Evolution and Mutations Predisposing to Daptomycin Resistance in Vancomycin-Resistant Enterococcus faecium ST736 Strains

We recently identified a novel vancomycin-resistant Enterococcus faecium (VREfm) clone ST736 with reduced daptomycin susceptibility. The objectives of this study were to assess the population dynamics of local VREfm strains and genetic alterations predisposing to daptomycin resistance in VREfm ST736 strains. Multilocus sequence typing and single nucleotide variant data were derived from whole-genome sequencing of 250 E. faecium isolates from 1994-1995 (n = 43), 2009-2012 (n = 115) and 2013 (n = 92). A remarkable change was noticed in the clonality and antimicrobial resistance profiles of E. faecium strains between 1994-1995 and 2013. VREfm sequence type 17 (ST17), the prototype strain of clade A1, was the dominant clone (76.7%) recognized in 1994-1995. By contrast, clone ST736 accounted for 46.7% of VREfm isolates, followed by ST18 (26.1%) and ST412 (20.7%) in 2013. Bayesian evolutionary analysis suggested that clone ST736 emerged between 1996 and 2009. Co-mutations (liaR.W73C and liaS.T120A) of the liaFSR system were identified in all ST736 isolates (n = 111, 100%) examined. Thirty-eight (34.2%) ST736 isolates exhibited daptomycin-resistant phenotype, of which 13 isolates had mutations in both the liaFSR and cardiolipin synthase (cls) genes and showed high level of resistance with a daptomycin MIC50 of 32 mug/mL. The emergence of ST736 strains with mutations predisposing to daptomycin resistance and subsequent clonal spread among inpatients contributed to the observed high occurrence of daptomycin resistance in VREfm at our institution. The expanding geographic distribution of ST736 strains in other states and countries raises concerns about its global dissemination

\u3ci\u3eBorrelia lonestari\u3c/i\u3e Infection after a Bite by an \u3ci\u3eAmblyomma americanum\u3c/i\u3e Tick

Erythematous rashes that are suggestive of early Lyme disease have been associated with the bite of Amblyomma americanum ticks, particularly in the southern United States. However, Borrelia burgdorferi, the causative agent of Lyme disease, has not been cultured from skin biopsy specimens from these patients, and diagnostic serum antibodies usually have not been found. Borrelia lonestari sp nov, an uncultured spirochete, has been detected in A. americanum ticks by DNA amplification techniques, but its role in human illness is unknown. We observed erythema migrans in a patient with an attached A. americanum tick. DNA amplification of the flagellin gene flaB produced B. lonestari sequences from the skin of the patient that were identical to those found in the attached tick. B. lonestari is a probable cause of erythema migrans in humans

A multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection.

BACKGROUND: This study was conducted to investigate decreases in catheter-related bloodstream infections (CRBSIs) through an evidence-based multimodal intervention. METHODS: This was a prospective interventional study of neonates with a central venous catheter (CVC) from a neonatal intensive care unit database, involving implementation of a multimodal approach to central venous catheter hub care using 2% chlorhexidine in 70% isopropyl alcohol and education of medical staff by audiovisual presentations. CRBSI rates in the pre-intervention period and postintervention period were compared. RESULTS: A total of 373 patients with a CVC (163 in the preintervention period and 210 in the postintervention period) were studied. Patient demographic and clinical characteristics were similar in the 2 periods. Extremely low birth weight infants constituted 40% of the cohort in the preintervention period and 38% of the cohort in the postintervention period. The CRBSI rate in patients with a umbilical artery catheter and an umbilical vein catheter decreased from 15/1000 catheter-days to 10/1000 catheter-days (odds ratio [OR], 0.47; 95% confidence interval [CI], 0.17-0.91). The CRBSI rate in patients with a peripherally inserted central catheter decreased from 23/1000 catheter-days to 10/1000 catheter-days (OR, 0.33; 95% CI, 0.12-0.91). These decreased CRBSI rates were sustained despite high device utilization. The incidence of gram-negative septicemia also decreased. Ten CRBSIs were prevented by this multimodal approach, representing significant health care cost savings. CONCLUSION: This study demonstrates significant decreases in CRBSI rate for all catheter types and birth weight categories associated with the multimodal intervention. Audiovisual education is an effective tool for practice change. Reeducation and compliance monitoring should be part of all nosocomial infection prevention strategies, resulting in significant savings in health care costs

