Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-30 (of 61 Records) |
Query Trace: Park BJ[original query] |
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Defining access without excess: expanding appropriate use of antibiotics targeting multidrug-resistant organisms
Patel TS , Sati H , Lessa FC , Patel PK , Srinivasan A , Hicks LA , Neuhauser MM , Tong D , van der Heijden M , Alves SC , Getahun H , Park BJ . Lancet Microbe 2023 Antimicrobial resistance remains a significant global public health threat. Although development of novel antibiotics can be challenging, several new antibiotics with improved activity against multidrug-resistant Gram-negative organisms have recently been commercialised. Expanding access to these antibiotics is a global public health priority that should be coupled with improving access to quality diagnostics, health care with adequately trained professionals, and functional antimicrobial stewardship programmes. This comprehensive approach is essential to ensure responsible use of these new antibiotics. |
High burden of intestinal colonization with antimicrobial-resistant bacteria in Chile: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study
Araos R , Smith RM , Styczynski A , Sánchez F , Acevedo J , Maureira L , Paredes C , González M , Rivas L , Spencer-Sandino M , Peters A , Khan A , Sepulveda D , Wettig LR , Rioseco ML , Usedo P , Soto PR , Huidobro LA , Ferreccio C , Park BJ , Undurraga E , D'Agata EMC , Jara A , Munita JM . Clin Infect Dis 2023 77 S75-s81 BACKGROUND: Antimicrobial resistance is a global threat, heavily impacting low- and middle-income countries. This study estimated antimicrobial-resistant gram-negative bacteria (GNB) fecal colonization prevalence in hospitalized and community-dwelling adults in Chile before the coronavirus disease 2019 pandemic. METHODS: From December 2018 to May 2019, we enrolled hospitalized adults in 4 public hospitals and community dwellers from central Chile, who provided fecal specimens and epidemiological information. Samples were plated onto MacConkey agar with ciprofloxacin or ceftazidime added. All recovered morphotypes were identified and characterized according to the following phenotypes: fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria) GNB. Categories were not mutually exclusive. RESULTS: A total of 775 hospitalized adults and 357 community dwellers were enrolled. Among hospitalized subjects, the prevalence of colonization with FQR, ESCR, CR, or MDR-GNB was 46.4% (95% confidence interval [CI], 42.9-50.0), 41.2% (95% CI, 37.7-44.6), 14.5% (95% CI, 12.0-16.9), and 26.3% (95% CI, 23.2-29.4). In the community, the prevalence of FQR, ESCR, CR, and MDR-GNB colonization was 39.5% (95% CI, 34.4-44.6), 28.9% (95% CI, 24.2-33.6), 5.6% (95% CI, 3.2-8.0), and 4.8% (95% CI, 2.6-7.0), respectively. CONCLUSIONS: A high burden of antimicrobial-resistant GNB colonization was observed in this sample of hospitalized and community-dwelling adults, suggesting that the community is a relevant source of antibiotic resistance. Efforts are needed to understand the relatedness between resistant strains circulating in the community and hospitals. |
Infection Prevention and Control Initiatives to Prevent Healthcare-Associated Transmission of SARS-CoV-2, East Africa
Gomes DJ , Hazim C , Safstrom J , Herzig C , Luvsansharav U , Dennison C , Ahmed Y , Wesangula E , Hokororo J , Amone J , Tekle B , Owiso G , Mutayoba R , Lamorde M , Akello E , Kassa G , Feleke B , Ndegwa L , Kazaura K , Musisi D , Date A , Park BJ , Bancroft E . Emerg Infect Dis 2022 28 (13) S255-s261 The coronavirus disease pandemic has highlighted the need to establish and maintain strong infection prevention and control (IPC) practices, not only to prevent healthcare-associated transmission of SARS-CoV-2 to healthcare workers and patients but also to prevent disruptions of essential healthcare services. In East Africa, where basic IPC capacity in healthcare facilities is limited, the US Centers for Disease Control and Prevention (CDC) supported rapid IPC capacity building in healthcare facilities in 4 target countries: Tanzania, Ethiopia, Kenya, and Uganda. CDC supported IPC capacity-building initiatives at the healthcare facility and national levels according to each country's specific needs, priorities, available resources, and existing IPC capacity and systems. In addition, CDC established a multicountry learning network to strengthen hospital level IPC, with an emphasis on peer-to-peer learning. We present an overview of the key strategies used to strengthen IPC in these countries and lessons learned from implementation. |
Human colonization with multidrug-resistant organisms: Getting to the bottom of antibiotic resistance
Smith RM , Lautenbach E , Omulo S , Araos R , Call DR , Kumar GCP , Chowdhury F , McDonald CL , Park BJ . Open Forum Infect Dis 2021 8 (11) ofab531 The spread of antimicrobial resistance (AR) is a public health threat in both high-income countries (HICs) and low- and middle-income countries (LMICs). Multidrug-resistant organisms (MDROs), particularly gram-negative bacteria, are of critical concern with several having been identified by the United States Centers for Disease Control and Prevention and the World Health Organization (WHO) as priority pathogens for control and research [1, 2]. Essential to the task of mitigating the spread of AR is the development and use of robust surveillance systems to measure and track the incidence, prevalence, and spread of AR as policies and interventions for its prevention and control are introduced and evaluated. |
Feasibility and acceptance of a cloud-based mobile app for antimicrobial stewardship and infection control in Colombian hospitals
Ketcherside WJ , Olson JBF , Hunt LN , Mehta JM , Gutiérrez CP , Coy LM , Pradera IP , Rivera AD , Cano JA , Saeed A , Sapiro V , Park BJ , Malpiedi P , Botero MVV . Int J Infect Control 2020 16 (3) 1-6 Infection control and antimicrobial stewardship programs (ICASPs) are essential to reduce the emergence and spread of antimicrobial resistance. The primary objective of this study was to assess the feasibility of extending a commercial off-the-shelf (COTS) software for ICASPs in low- and middle-income countries (LMICs). This project involved three hospitals in Colombia, including Centro Médico Imbanaco, Clínica San Francisco, and DIME Clínica Neurocardiovascular. A COTS platform (ILÚM Health Solutions(™) Kenilworth, NJ) was extended to function in a range of technology settings, and translatable to almost any language. ICASP features were added, including clinical practice guidelines, hand hygiene (HH) documentation, and isolation precaution (IP) documentation. The platform was delivered as a smartphone mobile application ("app") for both iOS and Android. The app was successfully implemented at all sites, however, full back-end data integration was not feasible at any site. In contrast to the United States, a suite of surveillance tools and physician-focused decision support without patient data proved to be valuable. Language translation processing occurred quickly and incurred minimal costs. HH and IP compliance tracking were the most used features among ICASP staff; treatment guidelines were most often used by physicians. Use of the app streamlined activities and reduced the time spent on ICASP tasks. Users consistently reported positive impressions including simplicity of design, ease of navigation, and improved efficiency. This ICASP app was feasible in limited-resource settings, highly acceptable to users, and represents an innovative approach to antimicrobial resistance prevention. |
Rapid Sentinel Surveillance for COVID-19 - Santa Clara County, California, March 2020.
