Last data update: Apr 29, 2024. (Total: 46658 publications since 2009)
Records 1-13 (of 13 Records) |
Query Trace: Walters Maroya [original query] |
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COVID-19 Case Investigations Among Federally Quarantined Evacuees From Wuhan, China, and Exposed Personnel at a US Military Base, United States, February 5-21, 2020.
Chuey MeaganR , Stewart RebekahJ , Walters Maroya , Curren EmilyJ , Hills SusanL , Moser KathleenS , Staples JErin , Braden ChristopherR , McDonald Eric . Public Health Rep 2022 137 (2) 203-207 In February 2020, during the early days of the COVID-19 pandemic, 232 evacuees from Wuhan, China, were placed under federal 14-day quarantine upon arrival at a US military base in San Diego, California. We describe the monitoring of evacuees and responders for symptoms of COVID-19, case and contact investigations, infection control procedures, and lessons learned to inform future quarantine protocols for evacuated people from a hot spot resulting from a novel pathogen. Thirteen (5.6%) evacuees had COVID-19compatible symptoms and 2 (0.9%) had laboratory-confirmed SARS-CoV-2. Two case investigations identified 43 contacts; 3 (7.0%) contacts had symptoms but tested negative for SARS-CoV-2 infection. Daily symptom and temperature screening of evacuees and enacted infection control procedures resulted in rapid case identification and isolation and no detected secondary transmission among evacuees or responders. Lessons learned highlight the challenges associated with public health response to a novel pathogen and the evolution of mitigation strategies as knowledge of the pathogen evolves. |
Antimicrobial Susceptibility Profiles to Predict the Presence of Carbapenemase Genes among Carbapenem-Resistant
Vallabhaneni S , Huang JY , Grass JE , Bhatnagar A , Sabour S , Lutgring JD , Campbell D , Karlsson M , Kallen AJ , Nazarian E , Snavely EA , Morris S , Wang C , Lee R , Koag M , Lewis R , Garcia B , Brown AC , Walters MS . J Clin Microbiol 2021 59 (6) Background: Detection of carbapenem-resistant Pseudomonas aeruginosa (CRPA) with carbapenamase-producing (CP) genes is critical for preventing transmission. Our objective was to assess whether certain antimicrobial susceptibility testing (AST) profiles can efficiently identify CP-CRPA.Methods: We defined CRPA as P. aeruginosa with imipenem or meropenem MICs of ≥8μg/ml; CP-CRPA were CRPA with CP genes (bla (KPC)/bla (IMP)/bla (NDM)/bla (VIM)). We assessed the sensitivity and specificity of AST profiles to detect CP-CRPA among CRPA collected by CDC's Antibiotic Resistance Laboratory Network (AR Lab Network) and the Emerging Infections Program (EIP) during 2017-2019.Results: Three percent (195/6192) of AR Lab Network CRPA were CP-CRPA. Among CRPA, adding not susceptible (NS) to cefepime or ceftazidime to the definition had 91% sensitivity and 50% specificity for identifying CP-CRPA; NS to ceftolozane-tazobactam had 100% sensitivity and 86% specificity. Of 965 EIP CRPA evaluated for CP genes, seven CP-CRPA were identified; 6 of 7 were NS to cefepime and ceftazidime, and all 7 were NS to ceftolozane-tazobactam. Among 4182 EIP isolates, clinical laboratory AST results were available for 96% for cefepime, 80% for ceftazidime, and 4% for ceftolozane-tazobactam. The number of CRPA needed to test (NNT) to identify one CP-CRPA decreased from 138 to 64 if the definition of NS to cefepime or ceftazidime was used and to 7 with NS to ceftolozane-tazobactam.Conclusion: Adding not susceptible to cefepime or ceftazidime to CRPA carbapenemase testing criteria would reduce the NNT by half and can be implemented in most clinical laboratories; adding not susceptible to ceftolozane-tazobactam could be even more predictive once AST for this drug is more widely available. |
Candida auris Outbreak in a COVID-19 Specialty Care Unit - Florida, July-August 2020.
