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Nguyen DC, Redmond SN, Dousa KM, Bethel C, Taracila MA, Li Q, Kurz SG, Pavelka MS, Papp-Wallace K, Holland SM, Kreiswirth BN, Boom H, Bonomo RA. 1432. Exploring Cell Wall Targets to Overcome Mycobacterium tuberculosis (Mtb): Ceftriaxone (CRO) Inhibits Ldt Mt2, a Major Peptidoglycan (PG) Synthase. Open Forum Infect Dis 2022. [PMCID: PMC9752925 DOI: 10.1093/ofid/ofac492.1261] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Drug-resistant tuberculosis (DR TB) is a deadly, difficult-to-treat infection, and new treatment strategies are needed. Despite the wide success of β-lactams (BLs), DR TB guidelines only include meropenem (MEM) and imipenem (IPM), given with clavulanate (CLA). BlaC, the Mtb β-lactamase, hydrolyzes CRO less efficiently than other cephems and β-lactamase inhibitors improve the in vitro susceptibility of Mtb to CRO. Surprisingly, CRO has not been evaluated in DR TB clinical studies. Moreover, the mechanisms by which CRO disrupts Mtb PG synthesis are not well characterized. CRO inhibits LdtMt1, but activity against LdtMt2, an important Mtb PG synthase, is unknown. To explore this knowledge gap, we examined CRO inhibition of LdtMt2. In addition, we investigated if combining CRO with MEM or IPM would lower minimum inhibitory concentrations (MICs) more than each agent alone. Methods A panel of Mtb isolates was selected for susceptibility testing with a broth microdilution method. Timed electrospray ionization-mass spectrometry (ESI-MS) and inhibition kinetic assays were performed. Results CRO MICs ranged 0.25 to 16 µg/mL and lowered ≤ 0.06 to 2 µg/mL with CLA (Table 1). Fractional inhibitory concentration indices for CRO + MEM or IPM was < 0.5 for six isolates, suggesting synergy. ESI-MS captured CRO-LdtMt2 acyl-complexes at timepoints 5 to 120 min, and a 158 Da fragment loss was observed; MEM and IPM were unchanged (Table 2, Figure 1). When LdtMt2 was co-incubated with MEM and CRO together, only MEM complexes were captured. Interestingly, Kiapp with CRO (0.07 ± 0.01 µM) was comparable to that with MEM (0.09 ± 0.01 µM).
![]() ![]() Mass spectrometry chromatograms with LdtMt2 (A) alone incubated with ceftriaxone at (B) 5 min, (C) 15 min, (D) 30 min, (E) 120 min. [Ldt¬Mt2] = 13.2 µM and [ceftriaxone] = 264 µM. Changes in MW are also listed in Table 1. (F) shows the structure of ceftriaxone with the proposed leaving group in red, leaving the remaining bound structure accounting for the observed change in MW. ![]() Conclusion CRO was effective in lowering MICs with MEM, IPM, and CLA for our Mtb isolates. Based upon ESI-MS, we found that CRO forms a stable complex with LdtMt2 and the R2 side chain is eliminated, while kinetic observations support inhibition of LdtMt2 by CRO (Figure 2). Previous work found MEM and IPM also inhibit multiple other PG synthases (e.g., PonA1, LdtMt1, LdtMt3). We hypothesize that CRO + MEM/IPM inhibits the growth of Mtb by the combined inactivation of multiple cell wall enzymes. Our observations support the further exploration of the notion of “target redundancy” as an approach to treat multidrug-resistant mycobacteria with BLs.
Ceftriaxone-LdtMt2 adduct formation leading to release of the R2 side group ![]() Disclosures Krisztina Papp-Wallace, Ph.D, Merck: Grant/Research Support|Venatorx: Grant/Research Support|Wockhardt: Advisor/Consultant Robert A. Bonomo, MD, NIH VA: Grant/Research Support|VenatoRx Merck Wockhardt Cystic Fibrosis Foundation: Grant/Research Support.
