Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-18 (of 18 Records) |
Query Trace: Ostrowsky B[original query] |
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Clusters of emerging multidrug-resistant organisms in United States healthcare facilities during the initial months of the SARS-CoV-2 pandemic
Ham DC , Li R , Mitsunaga T , Czaja C , Prestel C , Bhaurla S , Cumming M , Brennan B , Innes G , Carrico S , Chan A , Merengwa E , Stahl A , Ostrowsky B , de Perio MA , Walters MS . Am J Infect Control 2024 52 (12) 1390-1396 BACKGROUND: Outbreaks of emerging multidrug-resistant organisms (eMDROs), including carbapenem-resistant Enterobacterales, carbapenem-resistant Acinetobacter baumannii, and Candida auris, have been reported among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients. We describe eMDRO clusters in SARS-CoV-2 units and associated infection control (IC) practices early in the SARS-CoV-2 pandemic. METHODS: We conducted a retrospective survey of a convenience sample of health departments in 11 states to describe clusters of eMDROs that began before November 1, 2020 and involved SARS-CoV-2 units. Cluster characteristics and IC practices during the cluster period were assessed using a standardized outbreak report form, and descriptive analyses were performed. RESULTS: Overall, 18 eMDRO clusters (10 carbapenem-resistant Enterobacterales, 6 C auris, 1 carbapenem-resistant Pseudomonas aeruginosa, and 1 carbapenem-resistant A baumannii) in 18 health care facilities involving 397 patients were reported from 10 states. During the cluster period, 60% of facilities reported a shortage of isolation gowns, 69% extended use of gowns, and 67% reported difficulty obtaining preferred disinfectants. Reduced frequency of hand hygiene audits was reported in 85% of acute care hospitals during the cluster period compared with before the pandemic. CONCLUSIONS: Changes in IC practices and supply shortages were identified in facilities with eMDRO outbreaks during the SARS-CoV-2 pandemic and might have contributed to eMDRO transmission. |
Measures to prevent and treat Nipah virus disease: research priorities for 2024-29
Moore KA , Mehr AJ , Ostrowsky JT , Ulrich AK , Moua NM , Fay PC , Hart PJ , Golding JP , Benassi V , Preziosi MP , Broder CC , de Wit E , Formenty PBH , Freiberg AN , Gurley ES , Halpin K , Luby SP , Mazzola LT , Montgomery JM , Spiropoulou CF , Mourya DT , Parveen S , Rahman M , Roth C , Wang LF , Osterholm MT . Lancet Infect Dis 2024 Nipah virus causes highly lethal disease, with case-fatality rates ranging from 40% to 100% in recognised outbreaks. No treatments or licensed vaccines are currently available for the prevention and control of Nipah virus infection. In 2019, WHO published an advanced draft of a research and development roadmap for accelerating development of medical countermeasures, including diagnostics, therapeutics, and vaccines, to enable effective and timely emergency response to Nipah virus outbreaks. This Personal View provides an update to the WHO roadmap by defining current research priorities for development of Nipah virus medical countermeasures, based primarily on literature published in the last 5 years and consensus opinion of 15 subject matter experts with broad experience in development of medical countermeasures for Nipah virus or experience in the epidemiology, ecology, or public health control of outbreaks of Nipah virus. The research priorities are organised into four main sections: cross-cutting issues (for those that apply to more than one category of medical countermeasures), diagnostics, therapeutics, and vaccines. The strategic goals and milestones identified in each section focus on key achievements that are needed over the next 6 years to ensure that the necessary tools are available for rapid response to future outbreaks of Nipah virus or related henipaviruses. |
Extensively drug-resistant pseudomonas aeruginosa outbreak associated with artificial tears
