scholarly journals Performance of a New Rapid Immunoassay Test Kit for Point-of-Care Diagnosis of Significant Bacteriuria

2015 ◽  
Vol 53 (9) ◽  
pp. 2805-2809 ◽  
Author(s):  
Ann E. Stapleton ◽  
Marsha E. Cox ◽  
Robert K. DiNello ◽  
Mark Geisberg ◽  
April Abbott ◽  
...  
Keyword(s):  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Age Groups ◽  
Clinical Microbiology Laboratory ◽  
Gram Negative ◽  
Content Type ◽  
Test Kit ◽  
Significant Bacteriuria ◽  
Tract Infections

Urinary tract infections (UTIs) are frequently encountered in clinical practice and most commonly caused byEscherichia coliand other Gram-negative uropathogens. We tested RapidBac, a rapid immunoassay for bacteriuria developed by Silver Lake Research Corporation (SLRC), compared with standard bacterial culture using 966 clean-catch urine specimens submitted to a clinical microbiology laboratory in an urban academic medical center. RapidBac was performed in accordance with instructions, providing a positive or negative result in 20 min. RapidBac identified as positive 245/285 (sensitivity 86%) samples with significant bacteriuria, defined as the presence of a Gram-negative uropathogen orStaphylococcus saprophyticusat ≥103CFU/ml. The sensitivities for Gram-negative bacteriuria at ≥104CFU/ml and ≥105CFU/ml were 96% and 99%, respectively. The specificity of the test, detecting the absence of significant bacteriuria, was 94%. The sensitivity and specificity of RapidBac were similar on samples from inpatient and outpatient settings, from male and female patients, and across age groups from 18 to 89 years old, although specificity was higher in men (100%) compared with that in women (92%). The RapidBac test for bacteriuria may be effective as an aid in the point-of-care diagnosis of UTIs especially in emergency and primary care settings.

scholarly journals Evaluation of the BioFire FilmArray Pneumonia Panel for Detection of Viral and Bacterial Pathogens in Lower Respiratory Tract Specimens in the Setting of a Tertiary Care Academic Medical Center

2020 ◽  
Vol 58 (7) ◽  
Author(s):  
Daniel M. Webber ◽  
Meghan A. Wallace ◽  
Carey-Ann D. Burnham ◽  
Neil W. Anderson
Keyword(s):  
Respiratory Tract ◽  
Lower Respiratory Tract ◽  
Medical Center ◽  
Bacterial Pathogens ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Content Type ◽  
Standard Methods ◽  
Academic Medical ◽  
Tract Infections

ABSTRACT Our objective was to evaluate the diagnostic yield and accuracy of the BioFire FilmArray pneumonia panel (BFPP) for identification of pathogens in lower respiratory tract specimens (n = 200) from emergency department (ED) and intensive care unit (ICU) patients at a tertiary care academic medical center. Specimens were collected between January and November 2018, from patients ≥18 years of age, and culture was performed as part of standard-of-care testing. The BFPP identified a viral or bacterial target in 117/200 (58.5%) samples, including Staphylococcus aureus in 22% of samples and Haemophilus influenzae in 14%, and both a viral and bacterial target in 4% of samples. The most common viruses detected by BFPP were rhinovirus/enterovirus (4.5%), influenza A virus (3%), and respiratory syncytial virus (RSV) (2%). Overall, there was strong correlation between BFPP and standard methods for detection of viruses (99.2%) and bacteria (96.8%). Most bacteria (60/61 [98.4%]) detected by standard methods were also identified by BFPP, and 92 additional bacteria were identified by BFPP alone, including 22/92 (23.9%) additional S. aureus isolates and 25/92 (27.2%) H. influenzae isolates, which were more frequently discordant when detected at low concentrations (S. aureus, P < 0.001; H. influenzae, P < 0.0001) and in sputum-type specimens (S. aureus, P < 0.05). A potential limitation of the BFPP assay is the absence of fungal targets and Stenotrophomonas maltophilia, which were detected in 26 and 4 of 200 specimens, respectively. Real-time specimen analysis with BFPP has the potential to identify bacterial pathogens and resistance markers 44.2 and 56.3 h faster than culture-based methods. The BFPP is a rapid and accurate method for detection of pathogens from lower respiratory tract infections.

scholarly journals 460. Point-of-Care, In-Home SARS-CoV-2 IgG Antibody Testing to Assess Seroprevalence in At-Risk Health Care Workers

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S297-S297
Author(s):  
Eric G Meissner ◽  
Christine Litwin ◽  
Tricia Crocker ◽  
Elizabeth Mack ◽  
Lauren Card
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Care Workers ◽  
Medical Center ◽  
Point Of Care ◽  
Academic Medical Center ◽  
Significant Risk ◽  
Documented Infection ◽  
Inconclusive Result ◽  
Care Workers