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Affiliation(s)
- David C Nguyen
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| | - Sarah N Redmond
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Khalid M Dousa
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | | | | | - Qing Li
- Case Western Reserve University, Cleveland, Ohio
| | - Sebastian G Kurz
- University Hospitals of Tuebingen, Tuebingen, Baden-Wurttemberg, Germany
| | | | - Krisztina Papp-Wallace
- Case Western Reserve University/ Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | | | - Barry N Kreiswirth
- Center for Discovery and Innovation, Hakensack Meridian Health, Nutley, New Jersey
| | - Henry Boom
- Case Western Reserve University / University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Jinadatha C, Jones LD, Choi H, Chatterjee P, Hwang M, Redmond SN, Navas ME, Zabarsky TF, Bhullar D, Cadnum JL, Donskey CJ. Transmission of SARS-CoV-2 in Inpatient and Outpatient Settings in a Veterans Affairs Health Care System. Open Forum Infect Dis 2021; 8:ofab328. [PMID: 34426792 PMCID: PMC8344547 DOI: 10.1093/ofid/ofab328] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health care personnel and patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in health care settings, including in outpatient clinics and ancillary care areas. METHODS Between May 1, 2020, and January 31, 2021, we identified clusters of 3 or more coronavirus disease 2019 (COVID-19) cases in which nosocomial transmission was suspected in a Veterans Affairs health care system. Asymptomatic employees and patients were tested for SARS-CoV-2 if they were identified as being at risk through contact tracing investigations; for 7 clusters, all personnel and/or patients in a shared work area were tested regardless of exposure history. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from the clusters and from control employees and patients. RESULTS Of 14 clusters investigated, 7 occurred in community-based outpatient clinics, 1 in the emergency department, 3 in ancillary care areas, and 3 on hospital medical/surgical wards that did not provide care for patients with known COVID-19 infection. Eighty-one of 82 (99%) symptomatic COVID-19 cases and 31 of 35 (89%) asymptomatic cases occurred in health care personnel. Sequencing analysis provided support for several transmission events between coworkers and in 2 cases supported transmission from health care personnel to patients. There were no documented transmissions from patients to personnel. CONCLUSIONS Clusters of COVID-19 with nosocomial transmission predominantly involved health care personnel and often occurred in outpatient clinics and ancillary care areas. There is a need for improved measures to prevent transmission of SARS-CoV-2 by health care personnel in inpatient and outpatient settings.
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Affiliation(s)
- Chetan Jinadatha
- Medical Service, Central Texas Veterans Healthcare System, Temple, Texas, USA
- College of Medicine, Texas A&M University, Bryan, Texas, USA
| | - Lucas D Jones
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Hosoon Choi
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas, USA
| | - Piyali Chatterjee
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas, USA
| | - Munok Hwang
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas, USA
| | - Sarah N Redmond
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Maria E Navas
- Pathology and Laboratory Medicine Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Trina F Zabarsky
- Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Davinder Bhullar
- Personnel Health Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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John AR, Raju S, Cadnum JL, Lee K, McClellan P, Akkus O, Miller SK, Jennings WD, Buehler JA, Li DF, Redmond SN, Braskie M, Hoyen CK, Donskey CJ. Scalable in-hospital decontamination of N95 filtering face-piece respirator with a peracetic acid room disinfection system. Infect Control Hosp Epidemiol 2021. [PMID: 33040749 DOI: 10.1101/2020.04.24.20073973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Critical shortages of personal protective equipment, especially N95 respirators, during the coronavirus disease 2019 (COVID-19) pandemic continues to be a source of concern. Novel methods of N95 filtering face-piece respirator decontamination that can be scaled-up for in-hospital use can help address this concern and keep healthcare workers (HCWs) safe. METHODS A multidisciplinary pragmatic study was conducted to evaluate the use of an ultrasonic room high-level disinfection system (HLDS) that generates aerosolized peracetic acid (PAA) and hydrogen peroxide for decontamination of large numbers of N95 respirators. A cycle duration that consistently achieved disinfection of N95 respirators (defined as ≥6 log10 reductions in bacteriophage MS2 and Geobacillus stearothermophilus spores inoculated onto respirators) was identified. The treated masks were assessed for changes to their hydrophobicity, material structure, strap elasticity, and filtration efficiency. PAA and hydrogen peroxide off-gassing from treated masks were also assessed. RESULTS The PAA room HLDS was effective for disinfection of bacteriophage MS2 and G. stearothermophilus spores on respirators in a 2,447 cubic-foot (69.6 cubic-meter) room with an aerosol deployment time of 16 minutes and a dwell time of 32 minutes. The total cycle time was 1 hour and 16 minutes. After 5 treatment cycles, no adverse effects were detected on filtration efficiency, structural integrity, or strap elasticity. There was no detectable off-gassing of PAA and hydrogen peroxide from the treated masks at 20 and 60 minutes after the disinfection cycle, respectively. CONCLUSION The PAA room disinfection system provides a rapidly scalable solution for in-hospital decontamination of large numbers of N95 respirators during the COVID-19 pandemic.
