The administration of spike monoclonal antibody treatment to patients with mild to moderate COVID-19 is very challenging. This article summarizes essential components and processes in establishing an effective spike monoclonal antibody infusion program. Rapid identification of a dedicated physical infrastructure was essential to circumvent the logistical challenges of caring for infectious patients, while maintaining compliance with regulations and ensuring the safety of our personnel and other patients. Our partnerships and collaborations among multiple different specialties and disciplines enabled contributions from personnel with specific expertise in medicine, nursing, pharmacy, infection prevention and control, EHR informatics, compliance, legal, medical ethics, engineering, administration and other critical areas. Clear communication and a culture where all roles are welcomed at the planning and operational tables are critical to the rapid development and refinement needed to adapt and thrive in providing this time-sensitive beneficial therapy. Our partnerships with leaders and providers outside our institutions, including those who care for underserved populations, have promoted equity in the access of monoclonal antibodies in our regions. Strong support from institutional leadership facilitated expedited action when needed, from a physical, personnel, and system infrastructure standpoint. Our ongoing real-time assessment and monitoring of our clinical program allowed us to improve and optimize our processes to ensure that the needs of our COVID-19 patients in the outpatient setting are met.

How extraintestinal pathogenic Escherichia coli (ExPEC) and antimicrobial-resistant E. coli disseminate through the population is undefined. We studied public restrooms for contamination with E. coli and ExPEC in relation to source and extensively characterized the E. coli isolates. For this, we cultured 1,120 environmental samples from 56 public restrooms in 33 establishments (obtained from 10 cities in the greater Minneapolis-St. Paul, MN, metropolitan area in 2003) for E. coli and compared ecological data with culture results. Isolates underwent virulence genotyping, phylotyping, clonal typing, pulsed-field gel electrophoresis (PFGE), and disk diffusion antimicrobial susceptibility testing. Overall, 168 samples (15% from 89% of restrooms) fluoresced, indicating presumptive E. coli: 25 samples (2.2% from 32% of restrooms) yielded E. coli isolates, and 10 samples (0.9% from 16% of restrooms) contained ExPEC. Restroom category and cleanliness level significantly predicted only fluorescence, gender predicted fluorescence and E. coli, and feces-like material and toilet-associated sites predicted all three endpoints. Of the 25 E. coli isolates, 7 (28%) were from phylogenetic group B2(virulence-associated), and 8 (32%) were ExPEC. ExPEC isolates more commonly represented group B2 (50% versus 18%) and had significantly higher virulence gene scores than non-ExPEC isolates. Six isolates (24%) exhibited >3-class antibiotic resistance, 10 (40%) represented classic human-associated sequence types, and one closely resembled reference human clinical isolates by pulsed-field gel electrophoresis. Thus, E. coli, ExPEC, and antimicrobial-resistant E. coli sporadically contaminate public restrooms, in ways corresponding with restroom characteristics and within-restroom sites. Such restroom-source E. coli strains likely reflect human fecal contamination, may pose a health threat, and may contribute to population-wide dissemination of such strains. E scherichia coli is a major cause of urinary tract and other extraintestinal infections, resulting in considerable morbidity, mortality, and costs (1). Most such infections are caused by distinctive E. coli strains called extraintestinal pathogenic E. coli (Ex-PEC) because of their enhanced ability to invade and cause disease at extraintestinal sites (2). Such strains' main reservoir is the human intestinal tract, where they usually reside harmlessly as longterm colonizers (3). ExPEC strains can be distinguished from other E. coli strains by their extensive virulence gene repertoire and primarily group B2 phylogenetic background (2).Dissemination of virulent and antimicrobial-resistant E. coli clones through the human population has been recognized recently as an important contributor to the overall burden of Ex-PEC-associated disease (4-7). However, the mechanisms of such clonal dissemination remain undefined. Flush toilets create microdroplets containing viable bacteria (8, 9), and both public and private restrooms have been shown to be variably contaminated with human-source bacteri...

