scholarly journals Bacteremia and Blood Culture Utilization during COVID-19 Surge in New York City

2020 ◽  
Vol 58 (8) ◽  
Author(s):  
Jorge Sepulveda ◽  
Lars F. Westblade ◽  
Susan Whittier ◽  
Michael J. Satlin ◽  
William G. Greendyke ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Blood Culture ◽  
York City ◽  
Diagnostic Yield ◽  
Cohort Analysis ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Retrospective Cohort Analysis ◽  
Bacterial Coinfection

ABSTRACT A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase in blood culture utilization, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the level in the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than among COVID-19-negative patients (8.0%) and those not tested (7.1%) (P < 0.001). COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, which, when excluded, reduced the bacteremia rate to 1.6%. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial coinfection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during patient surges, and laboratories should consider shortening the incubation period from 5 days to 4 days, if necessary, to free additional capacity.

scholarly journals Bacteremia and Blood Culture Utilization During COVID-19 Surge in New York City

2020 ◽  
Author(s):  
Jorge Sepulveda ◽  
Lars F. Westblade ◽  
Susan Whittier ◽  
Michael J. Satlin ◽  
William G. Greendyke ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Blood Culture ◽  
York City ◽  
Diagnostic Yield ◽  
Cohort Analysis ◽  
Bloodstream Infections ◽  
Blood Cultures ◽  
Retrospective Cohort Analysis ◽  
Bacterial Coinfection

AbstractA surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase in the utilization of blood cultures, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia, and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than COVID-19 negative patients (8.0%) and those not tested (7.1%), p < 0.001. COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, reducing the bacteremia rate to 1.6% when excluded. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial coinfection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during COVID-19 surges, and laboratories should consider shortening the incubation period from 5 days to 4 days to free additional capacity.

scholarly journals Clinical Impact of Rapid Molecular Diagnosis of Bloodstream Infections at an Academic Medical Center in New York City

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Matthew S. Simon ◽  
Angela Loo ◽  
Michael Satlin ◽  
Harjot Singh ◽  
Christina Chai ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Molecular Diagnosis ◽  
York City ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Clinical Impact ◽  
Academic Medical

scholarly journals Population Structure of Klebsiella pneumoniae Causing Bloodstream Infections at a New York City Tertiary Care Hospital: Diversification of Multidrug-Resistant Isolates

2015 ◽  
Vol 53 (7) ◽  
pp. 2060-2067 ◽  
Author(s):  
Angela Gomez-Simmonds ◽  
Michelle Greenman ◽  
Sean B. Sullivan ◽  
Joshua P. Tanner ◽  
Madeleine G. Sowash ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Klebsiella Pneumoniae ◽  
York City ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Mortality Rates ◽  
Care Hospital ◽  
Content Type

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.

scholarly journals 558. Evaluating Length of Stay Data for Use in Targeting Prevention of Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S265-S265
Author(s):  
Katryna Gouin ◽  
Kelly M Hatfield ◽  
Sarah H Yi ◽  
Sujan Reddy ◽  
Hannah Wolford ◽  
...  
Keyword(s):  
New York ◽  
Length Of Stay ◽  
Blood Culture ◽  
Large Fraction ◽  
Bloodstream Infections ◽  
Hospital Length ◽  
Blood Cultures ◽  
Hospital Length Of Stay ◽  
Birth Date ◽  
Post Discharge

