The Need for Dedicated Microbiology Leadership in the Clinical Microbiology Laboratory

Clinical microbiology laboratories play a crucial role in patient care using traditional and innovative diagnostics. Challenges faced by laboratories include emerging pathogens, rapidly evolving technologies, healthcare-acquired infections, antibiotic-resistant organisms and diverse patient populations. Despite these challenges, many clinical microbiology laboratories in the United States are not directed by doctoral level microbiology-trained individuals with sufficient time dedicated to laboratory leadership. This manuscript highlights the need for medical microbiology laboratory directors with appropriate training and qualifications

The long-term sustainability of a respiratory culture nudge

Resource-intensive interventions and education are susceptible to a lack of long-term sustainability and regression to the mean. The respiratory culture nudge changed reporting to Commensal Respiratory Flora only: No S. aureus/MRSA or P. aeruginosa. This study demonstrated sustained reduction in broad-spectrum antibiotic duration and long-term sustainability 3 years after implementation

Role of diagnostic stewardship in reducing healthcare-facility-onset Clostridioides difficile infections

We describe the implementation of an electronic medical record hard stop to decrease inappropriate Clostridioides difficile testing across a 5-hospital health system, effectively reducing the rates of healthcare-facility-onset C. difficile infection. This novel approach included expert consultation with medical director of infection prevention and control for test-order override

Performance of lateral flow device and galactomannan for the detection of Aspergillus species in bronchoalveolar fluid of patients at risk for invasive pulmonary aspergillosis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111755/1/myc12327.pd

Risk Factors Associated With Hospitalization and Death in COVID-19 Breakthrough Infections

BACKGROUND: Characterizations of coronavirus disease 2019 (COVID-19) vaccine breakthrough infections are limited. We aim to characterize breakthrough infections and identify risk factors associated with outcomes. METHODS: This was a retrospective case series of consecutive fully vaccinated patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a multicenter academic center in Southeast Michigan, between December 30, 2020, and September 15, 2021. RESULTS: A total of 982 patients were identified; the mean age was 57.9 years, 565 (59%) were female, 774 (79%) were White, and 255 (26%) were health care workers (HCWs). The median number of comorbidities was 2; 225 (23%) were immunocompromised. BNT162b2 was administered to 737 (75%) individuals. The mean time to SARS-CoV-2 detection was 135 days. The majority were asymptomatic or exhibited mild to moderate disease, 154 (16%) required hospitalization, 127 (13%) had severe-critical illness, and 19 (2%) died. Age (odds ratio [OR], 1.14; 95% CI, 1.04-1.07; P \u3c .001), cardiovascular disease (OR, 3.02; 95% CI, 1.55-5.89; P = .001), and immunocompromised status (OR, 2.57; 95% CI, 1.70-3.90; P \u3c .001) were independent risk factors for hospitalization. Additionally, age (OR, 1.06; 95% CI, 1.02-1.11; P = .006) was significantly associated with mortality. HCWs (OR, 0.15; 95% CI, 0.05-0.50; P = .002) were less likely to be hospitalized, and prior receipt of BNT162b2 was associated with lower odds of hospitalization (OR, 0.436; 95% CI, 0.303-0.626; P \u3c .001) and/or death (OR, 0.360; 95% CI, 0.145-0.898; P = .029). CONCLUSIONS: COVID-19 vaccines remain effective at attenuating disease severity. However, patients with breakthrough infections necessitating hospitalization may benefit from early treatment modalities and COVID-19-mitigating strategies, especially in areas with substantial or high transmission rates

Project #37: Management Guidelines for Patients with COVID-19: Rapid Cycle Improvement

Project’s purpose is to rapidly devise, continually improve, educate, and implement a live and changing COVID-19 management guideline based upon emerging best available evidence. This project also aims to optimize the care of patients with COVID-19 and improve patient outcomes.https://scholarlycommons.henryford.com/qualityexpo2022/1004/thumbnail.jp

Immunogenicity, Subcellular Localization And Function Of the Eis Protein Of Mycobacterium tuberculosis

The eis gene of M. tuberculosis is believed to play a role in the intracellular survival of this pathogen. Significantly higher levels of antibodies to Eis were detected by ELISA in the sera of patients with tuberculosis as compared to healthy controls. PBMCs from recovered TB donors were also found to demonstrate significantly higher levels of proliferation in response to stimulation with the Eis protein than PBMCs from either active TB cases or healthy controls. Neither the active TB population nor the healthy controls showed significant levels of IFN- or IL-4 secretion in response to stimulation of PBMC with Eis or ESAT-6. Far Western analysis determined that Eis interacts with a ~65 kDa protein that localizes to the cytoplasmic fraction of M. tuberculosis lysate. Real-time PCR analysis of M. tuberculosis infected U-937 macrophages showed that the eis gene is constitutively expressed during infection. Using immunofluorescence microscopy (IF), the Eis protein was detected within the cytoplasm of M. tuberculosis infected macrophages indicating that the protein was being released/secreted from the mycobacterium containing phagosomes. Western blot analysis of the cytoplasm of macrophages infected with M. tuberculosis expressing green fluorescent protein confirmed these results. Western blot analysis also detected the presence of native Eis both in the culture supernatant of infected macrophages and vesicles released from the macrophages. IF also detected the presence of Eis in uninfected macrophages. The Eis protein in the cytoplasm of M. tuberculosis infected macrophages was also found to colocalize with EEA1, an endosomal marker, indicating a possible association of the protein with early endosomes. Eis was also shown to elicit higher levels of IL-10 secretion than PPD in human monocytes. Infection of monocytes from healthy tuberculin reactors with M. tuberculosis wild type and eis mutant demonstrated that eis plays a role in modulation of IL-10/TNF- secretion in response to infection. Bioinformatic analysis of the amino acid sequence of Eis indicates that Eis is an acetyltransferase of the GCN5 related family of N-acetyltransferases. Further work is required to determine the role Eis plays in the survival of M. tuberculosis within the macrophage

Point-of-Care Testing in Microbiology

Point-of-care (POC) or near patient testing for infectious diseases is a rapidly expanding space that is part of an ongoing effort to bring care closer to the patient. Traditional POC tests were known for their limited utility, but advances in technology have seen significant improvements in performance of these assays. The increasing promise of these tests is also coupled with their increasing complexity, which requires the oversight of qualified laboratory-trained personnel