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Shope TR, Chedid K, Hashikawa AN, Martin ET, Sieber MA, Des Ruisseau G, Williams JV, Wheeler SE, Johnson M, Stiegler M, D’Agostino H, Balasubramani GK, Yahner KA, Wang-Erickson AF. Incidence and Transmission of SARS-CoV-2 in US Child Care Centers After COVID-19 Vaccines. JAMA Netw Open 2023; 6:e2339355. [PMID: 37874566 PMCID: PMC10599125 DOI: 10.1001/jamanetworkopen.2023.39355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
Importance SARS-CoV-2 surveillance studies in US child care centers (CCCs) in the post-COVID-19 vaccine era are needed to provide information on incidence and transmission in this setting. Objective To characterize SARS-CoV-2 incidence and transmission in children attending CCCs (students) and their child care providers (CCPs) and household contacts. Design, Setting, and Participants This prospective surveillance cohort study was conducted from April 22, 2021, through March 31, 2022, and included 11 CCCs in 2 cities. A subset (surveillance group) of CCPs and students participated in active surveillance (weekly reverse transcription-polymerase chain reaction [RT-PCR] swabs, symptom diaries, and optional baseline and end-of-study SARS-CoV-2 serologic testing), as well as all household contacts of surveillance students. Child care center directors reported weekly deidentified self-reported COVID-19 cases from all CCPs and students (self-report group). Exposure SARS-CoV-2 infection in CCC students. Main Outcomes and Measures SARS-CoV-2 incidence, secondary attack rates, and transmission patterns were determined from diary entries, self-reports to CCC directors, and case logs. Incidence rate ratios were measured using Poisson regression clustering on centers with a random intercept and unstructured matrix. Results From a total population of 1154 students and 402 CCPs who self-reported cases to center directors, 83 students (7.2%; mean [SD] age, 3.86 [1.64] years; 55 male [66%]), their 134 household contacts (118 adults [mean (SD) age, 38.39 (5.07) years; 62 female (53%)], 16 children [mean (SD) age, 4.73 (3.37) years; 8 female (50%)]), and 21 CCPs (5.2%; mean [SD] age, 38.5 [12.9] years; 18 female [86%]) participated in weekly active surveillance. There were 154 student cases (13%) and 87 CCP cases (22%), as defined by positive SARS-CoV-2 RT-PCR or home antigen results. Surveillance students had a higher incidence rate than self-report students (incidence rate ratio, 1.9; 95% CI, 1.1-3.3; P = .01). Students were more likely than CCPs to have asymptomatic infection (34% vs 8%, P < .001). The CCC secondary attack rate was 2.7% to 3.0%, with the upper range representing possible but not definite secondary cases. Whether the index case was a student or CCP, transmission within the CCC was not significantly different. Household cumulative incidence was 20.5%, with no significant difference in incidence rate ratio between adults and children. Household secondary attack rates were 50% for children and 67% for adults. Of 30 household cases, only 5 (17%) represented secondary infections caused by 3 students who acquired SARS-CoV-2 from their CCC. Pre- and poststudy seroprevalence rates were 3% and 22%, respectively, with 90% concordance with antigen or RT-PCR results. Conclusions and Relevance In this study of SARS-CoV-2 incidence and transmission in CCCs and students' households, transmission within CCCs and from children infected at CCCs into households was low. These findings suggest that current testing and exclusion recommendations for SARS-CoV-2 in CCCs should be aligned with those for other respiratory viruses with similar morbidity and greater transmission to households.