Abstract Background Evidence suggests that interventions such as MRSA decolonization are useful in the prevention of MRSA bloodstream infections (BSI) both during hospitalization and post-discharge. However, decolonization may be costly and have diminishing effectiveness when used on all inpatients. Hospital length of stay (LOS) is a known risk factor for MRSA BSI. To determine whether LOS could be useful in prioritizing patients for intervention, we aimed to evaluate (i) distribution of time from admission to hospital-onset (HO) MRSA BSI, and (ii) frequency and LOS of hospitalizations that preceded community-onset (CO) MRSA BSI. Methods MRSA-positive blood cultures among adults admitted to New York hospitals from 2013 to 20s16 were identified in the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN). We linked these data to admissions in New York’s hospital discharge dataset, the Statewide Planning and Research Cooperative System (SPARCS), where the NHSN blood culture collection date was between a patient’s SPARCS admission and discharge dates and there was an exact match for birth date, gender and facility. Time to MRSA BSI was defined as the number of days from admission (day 1) to collection of a blood culture positive for MRSA. We defined positive blood cultures collected on days 1–3 as CO, and those collected ≥day 4 as HO. Results We linked 10,425 (79%) MRSA BSIs from NHSN to SPARCS. 78% (8,147) of MRSA BSIs were CO and 22% (2,278) were HO. The median time to HO MRSA BSI was 10 days (IQR 6–21) (Figure 1), in contrast to the median LOS for all hospitalizations of 4 days (IQR 3–7). By definition, 35% of all hospitalizations were never at risk of HO MRSA BSI because their LOS was < 4 days. Among CO MRSA BSI, 48% were discharged from a hospital in the 90 days preceding their BSI (Figure 2). The median LOS of these prior hospitalizations was 8 days (IQR 5–14), and 87% were at least 4 days in length. Conclusion Over half of HO MRSA BSI occur on or after day 10 of hospitalization and a large fraction of CO MRSA BSI had a lengthy hospitalization shortly before their BSI diagnosis. Our results suggest that patients likely to have a long LOS could be evaluated as potential targets for prevention strategies (e.g., decolonization) to reduce both HO and CO MRSA BSI. Disclosures All authors: No reported disclosures.

scholarly journals Notes from the Field: Fungal Bloodstream Infections Associated with a Compounded Intravenous Medication at an Outpatient Oncology Clinic — New York City, 2016

2016 ◽  
Vol 65 (45) ◽  
pp. 1274-1275 ◽  
Author(s):  
Amber M. Vasquez ◽  
Jason Lake ◽  
Stephanie Ngai ◽  
Megan Halbrook ◽  
Snigdha Vallabhaneni ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Bloodstream Infections ◽  
Intravenous Medication

Insight into the Infection Dynamics of the AIDS Epidemic: A Birth Cohort Analysis of New York City AIDS Mortality

1993 ◽  
Vol 138 (12) ◽  
pp. 1093-1104 ◽  
Author(s):  
Rand L. Stonebumer ◽  
Larry Lessner ◽  
E. James Fordyce ◽  
Pamela Bevier ◽  
Mary Ann Chiasson
Keyword(s):  
New York ◽  
New York City ◽  
Birth Cohort ◽  
York City ◽  
Cohort Analysis ◽  
Aids Epidemic ◽  
Infection Dynamics ◽  
Insight Into ◽  
Birth Cohort Analysis

An Important Armenian MS. with Greek Miniatures

1942 ◽  
Vol 74 (3-4) ◽  
pp. 155-162
Author(s):  
H. Kurdian
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Christian Iconography

In 1941 while in New York City I was fortunate enough to purchase an Armenian MS. which I believe will be of interest to students of Eastern Christian iconography.

Hospitals: N.Y. Appellate Court Denies Move to Privatize Public Hospital

1999 ◽  
Vol 27 (2) ◽  
pp. 202-203
Author(s):  
Robert Chatham
Keyword(s):  
New York ◽  
New York City ◽  
York City ◽  
Public Health System ◽  
Municipal Hospital ◽  
The Public ◽  
Public Benefit ◽  
For Profit ◽  
Benefit Corporation ◽  
The City

The Court of Appeals of New York held, in Council of the City of New York u. Giuliani, slip op. 02634, 1999 WL 179257 (N.Y. Mar. 30, 1999), that New York City may not privatize a public city hospital without state statutory authorization. The court found invalid a sublease of a municipal hospital operated by a public benefit corporation to a private, for-profit entity. The court reasoned that the controlling statute prescribed the operation of a municipal hospital as a government function that must be fulfilled by the public benefit corporation as long as it exists, and nothing short of legislative action could put an end to the corporation's existence.In 1969, the New York State legislature enacted the Health and Hospitals Corporation Act (HHCA), establishing the New York City Health and Hospitals Corporation (HHC) as an attempt to improve the New York City public health system. Thirty years later, on a renewed perception that the public health system was once again lacking, the city administration approved a sublease of Coney Island Hospital from HHC to PHS New York, Inc. (PHS), a private, for-profit entity.

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