Zwald ML , Lin W , Sondermeyer Cooksey GL , Weiss C , Suarez A , Fischer M , Bonin BJ , Jain S , Langley GE , Park BJ , Moulia D , Benedict R , Nguyen N , Han GS . MMWR Morb Mortal Wkly Rep 2020 69 (14) 419-421 On February 27, 2020, the Santa Clara County Public Health Department (SCCPHD) identified its first case of coronavirus disease 2019 (COVID-19) associated with probable community transmission (i.e., infection among persons without a known exposure by travel or close contact with a patient with confirmed COVID-19). At the time the investigation began, testing guidance recommended focusing on persons with clinical findings of lower respiratory illness and travel to an affected area or an epidemiologic link to a laboratory-confirmed COVID-19 case, or on persons hospitalized for severe respiratory disease and no alternative diagnosis (1). To rapidly understand the extent of COVID-19 in the community, SCCPHD, the California Department of Public Health (CDPH), and CDC began sentinel surveillance in Santa Clara County. During March 5-14, 2020, four urgent care centers in Santa Clara County participated as sentinel sites. For this investigation, county residents evaluated for respiratory symptoms (e.g., fever, cough, or shortness of breath) who had no known risk for COVID-19 were identified at participating urgent care centers. A convenience sample of specimens that tested negative for influenza virus was tested for SARS-CoV-2 RNA. Among 226 patients who met the inclusion criteria, 23% had positive test results for influenza. Among patients who had negative test results for influenza, 79 specimens were tested for SARS-CoV-2, and 11% had evidence of infection. This sentinel surveillance system helped confirm community transmission of SARS-CoV-2 in Santa Clara County. As a result of these data and an increasing number of cases with no known source of transmission, the county initiated a series of community mitigation strategies. Detection of community transmission is critical for informing response activities, including testing criteria, quarantine guidance, investigation protocols, and community mitigation measures (2). Sentinel surveillance in outpatient settings and emergency departments, implemented together with hospital-based surveillance, mortality surveillance, and serologic surveys, can provide a robust approach to monitor the epidemiology of COVID-19. |
Performance of simplified surgical site infection (SSI) surveillance case definitions for resource limited settings: Comparison to SSI cases reported to the National Healthcare Safety Network, 2013-2017
Westercamp MD , Dudeck MA , Allen-Bridson K , Konnor R , Edwards JR , Park BJ , Smith RM . Infect Control Hosp Epidemiol 2020 41 (5) 1-3 Surgical site infections (SSIs) are among the most common healthcare-associated infections in low- and middle-income countries. To encourage establishment of actionable and standardized SSI surveillance in these countries, we propose simplified surveillance case definitions. Here, we use NHSN reports to explore concordance of these simplified definitions to NHSN as 'reference standard.' |
Evaluation of infection prevention and control readiness at frontline health care facilities in high-risk districts bordering Ebola virus disease-affected areas in the Democratic Republic of the Congo - Uganda, 2018
Biedron C , Lyman M , Stuckey MJ , Homsy J , Lamorde M , Luvsansharav UO , Wilson K , Gomes D , Omuut W , Okware S , Semanda JN , Kiggundu R , Bulwadda D , Brown V , Nelson LJ , Driwale A , Fagan R , Park BJ , Smith RM . MMWR Morb Mortal Wkly Rep 2019 68 (39) 851-854 Infection prevention and control (IPC) in health care facilities is essential to protecting patients, visitors, and health care personnel from the spread of infectious diseases, including Ebola virus disease (Ebola). Patients with suspected Ebola are typically referred to specialized Ebola treatment units (ETUs), which have strict isolation and IPC protocols, for testing and treatment (1,2). However, in settings where contact tracing is inadequate, Ebola patients might first seek care at general health care facilities, which often have insufficient IPC capacity (3-6). Before 2014-2016, most Ebola outbreaks occurred in rural or nonurban communities, and the role of health care facilities as amplification points, while recognized, was limited (7,8). In contrast to these earlier outbreaks, the 2014-2016 West Africa Ebola outbreak occurred in densely populated urban areas where access to health care facilities was better, but contact tracing was generally inadequate (8). Patients with unrecognized Ebola who sought care at health care facilities with inadequate IPC initiated multiple chains of transmission, which amplified the epidemic to an extent not seen in previous Ebola outbreaks (3-5,7). Implementation of robust IPC practices in general health care facilities was critical to ending health care-associated transmission (8). In August 2018, when an Ebola outbreak was recognized in the Democratic Republic of the Congo (DRC), neighboring countries began preparing for possible introduction of Ebola, with a focus on IPC. Baseline IPC assessments conducted in frontline health care facilities in high-risk districts in Uganda found IPC gaps in screening, isolation, and notification. Based on findings, additional funds were provided for IPC, a training curriculum was developed, and other corrective actions were taken. Ebola preparedness efforts should include activities to ensure that frontline health care facilities have the IPC capacity to rapidly identify suspected Ebola cases and refer such patients for treatment to protect patients, staff members, and visitors. |
Implementation research for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva infection prevention and control (IPC)-think tank (part 1)