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Affiliation(s)
- Timothy R. Shope
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Khalil Chedid
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Andrew N. Hashikawa
- Department of Emergency Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Emily T. Martin
- University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Mary Ann Sieber
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Gabrielle Des Ruisseau
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - John V. Williams
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Institute for Infection, Inflammation, and Immunity in Children (i4kids), Pittsburgh, Pennsylvania
| | - Sarah E. Wheeler
- Department of Pathology, University of Pittsburgh School of Medicine, UPMC, Pittsburgh, Pennsylvania
| | - Monika Johnson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Myla Stiegler
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Helen D’Agostino
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | | | - Kristin A. Yahner
- Division of General Academic Pediatrics, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anna F. Wang-Erickson
- Division of Pediatric Infectious Diseases, Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Institute for Infection, Inflammation, and Immunity in Children (i4kids), Pittsburgh, Pennsylvania
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Dadon M, Chedid K, Martin ET, Shaul I, Greiver O, Katz I, Saadon H, Alfaro M, Hod L, Shorbaje A, Braslavsky-Siag A, Moscovici S, Kaye KS, Marchaim D. The impact of bedside wipes in multi-patient rooms: a prospective, crossover trial evaluating infections and survival. J Hosp Infect 2023; 134:50-56. [PMID: 36754289 DOI: 10.1016/j.jhin.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Multidrug-resistant organisms (MDROs) are prevalent on high-touch surfaces in multi-patient rooms. AIM To quantify the impact of hanging single-use cleaning/disinfecting wipes next to each bed. Pre-specified outcomes were: (1) hospital-acquired infections (HAIs), (2) cleaning frequency, (3) MDRO room contamination, (4) new MDRO acquisitions, and (5) mortality. METHODS Clustered randomized crossover trial at Shamir Medical Center, Israel (October 2016 to January 2018). Clusters were randomly assigned to use for cleaning either single-use quaternary ammonium wipes (Clinell) or standard practices (reusable cloths and buckets with bleach). Six-month intervention periods were implemented in alternating sequence, separated by a washout period. Five high-touch surfaces were monitored by fluorescent markers. Study outcomes were compared between periods using generalized estimating equations, Poisson regression, and Cox proportional hazards models. FINDINGS Overall, 7725 patients were included (47,670 person-days), 3793 patients in rooms with intervention cleaning and 3932 patients in rooms with standard practices. During the intervention, there was no significant difference in HAI rates (incidence rate ratio: 1.6; 95% confidence interval (CI): 0.7-3.5; P = 0.3). However, in intervention rooms, the frequency of environmental cleaning was higher (odds ratio: 3.73; 95% CI: 2.0-7.1; P < 0.0001), MDRO environmental contamination rate was insignificantly lower (odds ratio: 0.7; 95% CI: 0.5-1.0; P = 0.06), new MDRO acquisition rate was lower (hazard ratio: 0.4; 95% CI: 0.2-1.0; P = 0.04), and in-hospital mortality rate was lower (incidence rate ratio: 0.8; 95% CI: 0.7-1.0; P = 0.03). CONCLUSION Hanging single-use cleaning/disinfecting wipes next to each bed did not affect the HAI rates but did improve the frequency of cleaning, reduce MDRO environmental contamination, and was associated with reduced incidence of new MDRO acquisitions and reduced mortality. This is a feasible, recommended practice to improve patient outcomes in multi-patient rooms.
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Affiliation(s)
- M Dadon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - K Chedid
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - E T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - I Shaul
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Greiver
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Katz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Saadon
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - M Alfaro
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Hod
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Shorbaje
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - S Moscovici
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K S Kaye
- Division of Allergy, Immunology and Infectious Diseases, Robert Wood Johnson Medical School, NJ, USA
| | - D Marchaim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
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DeJonge PM, Gribbin W, Gaughan A, Chedid K, Martin ET, Miller AL, Hashikawa AN. Expanding Surveillance Toward Sharing Data with the Community: Qualitative Insights from a Childcare Center Illness Surveillance Program. Health Secur 2021; 19:262-270. [PMID: 33956525 DOI: 10.1089/hs.2020.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childcare attendance is a recognized independent risk factor for pediatric infectious diseases due to the pathogen-sharing behaviors of young children and the crowded environments of childcare programs. The Michigan Child Care Related Infections Surveillance Program (MCRISP) is a novel online illness surveillance network used by community childcare centers to track disease incidence. It has been used to warn local public health departments about emerging outbreaks. The flow of data from MCRISP, however, remains largely unidirectional-from data reporter to public health researchers. With the intent to ultimately improve the system for users, we wanted to better understand how community illness data collected by MCRISP might best benefit childcare stakeholders themselves. Using a ground-up design approach, we conducted a series of focus groups among childcare directors participating in MCRISP. All primary data reporters from each of the 30 MCRISP-affiliated childcare centers were eligible to participate in the focus groups. A thematic assessment from the focus groups revealed that participants wanted surveillance system improvements that would (1) support subjective experiences with objective data, (2) assist with program decision making, (3) provide educational resources, and (4) prioritize the user's experience. Our findings support a framework by which community disease surveillance networks can move toward greater transparency and 2-way data flow. Ultimately, a more mutually beneficial surveillance system improves stakeholder engagement, provides opportunities for rapid mitigation strategies, and can help allocate timely resources in responding to emerging outbreaks and pandemics.
