المؤلفون: Pompeii, Lisa, Rios, Janelle, Kraft, Colleen S., Kasbaum, Marie, Benavides, Elisa, Patlovich, Scott J., Ostrosky-Zeichner, Luis, Hornbeck, Adam, McClain, Caitlin, Fernando, Rohan D., Sietsema, Margaret, Lane, Morgan

المساهمون: Centers for Disease Control and Prevention’s National Personal Protective Technology Laboratory

المصدر: Workplace Health & Safety ; ISSN 2165-0799 2165-0969

مصطلحات موضوعية: Nursing (miscellaneous), Public Health, Environmental and Occupational Health

الوصف: Background: Reusable elastomeric half-mask respirators (EHMR) are an alternative to address shortages of disposable respirators. While respirator discomfort has been noted as a barrier to adherence to wearing an N95 filtering facepiece respirator (FFR) among health care personnel (HCP), few have examined EHMR comfort while providing patient care, which was the purpose of this study. Method: Among a cohort of 183 HCP, we prospectively examined how HCP rated EHMR tolerability using the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI) questionnaire at Study Week 2 and Week 10. At the completion of the study (Week-12), HCP compared EHMR comfort with their prior N95 FFR use. Overall R-COMFI scores and three subscales (comfort, wear experience, and function) were examined as well as individual item scores. Findings: The HCP reported an improved overall R-COMFI score (lower score more favorable, 30.0 vs. 28.7/47, respectively) from Week 2 to Week 10. Many individual item scores improved or remained low over this period, except difficulty communicating with patients and coworkers. The overall R-COMFI scores for the EHMR were more favorable than for the N95 FFR (33.7 vs. 37.4, respectively), with a large proportion of workers indicating their perception that EHMR fit better, provided better protection, and they preferred to wear it in pandemic conditions compared with the N95 FFR. Conclusion/Application to Practice: Findings suggest that the EHMR is a feasible respiratory protection device with respect to tolerance. EHMRs can be considered as a possible alternative to the N95 FFR in the health care setting. Future work is needed in the EHMR design to improve communication.

الإتاحة: https://doi.org/10.1177/21650799241238755Test

المؤلفون: Babiker, Ahmed, Karadkhele, Geeta, Bombin, Andrei, Watkins, Rockford, Robichaux, Chad, Smith, Gillian, Beechar, Vivek B, Steed, Danielle B, Jacobs, Jesse T, Read, Timothy D, Satola, Sarah, Larsen, Christian P, Kraft, Colleen S, Pouch, Stephanie M, Woodworth, Michael H

المساهمون: Antibacterial Resistance Leadership Group Early Faculty Seedling Award, National Institute of Allergy and Infectious Diseases

المصدر: Open Forum Infectious Diseases ; volume 11, issue 3 ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background Reducing the burden of multidrug-resistant organism (MDRO) colonization and infection among renal transplant recipients (RTRs) may improve patient outcomes. We aimed to assess whether the detection of an MDRO or a comparable antibiotic-susceptible organism (CSO) during the early post-transplant (EPT) period was associated with graft loss and mortality among RTRs. Methods We conducted a retrospective cohort study of RTRs transplanted between 2005 and 2021. EPT positivity was defined as a positive bacterial culture within 30 days of transplant. The incidence and prevalence of EPT MDRO detection were calculated. The primary outcome was a composite of 1-year allograft loss or mortality following transplant. Multivariable Cox hazard regression, competing risk, propensity score–weighted sensitivity, and subgroup analyses were performed. Results Among 3507 RTRs, the prevalence of EPT MDRO detection was 1.3% (95% CI, 0.91%–1.69%) with an incidence rate per 1000 EPT-days at risk of 0.42 (95% CI, 0.31–0.57). Among RTRs who met survival analysis inclusion criteria (n = 3432), 91% (3138/3432) had no positive EPT cultures and were designated as negative controls, 8% (263/3432) had a CSO detected, and 1% (31/3432) had an MDRO detected in the EPT period. EPT MDRO detection was associated with the composite outcome (adjusted hazard ratio [aHR], 3.29; 95% CI, 1.21–8.92) and death-censored allograft loss (cause-specific aHR, 7.15; 95% CI, 0.92–55.5; subdistribution aHR, 7.15; 95% CI, 0.95–53.7). A similar trend was seen in the subgroup and sensitivity analyses. Conclusions MDRO detection during the EPT period was associated with allograft loss, suggesting the need for increased strategies to optimize prevention of MDRO colonization and infection.

