Endemic Acinetobacter baumannii in a New York Hospital

Acinetobacter baumannii is an increasingly multidrug-resistant (MDR) cause of hospital-acquired infections, often associated with limited therapeutic options. We investigated A. baumannii isolates at a New York hospital to characterize genetic relatedness.Thirty A. baumannii isolates from geographically-dispersed nursing units within the hospital were studied. Isolate relatedness was assessed by repetitive sequence polymerase chain reaction (rep-PCR). The presence and characteristics of integrons were assessed by PCR. Metabolomic profiles of a subset of a prevalent strain isolates and sporadic isolates were characterized and compared.We detected a hospital-wide group of closely related carbapenem resistant MDR A. baumannii isolates. Compared with sporadic isolates, the prevalent strain isolates were more likely to be MDR (p = 0.001). Isolates from the prevalent strain carried a novel Class I integron sequence. Metabolomic profiles of selected prevalent strain isolates and sporadic isolates were similar.The A. baumannii population at our hospital represents a prevalent strain of related MDR isolates that contain a novel integron cassette. Prevalent strain and sporadic isolates did not segregate by metabolomic profiles. Further study of environmental, host, and bacterial factors associated with the persistence of prevalent endemic A. baumannii strains is needed to develop effective prevention strategies

Monoclonal Antibodies for Early Treatment of COVID-19 in a World of Evolving SARS-CoV-2 Mutations and Variants

Monoclonal antibodies targeting the receptor binding domain (RBD) of severe acute respiratory syndrome coronavirus 2 spike protein are important outpatient treatment options in coronavirus disease 2019 to mitigate progression of disease and prevent hospitalization. The impact of different RBD mutations on the efficacy of the available monoclonal antibodies and processes for incorporating this impact into treatment algorithms are ill defined. Herein, we synthesize the data surrounding the impact of key RBD mutations on the efficacy of US Food and Drug Administration Emergency Use Authorized monoclonal antibodies and describe our approach at Michigan Medicine at monitoring mutation frequency in circulating virus and developing an algorithm that incorporates these data into outpatient treatment pathways.http://deepblue.lib.umich.edu/bitstream/2027.42/174136/2/Monoclonal Antibodies for Early Treatment of COVID-19 in a World of Evolving SARS-CoV-2 Mutations and Variants.pdfPublished versionDescription of Monoclonal Antibodies for Early Treatment of COVID-19 in a World of Evolving SARS-CoV-2 Mutations and Variants.pdf : Accepted versio

Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 Replication in an Immunocompromised Patient

We describe a case of chronic coronavirus disease 2019 (COVID-19) in a patient with lymphoma and associated B-cell immunodeficiency. Viral cultures and sequence analysis demonstrate ongoing replication of infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for at least 119 days. The patient had 3 admissions related to COVID-19 over a 4-month period and was treated twice with remdesivir and convalescent plasma with resolution of symptoms. The patient's lack of seroconversion and prolonged course illustrate the importance of humoral immunity in resolving SARS-CoV-2 infection. This case highlights challenges in managing immunocompromised hosts, who may act as persistent shedders and sources of transmission.http://deepblue.lib.umich.edu/bitstream/2027.42/174139/2/Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 Replication in an Immunocompromised Patient.pdfPublished versionDescription of Prolonged Severe Acute Respiratory Syndrome Coronavirus 2 Replication in an Immunocompromised Patient.pdf : Accepted versio

Risk Factors for Klebsiella Infections among Hospitalized Patients with Preexisting Colonization

Klebsiella commonly colonizes the intestinal tract of hospitalized patients and is a leading cause of health care-associated infections. Colonization is associated with subsequent infection, but the factors determining this progression are unclear. A cohort study was performed, in which intensive care and hematology/oncology patients with Klebsiella colonization based on rectal swab culture were enrolled and monitored for infection for 90 days after a positive swab. Electronic medical records were analyzed for patient factors associated with subsequent infection, and variables of potential significance in a bivariable analysis were used to build a final multivariable model. Concordance between colonizing and infecting isolates was assessed by wzi capsular gene sequencing. Among 2,087 hospitalizations from 1,978 colonized patients, 90 cases of infection (4.3%) were identified. The mean time to infection was 20.6 6 24.69 (range, 0 to 91; median, 11.5) days. Of 86 typed cases, 68 unique wzi types were identified, and 69 cases (80.2%) were colonized with an isolate of the same type prior to infection. Based on multivariable modeling, overall comorbidities, depression, and low albumin levels at the time of rectal swab collection were independently associated with subsequent Klebsiella infection (i.e., cases). Despite the high diversity of colonizing strains of Klebsiella, there is high concordance with subsequent infecting isolates, and progression to infection is relatively quick. Readily accessible data from the medical record could be used by clinicians to identify colonized patients at an increased risk of subsequent Klebsiella infection.http://deepblue.lib.umich.edu/bitstream/2027.42/174137/2/Risk Factors for Klebsiella Infections among Hospitalized Patients with Preexisting Colonization.pdfPublished versionDescription of Risk Factors for Klebsiella Infections among Hospitalized Patients with Preexisting Colonization.pdf : Accepted versio

Design and construction of the KSTAR tokamak

The extensive design effort for KSTAR has been focused on two major aspects of the KSTAR project mission - steady-state-operation capability and advanced tokamak physics. The steady state aspect of the mission is reflected in the choice of superconducting magnets, provision of actively cooled in-vessel components, and long pulse current drive and heating systems. The advanced tokamak aspect of the mission is incorporated in the design features associated with flexible plasma shaping, double null divertor and passive stabilizers, internal control coils and a comprehensive set of diagnostics. Substantial progress in engineering has been made on superconducting magnets, the vacuum vessel, plasma facing components and power supplies. The new KSTAR experimental facility with cryogenic system and deionized water cooling and main power systems has been designed, and the construction work is under way for completion in 2004.11sciescopu

The KSTAR project: An advanced steady state superconducting tokamak experiment

The Korea Superconducting Tokamak Advanced Research (KSTAR) project is the major effort of the national fusion programme of the Republic of Korea. Its aim is to develop a steady state capable advanced superconducting tokamak to establish a scientific and technological basis for an attractive fusion reactor. The major parameters of the tokamak are: major radius 1.8 mi minor radius 0.5 m. toroidal held 3.5 T and plasma current 2 MA, with a strongly shaped plasma cross-section and double null divertor. The initial pulse length provided by the poloidal magnet system is 20 s, but the pulse length can be increased to 300 s through non-inductive current drive. The plasma heating and current drive system consists of neutral beams? ion cyclotron waves, lower hybrid waves and electron cyclotron waves for flexible profile control in advanced tokamak operating modes. A comprehensive set of diagnostics is planned for plasma control, performance evaluation and physics understanding. The project has completed its conceptual design and moved to the engineering design and construction phase. The target date for the first plasma is 2002.11139sciescopu