Assessing diagnostic coding practices among a sample of healthcare facilities in Lyme disease endemic areas: Maryland and New York - A Brief Report

Abstract Objective: Candida auris infections continue to occur across the United States and abroad, and healthcare facilities that care for vulnerable populations must improve their readiness to respond to this emerging organism. We aimed to identify and better understand challenges faced and lessons learned by those healthcare facilities who have experienced C. auris cases and outbreaks to better prepare those who have yet to experience or respond to this pathogen. Design: Semi-structured qualitative interviews. Setting: Health departments, long-term care facilities, acute-care hospitals, and healthcare organizations in New York, Illinois, and California. Participants: Infectious disease physicians and nurses, clinical and environmental services, hospital leadership, hospital epidemiology, infection preventionists, emergency management, and laboratory scientists who had experiences either preparing for or responding to C. auris cases or outbreaks. Methods: In total, 25 interviews were conducted with 84 participants. Interviews were coded using NVivo qualitative coding software by 2 separate researchers. Emergent themes were then iteratively discussed among the research team. Results: Key themes included surveillance and laboratory capacity, inter- and intrafacility communication, infection prevention and control, environmental cleaning and disinfection, clinical management of cases, and media concerns and stigma. Conclusions: Many of the operational challenges noted in this research are not unique to C. auris, and the ways in which we address future outbreaks should be informed by previous experiences and lessons learned, including the recent outbreaks of C. auris in the United States.

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Controlling a Multicenter Outbreak Involving the New York/Japan Methicillin-ResistantStaphylococcus aureusClone

Infection Control and Hospital Epidemiology ◽

10.1086/518726 ◽

2007 ◽

Vol 28 (7) ◽

pp. 845-852 ◽

Cited By ~ 25

Author(s):

G. W. Coombs ◽

H. Van Gessel ◽

J. C. Pearson ◽

M.-R. Godsell ◽

F. G. O'Brien ◽

...

Keyword(s):

Public Health ◽

New York ◽

Molecular Typing ◽

Management Strategies ◽

Research Unit ◽

Management Policy ◽

Teaching Hospitals ◽

Term Care ◽

Outbreak Management ◽

Healthcare Facilities

Objective.To describe the control of an outbreak of infection and colonization with the New York/Japan methicillin-resistantStaphylococcus aureus(MRSA) clone in multiple healthcare facilities, and to demonstrate the importance of making an MRSA management policy involving molecular typing of MRSA into a statewide public health responsibility.Setting.A range of healthcare facilities, including 2 metropolitan teaching hospitals and a regional hospital, as well as several community hospitals and long-term care facilities in a nonmetropolitan healthcare region.Interventions.A comprehensive, statewide MRSA epidemiological investigation and management policy.Results.In May 2005, there were 3 isolates referred to the Western Australian Gram-Positive Bacteria Typing and Research Unit that were identified as the New York/Japan MRSA clone, a pandemic MRSA clone with the ability to spread and replace existing clones in a region. Subsequent investigation identified 28 additional cases of infection and/or colonization dating from 2002 onward, including 1 involving a colonized healthcare worker (HCW) who had previously been hospitalized overseas. Of the 31 isolates detected, 25 were linked epidemiologically and via molecular typing to the isolate recovered from the colonized HCW. Four isolates appeared to have been introduced separately from overseas. Although the isolate from the single remaining case patient was genetically indistinct from the isolates that spread within Western Australia, no specific epidemiological link could be established. The application of standard outbreak management strategies reduced further spread.Conclusions.The elimination of the New/York Japan MRSA clone in a healthcare region demonstrates the importance of incorporating MRSA management policy into statewide public health programs. The mainstays of such programs should include a comprehensive and effective outbreak identification and management policy (including pre-employment screening of HCWs, where applicable) and MRSA clone identification by multilocus sequence typing.

