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Saade EA, Lytle FT, Pronovost PJ. Enhancing Quality and Safety in Critical Care-Challenges and Strategies for Central Venous Catheters. JAMA Intern Med 2024; 184:482-483. [PMID: 38436978 DOI: 10.1001/jamainternmed.2023.8243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Elie A Saade
- University Hospitals of Cleveland, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Francis T Lytle
- University Hospitals of Cleveland, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Peter J Pronovost
- University Hospitals of Cleveland, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
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Jinadatha C, Jones LD, Hailes JM, Marshall EK, Hwang M, Cadnum JL, Choi H, Chatterjee P, Chan ER, Zimmerman PA, Chakhtoura NGE, Saade EA, Donskey CJ. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Among Residents and Employees in a Veterans Affairs Community Living Center: A 42-Month Prospective Cohort Study. Pathog Immun 2024; 9:91-107. [PMID: 38690562 PMCID: PMC11060326 DOI: 10.20411/pai.v9i1.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Background Understanding routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in long-term care facilities is essential for the development of effective control measures. Methods Between March 1, 2020, and August 31, 2023, we identified coronavirus disease 2019 (COVID-19) cases among residents and employees in a Veterans Affairs community living center that conducted routine screening for asymptomatic COVID-19. Contact tracing was conducted to identify suspected transmission events, and whole genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples. Results During the 42-month study period, 269 cases of COVID-19 were diagnosed, including 199 employees and 70 residents. A total of 48 (24.1%) employees and 30 (42.9%) residents were asymptomatic. Sequencing analysis provided support for multiple events in which employees transmitted SARS-CoV-2 to co-workers and residents. There was 1 episode of likely transmission of SARS-CoV-2 from one resident to another resident, but no documented transmissions from residents to employees. Conclusions Transmission of SARS-CoV-2 in the community living center predominantly involved transmission from employees to co-workers and residents. There is a need for improved measures to prevent transmission of SARS-CoV-2 by healthcare personnel.
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Affiliation(s)
- Chetan Jinadatha
- Medical Service, Central Texas Veterans Healthcare System, Temple, Texas
- School of Medicine, Texas A&M University, Bryan, Texas
| | - Lucas D. Jones
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jennifer M. Hailes
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland Ohio
| | - Emma K. Marshall
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland Ohio
| | - Munok Hwang
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas
| | - Jennifer L. Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland Ohio
| | - Hosoon Choi
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas
| | - Piyali Chatterjee
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas
| | - Ernest R. Chan
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio
| | - Peter A. Zimmerman
- The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Nadim G. El Chakhtoura
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Elie A. Saade
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Curtis J. Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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Frutos AM, Price AM, Harker E, Reeves EL, Ahmad HM, Murugan V, Martin ET, House S, Saade EA, Zimmerman RK, Gaglani M, Wernli KJ, Walter EB, Michaels MG, Staat MA, Weinberg GA, Selvarangan R, Boom JA, Klein EJ, Halasa NB, Ginde AA, Gibbs KW, Zhu Y, Self WH, Tartof SY, Klein NP, Dascomb K, DeSilva MB, Weber ZA, Yang DH, Ball SW, Surie D, DeCuir J, Dawood FS, Moline HL, Toepfer AP, Clopper BR, Link-Gelles R, Payne AB, Chung JR, Flannery B, Lewis NM, Olson SM, Adams K, Tenforde MW, Garg S, Grohskopf LA, Reed C, Ellington S. Interim Estimates of 2023-24 Seasonal Influenza Vaccine Effectiveness - United States. MMWR Morb Mortal Wkly Rep 2024; 73:168-174. [PMID: 38421935 PMCID: PMC10907036 DOI: 10.15585/mmwr.mm7308a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