bEmerging multidrug-resistant (MDR) Gram-negative bacilli (GNB), including Escherichia coli sequence type 131 (ST131) and its resistance-associated H30 subclone, constitute an ever-growing public health threat. Their reservoirs and transmission pathways are incompletely defined. To assess diarrheal stools as a potential reservoir for ST131-H30 and other MDR GNB, we cultured 100 clinical stool samples from a Veterans Affairs Medical Center clinical laboratory (October to December 2011) for fluoroquinolone-and extended-spectrum cephalosporin (ESC)-resistant E. coli and other GNB, plus total E. coli. We then characterized selected resistant and susceptible E. coli isolates by clonal group, phylogenetic group, virulence genotype, and pulsotype and screened all isolates for antimicrobial resistance. Overall, 79 of 100 stool samples yielded GNB (52 E. coli; 48 other GNB). Fifteen samples yielded fluoroquinolone-resistant E. coli (10 were ST131, of which 9 were H30), 6 yielded ESC-resistant E. coli (2 were ST131, both non-H30), and 31 yielded susceptible E. coli (1 was ST131, non-H30), for 13 total ST131-positive samples. Fourteen non-E. coli GNB were ESC resistant, and three were fluoroquinolone resistant. Regardless of species, almost half (46%) of the fluoroquinolone-resistant and/or ESC-resistant non-E. coli GNB were resistant to at least three drug classes. Fecal ST131 isolates closely resembled reference clinical ST131 isolates according to virulence genotypes and pulsed-field gel electrophoresis (PFGE) profiles. Thus, a substantial minority (30%) of veterans with diarrhea who undergo stool testing excrete antibiotic-resistant GNB, including E. coli ST131. Consequently, diarrhea may pose transmission risks for more than just diarrheal pathogens and may help disseminate clinically relevant ST131 strains and other MDR GNB within hospitals and the community. M ultidrug-resistant (MDR) Gram-negative bacilli (GNB) are important extraintestinal pathogens that pose an evergrowing public health threat. Among the various clinically important GNB, Escherichia coli is a leading source of illness, death, and health care costs (1). Over the past 2 decades E. coli clinical isolates have shown an increasing prevalence of resistance to first-line antibiotics, notably fluoroquinolones (FQs) and extended-spectrum cephalosporins (ESCs) (2-4). The main contributor to this worsening resistance trend is the H30 subclone within E. coli sequence type 131 (ST131), which is a newly emerged, globally disseminated MDR extraintestinal pathogen (5).One suspected route of transmission of MDR GNB is humanto-human spread via the fecal-oral route. Supporting this hypothesis for ST131 is the evidence of fecal colonization with ST131 among patients with an ST131 infection and their healthy close contacts in patterns suggesting within-household transmission (6-8). Compared with formed stools, diarrhea presumably would provide even more opportunities for fecal shedding, environmental contamination, and person-to-person transmission. To our knowledge,...

Background Emerging antimicrobial-resistant Escherichia coli represent mainly the nested (fluoroquinolone-resistant [FQR]) H30R and H30Rx subclones within sequence type 131 (ST131). Intestinal colonization and within-household transmission may underlie H30R’s emergence. Methods We screened fecal samples from 741 volunteers (383 veterans, 358 household members, including pets) for ST131 and FQR E. coli (FQREC) and used molecular profiling to resolve unique strains. Selected strains underwent PCR-based detection of phylogroups, sequence types (STs), H30, H30Rx, and 53 virulence genes (VGs). Within-household strain sharing was compared with household, host, and bacterial characteristics. Fecal isolates were compared with clinical isolates. Results Colonization prevalence was 5.1% for H30R, 8% for ST131 (67% FQREC), and 10% for FQREC (52% ST131). ST131 isolates exhibited more VGs than non-ST131 isolates. Strain sharing (27% of multisubject households, 18% of corresponding subjects) was associated with the elderly, FQREC, H30R, H30Rx, ST73, and specific VGs. Fecal ST131 and FQREC isolates resembled contemporaneous and historical clinical isolates according to all studied traits. Conclusions Veterans and their human household members commonly carry and extensively share FQREC, predominantly H30R, thereby likely facilitating the ST131 pandemic. Strain sharing corresponds with multiple bacterial characteristics, including FQ resistance and specific VGs, which may promote intestinal colonization and/or host-to-host transmission.

A total of 30 samples of butter analysed during the course of the investigation showed that fecal coliforms were absent from only 13.3% of samples. One hundred forty colonies of fecal coliforms were biochemically characterized with the following types obtained (Escherichia sp. 41.4%, Enterobacter sp. 25.7%, Citrobacter sp. 20%, Klebsiella sp. 10%). Five different serotypes, namely 0 125 K70(2), 0 142K86(1), 0 127K63(1), 0 114 K90(2), 0 111 K58(1) were detected in 7 of 58 Escherichia coli isolates and 51 strains were untypable. Three strains produced heat stable (ST) enterotoxin and belonged to the enteropathogenic serotype. The antibiotic resistance patterns of coliform strains are presented.