(2) and is associated with prolonged hospitalization, with higher health care costs (3). The clinical microbiology laboratory plays a vital role in the treatment of patients with bloodstream infections. While current methods for the detection and characterization of bloodstream pathogens can take days, the risk of death from sepsis increases by 6 to 10% per hour from the onset of shock to the start of effective antimicrobial treatment (4).Over 50% of organisms identified in positive blood cultures are Gram-positive bacteria (5). Gram-positive organisms also are common contaminants of blood cultures. Therefore, rapid differentiation of pathogens from contaminants would be clinically useful.The Verigene Gram-positive blood culture (BC-GP) nucleic acid test for investigational use only (IUO) (Nanosphere, Northbrook, IL) is a random-access, automated test that performs nucleic acid extraction directly from positive blood culture media, hybridization onto a microarray, and analysis in 2.5 h. Targets in the assay include Staphylococcus spp., Streptococcus spp., Micrococcus spp., Listeria spp., Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdunensis, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus agalactiae, Streptococcus anginosus group, Enterococcus faecalis, and Enterococcus faecium. In addition, if S. aureus or S. epidermidis is detected, then the presence or absence of the mecA gene is reported. Similarly, if E. faecium or E. faecalis is detected, then the presence or absence of the vanA and vanB genes is reported. The BC-GP test was approved by the U.S. Food and Drug Administration (FDA) on 27 June 2012 for the reporting of all IUO targets except Micrococcus spp. (6).We evaluated the performance of the Verigene BC-GP IUO assay in comparison with routine laboratory methods used in the clinical laboratory. A recent evaluation of the BC-GP assay (7) tested blood cultures from a blood culture system (VersaTREK; Trek Diagnostic Systems, Cleveland, OH) that is used by Ͻ10% of U.S. laboratories, while our study utilized the BacT/Alert instrument (bioMérieux, Durham, NC), which is found in ϳ50% of laboratories (N. Safwat, personal communication). Another novel aspect of our study is the assessment of the time from Gram stain result reporting to identification and susceptibility result reporting for current laboratory methods, in comparison to the time for BC-GP results. This research was conducted at the Cleveland Clinic, after approval by the institutional internal review board.(This study was presented in part at ID Week, San Diego, CA, 20 October 2012.) MATERIALS AND METHODSBlood culture samples. The BC-GP IUO test was evaluated with blood cultures submitted for testing at the Cleveland Clinic microbiology laboratory in February to August 2012. Positive aerobic blood culture samples (in BacT/Alert FA bottles [bioMérieux, Durham, NC]) that contained Gram-positive cocci from unique patients were included in the study. Specimens were excluded if multiple morphologies were observed ...

Highlights Healthcare personnel are at risk for nosocomial acquisition of COVID-19. We evaluated the exposure history of hospital personnel with COVID-19. Twenty-five percent of personnel with COVID-19 were exposed to an infected patient or co-worker. Exposure to infected co-workers occurred in nonpatient care settings. Fourteen percent of personnel with COVID-19 were exposed in the community.

Lactococcus garvieae is a Gram-positive coccus that has morphological and biochemical similarities to enterococci. L. garvieae strains rare human pathogens, with only a few cases reported in the literature, mainly as a cause of infective endocarditis. L. garvieae is well known as a fish pathogen, and in some of the reported cases, the patients had a history of contact with raw fish. Some of the reported endocarditis patients had valvular damage as a predisposing condition. We report a case of L. garvieae endocarditis in a patient with no history of contact with raw fish and with history of valvular repair in an unaffected heart valve. CASE REPORT We present the case of a 64-year-old male with an extensive cardiac history, including mitral valve repair and coronary artery bypass grafting (CABG) 3 years prior to presentation and an intracardiac defibrillator (ICD) placed 2 years prior to presentation. His past medical history was also significant for hypertension, diabetes mellitus type II, and chronic obstructive pulmonary disease. The patient was referred to our institution from an outside hospital with the diagnosis of aortic valve endocarditis complicated by hypotension.The patient had presented to the outside facility with a history of progressive fatigue, weight loss, and anorexia over several weeks. The symptoms worsened gradually, and he ultimately developed a significant decline in physical abilities and lost the ability to ambulate. After admission, an echocardiogram showed 4ϩ aortic insufficiency with vegetations on the aortic valve. One of two blood cultures drawn grew Gram-positive cocci in chains. The patient was started on vancomycin and transferred to our institution for further management.The patient recalled having had a dental procedure 6 months prior. He had received 3 weeks of prophylactic antibiotics at that time. No other relevant history was found.At our institution, the surgical management included a median sternotomy with open heart and aortic valve replacement with a Carpentier-Edwards valve, as well as ascending aorta repair with bovine pericardial patch and ICD lead and pacemaker removal. The heart valve obtained during surgery was positive in culture for the same organism that was later detected in the same tissue by universal PCR followed by sequencing. However, multiple blood cultures drawn at our institution were negative. The positive blood culture at the outside laboratory reported a gamma-hemolytic streptococcus; the Microscan Walk Away system (Dade Behring, Inc., West Sacramento, CA), was used for identification without success in this case. Susceptibility testing, also performed with the Microscan system, reported full resistance to clindamycin and intermediate resistance to penicillin and ampicillin using Streptococcus sp. breakpoints.At our laboratory, small to medium-sized, white transparent colonies with a smooth and shiny surface and alpha-hemolysis were seen on the blood agar plate after 48 h of incubation of the valvular tissue. At 24 h, growth was incipient. A Gram sta...

We report 2 episodes of potential SARS-CoV-2 transmission from infected van drivers to passengers despite masking and physical distancing. Whole-genome sequencing confirmed relatedness of driver and passenger SARS-CoV-2. With the heater operating, fluorescent microspheres were transported by airflow >3 meters from the front to the back of the van.

Several recent reports have raised concern that infected co-workers may be an important source of SARS-CoV-2 acquisition by healthcare personnel. In a suspected outbreak among emergency department personnel, sequencing of SARS-CoV-2 confirmed transmission among co-workers. The suspected 6-person outbreak included 2 distinct transmission clusters and 1 unrelated infection.