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1579. Multidrug-Resistant Candida auris Isolates From New York Hospitals and Healthcare Facilities Are Susceptible to Antifungal Combinations

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1443 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S576-S577

Author(s):

Brittany O’Brien ◽

Sudha Chaturvedi ◽

Vishnu Chaturvedi

Keyword(s):

New York ◽

Diagnostic System ◽

Multidrug Resistant ◽

Drug Combinations ◽

Antifungal Drugs ◽

Drug Resistant ◽

Candida Auris ◽

Current Case ◽

Healthcare Facilities ◽

Broth Microdilution Method

Abstract Background Candida auris outbreak continues unabated in New York with the current case counts exceeding 300 patients. We used a modification of standard CLSI broth microdilution method (BMD) if two-drug combinations are efficacious against C. auris isolates with high-resistance to fluconazole (FZ, MIC50 >256 mg/L), and variable resistance to other broad-spectrum antifungal drugs. Methods BMD plates were custom-designed and quality controlled by TREK Diagnostic System. The combination tests of 15 drug-resistant C. auris involved microtiter wells with the initial 144 two-drug combinations and their two-fold dilutions (1/2–1/32) to get 864 two-drug combinations finally. We utilized MIC100 endpoints for the drug combination readings as reported earlier for the intra- and inter-laboratory agreements obtained against Candida species and Aspergillus fumigatus (Antimicrob Agents Chemother. 2015. 59:1759–1766). We also tested minimum fungicidal concentrations (MFC). Results We tested all possible 864 two-drug antifungal combinations for nine antifungal drugs in use to yield 12,960 MIC100 readings, and MFC readings for 15 C. auris isolates. Flucytosine (FLC) at 2.0 mg/L potentiated most successful combinations with other drugs. Micafungin (MFG), Anidulafungin (AFG), Caspofungin (CAS) at individual concentrations of 0.25 mg/L combined well with FLC (2.0 mg/L) to yield MIC100 for 14, 13, and 12 of 15 C. auris isolates tested, respectively. MFG/FLC combination was also fungicidal for 4 of 15 isolates. AMB / FLC (0.25/1.0 mg/L) yielded MIC100 for 13 isolates and MFC for three test isolates. Posaconazole (POS), and Isavuconazole (ISA) and Voriconazole (VRC) also combined well with FLC (0.25/2.0 mg/L) to yield MIC100 for 12, 13, and 13 isolates, respectively. POS/FLC combination was fungicidal for three isolates. Conclusion We identified seven two drug-combinations of antifungals efficacious against drug-resistant C. auris strains. The modified BMD combination susceptibility testing could be used by the clinical laboratories to assist providers with the selection of optimal treatment for C. auris candidemia. Disclosures All authors: No reported disclosures.

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Epidemiology of Lyme disease among US Veterans in Long Island, New York

Ticks and Tick-borne Diseases ◽

10.1016/j.ttbdis.2018.12.003 ◽

2019 ◽

Vol 10 (2) ◽

pp. 407-411

Author(s):

George Psevdos ◽

Teresa Khoo ◽

Robert Chow ◽

Christopher L Romano ◽

Scott Campbell

Keyword(s):

New York ◽

Lyme Disease ◽

Long Island ◽

Us Veterans

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Awareness that Dogs Can Be Carriers for Ticks that Transmit Lyme Disease

Californian Journal of Health Promotion ◽

10.32398/cjhp.v14i2.1877 ◽

2016 ◽

Vol 14 (2) ◽

pp. 74-80

Author(s):

Joshua Fogel ◽

Sherilyne Co

Keyword(s):

College Students ◽

New York ◽

Lyme Disease ◽

Disease Knowledge ◽

Disease Awareness ◽

Previous Diagnosis ◽

Health Practitioners ◽

Dog Owners ◽

Public Health Practitioners ◽

African American Race

Background and Purpose: Tick exposure places one at possible risk for Lyme disease. Awareness of this fact can possibly prevent its occurrence. Urban college students are often in outdoor areas where there is potential tick exposure. Methods: College students in New York City (n=714) were surveyed about demographics, Lyme-disease knowledge, Lyme disease related topics, and dog-specific items. Multivariate logistic regression analyses were conducted to identify factors that are related to awareness that dogs can be carriers for ticks that transmit Lyme disease. Results: For both dog owners and those who do not own dogs, certain Lyme disease knowledge topics, previously heard of Lyme disease, and aware of a Lyme disease dog vaccine were each associated with increased odds for awareness about dogs being carriers. Among dog owners, African American race/ethnicity and knowing someone diagnosed with Lyme disease were each associated with increased odds for awareness, while previous diagnosis of Lyme disease had decreased odds for awareness. Conclusion: One-on-one education by physicians, nurses, veterinarians, healthcare practitioners and public health practitioners could help address some of the lack of awareness among urban college students that dogs can be carriers for ticks that can transmit Lyme disease.