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Affiliation(s)
- Amrita R John
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Shine Raju
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Kipum Lee
- UH Ventures, Innovation Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio
| | - Phillip McClellan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Ozan Akkus
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
- Department of Orthopedics, Case Western Reserve University, Cleveland, Ohio
| | - Sharon K Miller
- NASA Glenn Research Center, Environmental Effects and Coatings Branch, Cleveland, Ohio
| | | | | | - Daniel F Li
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sarah N Redmond
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa Braskie
- Department of Environmental Health and Safety, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Claudia K Hoyen
- Department of Pediatric Infectious Diseases, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Curtis J Donskey
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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John AR, Raju S, Cadnum JL, Lee K, McClellan P, Akkus O, Miller SK, Jennings WD, Buehler JA, Li DF, Redmond SN, Braskie M, Hoyen CK, Donskey CJ. Scalable in-hospital decontamination of N95 filtering face-piece respirator with a peracetic acid room disinfection system. Infect Control Hosp Epidemiol 2021; 42:678-687. [PMID: 33040749 PMCID: PMC7642971 DOI: 10.1017/ice.2020.1257] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Critical shortages of personal protective equipment, especially N95 respirators, during the coronavirus disease 2019 (COVID-19) pandemic continues to be a source of concern. Novel methods of N95 filtering face-piece respirator decontamination that can be scaled-up for in-hospital use can help address this concern and keep healthcare workers (HCWs) safe. METHODS A multidisciplinary pragmatic study was conducted to evaluate the use of an ultrasonic room high-level disinfection system (HLDS) that generates aerosolized peracetic acid (PAA) and hydrogen peroxide for decontamination of large numbers of N95 respirators. A cycle duration that consistently achieved disinfection of N95 respirators (defined as ≥6 log10 reductions in bacteriophage MS2 and Geobacillus stearothermophilus spores inoculated onto respirators) was identified. The treated masks were assessed for changes to their hydrophobicity, material structure, strap elasticity, and filtration efficiency. PAA and hydrogen peroxide off-gassing from treated masks were also assessed. RESULTS The PAA room HLDS was effective for disinfection of bacteriophage MS2 and G. stearothermophilus spores on respirators in a 2,447 cubic-foot (69.6 cubic-meter) room with an aerosol deployment time of 16 minutes and a dwell time of 32 minutes. The total cycle time was 1 hour and 16 minutes. After 5 treatment cycles, no adverse effects were detected on filtration efficiency, structural integrity, or strap elasticity. There was no detectable off-gassing of PAA and hydrogen peroxide from the treated masks at 20 and 60 minutes after the disinfection cycle, respectively. CONCLUSION The PAA room disinfection system provides a rapidly scalable solution for in-hospital decontamination of large numbers of N95 respirators during the COVID-19 pandemic.
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Affiliation(s)
- Amrita R. John
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Shine Raju
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jennifer L. Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Kipum Lee
- UH Ventures, Innovation Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio
- Weatherhead School of Management, Case Western Reserve University, Cleveland, Ohio
| | - Phillip McClellan
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Ozan Akkus
- Department of Mechanical and Aerospace Engineering, Case Western Reserve University, Cleveland, Ohio
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
- Department of Orthopedics, Case Western Reserve University, Cleveland, Ohio
| | - Sharon K. Miller
- NASA Glenn Research Center, Environmental Effects and Coatings Branch, Cleveland, Ohio
| | | | | | - Daniel F. Li
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sarah N. Redmond
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa Braskie
- Department of Environmental Health and Safety, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Claudia K. Hoyen
- Department of Pediatric Infectious Diseases, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Curtis J. Donskey
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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Jones LD, Chan ER, Zabarsky TF, Cadnum JL, Navas ME, Redmond SN, Kovach JD, Linger M, Rutala WA, Zimmerman PA, Donskey CJ. Transmission of SARS-CoV-2 on a Patient Transport Van. Clin Infect Dis 2021; 74:339-342. [PMID: 33893474 PMCID: PMC8135457 DOI: 10.1093/cid/ciab347] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 03/18/2021] [Indexed: 01/09/2023] Open
Abstract
We report 2 episodes of potential SARS-CoV-2 transmission from infected van drivers to passengers despite masking and physical distancing. Whole genome sequencing confirmed relatedness of driver and passenger SARS-CoV-2. With the heater operating, fluorescent microspheres were transported by airflow >3 meters from the front to the back of the van.