Use of a Perianal Swab Compared With a Stool Sample to Detect Symptomatic Clostridium difficile Infection

OBJECTIVE To evaluate the use of a perianal swab to detect CDI. METHODS A perianal swab was collected from each inpatient with a positive stool sample for C. difficile (by polymerase chain reaction [PCR] test) and was tested for C. difficile by PCR and by culture. The variables evaluated included demographics, CDI severity, bathing before perianal swab collection, hours between stool sample and perianal swab, cycle threshold (Ct) to PCR positivity, and doses of CDI treatment before stool sample and before perianal swab. RESULTS Of 83 perianal swabs, 59 (71.1%) tested positive for C. difficile by PCR when perianal swabs were collected an average of 21 hours after the stool sample. Compared with the respective stool sample, the perianal sample was less likely to grow C. difficile (P=.005) and had a higher PCR Ct (

Fourteenth Symposium on COVID-19: COVID-19 as of August 26, 2021: What Have We Learned? How Can We Use What We Have Learned?

Opening Remarks and Moderator: Edward C. Halperin, M.D., M.A. Chancellor and CEO, Professor of Radiation Oncology, Pediatrics and History, New York Medical College, Provost for Biomedical Affairs, Touro College and University System Vaccine Protection for SARS-CoV-2: What Can We Expect? Marisa A. Montecalvo, M.D. Medical Director, Health Services, New York Medical College, Infectious Disease Specialist I am Thinking of Getting Pregnant. Should I Be Hesitant to Get Vaccinated? I am Breastfeeding. Should I Be Hesitant to Get Vaccinated? Karen M. Murray, M.D. Associate Dean for Admissions, School of Medicine, Assistant Professor of Obstetrics and Gynecology, New York Medical College The Children Have Been Going to School Virtually for a Year. Now It\u27s Back-to-the-Classroom. What Do We Know About the Effect of These Transitions on the Educational Process? Susan H. Shapiro, Ed.D., M.S.Ed. Assistant Professor of Early Childhood Special Education, Graduate School of Education, Touro College What Did the Pandemic Teach Us About How to Deliver Medical Education? Wolfgang G. Gilliar, DO, FAAPMR Dean, Touro University Nevada College of Osteopathic Medicine Q & A Hosted by: Alan Kadish, M.D. Cardiologist, President of Touro College and University System and President, New York Medical Colleg

22nd Symposium on COVID-19: What Have We Learned? How Can We Use What We Have Learned?