Zingg W , Storr J , Park BJ , Ahmad R , Tarrant C , Castro-Sanchez E , Tomczyk S , Kilpatrick C , Allegranzi B , Cardo D , Pittet D . Antimicrob Resist Infect Control 2019 8 87 Background: Around 5-15% of all hospital patients worldwide suffer from healthcare-associated infections (HAIs), and years of excessive antimicrobial use in human and animal medicine have created emerging antimicrobial resistance (AMR). A considerable amount of evidence-based measures have been published to address these challenges, but the largest challenge seems to be their implementation. Methods: In June 2017, a total of 42 experts convened at the Geneva IPC-Think Tank to discuss four domains in implementation science: 1) teaching implementation skills; 2) fostering implementation of IPC and antimicrobial stewardship (AMS) by policy making; 3) national/international actions to foster implementation skills; and 4) translational research bridging social sciences and clinical research in infection prevention and control (IPC) and AMR. Results: Although neglected in the past, implementation skills have become a priority in IPC and AMS. They should now be part of any curriculum in health care, and IPC career paths should be created. Guidelines and policies should be aligned with each other and evidence-based, each document providing a section on implementing elements of IPC and AMS in patient care. International organisations should be advocates for IPC and AMS, framing them as patient safety issues and emphasizing the importance of implementation skills. Healthcare authorities at the national level should adopt a similar approach and provide legal frameworks, guidelines, and resources to allow better implementation of patient safety measures in IPC and AMS. Rather than repeating effectiveness studies in every setting, we should invest in methods to improve the implementation of evidence-based measures in different healthcare contexts. For this, we need to encourage and financially support collaborations between social sciences and clinical IPC research. Conclusions: Experts of the 2017 Geneva Think Tank on IPC and AMS, CDC, and WHO agreed that sustained efforts on implementation of IPC and AMS strategies are required at international, country, and hospital management levels, to provide an adequate multimodal framework that addresses (not exclusively) leadership, resources, education and training for implementing IPC and AMS. Future strategies can build on this agreement to make strategies on IPC and AMS more effective. |
Technology for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva IPC-Think Tank (Part 2).
Zingg W , Park BJ , Storr J , Ahmad R , Tarrant C , Castro-Sanchez E , Perencevich E , Widmer A , Krause KH , Kilpatrick C , Tomczyk S , Allegranzi B , Cardo D , Pittet D . Antimicrob Resist Infect Control 2019 8 83 Background: The high burden of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) is partially due to excessive antimicrobial use both in human and animal medicine worldwide. How can technology help to overcome challenges in infection prevention and control (IPC) and to prevent HAI and emerging AMR? Methods: In June 2017, 42 international experts convened in Geneva, Switzerland to discuss four potential domains of technology in IPC and AMR: 1) role and potential contribution of microbiome research; 2) whole genome sequencing; 3) effectiveness and benefit of antimicrobial environmental surfaces; and 4) future research in hand hygiene. Results: Research on the microbiome could expand understanding of antimicrobial use and also the role of probiotics or even faecal transplantation for therapeutic purposes. Whole genome sequencing will provide new insights in modes of transmission of infectious diseases. Although it is a powerful tool for public health epidemiology, some challenges with interpretation and costs still need to be addressed. The effectiveness and cost-effectiveness of antimicrobially coated or treated environmental high-touch surfaces requires further research before they can be recommended for routine use. Hand hygiene implementation can be advanced, where technological enhancement of surveillance, technique and compliance are coupled with reminders for healthcare professionals. Conclusions: The four domains of technological innovation contribute to the prevention of HAI and AMR at different levels. Microbiome research may offer innovative concepts for future prevention, whole genome sequencing could detect new modes of transmission and become an additional tool for effective public health epidemiology, antimicrobial surfaces might help to decrease the environment as source of transmission but continue to raise more questions than answers, and technological innovation may have a role in improving surveillance approaches and supporting best practice in hand hygiene. |
Broadening the infection prevention and control network globally; 2017 Geneva IPC-think tank (part 3)
Zingg W , Storr J , Park BJ , Jernigan JA , Harbarth S , Grayson ML , Tacconelli E , Allegranzi B , Cardo D , Pittet D . Antimicrob Resist Infect Control 2019 8 (1) 74 Background: Healthcare-associated infection (HAI) is a major challenge for patient safety worldwide, and is further complicated by antimicrobial resistance (AMR) due to excessive antimicrobial use in both humans and animals. Existing infection prevention and control (IPC) networks must be strengthened and adapted to better address the global challenges presented by emerging AMR. Methods: In June 2017, 42 international experts convened in Geneva, Switzerland, to discuss two key areas for strengthening the global IPC network: 1) broadening collaboration in IPC; and 2) how to bring the fields IPC and AMR control together. Results: The US Centers for Disease Prevention and Control, the European Centre for Disease Prevention and Control, and the World Health Organization (WHO) convened together with international experts to discuss collaboration and networks, demonstrating the participating organizations' commitment to close collaboration in IPC. The challenge of emerging AMR can only be addressed by strengthening this collaboration across international organisations and between public health and academia. The WHO SAVE LIVES: Clean Your Hands initiative is an example of a successful collaboration between multiple global stakeholders including academia and international public health organisations; it can be used as a model. IPC-strategies are included within the four pillars to combat AMR: surveillance, IPC, antimicrobial and diagnostic stewardship, research and development. The prevention of transmission of multidrug-resistant microorganisms is a patient safety issue, and must be strengthened in the fight against AMR. Conclusions: The working group determined that international organisations should take the lead in creating new networks, which will in turn attract academia and other stakeholders to join. At the same time, they should invest in bringing existing IPC and AMR networks under one umbrella. Transmission of multidrug-resistant microorganisms in hospitals and in the community threatens the success of antimicrobial stewardship programmes, and thus, research and development in IPC should be addressed as an enhanced global priority. |