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Affiliation(s)
- Peter M DeJonge
- Peter M. DeJonge, MPH, and Khalil Chedid, MD, MPH, are PhD Candidates, Department of Epidemiology; Abigail Gaughan is an Undergraduate Student; Emily T. Martin, PhD, MPH, is an Associate Professor, Department of Epidemiology; and Alison L. Miller, PhD, is an Associate Professor, Department of Health Behavior and Health Education; all at the University of Michigan School of Public Health, Ann Arbor, MI. William Gribbin, MS, is a Medical Student and Andrew N. Hashikawa, MD, MPH, is an Associate Professor, Department of Emergency Medicine and Department of Pediatrics; both at the University of Michigan Medical School, Ann Arbor, MI
| | - William Gribbin
- Peter M. DeJonge, MPH, and Khalil Chedid, MD, MPH, are PhD Candidates, Department of Epidemiology; Abigail Gaughan is an Undergraduate Student; Emily T. Martin, PhD, MPH, is an Associate Professor, Department of Epidemiology; and Alison L. Miller, PhD, is an Associate Professor, Department of Health Behavior and Health Education; all at the University of Michigan School of Public Health, Ann Arbor, MI. William Gribbin, MS, is a Medical Student and Andrew N. Hashikawa, MD, MPH, is an Associate Professor, Department of Emergency Medicine and Department of Pediatrics; both at the University of Michigan Medical School, Ann Arbor, MI
| | - Abigail Gaughan
- Peter M. DeJonge, MPH, and Khalil Chedid, MD, MPH, are PhD Candidates, Department of Epidemiology; Abigail Gaughan is an Undergraduate Student; Emily T. Martin, PhD, MPH, is an Associate Professor, Department of Epidemiology; and Alison L. Miller, PhD, is an Associate Professor, Department of Health Behavior and Health Education; all at the University of Michigan School of Public Health, Ann Arbor, MI. William Gribbin, MS, is a Medical Student and Andrew N. Hashikawa, MD, MPH, is an Associate Professor, Department of Emergency Medicine and Department of Pediatrics; both at the University of Michigan Medical School, Ann Arbor, MI
| | - Khalil Chedid
- Peter M. DeJonge, MPH, and Khalil Chedid, MD, MPH, are PhD Candidates, Department of Epidemiology; Abigail Gaughan is an Undergraduate Student; Emily T. Martin, PhD, MPH, is an Associate Professor, Department of Epidemiology; and Alison L. Miller, PhD, is an Associate Professor, Department of Health Behavior and Health Education; all at the University of Michigan School of Public Health, Ann Arbor, MI. William Gribbin, MS, is a Medical Student and Andrew N. Hashikawa, MD, MPH, is an Associate Professor, Department of Emergency Medicine and Department of Pediatrics; both at the University of Michigan Medical School, Ann Arbor, MI
| | - Emily T Martin
- Peter M. DeJonge, MPH, and Khalil Chedid, MD, MPH, are PhD Candidates, Department of Epidemiology; Abigail Gaughan is an Undergraduate Student; Emily T. Martin, PhD, MPH, is an Associate Professor, Department of Epidemiology; and Alison L. Miller, PhD, is an Associate Professor, Department of Health Behavior and Health Education; all at the University of Michigan School of Public Health, Ann Arbor, MI. William Gribbin, MS, is a Medical Student and Andrew N. Hashikawa, MD, MPH, is an Associate Professor, Department of Emergency Medicine and Department of Pediatrics; both at the University of Michigan Medical School, Ann Arbor, MI
| | - Alison L Miller
- Peter M. DeJonge, MPH, and Khalil Chedid, MD, MPH, are PhD Candidates, Department of Epidemiology; Abigail Gaughan is an Undergraduate Student; Emily T. Martin, PhD, MPH, is an Associate Professor, Department of Epidemiology; and Alison L. Miller, PhD, is an Associate Professor, Department of Health Behavior and Health Education; all at the University of Michigan School of Public Health, Ann Arbor, MI. William Gribbin, MS, is a Medical Student and Andrew N. Hashikawa, MD, MPH, is an Associate Professor, Department of Emergency Medicine and Department of Pediatrics; both at the University of Michigan Medical School, Ann Arbor, MI
