Vancomycin-resistant enterococci (VRE) are an important cause of health care-acquired infections (HAIs). Studies have shown that active surveillance of high-risk patients for VRE colonization can aid in reducing HAIs; however, these screens generate a significant cost to the laboratory and health care system. Digital imaging capable of differentiating negative and "nonnegative" chromogenic agar can reduce the labor cost of these screens and potentially improve patient care. In this study, we evaluated the performance of the WASPLab Chromogenic Detection Module (CDM) (Copan, Brescia, Italy) software to analyze VRE chromogenic agar and compared the results to technologist plate reading. Specimens collected at 3 laboratories were cultured using the WASPLab CDM and plated to each site's standard-of-care chromogenic media, which included Colorex VRE (BioMed Diagnostics, White City, OR) or Oxoid VRE (Oxoid, Basingstoke, United Kingdom). Digital images were scored using the CDM software after 24 or 40 h of growth, and all manual reading was performed using digital images on a high-definition (HD) monitor. In total, 104,730 specimens were enrolled and automation agreed with manual analysis for 90.1% of all specimens tested, with sensitivity and specificity of 100% and 89.5%, respectively. Automation results were discordant for 10,348 specimens, and all discordant images were reviewed by a laboratory supervisor or director. After a second review, 499 specimens were identified as representing missed positive cultures falsely called negative by the technologist, 1,616 were identified as containing borderline color results (negative result but with no package insert color visible), and 8,234 specimens were identified as containing colorimetric pigmentation due to residual matrix from the specimen or yeast (Candida). Overall, the CDM was accurate at identifying negative VRE plates, which comprised 84% (87,973) of the specimens in this study. Members of the genus Enterococcus are commensal colonizers of the gastrointestinal tract but can cause a variety of serious nosocomial infections, including bacteremia, endocarditis, intraabdominal and pelvic infections, urinary tract infections, and, in rare cases, central nervous system infections (1-4). Treatment can be difficult, as E. faecalis has been observed to be 10 to 100 times more resistant to -lactams than other streptococcal species and E. faecium is 4 to 16 times more resistant than E. faecalis (5). Vancomycin had been used for years to successfully treat enterococcal infections; however, in 1988, the first case of a vancomycinresistant-enterococcus (VRE) infection was reported (6). Resistance is conferred by the van operon, carried in either the chromosome or a plasmid, and is inducible in response to membrane disruption caused by vancomycin (7,8). Currently, resistance is widespread, with prevalence rates ranging from 1.0% to 35.5% of all Enterococcus specimens isolated, depending on the geographical location, and is more commonly found in E. faecium (4).The success of ...
Background: In the United States, approximately 30% of about 10,000 annual blast injuries involve the hand, causing a broad spectrum of injury severity. The first web space is typically most severely affected. As the carpometacarpal (CMC) joint is critical to the unique function of the thumb, we evaluated typical patterns of injury to this joint, subsequent salvageability and functional outcomes of the thumb. Methods: We conducted a retrospective chart review on patients with blast injuries to the hand from January 1995 through July 2019 and excluded penetrating trauma. We assessed hand function as reported in occupational therapy records. Injury severity was classified independently by structures.Results: Twenty-one patients were included, two with bilateral injuries, for a total of 23 hands. Eighteen patients had injuries to one or both thumbs, for a total of 20 thumbs evaluated. Average follow-up was 1.58 years. Most injuries qualified as severe in at least one category: soft tissue, neurovascular, or bone/joint. All 10 CMC joint dislocations required surgical fixation and pinning. Eight patients had applicable occupational therapy notes available. Severely injured thumbs had statistically significant decreased range of motion (ROM) at the interphalangeal joint, metacarpophalangeal joint and with radial abduction compared to mildly injury thumbs (P value 0.02, 0.03, 0.04, respectively). Conclusions: Blast injury to the hand often results in severe deficits, frequently affecting thumb functionality and irreversibly altering occupational capabilities. Half the patients studied had severe damage to the thumb CMC joint. Objectively, severely injured thumbs had significantly worse ROM than mildly injured thumbs.
Background: Accurately diagnosing the etiologic agents of lower respiratory tract infections (LRTI) requires screening for multiple pathogens including bacteria, viruses, and fungi in complex sample types like sputum, endotracheal aspirates (ETA) and bronchoalveolar lavage (BAL). Many potential LRTI pathogens are opportunistic bacteria and actionable diagnosis requires determining clinically significant levels of these organisms. Co-infections can also add to the diagnostic challenge of pneumonia. To address this unmet need in LRTI diagnostics, BioFire Diagnostics, LLC is developing the FilmArray ® LRTI Panel; a multiplexed PCR-based test for use on the FilmArray platform. This system will provide a comprehensive result, including bacteria, viruses and fungi, in approximately 1 h. In this study, a research use only prototype of the FilmArray LRTI panel was used to identify the prevalence of adenovirus, coronavirus, human metapneumovirus, influenza A, influenza B, parainfluenza virus, and respiratory syncytial virus in two sample matrices: sputum-like (sputum and ETA) and BAL-like (BAL, mini-BAL, and bronchial wash). The prevalence of viral detections as well as the incidence of co-detections with bacteria and fungi were assessed for both sample types.Methods: This study was conducted using residual fresh sputa, ETA, and BAL that were submitted for standard care testing. Specimens were collected at the Medical College of Wisconsin during November 2014-May 2015. All specimens were tested on the prototype FilmArray LRTI panel. A subset of specimens found to be positive for viruses were verified by another molecular method when a physician specified request for a viral test was not submitted to the laboratory. To date, 156 sputum and 130 BAL-like specimens were tested by FilmArray for this study.Results: Physician requested Nucleic Acid Amplification Tests (NAAT) were only requested in 3.5% (10/286) of all specimens. Of these, all but one NAAT returned negative results. FilmArray confirmed these findings and identified additional viruses in in 18.6% (29/156) of sputum-like and 17% (22/130) of BAL-like specimens. Results from a subset of these viral positive specimens were confirmed by additional PCR assays. Additionally, 62% (18/29) of sputa specimens and 63.6% (14/22) of BAL specimens positive for virus were found to have a co-detection with a bacteria or fungus.Conclusions: The FilmArray can accurately and efficiently detect viral pathogens in lower respiratory sample matrices. These findings highlight the advantages of the multi-target approach offered by the FilmArray LRTI panel where standard of care testing might fail to accurately report incidence of viral pneumonia.
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