Africa Centres for Disease Control and Prevention's framework for antimicrobial resistance control in Africa
Varma JK , Oppong-Otoo J , Ondoa P , Perovic O , Park BJ , Laxminarayan R , Peeling RW , Schultsz C , Li H , Ihekweazu C , Sall AA , Jaw B , Nkengasong JN . Afr J Lab Med 2018 7 (2) 830 Antimicrobial resistant (AMR) organisms are increasing globally, threatening to render existing treatments ineffective against many infectious diseases.1,2 AMR strains of bacteria, fungi, parasites, and viruses prolong illness, increase case fatality, facilitate transmission, and increase treatment costs.3,4 In Africa where many health systems are weak, the likelihood of AMR increasing and the consequences of AMR infections are particularly high, and drug resistance has already been documented for HIV and the pathogens that cause malaria, tuberculosis, typhoid, cholera, meningitis, gonorrhoea, and dysentery.5 Patients in these countries have limited access to accurate diagnosis and adequate antimicrobial treatment, which can lead to sepsis and other life-threatening complications.6,7 |
Establishment of a sentinel laboratory-based antimicrobial resistance surveillance network in Ethiopia
Hazim C , Abubeker Ibrahim R , Westercamp M , Belete GA , Amare Kibret B , Kanter T , Yimer G , Adem TS , Stevenson KB , Urrego M , Kale KN , Omondi MW , VanderEnde D , Park BJ , Parsons MMB , Gallagher KM . Health Secur 2018 16 S30-s36 In 2014, as part of the Global Health Security Agenda, Ethiopia was provided the technical and financial resources needed to prioritize antimicrobial resistance (AMR) in the national public health sphere. Under the direction of a multi-stakeholder working group, AMR surveillance was launched in July 2017 at 4 sentinel sites across the country. The AMR surveillance initiative in Ethiopia represents one of the first systematic efforts to prospectively collect, analyze, and report national-level microbiology results from a network of hospitals and public health laboratories in the country. Baseline readiness assessments were conducted to identify potential challenges to implementation to be addressed through capacity-building efforts. As part of these efforts, the working group leveraged existing resources, initiated laboratory capacity building through mentorship, and established infrastructure and systems for quality assurance, data management, and improved coordination. As a result, AMR surveillance data are being reported and analyzed for use; data from more than 1,700 patients were collected between July 2017 and March 2018. The critical challenges and effective solutions identified through surveillance planning and implementation have provided lessons to help guide successful AMR surveillance in other settings. Ultimately, the surveillance infrastructure, laboratory expertise, and communication frameworks built specifically for AMR surveillance in Ethiopia can be extended for use with other infectious diseases and potential public health emergencies. Thus, building AMR surveillance in Ethiopia has illustrated how laying the foundation for a specific public health initiative can develop capacity for core public health functions with potential benefit. |
Reflexive laboratory-based cryptococcal antigen screening and preemptive fluconazole therapy for cryptococcal antigenemia in HIV-infected individuals with CD4 <100 cells/microL: a stepped-wedge, cluster-randomized trial
Meya DB , Kiragga AN , Nalintya E , Morawski BM , Rajasingham R , Park BJ , Mubiru A , Kaplan JE , Manabe YC , Boulware DR . J Acquir Immune Defic Syndr 2018 80 (2) 182-189 BACKGROUND: HIV-infected persons with cryptococcal antigenemia (CrAg) are at high risk for meningitis or death. We evaluated the effect of CrAg screening and pre-emptive fluconazole therapy, as an adjunct to antiretroviral therapy (ART), on six-month survival among persons with advanced HIV disease. METHODS: We enrolled HIV-infected, ART-naive eligible participants with <100 CD4 cells/microL, in a stepped-wedge, cluster-randomized trial from July 2012 - December 2014 at 17 Ugandan clinics. Clinics participated in a prospective observational phase, followed by an interventional phase with lab-based, reflexive CrAg screening of residual CD4 count plasma. Asymptomatic CrAg-positive participants received preemptive fluconazole therapy for ten weeks. We assessed six-month survival using Cox-regression, adjusting for nadir CD4, calendar time, and stepped-wedge steps. RESULTS: We included 1,280 observational and 2,108 interventional participants, of whom 9.3% (195/2,108) were CrAg-positive. CD4-, time-, and stepped-wedge-adjusted analyses demonstrated no difference in survival in the observational vs the interventional arms (HR = 1.34; 95% CI, 0.86-2.10; P = 0.20), including when the analysis was limited to persons who started ART (HR=1.11; 95% CI, 0.62 - 1.79, P=0.86) However, six-month mortality of participants with CrAg titers <1:160 and CrAg-negative patients did not differ. Patients with CrAg titers >/=1:160 had 2.6-fold higher six-month mortality than patients with titers <1:160. CONCLUSION: We observed no overall survival benefit of the lab-based reflexive CrAg screen-and-treat intervention. However, preemptive antifungal therapy for asymptomatic cryptococcosis appeared to be effective in patients with CrAg titer <1:160. A more aggressive approach may be required for persons with CrAg titer >/=1:160.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
Interlaboratory agreement of coccidioidomycosis enzyme immunoassay from two different manufacturers