In the United States, annual influenza vaccination is recommended for all persons aged ≥6 months. Using data from four vaccine effectiveness (VE) networks during the 2023-24 influenza season, interim influenza VE was estimated among patients aged ≥6 months with acute respiratory illness-associated medical encounters using a test-negative case-control study design. Among children and adolescents aged 6 months-17 years, VE against influenza-associated outpatient visits ranged from 59% to 67% and against influenza-associated hospitalization ranged from 52% to 61%. Among adults aged ≥18 years, VE against influenza-associated outpatient visits ranged from 33% to 49% and against hospitalization from 41% to 44%. VE against influenza A ranged from 46% to 59% for children and adolescents and from 27% to 46% for adults across settings. VE against influenza B ranged from 64% to 89% for pediatric patients in outpatient settings and from 60% to 78% for all adults across settings. These findings demonstrate that the 2023-24 seasonal influenza vaccine is effective at reducing the risk for medically attended influenza virus infection. CDC recommends that all persons aged ≥6 months who have not yet been vaccinated this season get vaccinated while influenza circulates locally.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - CDC Influenza Vaccine Effectiveness Collaborators
- Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; Epidemic Intelligence Service, CDC; Biodesign Center for Personalized Diagnostics, Arizona State University, Tempe, Arizona; University of Michigan School of Public Health, Ann Arbor, Michigan; Washington University School of Medicine in St. Louis, St. Louis, Missouri; University Hospitals of Cleveland, Cleveland, Ohio; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Baylor Scott & White Health, Temple, Texas; Baylor College of Medicine, Temple, Texas; Texas A&M University College of Medicine, Temple, Texas; Kaiser Permanente Washington Health Research Institute, Seattle, Washington; Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Duke Human Vaccine Institute, Duke University School of Medicine, Durham, North Carolina; UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania; University of Cincinnati College of Medicine, Cincinnati, Ohio; Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; University of Rochester School of Medicine and Dentistry, Rochester, New York; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Children’s Mercy Hospital, Kansas City, Missouri; Baylor College of Medicine, Houston, Texas; Texas Children’s Hospital, Houston, Texas; Seattle Children’s Research Institute, Seattle, Washington; Vanderbilt University Medical Center, Nashville, Tennessee; University of Colorado School of Medicine, Aurora, Colorado; Wake Forest University School of Medicine, Winston-Salem, North Carolina; Kaiser Permanente Department of Research & Evaluation, Pasadena, California; Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland, California; Division of Infectious Diseases and Clinical Epidemiology, Intermountain Health, Salt Lake City, Utah; HealthPartners Institute, Minneapolis, Minnesota; Westat, Rockville, Maryland; Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, CDC
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Al-Jabri M, Rosero C, Saade EA. Vaccine-Preventable Diseases in Older Adults. Infect Dis Clin North Am 2023; 37:103-121. [PMID: 36805008 DOI: 10.1016/j.idc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Older adults are at an increased risk of vaccine-preventable diseases partly because of physiologic changes in the immune and other body systems related to age and/or accumulating comorbidities that increase the vulnerability to infections and decrease the response to vaccines. Strategies to improve the response to vaccines include using a higher antigenic dose (such as in the high-dose inactivated influenza vaccines) as well as adding adjuvants (such as MF59 in the adjuvanted inactivated influenza vaccine).
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Affiliation(s)
- Maha Al-Jabri
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue - Mailstop Fol. 5083, Cleveland, OH 44106, USA; Case Western Reserve University, Cleveland, OH, USA
| | - Christian Rosero
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue - Mailstop Fol. 5083, Cleveland, OH 44106, USA; Case Western Reserve University, Cleveland, OH, USA
| | - Elie A Saade
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue - Mailstop Fol. 5083, Cleveland, OH 44106, USA.
