Microorganism contamination of mezuzahs in a tertiary care hospital in Brooklyn, New York City

Despite the growing importance of carbapenem-resistantKlebsiella pneumoniae(CRKP), the clonal relationships between CRKP and antibiotic-susceptible isolates remain unclear. We compared the genetic diversity and clinical features of CRKP, third-generation and/or fourth-generation cephalosporin-resistant (Ceph-R)K. pneumoniae, and susceptibleK. pneumoniaeisolates causing bloodstream infections at a tertiary care hospital in New York City between January 2012 and July 2013. Drug susceptibilities were determined with the Vitek 2 system. Isolates underwent multilocus sequence typing and PCR sequencing of thewziandblaKPCgenes. Clinical and microbiological data were extracted from patient records and correlated with molecular data. Among 223 patients, we identified 272 isolates. Of these, 194 were susceptible, 30 Ceph-R, and 48 CRKP, belonging to 144 sequence types (STs). Susceptible (127 STs) and Ceph-R (20 STs) isolates were highly diverse. ST258 dominated CRKP strains (12 STs, with 63% ST258). There was minimal overlap in STs between resistance groups. TheblaKPC-3gene (30%) was restricted to ST258/wzi154, whereasblaKPC-2(70%) was observed for severalwziallele types. CRKP infections occurred more frequently among solid organ transplant (31%) and dialysis (17%) patients. Mortality rates were high overall (28%) and highest among CRKP-infected patients (59%). In multivariable analyses, advanced age, comorbidities, and disease severity were significant predictors of 30-day mortality rates, whereas theK. pneumoniaesusceptibility phenotype was not. Among CRKP infections, we observed a borderline significant association of increased mortality rates with ST258 and thewzi154 allele. Although the clonal spread of ST258 continues to contribute substantially to the dissemination of CRKP, non-ST258 strains appear to be evolving. Further investigations into the mechanisms promoting CRKP diversification and the effects of clonal backgrounds on outcomes are warranted.

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All-cause mortality in hospitalized HIV-infected patients at an acute tertiary care hospital with a comprehensive outpatient HIV care program in New York City in the era of highly active antiretroviral therapy (HAART)

Infection ◽

10.1007/s15010-012-0386-7 ◽

2012 ◽

Vol 41 (2) ◽

pp. 545-551 ◽

Cited By ~ 40

Author(s):

J. H. Kim ◽

G. Psevdos ◽

E. Gonzalez ◽

S. Singh ◽

M. C. Kilayko ◽

...

Keyword(s):

New York ◽

New York City ◽

Highly Active Antiretroviral Therapy ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Program ◽

Hiv Care ◽

Care Hospital ◽

Highly Active ◽

All Cause Mortality

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Appropriateness of Gram-Negative Agent Use at a Tertiary Care Hospital in the Setting of Significant Antimicrobial Resistance

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv009 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 5

Author(s):

Neil M. Vora ◽

Christine J. Kubin ◽

E. Yoko Furuya

Keyword(s):

New York ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Categorical Variables ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Gram Negative ◽

Stewardship Program

Abstract Background. Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods. We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ2 or Fischer's exact test for categorical variables and Student t test or Mann–Whitney U test for continuous variables. Results. A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29–.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28–.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09–.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35–5.16) was associated with suboptimal use. Conclusions. Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.

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Associations of Early COVID-19 Cases in San Francisco With Domestic and International Travel

Clinical Infectious Diseases ◽

10.1093/cid/ciaa599 ◽

2020 ◽

Vol 71 (11) ◽

pp. 2976-2980 ◽

Cited By ~ 1

Author(s):

Wei Gu ◽

Xianding Deng ◽

Kevin Reyes ◽

Elaine Hsu ◽

Candace Wang ◽

...

Keyword(s):

New York ◽

San Francisco ◽

Odds Ratio ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

International Travel ◽

Care Hospital ◽

Viral Genomes

Abstract In early-to-mid March 2020, 20 of 46 (43%) COVID-19 cases at a tertiary care hospital in San Francisco, California were travel related. Cases were significantly associated with travel to either Europe (odds ratio, 6.1) or New York (odds ratio, 32.9). Viral genomes recovered from 9 of 12 (75%) cases co-clustered with lineages circulating in Europe.

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Epidemiology of bloodstream infections caused by methicillin-resistant Staphylococcus aureus at a tertiary care hospital in New York

American Journal of Infection Control ◽

10.1016/j.ajic.2015.08.005 ◽

2016 ◽

Vol 44 (1) ◽

pp. 41-46 ◽

Cited By ~ 9

Author(s):

Mohamad Yasmin ◽

Halim El Hage ◽

Rita Obeid ◽

Hanine El Haddad ◽

Mazen Zaarour ◽

...