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Affiliation(s)
- Lucas D Jones
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland Ohio, USA
| | - Ernest R Chan
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Trina F Zabarsky
- Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Maria E Navas
- Pathology and Laboratory Medicine Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Sarah N Redmond
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jeffrey D Kovach
- The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Marlin Linger
- The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Peter A Zimmerman
- The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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Cadnum JL, Jencson AL, Livingston SH, Li DF, Redmond SN, Pearlmutter B, Wilson BM, Donskey CJ. Evaluation of an electrostatic spray disinfectant technology for rapid decontamination of portable equipment and large open areas in the era of SARS-CoV-2. Am J Infect Control 2020; 48:951-954. [PMID: 32522608 PMCID: PMC7275188 DOI: 10.1016/j.ajic.2020.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 04/18/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022]
Abstract
In the setting of the coronavirus disease 2019 pandemic, efficient methods are needed to decontaminate shared portable devices and large open areas such as waiting rooms. We found that wheelchairs, portable equipment, and waiting room chairs were frequently contaminated with potential pathogens. After minimal manual precleaning of areas with visible soiling, application of a dilute sodium hypochlorite disinfectant using an electrostatic sprayer provided rapid and effective decontamination and eliminated the benign virus bacteriophage MS2 from inoculated surfaces.
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Affiliation(s)
- Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Annette L Jencson
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | | | - Daniel F Li
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Sarah N Redmond
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Basya Pearlmutter
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Brigid M Wilson
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.
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Redmond SN, Helms R, Pensiero A. A Case of Actinomyces Prosthetic Hip Infection. Cureus 2020; 12:e9148. [PMID: 32789085 PMCID: PMC7417308 DOI: 10.7759/cureus.9148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Actinomyces is a species of gram-positive anaerobic commensal organisms found in the human oropharynx, gastrointestinal, and genitourinary tracts, which most often are implicated in cervicofacial infections. Rarely do these organisms cause joint infections. We present the case of a 68-year-old man with a prosthetic hip infection due to Actinomyces species. He underwent surgical incision and drainage with replacement of the prosthetic joint. Cultures grew Actinomyces species, and he was treated with a four-week course of ampicillin-sulbactam followed by eight weeks of amoxicillin-clavulanate. This organism is an uncommon pathogen, and few cases of prosthetic joint infection due to Actinomyces have previously been reported.
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Li DF, Cadnum JL, Redmond SN, Jones LD, Pearlmutter B, Haq MF, Donskey CJ. Steam treatment for rapid decontamination of N95 respirators and medical face masks. Am J Infect Control 2020; 48:855-857. [PMID: 32417321 PMCID: PMC7227495 DOI: 10.1016/j.ajic.2020.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/26/2022]
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Li DF, Cadnum JL, Redmond SN, Jones LD, Donskey CJ. It's not the heat, it's the humidity: Effectiveness of a rice cooker-steamer for decontamination of cloth and surgical face masks and N95 respirators. Am J Infect Control 2020; 48:854-855. [PMID: 32334003 PMCID: PMC7174981 DOI: 10.1016/j.ajic.2020.04.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/27/2022]
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Cadnum JL, Li DF, Jones LD, Redmond SN, Pearlmutter B, Wilson BM, Donskey CJ. Evaluation of Ultraviolet-C Light for Rapid Decontamination of Airport Security Bins in the Era of SARS-CoV-2. Pathog Immun 2020; 5:133-142. [PMID: 32582873 PMCID: PMC7307442 DOI: 10.20411/pai.v5i1.373] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/08/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Contaminated surfaces are a potential source for spread of respiratory viruses including SARS-CoV-2. Ultraviolet-C (UV-C) light is effective against RNA and DNA viruses and could be useful for decontamination of high-touch fomites that are shared by multiple users. Methods: A modification of the American Society for Testing and Materials standard quantitative carrier disk test method (ASTM E-2197-11) was used to examine the effectiveness of UV-C light for rapid decontamination of plastic airport security bins inoculated at 3 sites with methicillin-resistant Staphylococcus aureus (MRSA) and bacteriophages MS2, PhiX174, and Phi6, an enveloped RNA virus used as a surrogate for coronaviruses. Reductions of 3 log10 on inoculated plastic bins were considered effective for decontamination. Results: UV-C light administered as 10-, 20-, or 30-second cycles in proximity to a plastic bin reduced contamination on each of the test sites, including vertical and horizontal surfaces. The 30-second cycle met criteria for decontamination of all 3 test sites for all the test organisms except bacteriophage MS2 which was reduced by greater than 2 log10 PFU at each site. Conclusions: UV-C light is an attractive technology for rapid decontamination of airport security bins. Further work is needed to evaluate the utility of UV-C light in real-world settings and to develop methods to provide automated movement of bins through a UV-C decontamination process.