| | - Andrew N Hashikawa
- Peter M. DeJonge, MPH, and Khalil Chedid, MD, MPH, are PhD Candidates, Department of Epidemiology; Abigail Gaughan is an Undergraduate Student; Emily T. Martin, PhD, MPH, is an Associate Professor, Department of Epidemiology; and Alison L. Miller, PhD, is an Associate Professor, Department of Health Behavior and Health Education; all at the University of Michigan School of Public Health, Ann Arbor, MI. William Gribbin, MS, is a Medical Student and Andrew N. Hashikawa, MD, MPH, is an Associate Professor, Department of Emergency Medicine and Department of Pediatrics; both at the University of Michigan Medical School, Ann Arbor, MI
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Zilberman-Itskovich S, Strul N, Chedid K, Shorbaje A, Lazarovitch T, Zohar Y, Razin H, Low A, Strulovici A, Katz D, Dhar S, Milton Parsons L, Ramos-Mercado A, Zaidenstein R, Martin ET, Marchaim D. 2043. The “Resistance Calculator”: Refining Empiric Practices of Antimicrobials Prescription in the Era of Widespread Resistance. Open Forum Infect Dis 2019. [PMCID: PMC6808668 DOI: 10.1093/ofid/ofz360.1723] [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 In the era of widespread resistance, there are two events in the course of a hospitalized septic patient where the majority of empiric prescription errors occur: (1) infections upon admission (UA) due to multi-drug-resistant organisms (MDRO) and (2) nosocomial infections due to extensively drug-resistant organisms (XDRO). These errors seriously impact patient outcomes and the ecological burden of resistance. Our objective was to develop a tool, to calculate the probability of MDRO UA, and nosocomial XDRO infections, in order to reduce delays in initiating appropriate therapy to the “right population,” i.e., with “resistant pathogens,” while avoiding overuse of broader (frequently more toxicת less efficacious) therapeutics to the “wrong population,” i.e., with “susceptible pathogens.” Methods Retrospective case–control analyses were conducted for septic adults at Shamir Medical Center, Israel (2016). Logistic regression was used to develop models of risk factors. All parameters incorporated into the models were readily accessible at the point of care. The performances of the development cohorts, and on 8 other validation cohorts, were assessed by the area under the receiver operating characteristic curve (ROC AUC). A web calculator (mobile modifiable) was generated. Results A total of 4,199 patients were enrolled: 2,472 with sepsis UA, and 1,727 with nosocomial sepsis. The “MDR UA score” included 10 parameters and with a cutoff of ≥22 points, had a ROC AUC of 0.85 (sensitivity 86%, NPV 98%). The “Nosocomial XDR score” included 7 parameters and with a cutoff of ≥36 points, had a ROC AUC of 0.88 (sensitivity 90%, NPV 96%). The median ROC AUC was 0.75 among the validation cohorts of the “MDR UA score,” and 0.66 among the “Nosocomial XDR score.” A free web tool was generated: https://assafharofe.azurewebsites.net/. Conclusion A simple electronic calculator was generated to aid in bedside empiric prescription practices. The tool is composed of two scores to assist in common scenarios where the majority of errors occur. Prospective interventional investigations, should trial the performances of this tool in improving patient outcomes and the ecological burden in the facility. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Nathan Strul
- Assaf Harofeh (Shamir) Medical Center, Ness-Ziona, HaMerkaz, Israel
| | - Khalil Chedid