الإتاحة: https://doi.org/10.1093/ofid/ofae060Test
https://academic.oup.com/ofid/article-pdf/11/3/ofae060/56914436/ofae060.pdfTest

المؤلفون: Berryhill, Brandon A., Burke, Kylie B., Smith, Andrew P., Morgan, Jill S., Tarabay, Jessica, Mamora, Josia, Varkey, Jay B., Mumma, Joel M., Kraft, Colleen S.

المصدر: Infection Control & Hospital Epidemiology ; page 1-7 ; ISSN 0899-823X 1559-6834

الوصف: Objective: To determine if the high-level personal protective equipment used in the treatment of high-consequence infectious diseases is effective at stopping the spread of pathogens to healthcare personnel (HCP) while doffing. Background: Personal protective equipment (PPE) is fundamental to the safety of HCPs. HCPs treating patients with high-consequence infectious diseases use several layers of PPE, forming complex protective ensembles. With high-containment PPE, step-by-step procedures are often used for donning and doffing to minimize contamination risk to the HCP, but these procedures are rarely empirically validated and instead rely on following infection prevention best practices. Methods: A doffing protocol video for a high-containment PPE ensemble was evaluated to determine potential contamination pathways. These potential pathways were tested using fluorescence and genetically marked bacteriophages. Results: The experiments revealed existing protocols permit contamination pathways allowing for transmission of bacteriophages to HCPs. Updates to the doffing protocols were generated based on the discovered contamination pathways. This updated doffing protocol eliminated the movement of viable bacteriophages from the outside of the PPE to the skin of the HCP. Conclusions: Our results illustrate the need for quantitative, scientific investigations of infection prevention practices, such as doffing PPE.

الإتاحة: https://doi.org/10.1017/ice.2024.84Test
https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0899823X24000849Test

المؤلفون: Adelman, Max W, Woodworth, Michael H, Langelier, Charles, Busch, Lindsay M, Kempker, Jordan A, Kraft, Colleen S, Martin, Greg S

المصدر: Critical Care. 24(1)

مصطلحات موضوعية: Hematology, Prevention, Digestive Diseases, Nutrition, Complementary and Integrative Health, Infectious Diseases, Sepsis, Aetiology, 2.1 Biological and endogenous factors, Oral and gastrointestinal, Inflammatory and immune system, Infection, Fecal Microbiota Transplantation, Gastrointestinal Microbiome, Humans, Probiotics, Gut microbiome, Review, Fecal microbiota transplant, Sepsis, Gut microbiome, Review, Probiotics, Fecal microbiota transplant, Medical and Health Sciences, Emergency & Critical Care Medicine

الوصف: The gut microbiome regulates a number of homeostatic mechanisms in the healthy host including immune function and gut barrier protection. Loss of normal gut microbial structure and function has been associated with diseases as diverse as Clostridioides difficile infection, asthma, and epilepsy. Recent evidence has also demonstrated a link between the gut microbiome and sepsis. In this review, we focus on three key areas of the interaction between the gut microbiome and sepsis. First, prior to sepsis onset, gut microbiome alteration increases sepsis susceptibility through several mechanisms, including (a) allowing for expansion of pathogenic intestinal bacteria, (b) priming the immune system for a robust pro-inflammatory response, and (c) decreasing production of beneficial microbial products such as short-chain fatty acids. Second, once sepsis is established, gut microbiome disruption worsens and increases susceptibility to end-organ dysfunction. Third, there is limited evidence that microbiome-based therapeutics, including probiotics and selective digestive decontamination, may decrease sepsis risk and improve sepsis outcomes in select patient populations, but concerns about safety have limited uptake. Case reports of a different microbiome-based therapy, fecal microbiota transplantation, have shown correlation with gut microbial structure restoration and decreased inflammatory response, but these results require further validation. While much of the evidence linking the gut microbiome and sepsis has been established in pre-clinical studies, clinical evidence is lacking in many areas. To address this, we outline a potential research agenda for further investigating the interaction between the gut microbiome and sepsis.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/0d0748wsTest