Khan S , Saubolle MA , Oubsuntia T , Heidari A , Barbian K , Goodin K , Eguchi M , McCotter OZ , Komatsu K , Park BJ , Geiger MC , Mohamed A , Chiller T , Sunenshine RH . Med Mycol 2018 57 (4) 441-446 Coccidioidomycosis, a fungal infection endemic to the Southwestern United States, is challenging to diagnose. The coccidioidomycosis enzyme immunoassay (EIA) test is the least expensive and simplest to perform to detect coccidioidomycosis antibodies in the serum. Concerns regarding falsely positive immunoglobulin (Ig) M EIA test results have led to questions about the agreement of commercially available EIA test kits among laboratories. We sought to evaluate the laboratory agreement of the EIA test at three laboratories using both IMMY and Meridian EIA test kits. Sensitivity and specificity of EIA IgM and IgG were calculated as secondary outcomes. The percent agreement of the EIA IgM and IgG test results among all three laboratories was 90% and 89% for IMMY test kits, respectively, and 67% and 80.5% for Meridian test kits, respectively. Agreement between IgM and IgG combined test results was 85.5% and 70.5%, for IMMY and Meridian, respectively. Combined IgM and IgG assays demonstrated a sensitivity of 68% (62.7%-76%) and a specificity of 99.3% (98%-100%) [IMMY] and a sensitivity of 72.4% (57.3%-87.3%) and a specificity of 91.3% (74%-100%) [Meridian]. In summary, results from the IMMY EIA test kit agreed more often across laboratories than Meridian EIA results, especially for the IgM assay. Isolated positive IgM EIA results using the Meridian test kit should be interpreted with caution and consideration of clinical information and test methodology. Further study of the sensitivity and specificity of coccidioidomycosis EIA test kits is warranted. |
Infection prevention and control training and capacity building during the Ebola epidemic in Guinea
Soeters HM , Koivogui L , de Beer L , Johnson CY , Diaby D , Ouedraogo A , Toure F , Bangoura FO , Chang MA , Chea N , Dotson EM , Finlay A , Fitter D , Hamel MJ , Hazim C , Larzelere M , Park BJ , Rowe AK , Thompson-Paul AM , Twyman A , Barry M , Ntaw G , Diallo AO . PLoS One 2018 13 (2) e0193291 BACKGROUND: During the 2014-2016 Ebola epidemic in West Africa, a key epidemiological feature was disease transmission within healthcare facilities, indicating a need for infection prevention and control (IPC) training and support. METHODS: IPC training was provided to frontline healthcare workers (HCW) in healthcare facilities that were not Ebola treatment units, as well as to IPC trainers and IPC supervisors placed in healthcare facilities. Trainings included both didactic and hands-on components, and were assessed using pre-tests, post-tests and practical evaluations. We calculated median percent increase in knowledge. RESULTS: From October-December 2014, 20 IPC courses trained 1,625 Guineans: 1,521 HCW, 55 IPC trainers, and 49 IPC supervisors. Median test scores increased 40% (interquartile range [IQR]: 19-86%) among HCW, 15% (IQR: 8-33%) among IPC trainers, and 21% (IQR: 15-30%) among IPC supervisors (all P<0.0001) to post-test scores of 83%, 93%, and 93%, respectively. CONCLUSIONS: IPC training resulted in clear improvements in knowledge and was feasible in a public health emergency setting. This method of IPC training addressed a high demand among HCW. Valuable lessons were learned to facilitate expansion of IPC training to other prefectures; this model may be considered when responding to other large outbreaks. |
Healthcare-associated measles following a nationwide outbreak in Mongolia
Lake JG , Luvsansharav UO , Hagan JE , Goodson JL , Jigjidsuren N , Gombojamts N , Park BJ , Smith R . Clin Infect Dis 2018 67 (2) 288-290 Measles virus is highly infectious and can spread rapidly through healthcare settings where vaccine coverage is low and isolation precautions are suboptimal. We describe healthcare-associated measles transmission during the large 2015-2016 measles outbreak in Mongolia, describe observed infection prevention gaps, and outline practical strategies to prevent healthcare-associated measles transmission. |
Global infection prevention and control priorities 2018-22: a call for action
Allegranzi B , Kilpatrick C , Storr J , Kelley E , Park BJ , Donaldson L . Lancet Glob Health 2017 5 (12) e1178-e1180 The Ebola virus disease outbreak in west Africa and the rapid spread of other emerging viruses, such as the severe acute respiratory syndrome or the Middle East respiratory syndrome coronaviruses, showed how limited or non-existent infection prevention and control (IPC) programmes, combined with an inadequate water supply, poor sanitation, and a weak hygiene infrastructure in health facilities, can threaten global health security. In such outbreaks, instead of serving as points where disease was controlled, health-care facilities became dangerous places for outbreak amplification among staff and patients and transmission back to communities. According to WHO, defective IPC practices during everyday health-care delivery also cause harm to hundreds of millions of patients worldwide every year.1, 2 The European Centre for Disease Prevention and Control estimated that more than 2·6 million new cases of health-care-associated infection occur every year in Europe, with a cumulative burden estimated in disability-adjusted-life-years that is higher than all other reported 32 communicable diseases.3 The burden of health-care-associated infections was also recently highlighted in southeast Asian countries.4 Many health systems fail to build strong foundations to reduce the risks and spread of health-care-associated outbreaks. They also tolerate an unacceptably poor level of IPC in everyday practice. | It is now urgent to consider IPC capacity building and actual implementation as global health priorities. This would create a unique opportunity to make IPC a strong contributor to the achievement of the health-related UN's Sustainable Development Goals (particularly, 3.1-3, 3.b, 3.d, and 6), including quality universal health coverage (3.8).5 It would also help effective implementation of other major global health priorities, including the International Health Regulations, antimicrobial resistance (AMR) action plans, patient and health worker safety, and integrated people-centred care.6, 7 |
Global burden of disease of HIV-associated cryptococcal meningitis: An updated analysis
