Proceedings of the Clinical Microbiology Open 2018 and 2019 - a Discussion about Emerging Trends, Challenges, and the Future of Clinical Microbiology.

Clinical Microbiology Open (CMO), a meeting supported by the American Society for Microbiology's Clinical and Public Health Microbiology Committee (CPHMC) and Corporate Council, provides a unique interactive platform for leaders from diagnostic microbiology laboratories, industry, and federal agencies to discuss the current and future state of the clinical microbiology laboratory. The purpose is to leverage the group's diverse views and expertise to address critical challenges, and discuss potential collaborative opportunities for diagnostic microbiology, through the utilization of varied resources. The first and second CMO meetings were held in 2018 and 2019, respectively. Discussions were focused on the diagnostic potential of innovative technologies and laboratory diagnostic stewardship, including expansion of next-generation sequencing into clinical diagnostics, improvement and advancement of molecular diagnostics, emerging diagnostics, including rapid antimicrobial susceptibility and point of care testing (POCT), harnessing big data through artificial intelligence, and staffing in the clinical microbiology laboratory. Shortly after CMO 2019, the coronavirus disease 2019 (COVID-19) pandemic further highlighted the need for the diagnostic microbiology community to work together to utilize and expand on resources to respond to the pandemic. The issues, challenges, and potential collaborative efforts discussed during the past two CMO meetings proved critical in addressing the COVID-19 response by diagnostic laboratories, industry partners, and federal organizations. Planning for a third CMO (CMO 2022) is underway and will transition from a discussion-based meeting to an action-based meeting. The primary focus will be to reflect on the lessons learned from the COVID-19 pandemic and better prepare for future pandemics.

A waterfall of susceptibility results: impact of microbiology testing cascade for MDROs.

Cascade reporting is an antimicrobial stewardship strategy which selectively reports broad-spectrum antibiotic susceptibility when narrower-spectrum agents are resistant. Three regional laboratories, which provide microbiology services for HCA Healthcare hospitals in Florida, implemented a standardized antibiotic testing cascade for multi-drug resistant organisms. This study evaluated the impact of the testing cascade on time to susceptibility results for carbapenem-resistant Gram-negative organisms. Appropriateness of manual susceptibility test selection was also assessed. Compliance with the testing cascade was 56%. Appropriateness of manual tests in the pre- and post-intervention groups was 87% (257/297) and 96% (310/323), respectively (P < 0.0001). Median time to first manual test result was 23.1 hours (IQR: 19.8-25.2 hours) in the pre-intervention group and 23.9 hours (IQR: 20.2-27.0 hours) in the post-intervention group (P = 0.11). Implementation of a testing cascade did not result in faster manual susceptibility results, however there was a significant increase in testing appropriateness.

Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system.

OBJECTIVES: To characterize isolates of Klebsiella pneumoniae producing KPC carbapenemase (KPC-Kp) associated with an outbreak in a long-term acute care hospital (LTACH) in South Florida. METHODS: During 21 March to 20 April 2008, 241 K. pneumoniae isolates detected at Integrated Regional Laboratories (Ft. Lauderdale, FL) for which the ertapenem MICs were > or =4 mg/L were studied. PCR, cloning and sequence analysis were used to detect bla(KPC) and to characterize the beta-lactamase and outer membrane proteins (Omps). The expression level of KPC enzymes was studied by immunoblotting. Genetic relatedness of isolates was investigated with rep-PCR and PFGE. Clinical records of patients were investigated. RESULTS: Seven KPC-Kp strains were isolated from different patients located at a single LTACH, with a further three isolates being recovered from patients at different hospitals. All KPC-Kp isolates in patients from the LTACH and from one hospital patient were genetically related and shared PFGE patterns that clustered with known sequence type (ST) 258 strains. These strains were highly resistant to carbapenems (MICs > or = 32 mg/L) due to an increased level of KPC expression and loss of Omps. Rectal colonization was documented in all LTACH patients with KPC-Kp isolates. Treatment failures were common (crude mortality rate of 69%). Active surveillance and enhanced infection control practices terminated the KPC-Kp outbreak. CONCLUSIONS: The detection of KPC-Kp in an LTACH represents a serious infection control and therapeutic challenge in a new clinical setting. The speed at which the epidemic of KPC-Kp is spreading in our healthcare system mandates urgent action.

