ABSTRACT
Background. Corynebacterium striatum (CS), a common human commensal colonizing the skin and nasopharynx, has been associated with nosocomial infections in immunocompromised and chronically ill patients. During the winter 2020-2021 COVID-19 surge, a 420-bed California hospital reported a marked increase in CS respiratory cultures among ventilated COVID-19 patients. We conducted a public health investigation to assess and mitigate nosocomial transmission and contributing infection prevention and control (IPC) practices. Methods. A case was defined as a patient with CS in respiratory cultures from January 1, 2020 - February 28, 2021. We reviewed clinical characteristics on a subset of cases in 2021 and IPC practices in affected hospital locations. CS respiratory isolates collected on different dates and locations were assessed for relatedness by whole genome sequencing (WGS) on MiSeq. Results. Eighty-three cases were identified, including 75 among COVID-19 patients (Figure 1). Among 62 patients identified in 2021, all were ventilated;58 also had COVID-19, including 4 cases identified on point prevalence survey (PPS). The median time from admission to CS culture was 19 days (range, 0-60). Patients were critically ill;often it was unclear whether CS cultures represented colonization or infection. During the COVID-19 surge, two hospital wings (7W and 7S) were converted to negative-pressure COVID-19 units. Staff donned and doffed personal protective equipment in anterooms outside the units;extended use of gowns was practiced, and lapses in glove changes and hand hygiene (HH) between patients likely occurred. In response to the CS outbreak, patients were placed in Contact precautions and cohorted. Staff were re-educated on IPC for COVID-19 patients. Gowns were changed between CS patients. Subsequent PPS were negative. Two CS clusters were identified by WGS: cluster 1 (5 cases) in unit 7W, and cluster 2 (2 cases) in unit 7S (Figure 2). Conclusion. A surge in patients, extended use of gowns and lapses in core IPC practices including HH and environmental cleaning and disinfection during the winter 2020-2021 COVID-19 surge likely contributed to this CS outbreak. WGS provides supportive evidence for nosocomial CS transmission among critically ill COVID-19 patients.
ABSTRACT
Background: Larger studies are needed to evaluate whether COVID-19 increases the risk of DKA presentation. Methods: We examined individual and joint associations of COVID-19 and preexisting diabetes (DM) with DKA presentation in a retrospective cohort of patients who presented to Montefiore Medical Center in the Bronx, NY from March to June 2020. We defined DKA as acidosis (pH <7.3 or anion gap ≥ 12), ketosis (positive serum or urinary ketones), and glucose >250 mg/dl. We defined COVID-19 status by PCR test result and preexisting DM by HbA1c ≥6.5%, ICD-10 code, or outpatient DM medications. Given likely bias in hospital presentation during the pandemic, a historical control from March to June 2019 was included in the COVID negative group. Data were analyzed using multivariate regression. Results: We included 46,479 patients: mean age 43 yrs, 56% male, 57% with DM of which 94% type 2 DM. COVID-19 alone was not associated with higher odds of DKA presentation, though as expected preexisting DM was. Adjusted regression analyses for interaction showed 64% higher odds of DKA for patients with both COVID-19 and preexisting DM than the additive effect of each condition alone (Table 1). Conclusions: COVID-19 has a multiplicative effect on the risk of hospital presentation of DKA in people with preexisting DM. Mechanistic studies examining DKA in COVID-19 in people with preexisting DM may help identify preventive targets.