Rajasingham R , Smith RM , Park BJ , Jarvis JN , Govender NP , Chiller TM , Denning DW , Loyse A , Boulware DR . Lancet Infect Dis 2017 17 (8) 873-881 BACKGROUND: Cryptococcus is the most common cause of meningitis in adults living with HIV in sub-Saharan Africa. Global burden estimates are crucial to guide prevention strategies and to determine treatment needs, and we aimed to provide an updated estimate of global incidence of HIV-associated cryptococcal disease. METHODS: We used 2014 Joint UN Programme on HIV and AIDS estimates of adults (aged >15 years) with HIV and antiretroviral therapy (ART) coverage. Estimates of CD4 less than 100 cells per muL, virological failure incidence, and loss to follow-up were from published multinational cohorts in low-income and middle-income countries. We calculated those at risk for cryptococcal infection, specifically those with CD4 less than 100 cells/muL not on ART, and those with CD4 less than 100 cells per muL on ART but lost to follow-up or with virological failure. Cryptococcal antigenaemia prevalence by country was derived from 46 studies globally. Based on cryptococcal antigenaemia prevalence in each country and region, we estimated the annual numbers of people who are developing and dying from cryptococcal meningitis. FINDINGS: We estimated an average global cryptococcal antigenaemia prevalence of 6.0% (95% CI 5.8-6.2) among people with a CD4 cell count of less than 100 cells per muL, with 278 000 (95% CI 195 500-340 600) people positive for cryptococcal antigen globally and 223 100 (95% CI 150 600-282 400) incident cases of cryptococcal meningitis globally in 2014. Sub-Saharan Africa accounted for 73% of the estimated cryptococcal meningitis cases in 2014 (162 500 cases [95% CI 113 600-193 900]). Annual global deaths from cryptococcal meningitis were estimated at 181 100 (95% CI 119 400-234 300), with 135 900 (75%; [95% CI 93 900-163 900]) deaths in sub-Saharan Africa. Globally, cryptococcal meningitis was responsible for 15% of AIDS-related deaths (95% CI 10-19). INTERPRETATION: Our analysis highlights the substantial ongoing burden of HIV-associated cryptococcal disease, primarily in sub-Saharan Africa. Cryptococcal meningitis is a metric of HIV treatment programme failure; timely HIV testing and rapid linkage to care remain an urgent priority. |
Estimated prevalence of cryptococcus antigenemia (CrAg) among HIV-infected adults with advanced immunosuppression in Namibia justifies routine screening and preemptive treatment
Sawadogo S , Makumbi B , Purfield A , Ndjavera C , Mutandi G , Maher A , Kaindjee-Tjituka F , Kaplan JE , Park BJ , Lowrance DW . PLoS One 2016 11 (10) e0161830 BACKGROUND: Cryptococcal meningitis is common and associated with high mortality among HIV infected persons. The World Health Organization recommends that routine Cryptococcal antigen (CrAg) screening in ART-naive adults with a CD4+ count <100 cells/muL followed by pre-emptive antifungal therapy for CrAg-positive patients be considered where CrAg prevalence is ≥3%. The prevalence of CrAg among HIV adults in Namibia is unknown. We estimated CrAg prevalence among HIV-infected adults receiving care in Namibia for the purpose of informing routine screening strategies. METHODS: The study design was cross-sectional. De-identified plasma specimens collected for routine CD4+ testing from HIV-infected adults enrolled in HIV care at 181 public health facilities from November 2013 to January 2014 were identified at the national reference laboratory. Remnant plasma from specimens with CD4+ counts <200 cells/muL were sampled and tested for CrAg using the IMMY(R) Lateral Flow Assay. CrAg prevalence was estimated and assessed for associations with age, sex, and CD4+ count. RESULTS: A total of 825 specimens were tested for CrAg. The median (IQR) age of patients from whom specimens were collected was 38 (32-46) years, 45.9% were female and 62.9% of the specimens had CD4 <100 cells/muL. CrAg prevalence was 3.3% overall and 3.9% and 2.3% among samples with CD4+ counts of CD4+<100 cells/muL and 100-200 cells/muL, respectively. CrAg positivity was significantly higher among patients with CD4+ cells/muL < 50 (7.2%, P = 0.001) relative to those with CD4 cells/muL 50-200 (2.2%). CONCLUSION: This is the first study to estimate CrAg prevalence among HIV-infected patients in Namibia. CrAg prevalence of ≥3.0% among patients with CD4+<100 cells/muL justifies routine CrAg screening and preemptive treatment among HIV-infected in Namibia in line with WHO recommendations. Patients with CD4+<100 cells/muL have a significantly greater risk for CrAg positivity. Revised guidelines for ART in Namibia now recommend routine screening for CrAg. |
Infection prevention and control for Ebola in health care settings - West Africa and United States
Hageman JC , Hazim C , Wilson K , Malpiedi P , Gupta N , Bennett S , Kolwaite A , Tumpey A , Brinsley-Rainisch K , Christensen B , Gould C , Fisher A , Jhung M , Hamilton D , Moran K , Delaney L , Dowell C , Bell M , Srinivasan A , Schaefer M , Fagan R , Adrien N , Chea N , Park BJ . MMWR Suppl 2016 65 (3) 50-6 The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html). |
Impact of nurse-targeted care on HIV outcomes among immunocompromised persons: a before-after study in Uganda
Kiragga AN , Nalintya E , Morawski BM , Kigozi J , Park BJ , Kaplan JE , Boulware DR , Meya DB , Manabe YC . J Acquir Immune Defic Syndr 2016 72 (2) e32-6 INTRODUCTION: Improving HIV outcomes among severely immunocompromised HIV-infected persons who have increased morbidity and mortality remains an important issue in sub-Saharan Africa. We sought to evaluate the impact of targeted clinic- based nurse care on ART initiation and retention among severely immunocompromised HIV-infected persons. METHODS: The study included ART-naive patients with CD4<100 cells/microL registered in seven urban clinics in Kampala, Uganda. Data were retrospectively collected on patients enrolled from July to December 2011 (routine care cohort). Between July 2012 and September 2013, one additional nurse per clinic was hired (nurse counselor cohort) to identify new patients, expedite ART initiation and trace those loss-to-follow-up. We compared time to ART initiation and 6-month retention in care between cohorts and used a generalized linear model to estimate the relative risk of retention. RESULTS: The study included 258 patients in the routine care cohort and 593 in the nurse counselor cohort. The proportion of patients who initiated ART increased from 190 (73.6%) in the routine care cohort to 506 (85.3%) in the nurse counselor cohort (p<0.001). At 6 months, 62% of the routine care cohort were retained in care versus 76% in the nurse counselor cohort (p=0.001). A 21% increase in likelihood of retention in the nurse counselor cohort (relative risk 1.21, 95% CI, 1.09-1.34) compared with the routine care cohort was observed. CONCLUSION: Implementation of targeted nurse-led care of severely immunocompromised HIV-infected patients in public outpatient health care facilities resulted in decreased time to ART initiation and increased retention. |