- University of Michigan School of Public Health, 1317 Millbrook Trl, Michigan
| | - Akram Shorbaje
- Assaf Harofeh (Shamir) Medical Center, Ness-Ziona, HaMerkaz, Israel
| | | | - Yarden Zohar
- Assaf Harofeh (Shamir) Medical Center, Ness-Ziona, HaMerkaz, Israel
| | - Hadas Razin
- Assaf Harofeh (Shamir) Medical Center, Ness-Ziona, HaMerkaz, Israel
| | - Amitai Low
- Assaf Harofeh (Shamir) Medical Center, Ness-Ziona, HaMerkaz, Israel
| | | | - David Katz
- Shaare Zedek Medical Center, the Hebrew University Hadassah Medical School, Jerusalem, Yerushalayim, Israel
| | - Sorabh Dhar
- Detroit Medical Center, Wayne State University, John D Dingell VA medical center, Detroit, Michigan
| | | | | | - Ronit Zaidenstein
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, HaMerkaz, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Zerifin, HaMerkaz, Israel
| | - Emily T Martin
- University of Michigan School of Public Health, 1317 Millbrook Trl, Michigan
| | - Dror Marchaim
- Assaf Harofeh (Shamir) Medical Center, Ness-Ziona, HaMerkaz, Israel
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5
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Chedid K, Zilberman-Itskovich S, Shorbaje A, Martin ET, Lazarovitch T, Zaidenstein R, Dadon M, Saadon H, Maya T, Marchaim D. 1204. The MDR Upon Admission Score for Shortening Time to Initiation of Appropriate Antimicrobial Therapy in the Era of Widespread Resistance to Antimicrobials. Open Forum Infect Dis 2018. [PMCID: PMC6252974 DOI: 10.1093/ofid/ofy210.1037] [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: 11/24/2022] Open
Abstract
Background Multi-drug-resistant organisms (MDRO) pose a growing burden, including in non-hospital settings. Delay in initiation of appropriate antimicrobial therapy (DAAT) upon admission to an acute care hospital is common and is associated with worse outcomes. The aim of this study was to develop a prediction score for MDRO infection upon admission, in order to improve patients’ outcomes and avoid misuse of broad-spectrum antimicrobials. Methods A retrospective case–control analysis was conducted at Assaf Harofeh Medical Center, Israel, comparing adult patients with MDRO infections diagnosed in the first 48 hours of hospitalization to patients presenting with non-MDRO sepsis (i.e., patients with microbiologically confirmed non-MDRO infection, or patients with non-microbiologically confirmed sepsis). MDROs were determined by clinical laboratory testing. Patients were identified over four consecutive months (August–December 2016). A multivariable logistic regression of predictors for MDRO infection upon admission was used to develop the prediction score. Results Ninety-five of 818 total patients (11.6%) had MDRO infection. The final score included 10 parameters: (1) home therapy (IV therapy, wound care, or specialized nursing care, 16 points), (2) routine (at least weekly) outpatient clinic visits in the past 3 months (15 points), (3) history (2 years) of past MDRO colonization (14 points), (4) any antibiotics in the preceding 3 months (12 points), (5) invasive procedure in the past 6 months (11 points), (6) elderly (≥65 years old, 10 points), (7) hemiplegia or paraplegia (8 points), (8) resident of long-term care facility (7 points), (9) severe sepsis (i.e., severe sepsis, septic shock, or multi-organ failure, 6 points), and (10) acute kidney injury (5 points). A cutoff of ≥24 points had a sensitivity of 90%, a specificity of 73% and an ROC AUC = 0.88 (figure). Conclusion This study presents the development of a new prediction score for MDRO infection upon admission, based on parameters that could easily be extracted at bedside for patients admitted with sepsis. A future prospective interventional study is needed in order to validate the score, captured at bedside electronically, in terms of improving patients’ outcomes. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Khalil Chedid