Abstract Background Health care workers are at significant risk for infection with the novel coronavirus SARS-CoV-2. Methods We utilized a point-of-care, lateral flow SARS-CoV-2 IgG immunoassay (RayBiotech) to conduct a seroprevalence study in a cohort of at-risk health care workers (n=339) and normal-risk controls (n=100) employed at an academic medical center. To minimize exposure risk while conducting the study, consents were performed electronically, tests were mailed and then self-administered at home using finger stick blood, and subjects uploaded a picture of the test result while answering an electronic questionnaire. We also validated the assay using de-identified serum samples from patients with PCR-proven SARS-CoV-2 infection. Results Between April 14th and May 6th 2020, 439 subjects were enrolled. Subjects were 68% female, 93% white, and most were physicians (38%) and nurses (27%). In addition, 37% had at least 1 respiratory symptom in the prior month, 34% had cared for a patient with known SARS-CoV-2 infection, 57% and 23% were worried about exposure at work or in the community, respectively, and 5 reported prior documented SARS-CoV-2 infection. On initial testing, 3 subjects had a positive IgG test, 336 had a negative test, and 87 had an inconclusive result. Of those with an inconclusive result who conducted a repeat test (85%), 96% had a negative result. All 3 positive IgG tests were in subjects reporting prior documented infection. Laboratory validation showed that of those with PCR-proven infection more than 13 days prior, 23/30 were IgG positive (76% sensitivity), whereas 1/26 with a negative prior PCR test were seropositive (95% specificity). Repeat longitudinal serologic testing every 30 days for up to 4 times is currently in progress. Conclusion We conducted a contact-free study in the setting of a pandemic to assess SARS-CoV-2 seroprevalence in an at-risk group of health care workers. The only subjects found to be IgG positive were those with prior documented infection, even though a substantial proportion of subjects reported significant potential occupational or community exposure and symptoms that were potentially compatible with SARS-COV-2 infection. Disclosures All Authors: No reported disclosures

Sex, Race, Insurance, and Pain: Do Patient Sociodemographics Influence Postoperative Opioid Prescriptions Among Hand Surgeons?

Hand ◽  
2021 ◽  
pp. 155894472199802
Author(s):  
Connor J. Peck ◽  
Martin Carney ◽  
Alexander Chiu ◽  
Kitae E. Park ◽  
Alexandre Prassinos ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Medical Center ◽  
Carpal Tunnel Release ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Age Groups ◽  
Postoperative Pain Management ◽  
Patient Treatment ◽  
Opioid Prescription ◽  
History Of

Background: Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons. Methods: We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups. Results: Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without ( P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without ( P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men ( P = .0048), and Hispanics were prescribed 16.6 MME more than whites ( P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare ( P < .0001), but 25.0 MME less than those with Medicaid ( P < .0001). There were no differences across age groups. Conclusions: Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.

Millennials Seeking Healthcare: Examining the Degree to Which Patients Utilize Online Resources (Preprint)

2021 ◽  
Author(s):  
Landon Arensberg ◽  
Jessica Kalender-Rich ◽  
Jaehoon Lee ◽  
Cheryl Gibson
Keyword(s):  
Medical Care ◽  
Baby Boomers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Age Groups ◽  
Online Reviews ◽  
Online Resources ◽  
Cross Sectional ◽  
Academic Medical ◽  
Us Census

BACKGROUND According to the 2020 US Census, a Silver Tsunami is looming with more than 75.4 million persons aged 57-75 (known as “Baby Boomers”) expected to need more costly medical care. Future estimates, however, indicate a much larger wave of individuals is imminent, given the 83.1 million Millennials approaching adulthood who will be seeking medical care. Because Millennials differ from Baby Boomers in several ways, it is important to understand how this population finds their physician to gain insight into what might influence this decision. OBJECTIVE To determine the extent and influence online resources and reviews have on the younger generation as compared to elder generations. METHODS Between the months of May and July 2020 a cross-sectional paper-based survey was conducted at primary care and geriatric clinics located within a large urban academic medical center in the Midwest. RESULTS A sample of 284 patients completed the survey (44.35 ± 17.54 yrs old [range=18-90], 60.6% female, 57.4% white). Of Millennials (respondents aged 22-38 yrs), 67.2% read online reviews before choosing a physician. Millennials were significantly more likely to read online reviews before choosing a physician (P=0.004) and utilize online resources to search for a new physician (P<.001) than older patients. The majority of millennials were likely to be influenced by both negative reviews (59%) and positive reviews (71.3%). Female patients were more likely to read online reviews and use online resources compared to men, but the differences were not significant. CONCLUSIONS Overall, Millennials are much more likely to research online reviews before choosing a physician. Other generations also use online resources to an extent but tend to use personal referrals. Across all age groups, negative online reviews were less influential in decision-making compared to positive ones. Therefore, a presence on review websites and search engines seems to only benefit one’s medical practice to capture the new wave of patients.