Prestel C , Anderson E , Forsberg K , Lyman M , de Perio MA , Kuhar D , Edwards K , Rivera M , Shugart A , Walters M , Dotson NQ . MMWR Morb Mortal Wkly Rep 2021 70 (2) 56-57 In July 2020, the Florida Department of Health was alerted to three Candida auris bloodstream infections and one urinary tract infection in four patients with coronavirus disease 2019 (COVID-19) who received care in the same dedicated COVID-19 unit of an acute care hospital (hospital A). C. auris is a multidrug-resistant yeast that can cause invasive infection. Its ability to colonize patients asymptomatically and persist on surfaces has contributed to previous C. auris outbreaks in health care settings (1-7). Since the first C. auris case was identified in Florida in 2017, aggressive measures have been implemented to limit spread, including contact tracing and screening upon detection of a new case. Before the COVID-19 pandemic, hospital A conducted admission screening for C. auris and admitted colonized patients to a separate dedicated ward. |
Increase in Hospital-Acquired Carbapenem-Resistant Acinetobacter baumannii Infection and Colonization in an Acute Care Hospital During a Surge in COVID-19 Admissions - New Jersey, February-July 2020.
Perez S , Innes GK , Walters MS , Mehr J , Arias J , Greeley R , Chew D . MMWR Morb Mortal Wkly Rep 2020 69 (48) 1827-1831 Carbapenem-resistant Acinetobacter baumannii (CRAB), an opportunistic pathogen primarily associated with hospital-acquired infections, is an urgent public health threat (1). In health care facilities, CRAB readily contaminates the patient care environment and health care providers' hands, survives for extended periods on dry surfaces, and can be spread by asymptomatically colonized persons; these factors make CRAB outbreaks in acute care hospitals difficult to control (2,3). On May 28, 2020, a New Jersey hospital (hospital A) reported a cluster of CRAB infections during a surge in patients hospitalized with coronavirus disease 2019 (COVID-19). Hospital A and the New Jersey Department of Health (NJDOH) conducted an investigation, and identified 34 patients with hospital-acquired multidrug-resistant CRAB infection or colonization during February-July 2020, including 21 (62%) who were admitted to two intensive care units (ICUs) dedicated to caring for COVID-19 patients. In late March, increasing COVID-19-related hospitalizations led to shortages in personnel, personal protective equipment (PPE), and medical equipment, resulting in changes to conventional infection prevention and control (IPC) practices. In late May, hospital A resumed normal operations, including standard IPC measures, as COVID-19 hospitalizations decreased, lessening the impact of personnel and supply chain shortages on hospital functions. CRAB cases subsequently returned to a pre-COVID-19 baseline of none to two cases monthly. The occurrence of this cluster underscores the potential for multidrug-resistant organisms (MDROs) to spread during events when standard hospital practices might be disrupted; conventional IPC strategies should be reinstated as soon as capacity and resources allow. |
Characteristics of Health Care Personnel with COVID-19 - United States, February 12-April 9, 2020.