Grossman MK , Rankin DA , Maloney M , Stanton RA , Gable P , Stevens VA , Ewing T , Saunders K , Kogut S , Nazarian E , Bhaurla S , Mephors J , Mongillo J , Stonehocker S , Prignano J , Valencia N , Charles A , McNamara K , Fritsch WA , Ruelle S , Plucinski CA , Sosa L , Ostrowsky B , Ham DC , Walters MS . Clin Infect Dis 2024 ![]() ![]() BACKGROUND: Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak. METHODS: Cases were defined as a U.S. patient's first isolation of P. aeruginosa sequence type 1203 with the carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to CDC between January 1, 2022-May 15, 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination. RESULTS: We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and four (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears compared to controls (crude matched OR: 5.0, 95% CI: 1.1, 22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. FDA inspection of the manufacturing plant identified likely sources of contamination. CONCLUSIONS: A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the U.S. The clinical impacts from this outbreak underscore the need for improved requirements for U.S. OTC product importers. |
Laboratory Analysis of an Outbreak of Candida auris in New York from 2016 to 2018-Impact and Lessons Learned (preprint)
Zhu Y , O'Brien B , Leach L , Clark A , Bates M , Adams E , Ostrowsky B , Quinn M , Dufort E , Southwick K , Erazo R , Haley VB , Bucher C , Chaturvedi V , Limberger RJ , Blog D , Lutterloh E , Chaturvedi S . bioRxiv 2019 760090 Candida auris is a multidrug-resistant yeast which has emerged in healthcare facilities worldwide, however little is known about identification methods, patient colonization, spread, environmental survival, and drug resistance. Colonization on both biotic and abiotic surfaces, along with travel, appear to be the major factors for the spread of this pathogen across the globe. In this investigation, we present laboratory findings from an ongoing C. auris outbreak in NY from August 2016 through 2018. A total of 540 clinical isolates, 11,035 patient surveillance specimens, and 3,672 environmental surveillance samples were analyzed. Laboratory methods included matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for yeast isolate identification, real-time PCR for rapid surveillance sample screening, culture on selective/non-selective media for recovery of C. auris and other yeasts from surveillance samples, antifungal susceptibility testing to determine the C. auris resistance profile, and Sanger sequencing of ribosomal genes for C. auris genotyping. Results included: a) identification and confirmation of C. auris in 413 clinical isolates and 931 patient surveillance isolates, as well as identification of 277 clinical cases and 350 colonized cases from 151 healthcare facilities including 59 hospitals, 92 nursing homes, 1 long-term acute care hospital (LTACH), and 2 hospices, b) successful utilization of an in-house developed C. auris real-time PCR assay for the rapid screening of patient and environmental surveillance samples, c) demonstration of relatively heavier colonization of C. auris in nares compared to the axilla/groin, and d) predominance of the South Asia Clade I with intrinsic resistance to fluconazole and elevated minimum inhibitory concentration (MIC) to voriconazole (81%), amphotericin B (61%), 5-FC (3%) and echinocandins (1%). These findings reflect greater regional prevalence and incidence of C. auris and the deployment of better detection tools in an unprecedented outbreak. |
Candida auris Admission Screening Pilot in Select Units of New York City Healthcare Facilities, 2017-2019.
Rowlands J , Dufort E , Chaturvedi S , Zhu Y , Quinn M , Bucher C , Erazo R , Haley V , Kuang J , Ostrowsky B , Southwick K , Vallabhaneni S , Greenko J , Tserenpuntsag B , Blog D , Lutterloh E . Am J Infect Control 2023 51 (8) 866-870 ![]() ![]() BACKGROUND: This pilot project implemented admission screening for Candida auris (C. auris) using real-time polymerase chain reaction (rt-PCR) in select high-risk units within health care facilities in New York City. METHODS: An admission screening encounter consisted of collecting 2 swabs, to be tested by rt-PCR, and a data collection form for individuals admitted to ventilator units at 2 nursing homes (NHA and NHB), and the ventilator/pulmonary unit, intensive care unit, and cardiac care unit at a hospital (Hospital C) located in New York City from November 2017 to November 2019. RESULTS: C. auris colonization was