المؤلفون: Takemiya, Kiyoko, Ning, Xinghai, Seo, Wonewoo, Wang, Xiaojian, Mohammad, Rafi, Joseph, Giji, Titterington, Jane S, Kraft, Colleen S, Nye, Jonathan A, Murthy, Niren, Goodman, Mark M, Taylor, W Robert

المصدر: JACC Cardiovascular Imaging. 12(5)

مصطلحات موضوعية: Biomedical and Clinical Sciences, Clinical Sciences, Infectious Diseases, Biomedical Imaging, Assistive Technology, Bioengineering, Infection, Animals, Disease Models, Animal, Early Diagnosis, Fluorescent Dyes, Fluorine Radioisotopes, Injections, Intravenous, Male, Oligosaccharides, Optical Imaging, Positron-Emission Tomography, Predictive Value of Tests, Prosthesis-Related Infections, Radiopharmaceuticals, Rats, Sprague-Dawley, Reproducibility of Results, Spectroscopy, Near-Infrared, Staphylococcal Infections, Staphylococcus aureus, Time Factors, bacterial imaging, medical device infections, optical imaging, PET, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences

الوصف: ObjectivesThe aim of this study was to develop imaging agents to detect early stage infections in implantable cardiac devices.BackgroundBacteria ingest maltodextrins through the specific maltodextrin transporter. We developed probes conjugated with either a fluorescent dye (maltohexaose fluorescent dye probe [MDP]) or a F-18 (F18 fluoromaltohexaose) and determined their usefulness in a model of infections associated with implanted cardiac devices.MethodsStainless steel mock-ups of medical devices were implanted subcutaneously in rats. On post-operative day 4, animals were injected with either Staphylococcus aureus around the mock-ups to induce a relatively mild infection or oil of turpentine to induce noninfectious inflammation. Animals with a sterile implant were used as control subjects. On post-operative day 6, either the MDP or F18 fluoromaltohexaose was injected intravenously, and the animals were scanned with the appropriate imaging device. Additional positron emission tomography imaging studies were performed with F18-fluorodeoxyglucose as a comparison of the specificity of our probes (n = 5 to 9 per group).ResultsThe accumulation of the MDP in the infected rats was significantly increased at 1 h after injection when compared with the control and noninfectious inflammation groups (intensity ratio 1.54 ± 0.07 vs. 1.26 ± 0.04 and 1.20 ± 0.05, respectively; p < 0.05) and persisted for more than 24 h. In positron emission tomography imaging, both F18 fluoromaltohexaose and F18 fluorodeoxyglucose significantly accumulated in the infected area 30 min after the injection (maximum standard uptake value ratio 4.43 ± 0.30 and 4.87 ± 0.28, respectively). In control rats, there was no accumulation of imaging probes near the device. In the noninfectious inflammation rats, no significant accumulation was observed with F18 fluoromaltohexaose, but F18 fluorodeoxyglucose accumulated in the mock-up area (maximum standard uptake value 2.53 ± 0.39 vs. 4.74 ± 0.46, respectively; p < 0.05).ConclusionsOur results indicate that maltohexaose-based imaging probes are potentially useful for the specific and sensitive diagnosis of infections associated with implantable cardiac devices.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/3jm4k9hrTest