CDC COVID-19 Response Team , Burrer Sherry L , de Perio Marie A , Hughes Michelle M , Kuhar David T , Luckhaupt Sara E , McDaniel Clinton J , Porter Rachael M , Silk Benjamin , Stuckey Matthew J , Walters Maroya . MMWR Morb Mortal Wkly Rep 2020 69 (15) 477-481 As of April 9, 2020, the coronavirus disease 2019 (COVID-19) pandemic had resulted in 1,521,252 cases and 92,798 deaths worldwide, including 459,165 cases and 16,570 deaths in the United States (1,2). Health care personnel (HCP) are essential workers defined as paid and unpaid persons serving in health care settings who have the potential for direct or indirect exposure to patients or infectious materials (3). During February 12-April 9, among 315,531 COVID-19 cases reported to CDC using a standardized form, 49,370 (16%) included data on whether the patient was a health care worker in the United States; including 9,282 (19%) who were identified as HCP. Among HCP patients with data available, the median age was 42 years (interquartile range [IQR] = 32-54 years), 6,603 (73%) were female, and 1,779 (38%) reported at least one underlying health condition. Among HCP patients with data on health care, household, and community exposures, 780 (55%) reported contact with a COVID-19 patient only in health care settings. Although 4,336 (92%) HCP patients reported having at least one symptom among fever, cough, or shortness of breath, the remaining 8% did not report any of these symptoms. Most HCP with COVID-19 (6,760, 90%) were not hospitalized; however, severe outcomes, including 27 deaths, occurred across all age groups; deaths most frequently occurred in HCP aged ≥65 years. These preliminary findings highlight that whether HCP acquire infection at work or in the community, it is necessary to protect the health and safety of this essential national workforce. |
Multispecies Outbreak of Verona Integron-Encoded Metallo-ß-Lactamase-Producing Multidrugresistant Bacteria Driven by a Promiscuous Incompatibility Group A/C2.
de Man TJB , Yaffee AQ , Zhu W , Batra D , Alyanak E , Rowe LA , McAllister G , Moulton-Meissner H , Boyd S , Flinchum A , Slayton RB , Hancock S , Spalding Walters M , Laufer Halpin A , Rasheed JK , Noble-Wang J , Kallen AJ , Limbago BM . Clin Infect Dis 2020 72 (3) 414-420 BACKGROUND: Antibiotic resistance is often spread through bacterial populations via conjugative plasmids. However, plasmid transfer is not well recognized in clinical settings because of technical limitations, and health care-associated infections are usually caused by clonal transmission of a single pathogen. In 2015, multiple species of carbapenem-resistant Enterobacteriaceae (CRE), all producing a rare carbapenemase, were identified among patients in an intensive care unit. This observation suggested a large, previously unrecognized plasmid transmission chain and prompted our investigation. METHODS: Electronic medical record reviews, infection control observations, and environmental sampling completed the epidemiologic outbreak investigation. A laboratory analysis, conducted on patient and environmental isolates, included long-read whole-genome sequencing to fully elucidate plasmid DNA structures. Bioinformatics analyses were applied to infer plasmid transmission chains and results were subsequently confirmed using plasmid conjugation experiments. RESULTS: We identified 14 Verona integron-encoded metallo-ss-lactamase (VIM)-producing CRE in 12 patients, and 1 additional isolate was obtained from a patient room sink drain. Whole-genome sequencing identified the horizontal transfer of blaVIM-1, a rare carbapenem resistance mechanism in the United States, via a promiscuous incompatibility group A/C2 plasmid that spread among 5 bacterial species isolated from patients and the environment. CONCLUSIONS: This investigation represents the largest known outbreak of VIM-producing CRE in the United States to date, which comprises numerous bacterial species and strains. We present evidence of in-hospital plasmid transmission, as well as environmental contamination. Our findings demonstrate the potential for 2 types of hospital-acquired infection outbreaks: those due to clonal expansion and those due to the spread of conjugative plasmids encoding antibiotic resistance across species. |
Notes from the Field: Clinical Klebsiella pneumoniae Isolate with Three Carbapenem Resistance Genes Associated with Urology Procedures - King County, Washington, 2018.
Vannice K , Benoliel E , Kauber K , Brostrom-Smith C , Montgomery P , Kay M , Walters M , Tran M , D'Angeli M , Duchin J . MMWR Morb Mortal Wkly Rep 2019 68 (30) 667-668 On December 31, 2018, Public Health — Seattle & King County (PHSKC) was notified by the Antibiotic Resistance Laboratory Network regarding a carbapenem-resistant Klebsiella pneumoniae (CR-Kp) isolate cultured from the urinary tract in a man aged 65 years. The specimen was collected on December 17, 2018. It tested positive for carbapenemase activity by the modified carbapenem inactivation method and positive for genes encoding the carbapenemases New Delhi metallo-beta-lactamase, Verona integron-encoded metallo-beta-lactamase, and OXA-48–type beta-lactamase, by polymerase chain reaction. Antimicrobial susceptibility testing by broth microdilution showed resistance to 15 antibiotics tested* but low minimum inhibitory concentrations (MIC) to colistin (MIC ≤0.25) and tigecycline (MIC = 1). CDC recommends a public health response when organisms with emerging forms of antibiotic resistance, such as the metallo-beta-lactamases this isolate harbored, are identified† because such organisms are often difficult to treat and have the potential to spread rapidly in health care settings (1). |
Transmission of Mobile Colistin Resistance (mcr-1) by Duodenoscope.