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Akram Shorbaje
- Unit of Infection Control, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Emily T Martin
- Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Tsilia Lazarovitch
- Unit of Infection Control, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ronit Zaidenstein
- Unit of Infection Control, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mor Dadon
- Unit of Infection Control, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Hodaya Saadon
- Unit of Infection Control, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Tal Maya
- Unit of Infection Control, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Dror Marchaim
- Unit of Infection Control, Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Waack U, Johnson TL, Chedid K, Xi C, Simmons LA, Mobley HLT, Sandkvist M. Targeting the Type II Secretion System: Development, Optimization, and Validation of a High-Throughput Screen for the Identification of Small Molecule Inhibitors. Front Cell Infect Microbiol 2017; 7:380. [PMID: 28894700 PMCID: PMC5581314 DOI: 10.3389/fcimb.2017.00380] [Citation(s) in RCA: 24] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/09/2017] [Indexed: 12/26/2022] Open
Abstract
Nosocomial pathogens that develop multidrug resistance present an increasing problem for healthcare facilities. Due to its rapid rise in antibiotic resistance, Acinetobacter baumannii is one of the most concerning gram-negative species. A. baumannii typically infects immune compromised individuals resulting in a variety of outcomes, including pneumonia and bacteremia. Using a murine model for bacteremia, we have previously shown that the type II secretion system (T2SS) contributes to in vivo fitness of A. baumannii. Here, we provide support for a role of the T2SS in protecting A. baumannii from human complement as deletion of the T2SS gene gspD resulted in a 100-fold reduction in surviving cells when incubated with human serum. This effect was abrogated in the absence of Factor B, a component of the alternative pathway of complement activation, indicating that the T2SS protects A. baumannii against the alternative complement pathway. Because inactivation of the T2SS results in loss of secretion of multiple enzymes, reduced in vivo fitness, and increased sensitivity to human complement, the T2SS may be a suitable target for therapeutic intervention. Accordingly, we developed and optimized a whole-cell high-throughput screening (HTS) assay based on secreted lipase activity to identify small molecule inhibitors of the T2SS. We tested the reproducibility of our assay using a 6,400-compound library. With small variation within controls and a dynamic range between positive and negative controls, the assay had a z-factor of 0.65, establishing its suitability for HTS. Our screen identified the lipase inhibitors Orlistat and Ebelactone B demonstrating the specificity of the assay. To eliminate inhibitors of lipase activity and lipase expression, two counter assays were developed and optimized. By implementing these assays, all seven tricyclic antidepressants present in the library were found to be inhibitors of the lipase, highlighting the potential of identifying alternative targets for approved pharmaceuticals. Although no T2SS inhibitor was identified among the compounds that reduced lipase activity by ≥30%, our small proof-of-concept pilot study indicates that the HTS regimen is simple, reproducible, and specific and that it can be used to screen larger libraries for the identification of T2SS inhibitors that may be developed into novel A. baumannii therapeutics.