Lack of sensitivity of rapid antigen tests for the diagnosis of respiratory syncytial virus infection in adults.

The diagnosis of respiratory syncytial virus (RSV) infection in older individuals and adults with cardiopulmonary diseases using available rapid antigen detection tests may be difficult due to the low virus shedding in this population. These tests have been extensively evaluated in hospitalized infants, but there is only limited data on their usefulness in adult populations. We evaluated the performance of three different rapid antigen detection tests: Becton Dickinson Directigen RSV (BD), Bartels RSV Direct Fluorescent Antibody Test (DFA) and the VIDAS RSV assay (VIDAS) in nasopharyngeal specimens from 60 older persons with RSV infection documented by cell culture, serology or reverse transcription polymerase chain reaction (RT-PCR). The three rapid antigen assays tested on all 60 samples performed poorly. DFA detected 14 (23%), VIDAS detected 12 (20%) and BD detected only 6 (10%) of the RSV infected persons. Rapid antigen detection tests for the diagnosis of RSV respiratory illness in adults are of limited value.

Usefulness of antibiogram surveillance for methicillin-resistant Staphylococcus aureus in outpatient pediatric populations.

We assessed the impact of distributing an outpatient age-specific methicillin-resistant Staphylococcus aureus (MRSA) antibiogram on physician knowledge of MRSA prevalence and choice of empiric therapy. Questionnaires were given to 125 physicians at outpatient pediatric clinics in Monroe County, NY, before and after antibiogram distribution (response rates, 42% and 24%, respectively). The median physician-estimated MRSA prevalence (among S. aureus skin infections) was 15% before they received the antibiogram and 20% after. According to the antibiogram, the true 2005 prevalence was 25% among skin infections. When asked to select empiric therapy for a pediatric outpatient with a skin abscess, while assuming varying levels of MRSA prevalence, most selected cephalexin when the prevalence was assumed to be 20% or less, and trimethoprim-sulfamethoxazole when the prevalence was assumed to be 30% or greater. These data suggest that antibiograms may improve empiric therapy decision making by increasing knowledge of local outpatient prevalence of antibiotic resistance.

Nuevos y viejos agentes asociados a diarrea en niños en Honduras / New and old agents of acute diarrhea In children In Honduras

INTRODUCCIÓN: La diarrea es la segunda causa de morbilidad y mortalidad en niños menores de 5 años en Honduras. El objetivo de este estudio fue determinar los agentes etiológicos virales, bacterianos y parasitarios en niños con diarrea no sanguino lenta de 2 barrios marginales de Comayagüela, Honduras. METODOLOGÍA: Estudio de casos y controles realizado del 1er de marzo al 31 de agosto 2004 en los centros de Salud de Las Crucitas y El Carrizal, en 151 niños de 6 meses a 5 años de edad con diarrea aguda que acudieron por demanda espontanea; con los correspondientes 151 controles apareados por edad, sexo y vecindario, una vez obtenido el consentimiento informado. Las muestras de heces se procesaron por virus, bacterias y parásitos utilizando métodos convencionales en el laboratorio. El análisis estadístico además de la prueba exacta de Fisher. RESULTADOS: Se encontró una asociación significativa entre los niños infectados por Cryptosporidium spp. y Adenovirus y los episodios de diarrea aguda, comparada con los no infectados por esos agentes patógenos (OR=9.31, 95%CI=1.24 - 69.97; OR = 5.47, 95%CI=1.51 – 19.80, respectivamente); los 8 pacientes infectados con Rotavirus tenían un cuadro diarreico agudo evidente (prueba exacta de Fisher p<0.01). CONCLUSIONES: Las infecciones por Adenovirus, Rotavirus y Cryptosporidium spp. se asociaron fuertemente con diarrea aguda no sanguinolenta en niños en Honduras...