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Lyme Arthritis in Children on the Uptick in Western New York Area

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/1179544119890851 ◽

2019 ◽

Vol 12 ◽

pp. 117954411989085

Author(s):

Lauren N Lucente ◽

Aseel Abu-Dayya ◽

Teresa Hennon ◽

Shamim Islam ◽

Brian H Wrotniak ◽

...

Keyword(s):

Health Care ◽

New York ◽

Lyme Disease ◽

Clinical Features ◽

Health Care Providers ◽

Pediatric Population ◽

Geographic Area ◽

Rapid Onset ◽

Lyme Arthritis ◽

Care Providers

Objective: This study explores a suspected increasing incidence of Lyme arthritis in the Western New York pediatric population. In addition, we aim to describe a clinical picture of Lyme arthritis and the clinical features that distinguish it from other forms of arthritis. Methods: Patients diagnosed with Lyme arthritis between January 2014 and September 2018 were identified using International Classification of Diseases—10th Revision (ICD 10) codes for Lyme disease and Lyme arthritis. Patients were included in the study if they (1) exhibited arthritis, (2) tested positive for Lyme antibodies, and (3) exhibited a positive Western blot. Results: A total of 22 patients were included in the study. There was a general trend toward an increasing number of cases of Lyme arthritis over the 45-month observation period. We identified 1 case in each 2014 and 2015, 4 cases in 2016, 7 in 2017, and 9 in the first 9 months of 2018. In total, 17 patients had arthritis as their only symptom at the time of diagnosis and 10 patients had a rash or a history that prompted suspicion of Lyme disease. The knee was the most frequent joint (86.4% of patients), and patients typically had 2 or fewer joints affected (86.4% of patients). Conclusions: A significant increase ( P = .02) in Lyme arthritis cases was observed at Oishei Children’s Hospital of Buffalo. Lyme arthritis may clinically present similarly to other forms of arthritis, such as oligoarticular juvenile idiopathic arthritis, so health care providers should be aware of distinguishing clinical features, which include rapid onset of swelling and patient age. Because the geographic area of endemic Lyme disease is expanding, all health care providers need to be aware of Lyme arthritis as a possible diagnosis.

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Quality Control Assessment of Canadian Laboratories Testing for Lyme Disease

Canadian Journal of Infectious Diseases ◽

10.1155/1991/128961 ◽

1991 ◽

Vol 2 (1) ◽

pp. 41-45

Author(s):

Harvey Artsob ◽

Maxwell Garvie

Keyword(s):

Public Health ◽

Quality Control ◽

Lyme Disease ◽

Borrelia Burgdorferi ◽

Western Blot ◽

Etiological Agent ◽

Immunofluorescent Assay ◽

Satisfactory Performance ◽

Endemic Areas ◽

Negative Controls

In June 1990 a quality control assessment was undertaken of Canadian public health laboratories testing for antibodies toBorrelia burgdorferi, the etiological agent of Lyme disease. Twenty sera were distributed to nine laboratories, including 12 obtained from patients in Lyme endemic areas and presumed to be serological positives, and eight prescreened negative controls. Seventeen serological reports were submitted, comprising nine enzyme-linked immunosorbent assays (elisa), six immunofluorescent assays and two Western blot assessments. Antibodies were detected in 11 of the 12 sera which had been presumed to be positive. Assuming 11 positive sera had been submitted, the test sensitivities varied from 88.9 to 100% byelisa, and 54.5 to 90.1% by immunofluorescent assay. Specificities were 100% for all but oneelisaand one immunofluorescent assay assessment. The results indicate a satisfactory performance byelisabut a need for upgrading or replacement of some immunofluorescent assay tests.

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