identified in 6.9% (n = 188/2,726) of admissions to participating units. Rates were higher among admissions to NHA and NHB (20.7% and 22.0%, respectively) than Hospital C (3.6%). Within Hospital C, the ventilator/pulmonary unit had a higher rate (5.7%) than the intensive care unit (3.8%) or cardiac care unit (2.5%). DISCUSSION: Consistent with prior research, we found that individuals admitted to ventilator units were at higher risk of C. auris colonization. CONCLUSIONS: This project demonstrates the utility of admission screening using rt-PCR testing to rapidly identify C. auris colonization among admissions to health care facilities so that appropriate transmission-based precautions and control measures can be implemented rapidly to help decrease transmission. |
Antifungal Resistance Trends of Candida auris Clinical Isolates, New York-New Jersey, 2016-2020
Kilburn S , Innes G , Quinn M , Southwick K , Ostrowsky B , Greenko JA , Lutterloh E , Greeley R , Magleby R , Chaturvedi V , Chaturvedi S . Antimicrob Agents Chemother 2022 66 (3) aac0224221 About 55% of U.S. Candida auris clinical cases were reported from New York and New Jersey from 2016 through 2020. Nearly all New York-New Jersey clinical isolates (99.8%) were fluconazole resistant, and 50% were amphotericin B resistant. Echinocandin resistance increased from 0% to 4% and pan-resistance increased from 0 to <1% for New York C. auris clinical isolates but not for New Jersey, highlighting the regional differences. |
A Description of the First Candida auris -Colonized Individuals in New York State, 2016-2017
Southwick K , Ostrowsky B , Greenko J , Adams E , Lutterloh E , Denis RJ , Patel R , Erazo R , Fernandez R , Bucher C , Quinn M , Green C , Chaturvedi S , Leach L , Zhu Y . Am J Infect Control 2021 50 (3) 358-360 Candida auris (C. auris) is a globally-emerging multi-drug resistant yeast. New York State (NYS) first detected C. auris in July 2016 and is the state most affected. This brief report describes characteristics of the first 114 individuals colonized with C. auris identified through active surveillance/screening by NYS Department of Health (NYSDOH). "Colonized/screened" individuals were old (median age,74 year), had extensive healthcare exposures and underlying conditions (multiple healthcare facility admissions in the 90 days prior with more than 80% requiring mechanical ventilation), and had 30 and 90 day mortality rates of 17.5% and 37.7%, respectively (with approximately 60% expired in the two-year follow-up period). This description is helpful to inform additional prevention measures and add to the collective understanding of C. auris in the U.S. |
A Research and Development (R&D) roadmap for influenza vaccines: Looking toward the future
Moore KA , Ostrowsky JT , Kraigsley AM , Mehr AJ , Bresee JS , Friede MH , Gellin BG , Golding JP , Hart PJ , Moen A , Weller CL , Osterholm MT . Vaccine 2021 39 (45) 6573-6584 Improved influenza vaccines are urgently needed to reduce the burden of seasonal influenza and to ensure a rapid and effective public-health response to future influenza pandemics. The Influenza Vaccines Research and Development (R&D) Roadmap (IVR) was created, through an extensive international stakeholder engagement process, to promote influenza vaccine R&D. The roadmap covers a 10-year timeframe and is organized into six sections: virology; immunology; vaccinology for seasonal influenza vaccines; vaccinology for universal influenza vaccines; animal and human influenza virus infection models; and policy, finance, and regulation. Each section identifies barriers, gaps, strategic goals, milestones, and additional R&D priorities germane to that area. The roadmap includes 113 specific R&D milestones, 37 of which have been designated high priority by the IVR expert taskforce. This report summarizes the major issues and priority areas of research outlined in the IVR. By identifying the key issues and steps to address them, the roadmap not only encourages research aimed at new solutions, but also provides guidance on the use of innovative tools to drive breakthroughs in influenza vaccine R&D. |
Real-Time Virtual Infection Prevention and Control Assessments in Skilled Nursing Homes, New York, March 2020 - A Pilot Project.