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Affiliation(s)
- Jennifer L Cadnum
- Research Service; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
| | - Daniel F Li
- Research Service; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
| | - Lucas D Jones
- Department of Molecular Biology and Microbiology; Case Western Reserve University School of Medicine; Cleveland Ohio
| | - Sarah N Redmond
- Case Western Reserve University School of Medicine; Cleveland, Ohio
| | - Basya Pearlmutter
- Research Service; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
| | - Brigid M Wilson
- Geriatric Research, Education, and Clinical Center; Louis Stokes Cleveland VA 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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Cadnum JL, Li DF, Redmond SN, John AR, Pearlmutter B, Donskey CJ. Effectiveness of Ultraviolet-C Light and a High-Level Disinfection Cabinet for Decontamination of N95 Respirators. Pathog Immun 2020; 5:52-67. [PMID: 32363254 PMCID: PMC7192214 DOI: 10.20411/pai.v5i1.372] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [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: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Shortages of personal protective equipment (PPE) including N95 respirators are an urgent concern in the setting of the global COVID-19 pandemic. Decontamination of PPE could be useful to maintain adequate supplies, but there is uncertainty regarding the efficacy of decontamination technologies. METHODS A modification of the American Society for Testing and Materials standard quantitative carrier disk test method (ASTM E-2197-11) was used to examine the effectiveness of 3 methods, including ultraviolet-C (UV-C) light, a high-level disinfection cabinet that generates aerosolized peracetic acid and hydrogen peroxide, and dry heat at 70°C for 30 minutes. We assessed the decontamination of 3 commercial N95 respirators inoculated with methicillin-resistant Staphylococcus aureus (MRSA) and bacteriophages MS2 and Phi6; the latter is an enveloped RNA virus used as a surrogate for coronaviruses. Three and 6 log10 reductions on respirators were considered effective for decontamination and disinfection, respectively. RESULTS UV-C administered as a 1-minute cycle in a UV-C box or a 30-minute cycle by a room decontamination device reduced contamination but did not meet criteria for decontamination of the viruses from all sites on the N95s. The high-level disinfection cabinet was effective for decontamination of the N95s and achieved disinfection with an extended 31-minute cycle. Dry heat at 70°C for 30 minutes was not effective for decontamination of the bacteriophages. CONCLUSIONS UV-C could be useful to reduce contamination on N95 respirators. However, the UV-C technologies studied did not meet pre-established criteria for decontamination under the test conditions used. The high-level disinfection cabinet was more effective and met criteria for disinfection with an extended cycle.
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Affiliation(s)
- Jennifer L Cadnum
- Research Service; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
| | - Daniel F Li
- Research Service; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
| | - Sarah N Redmond
- Geriatric Research, Education, and Clinical Center; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
| | - Amrita R John
- Department of Medicine; University Hospitals Cleveland Medical Center; Cleveland, Ohio
| | - Basya Pearlmutter
- Research Service; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
| | - Curtis J Donskey
- Geriatric Research, Education, and Clinical Center; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
- Case Western Reserve University School of Medicine; Cleveland, Ohio
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Redmond SN, Silva SY, Wilson BM, Cadnum JL, Donskey CJ. Impact of Reduced Fluoroquinolone Use on Clostridioides difficile Infections Resulting From the Fluoroquinolone-Resistant Ribotype 027 Strain in a Veterans Affairs Medical Center. Pathog Immun 2019; 4:251-259. [PMID: 31637329 PMCID: PMC6782113 DOI: 10.20411/pai.v4i2.327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 08/16/2019] [Accepted: 09/23/2019] [Indexed: 12/18/2022] Open
Abstract
