve W, Naumovski S, Epson E, Zenilman J, Kaye KS, File TM. Approaches to Modifying the Behavior of Clinicians Who Are Noncompliant With Antimicrobial Stewardship Program Guidelines. Clin Infect Dis 2016; 63:532-8. [PMID: 27098167 DOI: 10.1093/cid/ciw247] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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: 12/17/2015] [Accepted: 04/14/2016] [Indexed: 01/01/2023] Open
Abstract
Antimicrobial stewardship programs (ASPs) are a key national initiative to promote appropriate use of antibiotics and to reduce the burden of resistance. The dilemma of managing the outlier physician is especially complex. We outline strategies to establish a successful ASP that reviews appropriate efforts to achieve the goal of modifying outlier physicians' behavior. One must try to differentiate deviation from ASP norms from all other issues of outliers. Essential elements include identifying and understanding the local problems, planning, and achieving hospital administration and medical staff support. A successful ASP includes effective communication and acceptance of evidence-based recommendations, so that patient clinical outcomes will be optimized.
Collapse
Affiliation(s)
- Ellie J C Goldstein
- R. M. Alden Research Laboratory, Santa Monica David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Debra A Goff
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus
| | | | - Snezana Naumovski
- Pharmacy Department, Providence St John's Health Center, Santa Monica
| | - Erin Epson
- California Department of Public Health, Healthcare-Associated Infections Program
| | - Jonathan Zenilman
- Infectious Diseases Division, John Hopkins University School of Medicine, Baltimore, Maryland
| | - Keith S Kaye
- Wayne State University and Detroit Medical Center, Michigan
| | - Thomas M File
- Summa Health System and Northeast Ohio Medical University, Akron
| |
Collapse
|
39
|
Rizzo K, Epson E. Surveillance of Antimicrobial Resistance in Bacteria-Associated with Central Line-Associated Bloodstream Infections, as Reported by California Hospitals From 2011 to 2014. Open Forum Infect Dis 2015. [DOI: 10.1093/ofid/ofv133.155] [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: 11/12/2022] Open
|
40
|
Dominguez SR, Dolan SA, West K, Dantes RB, Epson E, Friedman D, Littlehorn CA, Arms LE, Walton K, Servetar E, Frank DN, Kotter CV, Dowell E, Gould CV, Hilden JM, Todd JK. High colonization rate and prolonged shedding of Clostridium difficile in pediatric oncology patients. Clin Infect Dis 2014; 59:401-3. [PMID: 24785235 DOI: 10.1093/cid/ciu302] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Surveillance testing for Clostridium difficile among pediatric oncology patients identified stool colonization in 29% of patients without gastrointestinal symptoms and in 55% of patients with prior C. difficile infection (CDI). A high prevalence of C. difficile colonization and diarrhea complicates the diagnosis of CDI in this population.
Collapse
Affiliation(s)
| | | | | | - Raymund B Dantes
- Epidemic Intelligence Service Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Epson
- Epidemic Intelligence Service Colorado Department of Public Health and Environment, Denver
| | - Deborah Friedman
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant Department of Nursing
| | | | | | - Karen Walton
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant Department of Nursing
| | - Ellen Servetar
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant Department of Nursing
| | - Daniel N Frank
- Department of Adult Infectious Diseases, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora
| | - Cassandra V Kotter
- Department of Adult Infectious Diseases, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora
| | | | - Carolyn V Gould
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joanne M Hilden
- Department of Pediatric Hematology/Oncology/Bone Marrow Transplant
| | - James K Todd
- Department of Pediatric Infectious Diseases Department of Epidemiology
| |
Collapse
|
41
|
Hessell AJ, Epson E, Moldt B, Rakasz E, Pandey S, Sutton WF, Brower Z, Hirsch VM, Burton DR, Haigwood NL. Biodistribution of neutralizing monoclonal antibodies IgG1 b12 and LALA in mucosal and lymphatic tissues of rhesus macaques. Retrovirology 2012. [PMCID: PMC3441812 DOI: 10.1186/1742-4690-9-s2-p204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
|
42
|
|