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5
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Hojat LS, Saade EA, Hernandez AV, Donskey CJ, Deshpande A. Can Electronic Clinical Decision Support Systems Improve the Diagnosis of Urinary Tract Infections? A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2022; 10:ofac691. [PMID: 36632418 PMCID: PMC9830539 DOI: 10.1093/ofid/ofac691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Background Urinary tract infection (UTI) is a commonly misdiagnosed infectious syndrome. Diagnostic stewardship interventions can reduce rates of asymptomatic bacteriuria treatment but are often labor intensive, and thus an automated means of reducing unnecessary urine testing is preferred. In this systematic review and meta-analysis, we sought to identify studies describing interventions utilizing clinical decision support (CDS) to optimize UTI diagnosis and to characterize the effectiveness of these interventions. Methods We conducted a comprehensive electronic search and manual reference list review for peer-reviewed articles published before July 2, 2021. Publications describing an intervention intending to enhance UTI diagnosis via CDS were included. The primary outcome was urine culture test rate. Results The electronic search identified 5013 studies for screening. After screening and full-text review, 9 studies met criteria for inclusion, and a manual reference list review identified 5 additional studies, yielding a total of 14 studies included in the systematic review. The most common CDS intervention was urinalysis with reflex to urine culture based on prespecified urinalysis parameters. All 9 studies that provided statistical comparisons reported a decreased urine culture rate postintervention, 8 of which were statistically significant. A meta-analysis including 4 studies identified a pooled urine culture incidence rate ratio of 0.56 (95% confidence interval, .52-.60) favoring the postintervention versus preintervention group. Conclusions In this systematic review and meta-analysis, CDS appeared to be effective in decreasing urine culture rates. Prospective trials are needed to confirm these findings and to evaluate their impact on antimicrobial prescribing, patient-relevant outcomes, and potential adverse effects.
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Affiliation(s)
- Leila S Hojat
- Correspondence: Leila S. Hojat, MD, 11100 Euclid Ave., Mailstop FOL5083, Cleveland, OH 44106, USA (). Elie Saade, MPH, MD, 11100 Euclid Ave, Mailstop FOL5083, Cleveland, OH 44106, USA ()
| | - Elie A Saade
- Correspondence: Leila S. Hojat, MD, 11100 Euclid Ave., Mailstop FOL5083, Cleveland, OH 44106, USA (). Elie Saade, MPH, MD, 11100 Euclid Ave, Mailstop FOL5083, Cleveland, OH 44106, USA ()
| | - Adrian V Hernandez
- Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA,Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Vicerrectorado de Investigación, Universidad San Ignacio de Loyola (USIL), Lima, Peru
| | - Curtis J Donskey
- Department of Medicine, Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio, USA,Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland Veterans’ Affairs Medical Center, Cleveland, Ohio, USA
| | - Abhishek Deshpande
- Center for Value Based Care Research, Cleveland Clinic Community Care, Cleveland Clinic, Cleveland, Ohio, USA,Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Saade EA, Abul Y, McConeghy K, Edward Davidson H, Han L, Joyce N, Canaday DH, Hsueh L, Bosco E, Gravenstein S. High-dose influenza vaccines for the prevention of hospitalization due to cardiovascular events in older adults in the nursing home: Post-hoc analysis of a cluster-randomized trial. Vaccine 2022; 40:6700-6705. [PMID: 36244879 DOI: 10.1016/j.vaccine.2022.09.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/31/2022] [Accepted: 09/26/2022] [Indexed: 01/22/2023]
Abstract
Older adults are at high risk of major acute cardiovascular events (MACE) linked to influenza illness andpreventable by influenza vaccination. It is unknown whether high-dose vaccine might incrementally reduce the risk of MACE.We conducted a post-hoc analysis of data collected from a pragmatic cluster randomized study of 823 nursing homes (NH) randomized to standard-dose (SD) or high-dose (HD) influenza vaccine in the 2013-14 season. Adults age 65 year or older who are Medicare-enrolled long-stay residents were included in the analysis.There were no statistically significant differences in hospitalization for MACE, acute coronary syndromes (ACS), stroke or heart failure between the HD and SD arms. However, in the fee-for-service group, participants in the HD arm had significantly decreased risk of hospitalization for respiratory problems, which was not observed in the Medicare Advantage group.High-dose influenza vaccine was not shown to be incrementally protective against MACE relative to standard-dose vaccine.