Background Fluoroquinolone restriction has been proposed as a control measure for Clostridioides difficile infection (CDI) outbreaks associated with fluoroquinolone-resistant ribotype 027 strains. However, relatively few reports of fluoroquinolone restriction interventions have evaluated the impact on C. difficile strain types and fluoroquinolone resistance. Methods In a hospital and affiliated long-term care facility (LTCF), antimicrobial stewardship and environmental cleaning interventions were implemented between 2009 and 2018, and C. difficile isolates during this period (~20 per year) were ribotyped and tested for fluoroquinolone resistance by moxifloxacin minimum inhibitory concentrations (MICs). Pearson's correlation coefficient was used to assess the association between use of fluoroquinolones and the percentage of CDI cases due to the 027 strain over time. Results Between 2009 and 2018, prescribing of fluoroquinolones to inpatients decreased by 43%, coinciding with significant reductions in the healthcare-associated CDI rates in the hospital and LTCF and a decline in the percentage of C. difficile isolates that were ribotype 027 from 70% to 10%. Ninety-five percent of ribotype 027 and 6% of non-027 isolates were moxifloxacin resistant. Hospital fluoroquinolone use was strongly correlated with the incidence of hospital-associated CDI (r = 0.79, 95% confidence interval, 0.31-0.95), but LTCF fluoroquinolone use was not correlated with LTCF-associated CDI (r = 0.29, 95% confidence interval, -0.43-0.77). During the study period, there were statistically significant downward trends in the use of penicillins, intravenous vancomycin, carbapenems, and clindamycin. Conclusion Our results provide support for fluoroquinolone restriction as a control measure for CDI outbreaks due to fluoroquinolone-resistant 027 strains, but also highlight the need for randomized trials as factors such as reduction in other antibiotic classes and improved cleaning may also impact CDI rates.
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Affiliation(s)
- Sarah N Redmond
- Case Western Reserve University School of Medicine; Cleveland, Ohio
| | - Sandra Y Silva
- Clinical and Translational Science Program; School of Medicine; Case Western Reserve University; Cleveland, Ohio
| | - Brigid M Wilson
- Geriatric Research, Education, and Clinical Center; Louis Stokes Cleveland VA Medical Center; Cleveland, Ohio
| | - Jennifer L Cadnum
- Research Service; Louis Stokes Cleveland VA 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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13
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Neafsey DE, Lawniczak MKN, Park DJ, Redmond SN, Coulibaly MB, Traoré SF, Sagnon N, Costantini C, Johnson C, Wiegand RC, Collins FH, Lander ES, Wirth DF, Kafatos FC, Besansky NJ, Christophides GK, Muskavitch MAT. SNP genotyping defines complex gene-flow boundaries among African malaria vector mosquitoes. Science 2010; 330:514-517. [PMID: 20966254 DOI: 10.1126/science.1193036] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mosquitoes in the Anopheles gambiae complex show rapid ecological and behavioral diversification, traits that promote malaria transmission and complicate vector control efforts. A high-density, genome-wide mosquito SNP-genotyping array allowed mapping of genomic differentiation between populations and species that exhibit varying levels of reproductive isolation. Regions near centromeres or within polymorphic inversions exhibited the greatest genetic divergence, but divergence was also observed elsewhere in the genomes. Signals of natural selection within populations were overrepresented among genomic regions that are differentiated between populations, implying that differentiation is often driven by population-specific selective events. Complex genomic differentiation among speciating vector mosquito populations implies that tools for genome-wide monitoring of population structure will prove useful for the advancement of malaria eradication.
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Affiliation(s)
| | | | - D J Park
- Broad Institute, Cambridge, MA 02142, USA
| | | | | | - S F Traoré
- Malaria Research and Training Center, Bamako, Mali
| | - N Sagnon
- Centre National de Recherche et Formation sur le Paludisme, Ouagadougou, Burkina Faso
| | - C Costantini
- Institut de Recherche pour le Développement, Unité de Recherche R016, Montpellier, France.,Organisation de Coordination pour la Lutte contre les Endémies en Afrique Centrale, Yaounde, Cameroon
| | - C Johnson
- Broad Institute, Cambridge, MA 02142, USA
| | | | - F H Collins
- University of Notre Dame, Notre Dame, IN 46556, USA
| | - E S Lander
- Broad Institute, Cambridge, MA 02142, USA
| | - D F Wirth
- Broad Institute, Cambridge, MA 02142, USA.,Harvard School of Public Health, Boston, MA 02115, USA
| | | | - N J Besansky
- University of Notre Dame, Notre Dame, IN 46556, USA
| | | | - M A T Muskavitch
- Broad Institute, Cambridge, MA 02142, USA.,Harvard School of Public Health, Boston, MA 02115, USA.,Boston College, Chestnut Hill, MA 02467, USA
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