Shenoy ES , Pierce VM , Walters MS , Moulton-Meissner H , Lawsin A , Lonsway D , Shugart A , McAllister G , Halpin AL , Zambrano-Gonzalez A , Ryan EE , Suslak D , DeJesus A , Barton K , Madoff LC , McHale E , DeMaria A , Hooper DC . Clin Infect Dis 2018 68 (8) 1327-1334 Background: Clinicians increasingly utilize polymyxins for treatment of serious infections caused by multidrug-resistant gram-negative bacteria. Emergence of plasmid-mediated, mobile colistin resistance genes creates potential for rapid spread of polymyxin resistance. We investigated the possible transmission of Klebsiella pneumoniae carrying mcr-1 via duodenoscope and report the first documented healthcare transmission of mcr-1-harboring bacteria in the United States. Methods: A field investigation, including screening targeted high-risk groups, evaluation of the duodenoscope, and genome sequencing of isolated organisms, was conducted. The study site included a tertiary care academic health center in Boston, Massachusetts, and extended to community locations in New England. Results: Two patients had highly related mcr-1-positive K. pneumoniae isolated from clinical cultures; a duodenoscope was the only identified epidemiological link. Screening tests for mcr-1 in 20 healthcare contacts and 2 household contacts were negative. K. pneumoniae and E. coli were recovered from the duodenoscope; neither carried mcr-1. Evaluation of the duodenoscope identified intrusion of biomaterial under the sealed distal cap; devices were recalled to repair this defect. Conclusions: We identified transmission of mcr-1 in a United States acute care hospital that likely occurred via duodenoscope despite no identifiable breaches in reprocessing or infection control practices. Duodenoscope design flaws leading to transmission of multidrug-resistant organsisms persist despite recent initiatives to improve device safety. Reliable detection of colistin resistance is currently challenging for clinical laboratories, particularly given the absence of an FDA-cleared test; improved clinical laboratory capacity for colistin susceptibility testing is needed to prevent the spread of mcr-carrying bacteria in healthcare settings. |
Environmental Panels as a Proxy for Nursing Facility Patients With Methicillin-Resistant Staphylococcus Aure and Vancomycin-Resistant Enterococcus Colonization.
Cassone M , Mantey J , Perri MB , Gibson K , Lansing B , McNamara S , Patel PK , Cheng VCC , Walters MS , Stone ND , Zervos MJ , Mody L . Clin Infect Dis 2018 67 (6) 861-868 Background: Most nursing facilities (NFs) lack methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) surveillance programs due to limited resources and high costs. We investigated the utility of environmental screening of high-touch surfaces in patient rooms as a way to circumvent these challenges. Methods: We compared MRSA and VRE culture data from high-touch surfaces in patients' rooms (14450 samples from 6 NFs) and ranked each site's performance in predicting patient colonization (7413 samples). The best-performing sites were included in a MRSA- and a VRE-specific panel that functioned as a proxy for patient colonization. Molecular typing was performed to confirm available concordant patient-environment pairs. Results: We identified and validated a MRSA panel that consisted of the bed controls, nurse call button, bed rail, and TV remote control. The VRE panel included the toilet seat, bed controls, bed rail, TV remote control, and top of the side table. Panel colonization data tracked patient colonization. Negative predictive values were 89%-92% for MRSA and 82%-84% for VRE. Molecular typing confirmed a strong clonal type relationship in available concordant patient-environment pairs (98% for MRSA, 91% for VRE), pointing to common epidemiological patterns for environmental and patient isolates. Conclusions: Environmental panels used as a proxy for patient colonization and incorporated into facility surveillance protocols can guide decolonization strategies, improve awareness of MRSA and VRE burden, and inform efforts to reduce transmission. Targeted environmental screening may be a viable surveillance strategy for MRSA and VRE detection in NFs. |
Genomic Analysis of a Pan-Resistant Isolate of Klebsiella pneumoniae , United States 2016.