OPENING REMARKS AND MODERATOR: by Edward C. Halperin, M.D., M.A. Chancellor/CEO, New York Medical College, Professor of Radiation Oncology, Pediatrics and History | Provost for Biomedical Affairs, Touro University | The Miriam Popack Chair in Biomedical Ethics After the Holocaust PANEL DISCUSSION: THE NEW BIVALENT COVID-19 BOOSTER SHOTS: WHAT ARE THEY? WHO SHOULD GET THEM? WHEN SHOULD PEOPLE GET THEM? Edward C. Halperin, M.D., M.A. Chancellor/CEO, New York Medical College, Professor of Radiation Oncology, Pediatrics and History | Provost for Biomedical Affairs, Touro University | The Miriam Popack Chair in Biomedical Ethics After the Holocaust Chandra Shekhar Bakshi, DVM, Ph.D. Associate Professor of Pathology, Microbiology and Immunology, New York Medical College Ted Barrett, Ph.D. Senior Director, Pharmacology, Lovelace Biomedical Research Institute Tami Hendriksz, DO, FACOP, FAAP Dean, Professor and Chief Academic Officer, Touro University California College of Osteopathic Medicine Marisa A. Montecalvo, M.D. Medical Director, Health Services, New York Medical College | Infectious Disease Specialist THE USE OF WASTEWATER ANALYSIS TO ASSESS THE PRESENCE OF COVID-19 AND POLIO IN A POPULATION by Salomon Amar, D.D.S., Ph.D. Vice President for Research, Professor of Pharmacology and Microbiology and Immunology, New York Medical College | Professor of Dental Medicine, Touro College of Dental Medicine at New York Medical College THE DIRECTOR OF THE CDC SAYS THAT A MAJOR REFORM/RESTRUCTURING IS NEEDED OF THE AGENCY. WHAT IS THE CDC? WHAT DOES IT DO? WHAT WOULD A RESTRUCTURING MEAN? by Robert Amler, M.D., MBA Dean, School of Health Sciences and Practice, Vice President for Government Affairs, New York Medical College | Former Regional Health Administrator, U.S. Department of Health and Human Services | Former Medical Epidemiologist, Centers for Disease Control and Prevention (CDC) POLIO HAS REAPPEARED IN NEW YORK. IT\u27S BEEN A LONG TIME SINCE MOST AMERICANS DEALT WITH POLIO. WHAT IS IT? WHAT CAUSES IT? WHY DID IT REAPPEAR? WHAT DO WE NEED TO DO ABOUT IT? by Mill Etienne, M.D., M.P.H., FAAN, FAES Vice Chancellor for Diversity and Inclusion, Associate Dean for Student Affairs, Associate Professor of Neurology and Medicine, New York Medical College Q&A: Hosted by Alan Kadish, M.D. Cardiologist | President, Touro University | President, New York Medical Colleg

COVID-19 as of October 28, 2020: What Have We Learned? How Can We Use What We Have Learned?

PROGRAM INTRODUCTION AND WELCOME by Alan Kadish, M.D.Cardiologist | President, Touro College and University System | President, New York Medical College WE\u27RE ALMOST A YEAR INTO THIS PANDEMIC. ARE THERE REALLY ANY PROVEN THERAPIES? IF SO, WHAT ARE THEY? by Marisa Montecalvo, M.D.Medical Director, Health Services, New York Medical College | Attending in Infectious Diseases, Westchester Medical Center OBSTETRICAL CARE DURING THE PANDEMIC: WHAT ARE THE KEY PRINCIPLES? by Karen M. Murray, M.D.Associate Dean for Admissions, School of Medicine | Assistant Professor of Obstetrics & Gynecology, New York Medical College NASOPHARYNGEAL SWABS, NASAL SWABS, SALIVA OR SEWAGE? POOLED TESTING OR INDIVIDUAL TESTING? by Janet Piscitelli, M.D.Director, Pathology and Laboratory Services, Westchester Medical Center WE ARE ALMOST A YEAR INTO THIS PANDEMIC. DO VIRUSES CHANGE DURING THE COURSE OF A PANDEMIC? DO THEY MUTATE AND BECOME MORE VIRULENT? DO THEY ATTENUATE? WHAT ABOUT DURING THIS PANDEMIC? by Salomon Amar, D.D.S, Ph.D.Vice President for Research, Professor of Pharmacology, Professor of Microbiology and Immunology, New York Medical College | Professor of Dental Medicine, Touro College of Dental Medicine | Provost for Biomedical Research, Chief Biomedical Research Officer, Touro College and University System MODERATOR: WHEN ILLNESS GOES PUBLIC: CELEBRITY AND PRESIDENTIAL ILLNESS by Edward C. Halperin, M.D., M.A.Chancellor and CEO, New York Medical College | Provost for Biomedical Affairs, Touro College and University Syste

Fifteenth Symposium on COVID-19: COVID-19 as of October 14, 2021: What Have We Learned? How Can We Use What We Have Learned?

