ABSTRACT
Background: The Antimicrobial Resistance Laboratory Network (AR Lab Network) was developed by the CDC to detect emerging antimicrobial-resistant (AR) threats and prevent outbreaks. However, low submission rates of AR isolates limit the potential of the AR Lab Network to address antimicrobial resistance (AMR). Aim: The aim of this study was to investigate barriers to submission of AR isolates in acute care hospitals (ACHs) and critical access hospitals (CAHs) within Texas Public Health Region 8 (PHR8) counties. Methods: A survey was designed and emailed to laboratory professionals to identify barriers to AR isolate submission. Responses were analyzed using 2-sided Fisher's exact tests to identify associations between responses and respondent characteristics. Results: Of the 33 hospitals within PHR8 invited to participate in the survey, responses were received from 21, a response rate of 63.6%. Lack of awareness of the AR Lab Network was the most frequently cited barrier to submission (65.4% of respondents). Other reported barriers to submission included lack of laboratory staff time (57.7%), lack of training with the submission process (34.6%), lack of personnel certified to ship infectious substances (23.1%), and lack of laboratory/shipping supplies (23.1%). Discussion: Regardless of the respondent's role, time in that role, or type of hospital in which they worked, the most common barrier to isolate submission was lack of awareness of the AR Lab Network. In the future, we will address the identified barriers by implementing educational outreach programs about AMR and the AR Lab Network for hospitals and other healthcare facilities within PHR8.
ABSTRACT
During July 7-11, 2023, CDC received reports of two patients in different states with a tuberculosis (TB) diagnosis following spinal surgical procedures that used bone allografts containing live cells from the same deceased donor. An outbreak associated with a similar product manufactured by the same tissue establishment (i.e., manufacturer) occurred in 2021. Because of concern that these cases represented a second outbreak, CDC and the Food and Drug Administration worked with the tissue establishment to determine that this product was obtained from a donor different from the one implicated in the 2021 outbreak and learned that the bone allograft product was distributed to 13 health care facilities in seven states. Notifications to all seven states occurred on July 12. As of December 20, 2023, five of 36 surgical bone allograft recipients received laboratory-confirmed TB disease diagnoses; two patients died of TB. Whole-genome sequencing demonstrated close genetic relatedness between positive Mycobacterium tuberculosis cultures from surgical recipients and unused product. Although the bone product had tested negative by nucleic acid amplification testing before distribution, M. tuberculosis culture of unused product was not performed until after the outbreak was recognized. The public health response prevented up to 53 additional surgical procedures using allografts from that donor; additional measures to protect patients from tissue-transmitted M. tuberculosis are urgently needed.
Subject(s)
Mycobacterium tuberculosis , Tuberculosis , Humans , United States/epidemiology , Tuberculosis/epidemiology , Tuberculosis/diagnosis , Mycobacterium tuberculosis/genetics , Tissue Donors , Disease Outbreaks , AllograftsABSTRACT
BACKGROUND: The Texas Department of State Health Services (DSHS) Healthcare Safety Unit (HCSU) conducts remote infection control assessments (tele-ICARs) in long-term care facilities (LTCFs) to evaluate COVID-19 infection prevention and control (IPC) knowledge and practices using a standardized assessment tool. Tele-ICARs are used to gauge different IPC measures specific to SARS-CoV-2 and are either proactive--conducted prior to identified cases--or responsive to an outbreak, which is defined as a new SARS-CoV-2 infection in any staff or any facility-onset infection in a resident. State and local partners use findings from the assessments to aid LTCFs by providing targeted and timely resources and support to mitigate identified gaps. METHODS: Data from tele-ICARs conducted between March 1 and October 30, 2020 were analyzed to assess major gaps across LTCF types. A major gap was defined as 10% or more of facilities not satisfying a specific IPC measure, excluding missing data. Gaps were also assessed by tele-ICAR type: proactive or responsive. Fisher's exact tests and univariate logistic regression were used to characterize significant