المؤلفون: Cheng, Yao-Wen, Phelps, Emmalee, Ganapini, Vincent, Khan, Noor, Ouyang, Fangqian, Xu, Huiping, Khanna, Sahil, Tariq, Raseen, Friedman-Moraco, Rachel J, Woodworth, Michael H, Dhere, Tanvi, Kraft, Colleen S, Kao, Dina, Smith, Justin, Le, Lien, El-Nachef, Najwa, Kaur, Nirmal, Kowsika, Sree, Ehrlich, Adam, Smith, Michael, Safdar, Nasia, Misch, Elizabeth Ann, Allegretti, Jessica R, Flynn, Ann, Kassam, Zain, Sharfuddin, Asif, Vuppalanchi, Raj, Fischer, Monika

المصدر: American Journal of Transplantation. 19(2)

مصطلحات موضوعية: Clinical Research, Transplantation, Vaccine Related, Biodefense, Prevention, Emerging Infectious Diseases, Infectious Diseases, Organ Transplantation, Patient Safety, Digestive Diseases, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Infection, Clostridioides difficile, Clostridium Infections, Fecal Microbiota Transplantation, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Recurrence, Retrospective Studies, Transplant Recipients, Treatment Outcome, United States, clinical research, practice, complication: infectious, immunosuppression, immune modulation, infection and infectious agents - bacterial: Clostridium difficile, infectious disease, intestinal disease: infectious, organ transplantation in general, patient safety, clinical research/practice, immunosuppression/immune modulation, Medical and Health Sciences, Surgery

الوصف: Fecal microbiota transplant (FMT) is recommended for Clostridium difficile infection (CDI) treatment; however, use in solid organ transplantation (SOT) patients has theoretical safety concerns. This multicenter, retrospective study evaluated FMT safety, effectiveness, and risk factors for failure in SOT patients. Primary cure and overall cure were defined as resolution of diarrhea or negative C difficile stool test after a single FMT or after subsequent FMT(s) ± anti-CDI antibiotics, respectively. Ninety-four SOT patients underwent FMT, 78% for recurrent CDI and 22% for severe or fulminant CDI. FMT-related adverse events (AE) occurred in 22.3% of cases, mainly comprising self-limiting conditions including nausea, abdominal pain, and FMT-related diarrhea. Severe AEs occurred in 3.2% of cases, with no FMT-related bacteremia. After FMT, 25% of patients with underlying inflammatory bowel disease had worsening disease activity, while 14% of cytomegalovirus-seropositive patients had reactivation. At 3 months, primary cure was 58.7%, while overall cure was 91.3%. Predictors of failing a single FMT included inpatient status, severe and fulminant CDI, presence of pseudomembranous colitis, and use of non-CDI antibiotics at the time of FMT. These data suggest FMT is safe in SOT patients. However, repeated FMT(s) or additional antibiotics may be needed to optimize rates of cure with FMT.

وصف الملف: application/pdf

الوصول الحر: https://escholarship.org/uc/item/97j343h5Test

المؤلفون: Berenson, Charles S, Lashner, Bret, Korman, Louis Y, Hohmann, Elizabeth, Deshpande, Abhishek, Louie, Thomas J, Sims, Matthew, Pardi, Darrell, Kraft, Colleen S, Wang, Elaine E L, Cohen, Stuart H, Feuerstadt, Paul, Oneto, Caterina, Misra, Bharat, Pullman, John, De, Ananya, Memisoglu, Asli, Lombardi, David A, Hasson, Brooke R, McGovern, Barbara H, von Moltke, Lisa, Lee, Christine H

المساهمون: Seres Therapeutics

المصدر: Clinical Infectious Diseases ; volume 77, issue 11, page 1504-1510 ; ISSN 1058-4838 1537-6591