Awareness and environmental exposures related to coccidioidomycosis among inmates at two California prisons, 2013
Benedict K , Purfield AE , Mohle-Boetani J , Wheeler C , Park BJ . J Correct Health Care 2016 22 (2) 157-63 Coccidioidomycosis (Valley fever) is a major cause of illness in inmates in some California prisons. This article discusses an investigation conducted at two prisons to describe potential environmental exposures. The study did not identify modifiable risk factors; limiting the type or duration of outdoor activity in these prisons may not decrease coccidioidomycosis morbidity. |
Phaeohyphomycosis in transplant recipients: results from the Transplant Associated Infection Surveillance Network (TRANSNET)
McCarty TP , Baddley JW , Walsh TJ , Alexander BD , Kontoyiannis DP , Perl TM , Walker R , Patterson TF , Schuster MG , Lyon GM , Wingard JR , Andes DR , Park BJ , Brandt ME , Pappas PG . Med Mycol 2015 53 (5) 440-6 Transplant recipients are at a high risk for developing invasive fungal infections. The agents of phaeohyphomycosis are environmental molds found worldwide, and they cause a broad spectrum of disease including skin and subcutaneous lesions, pneumonia, central nervous system disease, fungemia, and disseminated disease. Using data from the Transplant Associated Infection Surveillance Network (TRANSNET), we evaluated patients with proven and probable phaeohyphomycosis. Centers collected data on demographics, co-morbid conditions, clinical features, treatment, and three-month mortality. Fifty-six patients with phaeohyphomycosis were identified from 15 centers, comprising 26 stem cell transplant (SCT) and 30 solid organ transplant (SOT) recipients. Median time to diagnosis post-transplant was 358 days (SCT 100 days; SOT 685 days; P = <.001). The most frequent pathogen was Alternaria species (32%). Disseminated disease was found in 55.4%. Cutaneous infection was more common in SOT (53.3% vs 23.1%; P = .021), while pulmonary disease was more common in SCT (57.7 vs. 26.7; P = .019). Voriconazole (44.6%) and amphotericin B preparations (37.5%) were the most common antifungal therapies. Overall mortality was 25% and was higher in SCT than in SOT (42% vs 10%; P = <.001). A wide variety of organisms encompass phaeohyphomycosis contributing to varying types of infection in transplant recipients. Site of infection, time to disease, and mortality varies significantly between SCT and SOT recipients. Lipid formulations of amphotericin B and voriconazole were the most common antifungals used to treat this disorder. |
Cardiothoracic surgical site phaeohyphomycosis caused by Bipolaris mould, multiple US states, 2008-2013: a clinical description
Vallabhaneni S , Purfield AE , Benedict K , Luvsansharav U , Lockhart SR , Pham CD , Pascoe N , Heseltine G , Chung W , Hall E , Brust KB , Wheeler CF , Halpin AL , Park BJ . Med Mycol 2015 54 (3) 318-21 Bipolaris mould surgical site infections (SSIs) are exceedingly rare. We describe 21 cases of Bipolaris SSIs in pediatric and adult cardiothoracic surgery patients at ten hospitals in Texas, Arkansas, and Florida during 2008-2013. Median case-patient age was 55 years (range: 3 days-82 years), and 19 (90%) were male. Ten (48%) had coronary artery bypass or valve surgery, and seven (33%) had heart transplantation. Fifteen (71%) had more than one cardiothoracic procedure (median: 3, range: 1-11). Thirteen (62%) case-patients (all 5 pediatric patients, and 8 (50%) of 16 adult patients) had delayed sternal closure (chest closed >1 day [median = 8 days; range: 2-22] following the initial cardiothoracic procedure). Thirteen (62%) had mediastinitis. Median time from initial surgery to positive Bipolaris culture was 20 days (range: 6-497). Sixteen (76%) case-patients died. |
Evaluation of the Specificity of Two Enzyme Immunoassays for Coccidioidomycosis by Using Sera from a Region of Endemicity and a Region of Nonendemicity
Lindsley MD , Ahn Y , McCotter O , Gade L , Hurst SF , Brandt ME , Park BJ , Litvintseva AP . Clin Vaccine Immunol 2015 22 (10) 1090-5 Coccidioidomycosis (CM), a serious and life threatening fungal infection endemic to arid regions of western United States and Mexico, can be challenging to diagnose in a timely manner. Commercially developed enzyme immunoassays (EIA; Meridian Biosciences and Immuno-Mycologics (IMMY)) have provided a faster, simpler means for serodiagnosis; however, independent evaluations have questioned EIA specificity, particularly IgM-positive/IgG-negative results. This study was conducted to evaluate EIA specificity in persons not likely to have been exposed to Coccidioides sp. residing in non-endemic Puerto Rico (PR; n=534) compared to sera from blood bank donors residing in endemic Arizona (AZ; n=1218). Upon comparing serum reactivity between PR and AZ, the Meridian EIA showed a significant difference in IgG-reactivity (0.37% vs. 3.6%, p<0.001), but not in IgM-reactivity (3.4% vs. 2.4%). No IgM/IgG-reactive sera were detected in PR sera compared to 7 (0.57%) from AZ. Similar results were observed using the IMMY EIA, although significantly (p=0.03) fewer IgM-reactive sera were observed from AZ, compared to Meridian EIA. EIA-reactive sera were also evaluated by immunodiffusion before and after 3-4-fold concentration of the sera. These results demonstrate that elevated IgG EIA-reactivity is present in sera from healthy individuals in endemic regions and that IgM EIA-reactivity observed in sera from individuals residing outside the endemic region is most likely false. Other criteria, including clinical and microbiological evaluation, should be taken into account when interpreting results from surveillance studies and other reporting measures. |
Histoplasmosis in Idaho and Montana, USA, 2012-2013