associations between major IPC gaps and LTCF or tele-ICAR type. RESULTS: DSHS conducted tele-ICARs in 438 LTCFs in Texas during 8 months; 191 were nursing homes/skilled nursing facilities (NH/SNFs), 206 were assisted living facilities (ALFs) and 41 were other settings. Of the assessments, 264 were proactive and 174 responsive. Major gaps identified were: (1) 22% did not have a preference for alcohol-based hand sanitizer (ABHS) over soap and water; (2) 18.1% were not aware of the contact time for disinfectants in use; (3) 17.9% had not stopped resident communal dining; (4) 16.8% did not audit hand hygiene and PPE compliance; and (5) 11.8% had not stopped inter-facility group activities and extra-facility field trips. When restricting analyses to proactive tele-ICARs, one additional gap was identified: 11.1% of facilities lacked a dedicated space to care for or cohort residents with confirmed SARS-CoV-2 infection. Significantly more ALFs than NH/SNFs had not suspended resident communal dining (P < .001) nor identified a dedicated space to cohort residents with confirmed SARS-CoV-2 infection (P < .001). Significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR reported a preference for ABHS over soap and water (P = .008) and reported suspending communal dining (P < .001) and group activities (P < .001). Also, significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR had identified a dedicated space to cohort residents with confirmed SARS-CoV-2 (P = .009). CONCLUSIONS: Increased facility education and awareness of federal and state guidelines for group activities and communal dining is warranted in Texas, emphasizing the importance of social distancing for preventing the transmission of SARS-CoV-2 in LTCFs, particularly ALFs. CDC recommendations for ABHS versus hand washing should be emphasized, as well as the importance of monitoring and auditing HCP hand hygiene and PPE compliance. Facilities may benefit from additional education and resources about disinfection, to ensure proper selection of disinfectants and understanding of the contact time required for efficacy. Analysis by tele-ICAR type suggests facilities may benefit from identifying space for dedicated COVID-19 units in advance of an outbreak in their facility. Conducting tele-ICARs in LTCFs enables public health agencies to provide direct and individualized feedback to facilities and identify state-wide opportunities for effective interventions in response to SARS-CoV-2.
Subject(s)
COVID-19 , Disinfectants , Hand Sanitizers , COVID-19/prevention & control , Humans , Infection Control , Iron-Dextran Complex , Long-Term Care , Nursing Homes , Pandemics/prevention & control , SARS-CoV-2 , Skilled Nursing Facilities , Soaps , Texas/epidemiology , WaterABSTRACT
Carbapenem-resistant Pseudomonas aeruginosa (CRPA) producing the Verona integronâencoded metallo-ß-lactamase (VIM) are highly antimicrobial drug-resistant pathogens that are uncommon in the United States. We investigated the source of VIM-CRPA among US medical tourists who underwent bariatric surgery in Tijuana, Mexico. Cases were defined as isolation of VIM-CRPA or CRPA from a patient who had an elective invasive medical procedure in Mexico during January 2018âDecember 2019 and within 45 days before specimen collection. Whole-genome sequencing of isolates was performed. Thirty-eight case-patients were identified in 18 states; 31 were operated on by surgeon 1, most frequently at facility A (27/31 patients). Whole-genome sequencing identified isolates linked to surgeon 1 were closely related and distinct from isolates linked to other surgeons in Tijuana. Facility A closed in March 2019. US patients and providers should acknowledge the risk for colonization or infection after medical tourism with highly drug-resistant pathogens uncommon in the United States.
Subject(s)
Drug Resistance, Multiple, Bacterial , Medical Tourism , Pseudomonas Infections , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins , Carbapenems , Humans , Mexico/epidemiology , Microbial Sensitivity Tests , Pseudomonas Infections/epidemiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics , United States/epidemiology , beta-Lactamases/geneticsABSTRACT
To our knowledge, environmental isolation of Burkholderia pseudomallei, the causative agent of melioidosis, from the continental United States has not been reported. We report a case of melioidosis in a Texas resident. Genomic analysis indicated that the isolate groups with B. pseudomallei isolates from patients in the same region, suggesting possible endemicity to this region.