الوصف: Background Although comorbidities are risk factors for recurrent Clostridioides difficile infection (rCDI), many clinical trials exclude patients with medical conditions such as malignancy or immunosuppression. In a phase 3, double-blind, placebo-controlled, randomized trial (ECOSPOR III), fecal microbiota spores, live (VOWST, Seres Therapeutics; hereafter “VOS,” formerly SER-109), an oral microbiota therapeutic, significantly reduced the risk of rCDI at week 8. We evaluated the efficacy of VOS compared with placebo in patients with comorbidities and other risk factors for rCDI. Methods Adults with rCDI were randomized to receive VOS or placebo (4 capsules daily for 3 days) following standard-of-care antibiotics. In this post hoc analysis, the rate of rCDI through week 8 was assessed in VOS-treated participants compared with placebo for subgroups including (i) Charlson comorbidity index (CCI) score category (0, 1–2, 3–4, ≥5); (ii) baseline creatinine clearance (<30, 30–50, >50 to 80, or >80 mL/minute); (iii) number of CDI episodes, inclusive of the qualifying episode (3 and ≥4); (iv) exposure to non-CDI-targeted antibiotics after dosing; and (v) acid-suppressing medication use at baseline. Results Of 281 participants screened, 182 were randomized (59.9% female; mean age, 65.5 years). Comorbidities were common with a mean overall baseline age-adjusted CCI score of 4.1 (4.1 in the VOS arm and 4.2 in the placebo arm). Across all subgroups analyzed, VOS-treated participants had a lower relative risk of recurrence compared with placebo. Conclusions In this post hoc analysis, VOS reduced the risk of rCDI compared with placebo, regardless of baseline characteristics, concomitant medications, or comorbidities.

الإتاحة: https://doi.org/10.1093/cid/ciad448Test
https://academic.oup.com/cid/article-pdf/77/11/1504/53899613/ciad448.pdfTest

المؤلفون: Busch, Lindsay M, Harris, Gavin, Ockers, Sandy, Kraft, Colleen S

المصدر: Open Forum Infectious Diseases ; volume 10, issue Supplement_2 ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background The Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) is a special pathogen treatment biocontainment unit. Medical care is led by Infectious Disease (ID) specialists with an interdisciplinary group of nurses, infection preventionists, laboratorians, and consultants. In the 2014 Ebola Virus Disease (EVD) outbreak, the SCDU treated four EVD patients, one critically-ill requiring mechanical ventilation and dialysis. Critical care (CC) services were provided through consultation by CC staff, requiring just-in-time (JIT) training in high-level personal protective equipment (PPE) and real-time adaptation of standard operating procedures (SOPs) to meet biocontainment needs. The care provided was successful: all patients survived and no serious PPE breaches or provider exposures occurred. However, these events revealed the need for a comprehensive plan for SCDU CC services. Methods SCDU-CC physician liaison and lead advance practice provider (APP) positions were created to implement SCDU CC in conjunction with the Emory Critical Care Center (ECCC). Previous CC services were reviewed and revised. Results An integrated staffing model of ID-CC co-management was proposed. CC provider roles were codified: participate in regular high-level PPE training/verification and procedural simulation; attend quarterly interdisciplinary trainings and monthly provider meetings; maintain high quality patient care per ECCC standards. Following unit activation, the SCDU-CC liaisons and lead APP construct a JIT CC schedule. APPs provide 24hour in-house coverage in 12hour day/night shifts. Depending on patient number/acuity, physician coverage consists of in-house day coverage with night home call or 12hour day/night shifts. CC co-manages with the ID physician. Conclusion CC delivery in the SCDU has been improved after 2014. CC services were previously deployed ad hoc, with simultaneous need for JIT high-level PPE training of new personnel, urgent patient assessment, and modification of SOPs for ...

الإتاحة: https://doi.org/10.1093/ofid/ofad500.1597Test
https://academic.oup.com/ofid/article-pdf/10/Supplement_2/ofad500.1597/53762924/ofad500.1597.pdfTest

المؤلفون: Brink, Catherine, Conrad, Roth, Babiker, Ahmed, Hatt, Janet, Barrios-Steed, Danielle, Kraft, Colleen S, Woodworth, Michael H, Konstantinidis, Konstantinos