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Affiliation(s)
- Elie A Saade
- University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University, Cleveland, OH, United States.
| | - Yasin Abul
- School of Public Health, Brown University, Providence, RI, United States; Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, RI, United States
| | - Kevin McConeghy
- School of Public Health, Brown University, Providence, RI, United States; Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, RI, United States
| | | | - Lisa Han
- Insight Therapeutics, LLC, Norfolk, VA, United States
| | - Nina Joyce
- School of Public Health, Brown University, Providence, RI, United States
| | - David H Canaday
- Case Western Reserve University, Cleveland, OH, United States; Veterans Administration Medical Center, Cleveland, OH, United States
| | - Leon Hsueh
- Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Elliott Bosco
- School of Public Health, Brown University, Providence, RI, United States
| | - Stefan Gravenstein
- School of Public Health, Brown University, Providence, RI, United States; Center on Innovation in Long-Term Services and Supports, Veterans Administration Medical Center, Providence, RI, United States; Warren Alpert Medical School of Brown University, Providence, RI, United States.
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7
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Saade EA, Hojat LS, Gundelly P, Salata RA. Prevention and treatment of COVID-19 in patients with benign and malignant blood disorders. Best Pract Res Clin Haematol 2022; 35:101375. [PMID: 36494144 PMCID: PMC9398935 DOI: 10.1016/j.beha.2022.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/27/2022] [Accepted: 08/11/2022] [Indexed: 12/15/2022]
Abstract
Patients with moderate to severe immunosuppression, a condition that is common in many hematologic diseases because of the pathology itself or its treatment, are at high risk for COVID-19 and its complications. While empirical data are sometimes conflicting, this heightened risk has been confirmed in multiple well-done studies for patients with hematologic malignancies, particularly those with B-cell lymphoid malignancies who received lymphocytotoxic therapies, those with a history of recent hematopoietic stem cell transplant and chimeric antigen receptor T-cell therapy, and, to a lesser degree, those with hemoglobinopathies. Patients with immunosuppression need to have a lower threshold for avoiding indoor public spaces where they are unable to effectively keep a safe distance from others, and wear a high-quality well-fitting mask, especially when community levels are not low. They should receive an enhanced initial vaccine regimen and additional boosting. Therapeutic options are available and immunosuppressed patients are prioritized per the NIH.
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Affiliation(s)
- Elie A. Saade
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,Case Western Reserve University, Cleveland, OH, USA,Corresponding author. Division of Infectious Diseases & HIV Medicine, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue – Mailstop Fol. 5083, Cleveland, OH, 44106, USA
| | - Leila S. Hojat
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,Case Western Reserve University, Cleveland, OH, USA
| | - Praveen Gundelly
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,Case Western Reserve University, Cleveland, OH, USA
| | - Robert A. Salata
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA,Case Western Reserve University, Cleveland, OH, USA
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8
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Saade EA, Zhang X, Noguez JH, Stempak LM, Tisch D, Schmotzer C, Salata RA. Seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) among healthcare providers prior to the vaccine era in an integrated midwestern healthcare system. Antimicrob Steward Healthc Epidemiol 2022; 2:e47. [PMID: 36310795 PMCID: PMC9614926 DOI: 10.1017/ash.2022.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 06/16/2023]
Abstract
We performed severe acute respiratory coronavirus virus 2 (SARS-CoV-2) antinucleocapsid IgG testing on 5,557 healthcare providers and found a seroprevalence of 3.9%. African Americans were more likely to test positive than Whites, and HCWs with household exposure and those working on COVID-19 cohorting units were more likely to test positive than their peers.