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Affiliation(s)
- Ursula Waack
- Department of Microbiology and Immunology, University of Michigan Medical SchoolAnn Arbor, MI, United States
| | - Tanya L Johnson
- Department of Microbiology and Immunology, University of Michigan Medical SchoolAnn Arbor, MI, United States.,Department of Chemistry, Eastern Michigan UniversityYpsilanti, MI, United States
| | - Khalil Chedid
- Department of Microbiology and Immunology, University of Michigan Medical SchoolAnn Arbor, MI, United States
| | - Chuanwu Xi
- Department of Environmental Health Sciences, University of Michigan School of Public HealthAnn Arbor, MI, United States
| | - Lyle A Simmons
- Department of Molecular, Cellular, and Developmental Biology, University of MichiganAnn Arbor, MI, United States
| | - Harry L T Mobley
- Department of Microbiology and Immunology, University of Michigan Medical SchoolAnn Arbor, MI, United States
| | - Maria Sandkvist
- Department of Microbiology and Immunology, University of Michigan Medical SchoolAnn Arbor, MI, United States
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Chazot C, Terrat JC, Dumoulin A, Ang KS, Gassia JP, Chedid K, Maurice F, Canaud B. Randomized Equivalence Study Evaluating the Possibility of Switching Hemodialysis Patients Receiving Subcutaneous Human Erythropoietin Directly to Intravenous Darbepoetin Alfa. Ann Pharmacother 2009; 43:228-34. [DOI: 10.1345/aph.1k664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Darbepoetin alfa is an erythropoiesis-stimulating agent (ESA) used either intravenously or subcutaneously with no dose penalty; however, the direct switch from subcutaneous recombinant human erythropoietin (rHuEPO) to intravenous darbepoetin has barely been studied. Objective: To establish the equivalence of a direct switch from subcutaneous rHuEPO to intravenous darbepoetin versus an indirect switch from subcutaneous rHuEPO to intravenous darbepoetin after 2 months of subcutaneous darbepoetin in patients undergoing hemodialysis. Methods: In this open, randomized, 6-month, prospective study, patients with end-stage kidney disease who were on hemodialysis were randomized into 2 groups: direct switch from subcutaneous rHuEPO to intravenous darbepoetin (group 1) and indirect switch from subcutaneous rHuEPO to intravenous darbepoetin after 2 months of subcutaneous darbepoetin (group 2). A third, nonrandomized group (control), consisting of patients treated with intravenous rHuEPO who were switched to intravenous darbepoetin, was also studied to reflect possible variations of hemoglobin (Hb) levels due to change from one type of ESA to the other. The primary outcome was the proportion of patients with stable Hb levels at month 6. Secondary endpoints included Hb stability at month 3, dosage requirements for darbepoetin, and safety of the administration route. Results: Among 154 randomized patients, the percentages with stable Hb levels were equivalent in groups 1 and 2, respectively, at month 3 (86.0% vs 91.3%) and month 6 (82.1% vs 81.6%; difference –0.5 [90% CI –12.8 to 11.8]). Mean Hb levels between baseline and month 6 remained stable in both groups, with no variation in mean darbepoetin dose. Mean ferritin levels remained above 100 μg/L in the 3 groups during the whole study, and darbepoetin was well tolerated. Conclusions: This study has shown equivalent efficacy on Hb stability without the need for dosage increase in patients switched directly from subcutaneous rHuEPO to intravenous darbepoetin.
