Background Vancomycin-resistant enterococci (VRE) are major therapeutic challenges. Prospective contemporary data characterizing the clinical and molecular epidemiology of VRE bloodstream infections (BSI) are lacking. Methods VENOUS I is a prospective observational cohort of adult patients with enterococcal BSI in 11 US hospitals. We included patients with Enterococcus faecalis or E. faecium BSI with ≥1 follow-up blood culture(s) within 7 days and availability of isolate(s) for further characterization. The primary study outcome was in-hospital mortality. Secondary outcomes were mortality at days 4, 7, 10, 12, and 15 after index blood culture. A desirability of outcome ranking was constructed to assess the association of vancomycin resistance with outcomes. All index isolates were subjected to whole genome sequencing. Results 42 of 232 (18%) patients died in hospital and 39 (17%) exhibited microbiological failure (lack of clearance in the first 4 days). Neutropenia (HR 3.13), microbiological failure (HR 2.15), VRE BSI (HR 2), use of urinary catheter (HR 1.85), and Pitt BSI score ≥2 (HR 1.83) were significant predictors of in-hospital mortality. Microbiological failure was the strongest predictor of in-hospital mortality in patients with E. faecium bacteremia (HR 5.03). The impact of vancomycin resistance on mortality in our cohort changed throughout the course of hospitalization. E. faecalis ST6 was a predominant multidrug-resistant lineage, whereas a heterogeneous genomic population of E. faecium was identified. Conclusions Failure of early eradication of VRE from the bloodstream is a major factor associated with poor outcomes.
Background: Hospitalizations among skilled nursing facility (SNF) residents in Detroit increased in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Outbreak response teams were deployed from local healthcare systems, the Centers for Disease Control and Prevention (CDC), and the Detroit Health Department (DHD) to understand the infection prevention and control (IPC) gaps in SNFs that may have accelerated the outbreak. Methods: We conducted 2 point-prevalence surveys (PPS-1 and PPS-2) at 13 Detroit SNFs from April 8 to May 8, 2020. The DHD and partners conducted facility-wide severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of all residents and staff and collected information regarding resident cohorting, staff cohorting, and personnel protective equipment (PPE) utilized during that time. Results: Resident cohorting had been implemented in 7 of 13 (58.3%) SNFs prior to point-prevalence survey 1 (PPS-1), and other facilities initiated cohorting after obtaining PPS-1 results. Cohorting protocols of healthcare practitioners and environmental service staff were not established in 4 (31%) of 13 facilities, and in 3 facilities (23.1%) the ancillary staff were not assigned to cohorts. Also, 2 SNFs (15%) had an observation unit prior to PPS-1, 2 (15%) had an observation unit after PPS-1, 4 (31%) could not establish an observation unit due to inadequate space, and 5 (38.4%) created an observation unit after PPS-2. Conclusion: On-site consultations identified gaps in IPC knowledge and cohorting that may have contributed to ongoing transmission of SARS-CoV-2 among SNF residents despite aggressive testing measures. Infection preventionists (IPs) are critical in guiding ongoing IPC practices in SNFs to reduce spread of COVID-19 through response and prevention.
An outbreak of listeriosis commenced in South Africa in 2017. The Listeria species responsible for the outbreak is Listeria monocytogenes (Lm), sequence-type 6 (ST-6). In response to the outbreak, testing of various food products and food processing environments for Lm occurred. It was critical that the diagnostic platform used, could differentiate Lm from other Listeria species. This is important as Listeria species and Lm share the same growth requirements and often co-exist in the same environment.To ensure that the most accurate automated, diagnostic system is used for Lm identification, our laboratory performed a verification on the available platforms to us.Methods & Materials: 50 Listeria species identified by whole genome sequencing (WGS) were tested on 4 platforms:(1) Microscan (Beckman & Coulter), (2) Vitek MS (Biomerieux), (3) Vitek 2 (Biomerieux) and ( 4) Surefast PCR kit (Congen). The Listeria species included 20 Lm strains and 30 Listeria species. The 30 Listeria species included 27 L innocua (a prominent Listeria species often associated with Lm), 2 L seeligeri and 1 L welshimeri.Results: Among the 4 diagnostic platforms tested, no platform was ideal. All platforms overcalled Lm in place of other Listeria species. The Vitek MS misidentified Lm for other species and the Vitek 2 gave both Lm and L innocua options for few L innocua isolates. From our assessment, the worst performing platform for Lm identification was Microscan and the best performer was the Surefast PCR kit.Conclusion: Although, isolate numbers were small, the above results suggest that further investigations are warranted. In addition, alternate testing platforms for Lm identification need to be investigated. Several ELISA based, fully automated technologies exist and need to be evaluated.
BackgroundHepatitis A (Hep A) is a self-limiting diarrheal illness occurring in underdeveloped countries. August 2016 marked the onset of an outbreak in Southeast Michigan. Our study characterizes the presentation and clinical course of Hep A patients that presented to our healthcare system.MethodsThis study included all Hep A positive cases that presented to Henry Ford Health System from August 2016 to December 2017. Electronic medical records were reviewed for demographics, sexual history, travel history, food exposure, illicit drug use, signs, symptoms and outcomes. Data were also collected on healthcare units of presentation, screening, and care including emergency department, clinic, inpatient hospitalization, or transfer from another facility. Outcomes included hospitalization, consultations with hepatology and transplant, re-admission, and death.ResultsA total of 166 cases were reviewed; Figure 1 displays the cases per month. The average age was 51 years and 54% were male. The most common symptoms were abdominal pain (47%) and nausea (42.8). Underlying conditions included illicit drug use (23%), alcohol abuse (22%), and diabetes (18.6%). Three percent of cases traveled outside of the state within 2 weeks prior to diagnosis. Twenty-three percent had history of illicit drug use and 4.2% were food handlers. Table 1 displays the healthcare unit where Hep A serology was ordered. One hundred Twenty-two (73.5%) cases were hospitalized, 44 (26.5%) required ICU admission and seven (4.2%) were readmitted within 30 days. Ninety-two cases (55%) required hepatology evaluation, 25 were evaluated for transplantation and one (0.6%) received a liver transplant. Eighteen (10.8%) patients died, two of which were never hospitalized).Figure 1.Number of cases per month and year.Table 1.Healthcare Unit Where Hep A Serology Was OrderedAdmission114 (68.6%)Office visit31 (18.7)Lab encounter13 (7.8)ED8 (4.8)Total166ConclusionHigh clinical suspicion is crucial during an outbreak. Most of our cases were diagnosed with Hep A during inpatient admission after presenting with abdominal pain and nausea. In an outbreak setting, consider testing for immunity from history of previous exposure or vaccination. High hospital admission, morbidity and mortality were seen.Disclosures All authors: No reported disclosures.
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