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Affiliation(s)
- Elie A. Saade
- Dvision of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
| | - Xiaochun Zhang
- Case Western Reserve University, Cleveland, Ohio
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jaime H Noguez
- Case Western Reserve University, Cleveland, Ohio
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Lisa M. Stempak
- Case Western Reserve University, Cleveland, Ohio
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Daniel Tisch
- Case Western Reserve University, Cleveland, Ohio
| | - Christine Schmotzer
- Case Western Reserve University, Cleveland, Ohio
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Robert A. Salata
- Dvision of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Case Western Reserve University, Cleveland, Ohio
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9
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White EM, Saade EA, Yang X, Canaday DH, Blackman C, Santostefano CM, Nanda A, Feifer RA, Mor V, Rudolph JL, Gravenstein S. SARS-CoV-2 antibody detection in skilled nursing facility residents. J Am Geriatr Soc 2021; 69:1722-1728. [PMID: 33544876 PMCID: PMC8013911 DOI: 10.1111/jgs.17061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To describe the frequency and timing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody detection in a convenience sample of skilled nursing facility (SNF) residents with and without confirmed SARS-CoV-2 infection. DESIGN Retrospective analysis of SNF electronic health records. SETTING Qualitative SARS-CoV-2 antibody test results were available from 81 SNFs in 16 states. PARTICIPANTS Six hundred and sixty nine SNF residents who underwent both polymerase chain reaction (PCR) and antibody testing for SARS-CoV-2. MEASUREMENTS Presence of SARS-CoV-2 antibodies following the first positive PCR test for confirmed cases, or first PCR test for non-cases. RESULTS Among 397 residents with PCR-confirmed infection, antibodies were detected in 4 of 7 (57.1%) tested within 7-14 days of their first positive PCR test; in 44 of 47 (93.6%) tested within 15-30 days; in 182 of 219 (83.1%) tested within 31-60 days; and in 110 of 124 (88.7%) tested after 60 days. Among 272 PCR negative residents, antibodies were detected in 2 of 9 (22.2%) tested within 7-14 days of their first PCR test; in 41 of 81 (50.6%) tested within 15-30 days; in 65 of 148 (43.9%) tested within 31-60 days; and in 9 of 34 (26.5%) tested after 60 days. No significant differences in baseline resident characteristics or symptoms were observed between those with versus without antibodies. CONCLUSIONS These findings suggest that vulnerable older adults can mount an antibody response to SARS-CoV-2, and that antibodies are most likely to be detected within 15-30 days of diagnosis. That antibodies were detected in a large proportion of residents with no confirmed SARS-CoV-2 infection highlights the complexity of identifying who is infected in real time. Frequent surveillance and diagnostic testing based on low thresholds of clinical suspicion for symptoms and/or exposure will remain critical to inform strategies designed to mitigate outbreaks in SNFs while community SARS-CoV-2 prevalence remains high.