de Man TJB , Lutgring JD , Lonsway DR , Anderson KF , Kiehlbauch JA , Chen L , Walters MS , Sjolund-Karlsson M , Rasheed JK , Kallen A , Halpin AL . mBio 2018 9 (2) Antimicrobial resistance is a threat to public health globally and leads to an estimated 23,000 deaths annually in the United States alone. Here, we report the genomic characterization of an unusual Klebsiella pneumoniae, nonsusceptible to all 26 antibiotics tested, that was isolated from a U.S. PATIENT: The isolate harbored four known beta-lactamase genes, including plasmid-mediated blaNDM-1 and blaCMY-6, as well as chromosomal blaCTX-M-15 and blaSHV-28, which accounted for resistance to all beta-lactams tested. In addition, sequence analysis identified mechanisms that could explain all other reported nonsusceptibility results, including nonsusceptibility to colistin, tigecycline, and chloramphenicol. Two plasmids, IncA/C2 and IncFIB, were closely related to mobile elements described previously and isolated from Gram-negative bacteria from China, Nepal, India, the United States, and Kenya, suggesting possible origins of the isolate and plasmids. This is one of the first K. pneumoniae isolates in the United States to have been reported to the Centers for Disease Control and Prevention (CDC) as nonsusceptible to all drugs tested, including all beta-lactams, colistin, and tigecycline.IMPORTANCE Antimicrobial resistance is a major public health threat worldwide. Bacteria that are nonsusceptible or resistant to all antimicrobials available are of major concern to patients and the public because of lack of treatment options and potential for spread. A Klebsiella pneumoniae strain that was nonsusceptible to all tested antibiotics was isolated from a U.S. PATIENT: Mechanisms that could explain all observed phenotypic antimicrobial resistance phenotypes, including resistance to colistin and beta-lactams, were identified through whole-genome sequencing. The large variety of resistance determinants identified demonstrates the usefulness of whole-genome sequencing for detecting these genes in an outbreak response. Sequencing of isolates with rare and unusual phenotypes can provide information on how these extremely resistant isolates develop, including whether resistance is acquired on mobile elements or accumulated through chromosomal mutations. Moreover, this provides further insight into not only detecting these highly resistant organisms but also preventing their spread. |
Evolutionary dynamics and genomic features of the Elizabethkingia anophelis 2015 to 2016 Wisconsin outbreak strain.
Perrin A , Larsonneur E , Nicholson AC , Edwards DJ , Gundlach KM , Whitney AM , Gulvik CA , Bell ME , Rendueles O , Cury J , Hugon P , Clermont D , Enouf V , Loparev V , Juieng P , Monson T , Warshauer D , Elbadawi LI , Walters MS , Crist MB , Noble-Wang J , Borlaug G , Rocha EPC , Criscuolo A , Touchon M , Davis JP , Holt KE , McQuiston JR , Brisse S . Nat Commun 2017 8 15483 An atypically large outbreak of Elizabethkingia anophelis infections occurred in Wisconsin. Here we show that it was caused by a single strain with thirteen characteristic genomic regions. Strikingly, the outbreak isolates show an accelerated evolutionary rate and an atypical mutational spectrum. Six phylogenetic sub-clusters with distinctive temporal and geographic dynamics are revealed, and their last common ancestor existed approximately one year before the first recognized human infection. Unlike other E. anophelis, the outbreak strain had a disrupted DNA repair mutY gene caused by insertion of an integrative and conjugative element. This genomic change probably contributed to the high evolutionary rate of the outbreak strain and may have increased its adaptability, as many mutations in protein-coding genes occurred during the outbreak. This unique discovery of an outbreak caused by a naturally occurring mutator bacterial pathogen provides a dramatic example of the potential impact of pathogen evolutionary dynamics on infectious disease epidemiology. |
Notes from the Field: Investigation of Elizabethkingia anophelis Cluster - Illinois, 2014-2016.