PROGRAM Opening Remarks and Moderator: Edward C. Halperin, M.D., M.A. Chancellor and CEO, Professor of Radiation Oncology, Pediatrics and History, New York Medical College, Provost for Biomedical Affairs, Touro College and University System Brain Fog and COVID-19: What It Is, What We Think Causes It, and How to Treat It Mill Etienne, M.D., M.P.H, FAAN, FAES Vice Chancellor for Diversity and Inclusion, Associate Dean for Student Affairs, Associate Professor of Neurology and Medicine, School of Medicine House Advisory Dean, New York Medical College COVID-19 Vaccinations for Children: What Pediatricians and Parents Need to Know Tami Hendriksz, DO, FACOP, FAAP Dean and Chief Academic Officer, Professor of Pediatrics, Touro University California College of Osteopathic Medicine A Review of the Evidence Regarding Radiation Therapy for COVID-19 Pneumonia Edward C. Halperin, M.D., M.A. Chancellor and CEO, Professor of Radiation Oncology, Pediatrics and History, New York Medical College, Provost for Biomedical Affairs, Touro College and University System The Molnupiavir Oral Capsule: What We Know So Far Marisa A. Montecalvo, M.D. Medical Director, Health Services, New York Medical College, Infectious Disease Specialist Is American Nursing In Crisis Because of COVID-19? If So, What Do We Need to Do About It? Sandra Russo, Ph.D., RN Chair and Director, Department of Nursing, Associate Professor, Nursing, The School of Health Sciences of Touro College You Need to Wear A Mask In This Building : Balancing the Individual Right to Personal Liberty and the Community\u27s Right to Maximize Safety John Loike, Ph.D. Professor of Biology and Bioethics, Lander College of Arts and Sciences, Touro College Q & A Q&A Hosted by: Alan Kadish, M.D. Cardiologist, President of Touro College and University System and President, New York Medical Colleg

COVID-19 as of March 30, 2020: What do we know? What don\u27t we know? What do we need to know?

PROGRAM INTRODUCTION AND WELCOME by Alan Kadish MDCardiologist | President, Touro College and University System THE EPIDEMIOLOGY OF COVID-19: WHAT WE KNOW SO FAR AND WHAT WE ARE LIKELY TO LEARN by Robert Amler, MD, MPHDean of the School of Health Sciences and Practice, New York Medical College | Former Regional Health Administrator at US Department of Health and Human Services | Former Medical Epidemiologist at the Centers for Disease Control and Prevention (CDC) LEGAL AND POLICY ISSUES IN THE MIDST OF A PANDEMIC: WHAT WE KNOW AND WHAT IS YET-TO-BE-DETERMINED? Rodger D. CitronAssociate Dean for Research and Scholarship & Professor of Law, Touro College, Jacob D. Fuchsberg Law Center WHAT WE HAVE LEARNED ABOUT THE CLINICAL MANAGEMENT OF SUSPECTED AND CONFIRMED COVID-19 PATIENTS IN THE LAST MONTH by Marisa Montecalvo, MDInfectious Disease Specialist, Professor of Medicine, New York Medical College “THE BETTER ANGELS OF OUR NATURE”, OR MAYBE NOT: A MEDICAL HISTORIAN’S PERSPECTIVE ON BIGOTRY AND XENOPHOBIA DURING A PANDEMIC by Edward C. Halperin, MD, MAChancellor/CEO, New York Medical College WHAT THE PUBLIC HEALTH COMMISSIONER KNOWS AND WHAT SHE WISHED SHE KNEW IN RESPONDING TO COVID-19 by Sherlita Amler, MD, MSCommissioner of Health, Westchester County NY “I’M GOING CRAZY AND MY KIDS ARE DRIVING ME CRAZY.”: PRACTICAL MENTAL HEALTH ADVICE WHILE SHELTERING-IN-PLACE by Jeffrey Lichtman, Touro College Graduate School of Education, Lucille Weidman Program Chair, Jewish Childhood Education & Special Education; Assistant Professor, Jewish Childhood Education & Special Educatio