Ostrowsky B , Weil LM , Olaisen R , Stricof R , Adams E , Tsivitis M , Eramo A , Giardina R , Erazo R , Southwick K , Greenko J , Lutterloh E , Blog D , Green C , Carrasco K , Fernandez R , Vallabhaneni S , Quinn M , Kogut S , Bennett J , Chico D , Luzinas M . Infect Control Hosp Epidemiol 2021 43 (3) 1-27 OBJECTIVE: to describe a pilot infection prevention and control (IPC) assessment conducted in skilled nursing facilities (SNFs) in New York State (NYS) during a pivotal two-week period when the region became the nation's epicenter for COVID-19. DESIGN: a telephone and video assessment of IPC measures in SNFs at high risk or experiencing COVID-19 activity. PARTICIPANTS: SNFs in 14 NYS counties including New York City. INTERVENTION: a three-component remote IPC assessment: 1) screening tool; 2) telephone IPC checklist; and 3) COVID-19 video IPC assessment ("COVIDeo"). RESULTS: 92 SNFs completed the IPC screening tool and checklist; 52/92 (57%) were conducted as part COVID-19 investigations, and 40/92 (43%) were proactive prevention-based assessments. Among the 40 proactive assessments, 14/40 (35%) identified suspected or confirmed COVID-19 cases. COVIDeo was performed in 26/92 (28%) of assessments and provided observations that other tools would have missed including: PPE (personal protective equipment) that was not easily accessible, redundant, or improperly donned, doffed, or stored and specific challenges implementing IPC in specialty populations. The IPC assessments took approximately one hour each, reached an estimated four times as many SNFs as onsite visits in a similar timeframe. CONCLUSIONS: Remote IPC assessments by telephone and video provided a timely and feasible method to assess the extent to which IPC interventions had been implemented in a vulnerable setting and to disseminate real-time recommendations. Remote assessments are now being implemented across NYS and in various healthcare facility types. Similar methods have been adapted nationally through CDC. |
Factors associated with Candida auris colonization and transmission in skilled nursing facilities with ventilator units, New York, 2016-2018
Rossow J , Ostrowsky B , Adams E , Greenko J , McDonald R , Vallabhaneni S , Forsberg K , Perez S , Lucas T , Alroy K , Slifka KJ , Walters M , Jackson BR , Quinn M , Chaturvedi S , Blog D . Clin Infect Dis 2020 72 (11) e753-e760 BACKGROUND: Candida auris is an emerging, multidrug-resistant yeast that spreads in healthcare settings. People colonized with C. auris can transmit this pathogen and are at risk for invasive infections. New York State (NYS) has the largest U.S. burden (>500 colonized and infected people); many colonized individuals are mechanically ventilated or have tracheostomy and are residents of ventilator-capable skilled nursing facilities (vSNF). We evaluated factors associated with C. auris colonization among vSNF residents to inform prevention interventions. METHODS: During 2016-2018, the NYS Department of Health conducted point prevalence surveys (PPS) to detect C. auris colonization among residents of vSNFs. In a case-control investigation, we defined a case as C. auris colonization in a resident and identified up to four residents with negative swabs during the same PPS as controls. We abstracted data from medical records on facility transfers, antimicrobials, and medical history. RESULTS: We included 60 cases and 218 controls identified from 6 vSNFs. After controlling for potential confounders, the following characteristics were associated with C. auris colonization: being on a ventilator (aOR: 5.9; CI: 2.3-15.4), receiving carbapenem antibiotics in the prior 90 days (aOR: 3.5; CI: 1.6-7.6), having ≥1 acute care hospital visit in the prior six months (aOR: 4.2; CI: 1.9-9.6), and receiving systemic fluconazole in the prior 90 days (aOR: 6.0; CI: 1.6-22.6). CONCLUSIONS: Targeted screening of patients in vSNFs with the above risk factors for C. auris can help identify colonized patients and facilitate implementation of infection control measures. Antimicrobial stewardship may be an important factor in the prevention of C. auris colonization. |
Opportunities to improve antibiotic appropriateness in U.S. ICUs: A multicenter evaluation