المصدر: Open Forum Infectious Diseases ; volume 10, issue Supplement_2 ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background Fecal microbiota transplantation (FMT) is a procedure that has gained popularity due to the high efficacy in treating recurrent Clostridioides difficile infections (RCDI) and other conditions associated with a dysbiotic gut microbiome. Despite the widespread acceptance of the technique, repeating its success in RCDI treatment in other diseases has been difficult due to the individual-level variation in disease effects on the gut and the emphasis on taxonomic, rather than functional, microbiome analyses. We present a metagenomic analysis of the use of FMT to treat renal transplant patients infected with multidrug-resistant organisms (MDROs). Methods DNA was extracted from longitudinally collected participant stool samples before and after FMT. Reads were assembled and binned into metagenome assembled genomes (MAGs), which were then mapped back to the reads to calculate relative abundance, breadth and sequencing depth in each patient sample. This allowed us to assess the species-level changes in the composition of patient microbiomes after FMT treatment. Results We identified four MAGs, representing close relatives of Akkermansia muciniphila, Dakarella massiliensis, Mesosutterella multiformis and Waltera intestinalis, that showed a pattern of engraftment (absent or undetectable before FMT, but present for at least two consecutive timepoints after treatment) in FMT-treated patients. We also observed clear evidence of a donor MAG closely related to Faecalibacterium gallinarum replacing patient MAGs identified as Faecalibacterium hattori, revealing a potential mechanism of successful FMT treatment though a resistant strain in the patient microbiome likely being outcompeted by a drug-susceptible strain of the same species from the donor. Conclusion Herein we elucidated the taxonomic changes that take place in renal transplant patient gut microbiomes with reduced MDRO colonisation in response to FMT treatment. Future efforts will aim to identify the shifts in the functional gene profiles of the ...

الإتاحة: https://doi.org/10.1093/ofid/ofad500.384Test
https://academic.oup.com/ofid/article-pdf/10/Supplement_2/ofad500.384/53755387/ofad500.384.pdfTest

المؤلفون: Burke, Kylie, Berryhill, Brandon A, Kraft, Colleen S, Smith, Andrew, Morgan, Jill, Tarabay, Jessica, Mamora, Josia, Varkey, Jay, Mumma, Joel, Grant, Darryl, Busch, Lindsay M, Carag, Jessica

المصدر: Open Forum Infectious Diseases ; volume 10, issue Supplement_2 ; ISSN 2328-8957

مصطلحات موضوعية: Infectious Diseases, Oncology

الوصف: Background Personal protective equipment (PPE) is the cornerstone of healthcare worker (HCW) safety and prevention of the spread of pathogens. To limit the potential risk to HCWs, healthcare institutions have employed infection control policies and procedures. When treating patients with high consequence infectious diseases, such as Ebola virus disease, HCWs wear complex personal protective equipment (PPE) ensembles that cover their entire body with multiple layers. These layers build redundancy to ensure protection of the HCWs' skin and clothing. Manufacturers typically provide recommendations for donning and doffing individual PPE pieces, but protocols differ between healthcare institutions for PPE ensembles. These PPE ensembles and their associated doffing protocols are rarely tested empirically. Methods We reviewed footage of the doffing protocol currently employed at a Regional Emerging Special Pathogen Treatment Center. From this analysis we identified potential contamination pathways which we verified by using a fluorescent pathogen proxy. To account for viable pathogen susceptibility to alcohol-based disinfectant, HCWs donned the PPE ensemble and were then contaminated with three genetically marked bacteriophages (phage). After completing the doffing protocol, the HCW’s skin and PPE were swabbed to test for the transfer of viable phage to the HCW. Results All four of the HCWs that completed the initial doffing protocol had a high recovery of phage from at least one sampling location. Subsequently, we implemented interventions to both the equipment and the doffing procedure. In nine trials with this modified protocol, no viable phage was recovered from any of the HCWs. Recovery of Bacteriophage Transferred to HCW during Doffing Before and After Protocol Interventions. N=4 subjects for original protocol, N=9 subjects for revised protocol. Percentage of HCW for whom bacteriophage PCR was positive, average density of recovered phage when available--% (avg density). X- PCR positive, phage inactivated ...

الإتاحة: https://doi.org/10.1093/ofid/ofad500.807Test
https://academic.oup.com/ofid/article-pdf/10/Supplement_2/ofad500.807/53778065/ofad500.807.pdfTest