Keyword(s):

New York ◽

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Bloodstream Infections ◽

Care Hospital ◽

Methicillin Resistant

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Ensuring Standardization, Quality Management And Improvement Of Point-Of-Care Testing In The Municipal Public Health System Based Ambulatory Care And School Health Clinics In New York City

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.243 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S114-S114

Author(s):

T Sherpa ◽

T Choesang ◽

S Ahmad ◽

F M Huq Ronny

Keyword(s):

New York ◽

New York City ◽

Health System ◽

Ambulatory Care ◽

Acute Care ◽

York City ◽

Point Of Care ◽

Care Hospital ◽

Laboratory Service

Abstract Introduction/Objective Operated under different acute care hospital clinical laboratory limited-service laboratory (LSL) licenses, our New York City five borough spanning multisite ambulatory clinics and school-based clinics have been offering various waived point-of-care tests (POCTs) and provider-performed microscopy (PPM) to the local communities. A wide range of variability existed among the clinics concerning regulatory compliance, test performance, quality control and training. To ensure standardization and quality of POCT across the health system, our laboratory service adopted and implemented a plan for systemwide LSL transfer from the acute care hospitals to ambulatory care laboratory service for centralized implementation, monitoring, and oversight of the POCT operations. Methods/Case Report Having over 60 clinics, while transferring the LSLs, we chose multi-site license with ten or more sites on each license and by phase transfer from NYSDOH. Since the commencement of the transfer, system wide our qualified laboratory personnel have been updating and providing standard operating procedures (SOP), performing quality assurance and validation of new tests/devices, providing competency assessments and helping clinical staffs maintain compliance with state and other regulatory agencies. Results (if a Case Study enter NA) After the final phase of the transfer and POCT standardization implementation in 63 clinics, currently the clinical staffs performing POCT, get expeditious training and troubleshooting in more timely manner and the providers get the results of the ordered POCTs much faster and more efficiently and overall the quality metrics get improved markedly, indicated by internal audit team. Conclusion Even though Implementation of the planned POCT standardization was initially challenging due to the vastness and complexity of our multisite ambulatory care network and later confounded by the COVID -19 pandemic effect but eventually, it helped improve patient care delivery significantly and very effectively. Expectedly, our planned transfer implementation provided standardization and ensured improved quality of POC testing across our health system.

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High prevalence of t895 and t9364 spa types of methicillin-resistant Staphylococcus aureus in a tertiary-care hospital in México: Different lineages of Clonal Complex 5

10.21203/rs.3.rs-16742/v1 ◽

2020 ◽

Author(s):

C Negrete-González ◽

E Turrubiartes-Martínez ◽

OG Galicia-Cruz ◽

DE Noyola ◽

G Martínez-Aguilar ◽

...

Keyword(s):

New York ◽

Staphylococcus Aureus ◽

Clonal Complex ◽

Tertiary Care Hospital ◽

Sccmec Type ◽

Tertiary Care ◽

Molecular Characteristics ◽

Care Hospital ◽

Methicillin Resistant ◽

Spa Types

Abstract BACKGROUND Staphylococcus aureus is a leading cause of broad-spectrum infections both, in the community and within the healthcare settings. The methicillin-resistant Staphylococcus aureus (MRSA) variant has became a global issue of public health. The aim of this study was to examine the clinical and molecular characteristics of Staphylococcus aureus isolates and to define the population structure and distribution of major MRSA clones present in a tertiary-care hospital in Mexico. RESULTS From April 2017 to April 2018, 191 isolates of Staphylococcus aureus were collected. The frequency of MRSA was 26.7%, these strains exhibited resistance to clindamycin (85.3%), erythromycin (86.2%), levofloxacin (80.3%), and ciprofloxacin (86.3%). The majority of MRSA strains harbored the SCCmec type II (39/51); the t895 (29/51) and t9364 (6/51) were the most common spa types in both, hospital-associated MRSA and community associated MRSA isolates. The clones ST5-MRSA-II-t895 (New York /Japan clone) and ST1011-MRSA-II-t9364 (New York /Japan-Mexican Variant clone) were the most frequent. Finally, different lineages of Clonal Complex 5 (90.6%) and Clonal Complex 8 (9.1%) were identified in this study. CONCLUSION Our study provides valuable information about the epidemiology of MRSA in a city of the central region of Mexico, and this is the first report on the association between the t895 and t9364 spa types and the ST5 and ST1011 lineages, respectively.

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505. Use of CLABSI Prevention Bundle Audits to Decrease CLABSI Rates in COVID Positive ICU Patients in an Acute Care Hospital in New York City During the COVID-19 Epidemic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.699 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S318-S319

Author(s):

Marie Moss ◽

Jordan Ehni ◽

Ilka Herbison ◽

Kristine B Rabii ◽

Caitlin Koepsell ◽

...