Trivedi KK , Bartash R , Letourneau AR , Abbo L , Fleisher J , Gagliardo C , Kelley S , Nori P , Rieg GK , Silver P , Srinivasan A , Vargas J , Ostrowsky B . Crit Care Med 2020 48 (7) 968-976 OBJECTIVES: To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities. DESIGN: Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017. SETTING: ICUs in 12 U.S. acute care hospitals with median bed size 563. PATIENTS: Receiving antibiotics on participating units on March 1, 2017. INTERVENTIONS: The Centers for Disease Control and Prevention tool for the Assessment of Appropriateness of Inpatient Antibiotics was made actionable by an expert antibiotic stewardship panel and implemented across hospitals. Data were collected by antibiotic stewardship program personnel at each hospital, deidentified and submitted in aggregate for benchmarking. hospital personnel identified most salient reasons for inappropriate use by category and agent. MEASUREMENTS AND MAIN RESULTS: Forty-seven ICUs participated. Most hospitals (83%) identified as teaching with median licensed ICU beds of 70. On March 1, 2017, 362 (54%) of 667 ICU patients were on antibiotics (range, 8-81 patients); of these, 112 (31%) were identified as inappropriate and administered greater than 72 hours among all 12 hospitals (range, 9-82%). Prophylactic antibiotic regimens and PICU patients demonstrated a statistically significant risk ratio of 1.76 and 1.90 for inappropriate treatment, respectively. Reasons for inappropriate use included unnecessarily broad spectrum (29%), no infection or nonbacterial syndrome (22%), and duration longer than necessary (21%). Of patients on inappropriate antibiotic therapy in surgical ICUs, a statistically significant risk ratio of 2.59 was calculated for noninfectious or nonbacterial reasons for inappropriate therapy. CONCLUSIONS: In this multicenter point prevalence study, 31% of ICU antibiotic regimens were inappropriate; prophylactic regimens were often inappropriate across different ICU types, particularly in surgical ICUs. Engaging intensivists in antibiotic stewardship program efforts is crucial to sustain the efficacy of antibiotics and quality of infectious diseases care in critical care settings. This study underscores the value of standardized assessment tools and benchmarking to be shared with local leaders for targeted antibiotic stewardship program interventions. |
Faces of resistance: Using real-world patients and their advocates to teach medical students about antimicrobial stewardship
Nori P , Cowman K , Jezek A , Nosanchuk JD , Slosar-Cheah M , Sarwar U , Bartash R , Ostrowsky B . Open Forum Infect Dis 2019 6 (12) ofz487 We engaged medical students with antimicrobial stewardship (AS) and antimicrobial resistance (AMR) through patient stories and a panel on AMR advocacy with experts from the Centers for Disease Control and Prevention and the Infectious Diseases Society of America. Students were surveyed on their perceptions about AS and AMR (response rate = 139 of 166, 84%). |
Laboratory Analysis of an Outbreak of Candida auris in New York from 2016 to 2018-Impact and Lessons Learned.
Zhu Y , O'Brien B , Leach L , Clark A , Bates M , Adams E , Ostrowsky B , Quinn M , Dufort E , Southwick K , Erazo R , Haley VB , Bucher C , Chaturvedi V , Limberger RJ , Blog D , Lutterloh E , Chaturvedi S . J Clin Microbiol 2019 58 (4) ![]() ![]() Candida auris is a multidrug-resistant yeast which has emerged in healthcare facilities worldwide, however little is known about identification methods, patient colonization, environmental survival, spread, and drug resistance. Colonization on both biotic (patients) and abiotic (healthcare objects) surfaces, along with travel, appear to be the major factors for the spread of this pathogen across the globe. In this investigation, we present laboratory findings from an ongoing C. auris outbreak in New York (NY) from August 2016 through 2018. A total of 540 clinical isolates, 11,035 patient surveillance specimens, and 3,672 environmental surveillance samples were analyzed. Laboratory methods included matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) for yeast isolate identification, real-time PCR for rapid surveillance sample screening, culture on selective/non-selective media for recovery of C. auris and other yeasts from surveillance samples, antifungal susceptibility testing to determine the C. auris resistance profile, and Sanger sequencing of the internal transcribed spacer (ITS) and D1/D2 regions of the ribosomal gene for C. auris