Adequacy of empiric gram-negative coverage for septic patients at an academic medical center

2019 ◽  
Vol 47 (10) ◽  
pp. 1194-1199 ◽  
Author(s):  
DaleMarie Vaughan ◽  
Amy Pakyz ◽  
Michael Stevens ◽  
Kimberly Lee ◽  
Shaina Bernard
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Gram Negative ◽  
Academic Medical

scholarly journals 1154. Impact of Educational Feedback on Reducing Hospital-Onset Catheter-Associated Urinary tract Infections at an Academic Medical Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S412-S412
Author(s):  
Bhagyashri D Navalkele ◽  
Nora Truhett ◽  
Miranda Ward ◽  
Sheila Fletcher
Keyword(s):  
Infection Prevention ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prevention Strategies ◽  
Intervention Period ◽  
Post Intervention ◽  
Frontline Staff ◽  
Post Intervention Period ◽  
Tract Infections ◽  
The Impact

Abstract Background High regulatory burden on hospital-onset (HO) infections has increased performance pressure on infection prevention programs. Despite the availability of comprehensive prevention guidelines, a major challenge has been communication with frontline staff to integrate appropriate prevention measures into practice. The objective of our study was to evaluate the impact of educational intervention on HO CAUTI rates and urinary catheter days. Methods At the University of Mississippi Medical Center, Infection prevention (IP) reports unit-based monthly HO infections via email to respective unit managers and ordering physician providers. Starting May 2018, IP assessed compliance to CAUTI prevention strategies per SHEA/IDSA practice recommendations (2014). HO CAUTI cases with noncompliance were labeled as “preventable” infections and educational justification was provided in the email report. No other interventions were introduced during the study period. CAUTI data were collected using ongoing surveillance per NHSN and used to calculate rates per 1,000 catheter days. One-way analysis of variance (ANOVA) was used to compare pre- and post-intervention data. Results Prior to intervention (July 2017–March 2018), HO CAUTI rate was 1.43 per 1,000 catheter days. In the post-intervention period (July 2018–March 2019), HO CAUTI rate decreased to 0.62 per 1,000 catheter days. Comparison of pre- and post-intervention rates showed a statistically significant reduction in HO CAUTIs (P = 0.04). The total number of catheter days reduced, but the difference was not statistically significant (8,604 vs. 7,583; P = 0.06). Of the 14 HO CAUTIs in post-intervention period, 64% (8/14) were reported preventable. The preventable causes included inappropriate urine culturing practice in asymptomatic patients (5) or as part of pan-culture without urinalysis (2), and lack of daily catheter assessment for necessity (1). Conclusion At our institute, regular educational feedback by IP to frontline staff resulted in a reduction of HO CAUTIs. Feedback measure improved accountability, awareness and engagement of frontline staff in practicing appropriate CAUTI prevention strategies. Disclosures All authors: No reported disclosures.

scholarly journals 151. Comparing the Clinical Utility of Rapid Diagnostic Tests for Gram-Negative Bloodstream Infection Using a Desirability of Outcomes Ranking

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S102-S102
Author(s):  
Kimberly C Claeys ◽  
Kathryn Schlaffer ◽  
Zegbeh Kpadeh-Rogers ◽  
Yunyun Jiang ◽  
Scott R Evans ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Scoring System ◽  
Clinical Utility ◽  
Medical Center ◽  
Credit Scoring ◽  
Small Sample ◽  
Clinical Microbiology Laboratory ◽  
Partial Credit ◽  
Gram Negative ◽  
Organism Identification