Keyword(s):

New York ◽

New York City ◽

Acute Care ◽

York City ◽

Acute Care Hospital ◽

Central Line ◽

Care Hospital ◽

Icu Patients ◽

Central Lines ◽

Audit Team

Abstract Background Mount Sinai Beth Israel (MSBI) is a 220 bed acute care hospital located in the Manhattan borough of Manhattan in New York City. Prior to COVID-19, the hospital had one 16-bed Medical/Surgical ICU. When the COVID epidemic struck New York City, the MSBI ED was flooded with critically ill patients requiring ICU care. Seven other ICUs were opened, all of which were filled with COVID patients. The majority of these patients required central lines for the multiple antibiotics, steroids, and vasopressors they needed to survive. Agency RNs were brought in to care for ICU patients. In April, the MSBI Infection Prevention (IP) department received several CLABSI notifications through its data mining system. The IPs were alarmed at the number of CLABSIs occurring in ICU COVID patients with central lines. ICU CLABSI Rates in an Acute Care Hospital During the COVID-19 Epidemic in New York City Methods A baseline assessment, using the central line maintenance bundle, was conducted on all COVID patients with central lines. This assessment revealed issues with central line maintenance, including: undated, bloody, and non-intact dressings, poorly placed CHG impregnated disks; blood in end-caps, and missing alcohol impregnated caps on ports. The decision was made to bring in infusion RNs from an outpatient system site to perform daily rounds on central lines. These RNs performed daily intensive maintenance bundle rounds for a month during the COVID epidemic. During their rounds, ICU nurses and managers were notified of central line dressing and cap issues and educated on how to correct them. These RNs also e-mailed daily reports of their findings to Nursing Leadership for their review. Central Line Audit Team: RNs Who Monitored Central Lines in COVID ICUs in An Acute Care Hospital in NYC Central Line Audit Team: RNs Who Monitored Central Lines in COVID ICUs in An Acute Care Hospital in NYC Results Central line rounds performed after the intervention showed a great improvement in compliance with the central line maintenance bundle, from 13% during the first rounds performed in April, to 88% in May, less than a month after these rounds started. Since this intervention, the ICU CLABSI rate has decreased from a rate of 3.3 per 1,000 central line days in April and May to a current rate of 0. Conclusion The timely identification and root cause analysis of a problem must be followed by timely, intensive, and repeated interventions that are designed to attack the causes of problems at their source. After the crisis period is over, the interventions must be maintained to ensure that gains made can be sustained. Disclosures All Authors: No reported disclosures

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Supervised Machine Learning Approach to Identify Early Predictors of Poor Outcome in Patients with COVID-19 Presenting to a Large Quaternary Care Hospital in New York City

Journal of Clinical Medicine ◽

10.3390/jcm10163523 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3523

Author(s):

Jason Zucker ◽

Angela Gomez-Simmonds ◽

Lawrence J. Purpura ◽

Sherif Shoucri ◽

Elijah LaSota ◽

...

Keyword(s):

New York ◽

New York City ◽

York City ◽

Supervised Machine Learning ◽

Symptom Duration ◽

Control Analysis ◽

Care Hospital ◽

Cart Analysis ◽

Poor Outcome ◽

Increased Risk

Background: The progression of clinical manifestations in patients with coronavirus disease 2019 (COVID-19) highlights the need to account for symptom duration at the time of hospital presentation in decision-making algorithms. Methods: We performed a nested case–control analysis of 4103 adult patients with COVID-19 and at least 28 days of follow-up who presented to a New York City medical center. Multivariable logistic regression and classification and regression tree (CART) analysis were used to identify predictors of poor outcome. Results: Patients presenting to the hospital earlier in their disease course were older, had more comorbidities, and a greater proportion decompensated (<4 days, 41%; 4–8 days, 31%; >8 days, 26%). The first recorded oxygen delivery method was the most important predictor of decompensation overall in CART analysis. In patients with symptoms for <4, 4–8, and >8 days, requiring at least non-rebreather, age ≥ 63 years, and neutrophil/lymphocyte ratio ≥ 5.1; requiring at least non-rebreather, IL-6 ≥ 24.7 pg/mL, and D-dimer ≥ 2.4 µg/mL; and IL-6 ≥ 64.3 pg/mL, requiring non-rebreather, and CRP ≥ 152.5 mg/mL in predictive models were independently associated with poor outcome, respectively. Conclusion: Symptom duration in tandem with initial clinical and laboratory markers can be used to identify patients with COVID-19 at increased risk for poor outcomes.

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