genotyping. Results included: a) identification and confirmation of C. auris in 413 clinical isolates and 931 patient surveillance isolates, as well as identification of 277 clinical cases and 350 colonized cases from 151 healthcare facilities including 59 hospitals, 92 nursing homes, 1 long-term acute care hospital (LTACH), and 2 hospices, b) successful utilization of an in-house developed C. auris real-time PCR assay for the rapid screening of patient and environmental surveillance samples, c) demonstration of relatively heavier colonization of C. auris in nares compared to the axilla/groin, and d) predominance of the South Asia clade I with intrinsic resistance to fluconazole and elevated minimum inhibitory concentration (MIC) to voriconazole (81%), amphotericin B (61%), 5-FC (3%) and echinocandins (1%). These findings reflect greater regional prevalence and incidence of C. auris and the deployment of better detection tools in an unprecedented outbreak. |
Brucella exposure risk events in ten clinical laboratories, New York City, 2015 - 2017
Ackelsberg J , Liddicoat A , Burke T , Szymczak WA , Levi MH , Ostrowsky B , Hamula C , Patel G , Kopetz V , Saverimuttu J , Sordillo EM , D'Souza D , Mitchell EA , Lowe W , Khare R , Tang YW , Bianchi AL , Egan C , Perry MJ , Hughes S , Rakeman JL , Adams E , Kharod GA , Tiller R , Saile E , Lee S , Gonzalez E , Hoppe B , Leviton IM , Hacker S , Ni KF , Orsini RL , Jhaveri S , Mazariegos I , Dingle T , Koll B , Stoddard RA , Galloway R , Hoffmaster A , Fine A , Lee E , Dentinger C , Harrison E , Layton M . J Clin Microbiol 2019 58 (2) During 2015-2017, 11 confirmed brucellosis cases were reported in New York City, leading to 10 Brucella exposure risk events ("Brucella events") in 7 clinical laboratories (CLs). Most patients traveled to endemic countries and presented with histories and findings consistent with brucellosis. CLs were not notified that specimens might yield a hazardous organism, as clinicians did not consider brucellosis until notified that bacteremia with Brucella was suspected.In 3 Brucella events, CLs did not suspect that slow-growing, small Gram-negative bacteria might be harmful. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), with limited capacity to identify biological threat agents (BTAs), was used during 4 Brucella events that accounted for 84% of exposures. In 3 of these incidents, initial staining of liquid media showed Gram-positive rods or cocci, including some cocci in chains, suggesting streptococci. Over 200 occupational exposures occurred when the unknown isolates were manipulated and/or tested on open benches, including procedures that could generate infectious aerosols. During 3 Brucella events, CLs examined and/or manipulated isolates in a biological safety cabinet (BSC); in each, CLs had isolated Brucella previously.Centers for Disease Control and Prevention recommendations to prevent laboratory-acquired brucellosis (LAB) were followed; no seroconversions or LAB cases occurred.Laboratory assessments were conducted after Brucella events to identify facility-specific risks and mitigations. With increasing MALDI-TOF MS use, CLs are well-advised to adhere strictly to safe work practices, such as handling and manipulating all slow-growing organisms in BSCs and not using MALDI-TOF for identification until BTAs have been ruled out. |
Public health management of persons under investigation for Ebola virus disease in New York City, 2014-2016
Winters A , Iqbal M , Benowitz I , Baumgartner J , Vora NM , Evans L , Link N , Munjal I , Ostrowsky B , Ackelsberg J , Balter S , Dentinger C , Fine AD , Harper S , Landman K , Laraque F , Layton M , Slavinski S , Weiss D , Rakeman JL , Hughes S , Varma JK , Lee EH . Public Health Rep 2019 134 (5) 33354919870200 During 2014-2016, the largest outbreak of Ebola virus disease (EVD) in history occurred in West Africa. The New York City Department of Health and Mental Hygiene (DOHMH) worked with health care providers to prepare for persons under investigation (PUIs) for EVD in New York City. From July 1, 2014, through December 29, 2015, we classified as a PUI a person with EVD-compatible signs or symptoms and an epidemiologic risk factor within 21 days before illness onset. Of 112 persons who met PUI criteria, 74 (66%) sought medical care and 49 (44%) were hospitalized. The remaining 38 (34%) were isolated at home with daily contact by DOHMH staff members. Thirty-two (29%) PUIs received a diagnosis of malaria. Of 10 PUIs tested, 1 received a diagnosis of EVD. Home isolation minimized unnecessary hospitalization. This case study highlights the importance of developing competency among clinical and public health staff managing persons suspected to be infected with a high-consequence pathogen. |