Navon L , Clegg WJ , Morgan J , Austin C , McQuiston JR , Blaney DD , Walters MS , Moulton-Meissner H , Nicholson A . MMWR Morb Mortal Wkly Rep 2016 65 (48) 1380-1381 Elizabethkingia spp., formerly known as Flavobacterium and Chryseobacterium, are multidrug-resistant, Gram negative bacilli found in the environment that can cause health care–associated outbreaks (1). Elizabethkingia meningoseptica was first identified by Elizabeth King in 1959 as a cause of meningitis outbreaks among hospitalized newborns (2). Elizabethkingia anophelis (EKA) was first identified in 2011 from the midgut of a mosquito (3); a recent series of cases from Hong Kong indicate that EKA health care–associated infections cause significant morbidity and have a high case-fatality rate (23.5%) (4). | In February 2016, the Wisconsin Department of Health Services notified the Illinois Department of Public Health (IDPH) and other neighboring health departments of an ongoing outbreak of EKA among Wisconsin residents. To determine if Illinois had related cases, IDPH sent memos on February 10 and March 29, 2016 to Illinois health care providers, infection preventionists and laboratories, requesting all available isolates of Elizabethkingia spp. dating back 2 years, to January 1, 2014. Twelve isolates from 11 patients were sent to CDC for testing; specimen collection dates ranged from June 23, 2014 to March 31, 2016. | On April 14, 2016, CDC informed IDPH that all submitted isolates were identified as EKA and that a genetic cluster (11 isolates from 10 patients) distinct from the Wisconsin outbreak strain had been identified, based on pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). The eleven isolates were an average of 39.6 single nucleotide polymorphisms (SNPs) apart by WGS, with a range of 9–60 SNPs in the core of the genomic sequence shared across the isolates (80% of the genome). This SNP range corresponded to PFGE patterns with zero (indistinguishable) to three (closely related) band pattern differences. By comparison, some historic EKA isolates tested by CDC have differed by approximately 1,000 SNPs, with the more distantly related EKA strains differing by tens of thousands of SNPs. Phylogenetic analysis followed by bootstrapping statistical analysis provided strong support that these Illinois isolates clustered together and were genetically distinct from other EKA isolates submitted to CDC. |
Investigation of Escherichia coli Harboring the mcr-1 Resistance Gene - Connecticut, 2016.
Vasquez AM , Montero N , Laughlin M , Dancy E , Melmed R , Sosa L , Watkins LF , Folster JP , Strockbine N , Moulton-Meissner H , Ansari U , Cartter ML , Walters MS . MMWR Morb Mortal Wkly Rep 2016 65 (36) 979-980 The mcr-1 gene confers resistance to the polymyxins, including the antibiotic colistin, a medication of last resort for multidrug-resistant infections. The mcr-1 gene was first reported in 2015 in food, animal, and patient isolates from China and is notable for being the first plasmid-mediated colistin resistance mechanism to be identified. Plasmids can be transferred between bacteria, potentially spreading the resistance gene to other bacterial species. Since its discovery, the mcr-1 gene has been reported from Africa, Asia, Europe, South America, and North America, including the United States, where it has been identified in Escherichia coli isolated from three patients and from two intestinal samples from pigs. In July 2016, the Pathogen Detection System at the National Center for Biotechnology Information (Bethesda, Maryland) identified mcr-1 in the whole genome sequence of an E. coli isolate from a Connecticut patient; this is the fourth isolate from a U.S. patient to contain the mcr-1 gene. |
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