Nett RJ , Skillman D , Riek L , Davis B , Blue SR , Sundberg EE , Merriman JR , Hahn CG , Park BJ . Emerg Infect Dis 2015 21 (6) 1071-2 Histoplasmosis occurs after infection with the dimorphic fungus Histoplasma capsulatum (1–6). Patients become ill after they inhale soil contaminated with H. capsulatum (1,2). Most infections are asymptomatic or result in mild illness not determined to be histoplasmosis (1,2). Symptoms usually develop 3–14 days after exposure and range from self-limited pneumonia to severe disseminated disease requiring antifungal therapy (2,7). | In the United States, H. capsulatum is endemic to the Mississippi and Ohio River Valleys (1,2,5,8) but is not known to be endemic to the Rocky Mountain region (8). During June 2012–November 2013, a total of 6 unrelated cases of histoplasmosis were reported in Idaho (n = 1) and Montana (n = 5) in patients who had no recent travel to recognized H. capsulatum–endemic regions. Public health authorities investigated the illnesses by reviewing medical records and collecting exposure and travel histories. | The median age of the patients (3 male, 3 female) was 68 (range 17–79) years (Table). Each case was diagnosed by a different physician; no known epidemiologic links existed among the patients. Five patients had >1 immunocompromising conditions (Table), and 2 had acute pneumonia; 1 each had left parotid gland enlargement, anterior cervical lymphadenopathy, tricuspid valve mass, and acute changes in mental status. Three patients were hospitalized: 2 required intensive care, and 1 died. |
Estimated deaths and illnesses averted during fungal meningitis outbreak associated with contaminated steroid injections, United States, 2012-2013
Smith RM , Derado G , Wise M , Harris JR , Chiller T , Meltzer MI , Park BJ . Emerg Infect Dis 2015 21 (6) 933-40 During 2012-2013, the US Centers for Disease Control and Prevention and partners responded to a multistate outbreak of fungal infections linked to methylprednisolone acetate (MPA) injections produced by a compounding pharmacy. We evaluated the effects of public health actions on the scope of this outbreak. A comparison of 60-day case-fatality rates and clinical characteristics of patients given a diagnosis on or before October 4, the date the outbreak was widely publicized, with those of patients given a diagnosis after October 4 showed that an estimated 3,150 MPA injections, 153 cases of meningitis or stroke, and 124 deaths were averted. Compared with diagnosis after October 4, diagnosis on or before October 4 was significantly associated with a higher 60-day case-fatality rate (28% vs. 5%; p<0.0001). Aggressive public health action resulted in a substantially reduced estimated number of persons affected by this outbreak and improved survival of affected patients. |
Initiation of a ring approach to infection prevention and control at non-Ebola health care facilities - Liberia, January-February 2015
Nyenswah T , Massaquoi M , Gbanya MZ , Fallah M , Amegashie F , Kenta A , Johnson KL , Yahya D , Badini M , Soro L , Pessoa-Silva CL , Roger I , Selvey L , VanderEnde K , Murphy M , Cooley LA , Olsen SJ , Christie A , Vertefeuille J , Navin T , McElroy P , Park BJ , Esswein E , Fagan R , Mahoney F . MMWR Morb Mortal Wkly Rep 2015 64 (18) 505-8 From mid-January to mid-February 2015, all confirmed Ebola virus disease (Ebola) cases that occurred in Liberia were epidemiologically linked to a single index patient from the St. Paul Bridge area of Montserrado County. Of the 22 confirmed patients in this cluster, eight (36%) sought and received care from at least one of 10 non-Ebola health care facilities (HCFs), including clinics and hospitals in Montserrado and Margibi counties, before admission to an Ebola treatment unit. After recognition that three patients in this emerging cluster had received care from a non-Ebola treatment unit, and in response to the risk for Ebola transmission in non-Ebola treatment unit health care settings, a focused infection prevention and control (IPC) rapid response effort for the immediate area was developed to target facilities at increased risk for exposure to a person with Ebola (Ring IPC). The Ring IPC approach, which provided rapid, intensive, and short-term IPC support to HCFs in areas of active Ebola transmission, was an addition to Liberia's proposed longer term national IPC strategy, which focused on providing a comprehensive package of IPC training and support to all HCFs in the country. This report describes possible health care worker exposures to the cluster's eight patients who sought care from an HCF and implementation of the Ring IPC approach. On May 9, 2015, the World Health Organization (WHO) declared the end of the Ebola outbreak in Liberia. |
Declining incidence of candidemia and the shifting epidemiology of Candida resistance in two US netropolitan areas, 2008-2013: results from population-based surveillance
Cleveland AA , Harrison LH , Farley MM , Hollick R , Stein B , Chiller TM , Lockhart SR , Park BJ . PLoS One 2015 10 (3) e0120452 BACKGROUND: Recent reports have demonstrated a decline in bacterial bloodstream infections (BSIs) following adherence to central line insertion practices; however, declines have been less evident for BSIs due to Candida species. METHODS: We conducted active, population-based laboratory surveillance for candidemia in metropolitan Atlanta, GA and Baltimore, MD over a 5-year period. We calculated annual candidemia incidence and antifungal drug resistance rates. RESULTS: We identified 3,848 candidemia cases from 2008-2013. Compared with 2008, candidemia incidence per 100,000 person-years decreased significantly by 2013 in both locations (GA: 14.1 to 9.5, p<0.001; MD: 30.9 to 14.4, p<0.001). A total of 3,255 cases (85%) had a central venous catheter (CVC) in place within 2 days before the BSI culture date. In both locations, the number of CVC-associated cases declined (GA: 473 to 294; MD: 384 to 151). Candida albicans (CA, 36%) and Candida glabrata (CG, 27%) were the most common species recovered. In both locations, the proportion of cases with fluconazole resistance decreased (GA: 8.0% to 7.1%, -10%; MD: 6.6% to 4.9%, -25%), while the proportion of cases with an isolate resistant to an echinocandin increased (GA: 1.2% to 2.9%, +147%; MD: 2.0% to 3.5%, +77%). Most (74%) echinocandin-resistant isolates were CG; 17 (<1%) isolates were resistant to both drug categories (multidrug resistant [MDR], 16/17 were CG). The proportion of CG cases with MDR Candida increased from 1.8% to 2.6%. CONCLUSIONS: We observed a significant decline in the incidence of candidemia over a five-year period, and increases in echinocandin-resistant and MDR Candida. Efforts to strengthen infection control practices may be preventing candidemia among high-risk patients. Further surveillance for resistant Candida is warranted. |
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