Neonatal conjunctivitis caused by Neisseria meningitidis US urethritis clade, New York, USA, August 2017
Kretz CB , Bergeron G , Aldrich M , Bloch D , Del Rosso PE , Halse TA , Ostrowsky B , Liu Q , Gonzalez E , Omoregie E , Chicaiza L , Zayas G , Tha B , Liang A , Wang JC , Levi M , Hughes S , Musser KA , Weiss D , Rakeman JL . Emerg Infect Dis 2019 25 (5) 972-975 We characterized a case of neonatal conjunctivitis in New York, USA, caused by Neisseria meningitidis by using whole-genome sequencing. The case was a rare occurrence, and the isolate obtained belonged to an emerging clade (N. meningitidis US nongroupable urethritis) associated with an increase in cases of urethritis since 2015. |
vanG element insertions within a conserved chromosomal site conferring vancomycin resistance to Streptococcus agalactiae and Streptococcus anginosus
Srinivasan V , Metcalf BJ , Knipe KM , Ouattara M , McGee L , Shewmaker PL , Glennen A , Nichols M , Harris C , Brimmage M , Ostrowsky B , Park CJ , Schrag SJ , Frace MA , Sammons SA , Beall B . mBio 2014 5 (4) e01386-14 ![]() Three vancomycin-resistant streptococcal strains carrying vanG elements (two invasive Streptococcus agalactiae isolates [GBS-NY and GBS-NM, both serotype II and multilocus sequence type 22] and one Streptococcus anginosus [Sa]) were examined. The 45,585-bp elements found within Sa and GBS-NY were nearly identical (together designated vanG-1) and shared near-identity over an ~15-kb overlap with a previously described vanG element from Enterococcus faecalis. Unexpectedly, vanG-1 shared much less homology with the 49,321-bp vanG-2 element from GBS-NM, with widely different levels (50% to 99%) of sequence identity shared among 44 related open reading frames. Immediately adjacent to both vanG-1 and vanG-2 were 44,670-bp and 44,680-bp integrative conjugative element (ICE)-like sequences, designated ICE-r, that were nearly identical in the two group B streptococcal (GBS) strains. The dual vanG and ICE-r elements from both GBS strains were inserted at the same position, between bases 1328 and 1329, within the identical RNA methyltransferase (rumA) genes. A GenBank search revealed that although most GBS strains contained insertions within this specific site, only sequence type 22 (ST22) GBS strains contained highly related ICE-r derivatives. The vanG-1 element in Sa was also inserted within this position corresponding to its rumA homolog adjacent to an ICE-r derivative. vanG-1 insertions were previously reported within the same relative position in the E. faecalis rumA homolog. An ICE-r sequence perfectly conserved with respect to its counterpart in GBS-NY was apparent within the same site of the rumA homolog of a Streptococcus dysgalactiae subsp. equisimilis strain. Additionally, homologous vanG-like elements within the conserved rumA target site were evident in Roseburia intestinalis. IMPORTANCE: These three streptococcal strains represent the first known vancomycin-resistant strains of their species. The collective observations made from these strains reveal a specific hot spot for insertional elements that is conserved between streptococci and different Gram-positive species. The two GBS strains potentially represent a GBS lineage that is predisposed to insertion of vanG elements. |
Low pathogenic avian influenza A (H7N2) virus infection in immunocompromised adult, New York, USA, 2003
Ostrowsky B , Huang A , Terry W , Anton D , Brunagel B , Traynor L , Abid S , Johnson G , Kacica M , Katz J , Edwards L , Lindstrom S , Klimov A , Uyeki TM . Emerg Infect Dis 2012 18 (7) 1128-31 In 2003, infection with low pathogenic avian influenza A (H7N2) virus was identified in an immunocompromised man with fever and community-acquired pneumonia in New York, USA. The patient recovered. Although the source of the virus was not identified, this case indicates the usefulness of virus culture for detecting novel influenza A viruses. |
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