Abstract Background Rapid diagnostic testing (RDT) technology in bloodstream infections (BSI) has outpaced provider understanding of how to effectively use it. To optimize the use of RDT platforms and antibiotic therapy, decision makers must determine which RDTs to implement at their institutions. A thorough understanding of which platform to choose extends beyond simple analytic measures of sensitivities and specificities and should include a robust analysis of how these RDTs could impact clinical decisions. Methods Retrospective study of adult patients with Gram-negative (GN) BSI from at University of Maryland Medical Center. The clinical microbiology laboratory used Verigene® BC-GN in clinical practice. Discarded blood samples were run on BioFire® FilmArray BCID. Final organism identification/susceptibility, antibiotic exposures, and clinical outcomes were reviewed. DOOR was applied to theoretical therapy decisions based on both actual prescribing adherence to institutional algorithm recommendations; 1 being most and 6 being least desirable (Table 1). A partial credit scoring system was applied to DOOR from most (100) to least desirable (0) outcome. Comparisons were made in a paired manner. Results 77 patients met inclusion. The median age was 58 (IQR 47, 68), 44.2% were in the ICU, and 75.3% had ID consult within 24 hours of BSI. Organism identification included: E. coli (35.1%), K. pneumoniae (23.4%), P. mirabilis (10.4%), S. marcescens (10.4%), Enterobacter spp. (9.4%), P. aeruginosa (3.9%). The only resistance determinant was CTX-M (11.6%). An antibiotic change occurred in 26.2% of cases, divided between antibiotic escalation and de-escalation. Based on the actual utilization of RDT results, median DOOR was not different between BC-GN and BCID (3 [IQR 3.4] vs. 4 [IQR 3.4], P = 0.44). Using a partial credit scoring system, the mean score was not different between platforms (49.8 [SD 26.8] vs. 47.7 [SD 20.3], P = 0.44). Through pairwise comparisons, BC-GN would have resulted in an optimal outcome of 15.3% (95% CI 4.7% to 19.3%) more often than BCID. Conclusion Based on the actual use of RDTs for GN BSI there was no difference in potential clinical outcomes between platforms in this relatively small sample. DOOR is a novel mechanism to quantitate clinical utility and compare RDTs. Disclosures All authors: No reported disclosures.

scholarly journals Complete Genome Sequence of Escherichia coli GW-AmxH19, Isolated from Hospital Wastewater in Greifswald, Germany

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Dominik Schneider ◽  
Daniela Zühlke ◽  
Tabea Petscheleit ◽  
Anja Poehlein ◽  
Katharina Riedel ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
University Hospital ◽  
Hospital Wastewater ◽  
Circular Chromosome ◽  
Protein Coding ◽  
Gram Negative ◽  
Content Type ◽  
Protein Coding Genes ◽  
Potential Association ◽  
Tract Infections

ABSTRACT The Gram-negative and rod-shaped Escherichia coli strain GW-AmxH19 was isolated from university hospital wastewater in Greifswald, Germany. The genome consists of two replicons, including one circular chromosome (5.04 Mb) and a circular plasmid (126.96 kb). The genome harbors 4,694 protein-coding genes, comprising multidrug resistance and a potential association with urogenital tract infections.

Pseudo-Outbreak ofMycobacterium chelonaeandMethtlobactertum mesophilicumCaused by Contamination of an Automated Endoscopy Washer

2001 ◽  
Vol 22 (7) ◽  
pp. 414-418 ◽  
Author(s):  
Amy Beth Kressel ◽  
Francine Kidd
Keyword(s):  
Dna Fingerprinting ◽  
Medical Center ◽  
Academic Medical Center ◽  
Gram Negative Bacteria ◽  
Source Water ◽  
Mycobacterium Chelonae ◽  
Gram Negative ◽  
Academic Medical ◽  
Control Department ◽  
Cleaning Cycle

AbstractObjective:To evaluate an unusual number of rapidly growing acid-fast bacilli, later identified asMycobacterium chelonae,and pink bacteria, later identified asMethylo-bacterium mesophilicum,from fungal cultures obtained by bronchoscopy.Design:Outbreak investigation.Setting:An academic medical center performing approximately 500 bronchoscopies and 4,000 gastrointestinal endoscopies in 1998.Patients:Patients undergoing bronchoscopy July 21 to October 2, 1998.Methods:The infection control department reviewed patient charts and bronchoscopy logs; obtained cultures of source water, faucets, washers, unopened glutaraldehyde, glutaraldehyde from the washers, and endoscopes; observed endoscope and bronchoscope cleaning and disinfecting procedures; reviewed glutaraldehyde monitoring records; and sentM chelonaeisolates for DNA fingerprinting.Results:M chelonae, M mesophilicum,gram-negative bacteria, and various molds grew from endoscopes, automated washers, and glutaraldehyde from the washers but not from unopened glutaraldehyde. The endoscopy unit regularly monitored the pH of glutaraldehyde, and the logs contained no deficiencies. The above sources remained positive for the same organisms after a glutaraldehyde cleaning cycle of the automated washers. DNA fingerprinting of theM chelonaerevealed that they were clonally related.Conclusions:The automated washers were contaminated with a biofilm that rendered them resistant to decontamination. The washers then contaminated the endoscopes and bronchoscopes they were used to disinfect. Our institution purchased new endoscopes and a new paracetic acid sterilization system.

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