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Affiliation(s)
- Charles Chazot
- Nephrologist, Centre de Dialyse, Tassin la Demi-Lune, France
| | | | - Alexandre Dumoulin
- Nephrologist, Centre d'Hémodialyse Languedoc Méditerranée, Béziers, France
| | - Kim-Seng Ang
- Nephrologist, Service de Néphrologie, Centre hospitalier Yves Le Foll, Saint Brieuc, France
| | - Jean Paul Gassia
- Nephrologist, Clinique d'Occitanie, Muret; Centre néphrologique d'Occitanie, Muret, France
| | - Khalil Chedid
- Nephrologist, Nephrocare Ile de France, Bois, France
| | - Francois Maurice
- Nephrologist, Centre d'Hémodialyse Languedoc Méditerranée, Montpellier, France
| | - Bernard Canaud
- Nephrologist, Service de Néphrologie, CHU Montpellier, Hôpital Lapeyronie, Montpellier
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Gobert D, Lidove O, de Fontbrune FS, Peltier J, Chedid K, Burnat P, Perrier F, Chauveheid MP, Papo T. [Adenosine deaminase is useful for the diagnosis of peritoneal tuberculosis in patients with end-stage renal failure]. Rev Med Interne 2007; 28:507-9. [PMID: 17397971 DOI: 10.1016/j.revmed.2007.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 02/07/2007] [Indexed: 11/22/2022]
Abstract
INTRODUCTION End-stage renal failure patients are particularly at risk for tuberculosis, especially for peritoneal tuberculosis. Microbiological diagnosis remains hazardous in many cases. CASE REPORT We report on a case of peritoneal tuberculosis in an end-stage renal failure patient. The diagnosis was suspected on the basis of adenosine deaminase dosage in peritoneal fluid, allowing an early presumptive treatment and a favourable outcome with a 3 years follow-up. DISCUSSION The measurement of adenosine deaminase activity in ascites represents a diagnostic advance in tuberculous peritonitis among end-stage renal failure patients.
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Affiliation(s)
- D Gobert
- Service de Médecine Interne, Hôpital Bichat, 46, rue Henri-Huchard, 75722 Paris cedex 18, France
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London GM, Marchais SJ, Safar ME, Genest AF, Guerin AP, Metivier F, Chedid K, London AM. Aortic and large artery compliance in end-stage renal failure. Kidney Int 1990; 37:137-42. [PMID: 2299800 DOI: 10.1038/ki.1990.19] [Citation(s) in RCA: 281] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pulse wave velocity (PWV) was measured in the aorta, right leg and arm of 90 control subjects (CS) and 92 hemodialysis patients (HD) of the same age and mean arterial pressure (MAP). Blood chemistry, including blood lipids, and echographic dimensions of the aorta, were measured in all subjects. Presence of aortic calcification was evaluated by abdominal X-ray and echography. Whereas femoral and brachial PWV were only slightly increased in HD (P less than 0.05), the aortic PWV was significantly elevated (1113 +/- 319 cm/sec) in comparison with CS (965 +/- 216 cm/sec; P = 0.0016). Aortic diameters were larger in HD, both at the root of aorta (32.7 +/- 4 vs. 28.2 +/- 2.8 mm; P less than 0.0001) and aortic bifurcation (16.9 +/- 3.1 vs. 14.6 +/- 2.2 mm; P less than 0.0001). Although the MAP was similar in HD (109.9 +/- 19.3 mm Hg) and CS (110.2 +/- 17.2 mm Hg), the pulse pressure was significantly increased in HD patients (76.6 +/- 23.7 vs. 63.9 +/- 22 mm Hg; P = 0.007). In the two populations, aortic PWV was found to increase with age (P less than 0.0001) and MAP (P less than 0.0001). The presence of aortic calcification showed only a borderline relationship with the increase in aortic PWV (P = 0.050 in CS and P = 0.069 in HD). As change in PWV is directly related to change in distensibility, and the aortic diameters were increased in HD, these results indicate that aortic wall compliance is decreased in HD, resulting in an increase in the pulsatile component of arterial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G M London
- Centre Hospitalier Manhes, Fleury Merogis, France
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Pocheville M, Chedid K. [A case of myoclonic encephalopathy in hemolysis patients]. Nouv Presse Med 1982; 11:1640. [PMID: 7099946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Pocheville M, Chedid K, Bianchi A, Jaudon MC, Rottembourg J, London A. [Myoclonic encephalopathy in dialyzed patients. Deterioration after arrest of the poisoning]. Nouv Presse Med 1981; 10:2587-8. [PMID: 7279640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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12
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Leski M, Gired E, Chedid K, Sebti T, Perles R. [Comparison between 2 new hemodialysers (RP 5 and G. L.). Their use in 3 short weekly sessions]. Nouv Presse Med 1974; 3:507-11. [PMID: 4822149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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