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Affiliation(s)
- Elizabeth M. White
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Elie A. Saade
- Case Western Reserve University School of MedicineDivision of Infectious Diseases and HIV MedicineClevelandOhioUSA
- Louis Stokes Veterans Administration Medical CenterClevelandOhioUSA
| | - Xiaofei Yang
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - David H. Canaday
- Case Western Reserve University School of MedicineDivision of Infectious Diseases and HIV MedicineClevelandOhioUSA
- Louis Stokes Veterans Administration Medical CenterClevelandOhioUSA
| | | | - Christopher M. Santostefano
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Aman Nanda
- Division of Geriatrics and Palliative MedicineBrown University Alpert Medical SchoolProvidenceRhode IslandUSA
| | | | - Vincent Mor
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Providence Veterans Administration Medical Center Research ServiceProvidenceRhode IslandUSA
| | - James L. Rudolph
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Providence Veterans Administration Medical Center Research ServiceProvidenceRhode IslandUSA
| | - Stefan Gravenstein
- Department of Health Services, Policy, and PracticeBrown University School of Public HealthProvidenceRhode IslandUSA
- Division of Geriatrics and Palliative MedicineBrown University Alpert Medical SchoolProvidenceRhode IslandUSA
- Providence Veterans Administration Medical Center Research ServiceProvidenceRhode IslandUSA
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Saade EA, Canaday DH, Davidson HE, Gravenstein S. VZV-containing vaccines and hospitalization for herpes zoster: careful optimism. Aging Clin Exp Res 2019; 31:1347-1348. [PMID: 31317517 DOI: 10.1007/s40520-019-01264-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 06/29/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Elie A Saade
- University Hospitals of Cleveland, Louis Stokes Veterans Administration Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - David H Canaday
- Louis Stokes Veterans Administration Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | | | - Stefan Gravenstein
- Schools of Medicine and Public Health, Brown University Providence Veterans Administration Medical Center, Providence, RI, USA
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Saade EA, Suwantarat N, Zabarsky TF, Wilson B, Donskey CJ. Fluoroquinolone-Resistant Escherichia coli Infections After Transrectal Biopsy of the Prostate in the Veterans Affairs Healthcare System. Pathog Immun 2016. [PMID: 27774521 PMCID: PMC5070472 DOI: 10.20411/pai.v1i2.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Recent reports suggest that infections due to fluoroquinolone-resistant Escherichia coli (E. coli) are an increasingly common complication of transrectal biopsy of the prostate (TBP) in the United States. A better understanding of the magnitude and scope of these infections is needed to guide prevention efforts. Our objective is to determine whether the incidence of infections due to fluoroquinolone-resistant E. coli after TBP has increased nationwide in the Veterans Affairs Health Care System and to identify risk factors for infection. Methods: We performed a retrospective, observational cohort study and a nested case-control study within the US Deparment of Veterans Affairs Healthcare System. The primary outcomes were the incidence of urinary tract infection (UTI) and bacteremia with E. coli and with fluoroquinolone-resistant E. coli strains within 30 days after TBP. Secondary endpoints focused on the correlation between fluoroquinolone-resistance in all urinary E. coli isolates and post-TBP infection and risk factors for infection due to fluoroquinolone-resistant E. coli infection. Results: 245,618 patients undergoing 302,168 TBP procedures from 2000 through 2013 were included in the cohort study, and 59,469 patients undergoing TBP from 2011 through 2013 were included in the nested case-control study. Between 2000 and 2013, there was a 5-fold increase in the incidence of E. coli UTI (0.18%–0.93%) and a 4-fold increase in the incidence of E. coli bacteremia (0.04%–0.18%) after TBP that was attributable to an increase in the incidence of fluoroquinolone-resistant E. coli UTI (0.03%–0.75%) and bacteremia (0.01%–0.14%). The increasing incidence of fluoroquinolone-resistant E. coli infections after TBP occurred in parallel with increasing rates of fluoroquinolone-resistance in all urinary E. coli isolates. By multivariable logistic regression analysis, independent risk factors for fluoroquinolone-resistant E. coli UTI after TBP included diabetes mellitus, fluoroquinolone exposure, prior hospitalization, and prior cultures with fluoroquinolone-resistant gram-negative bacilli. Conclusion: In the Veterans Affairs Healthcare System, the incidence of E. coli infection after TBP has increased significantly since 2000 due to a dramatic rise in infections with fluoroquino-lone-resistant E. coli.
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Affiliation(s)
- Elie A Saade
- Infectious Diseases Division, University Hospitals, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Nuntra Suwantarat
- Infectious Diseases Division, University Hospitals, Cleveland, OH; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Trina F Zabarsky
- Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Brigid Wilson
- Geriatric Research Education and Clinical Center, Cleveland VA Medical Center, Cleveland, OH
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research Education and Clinical Center, Cleveland VA Medical Center, Cleveland, OH
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