Antibiotic-resistant gram-negative bacterial infections among persons with or without a prior positive test for SARS-CoV-2 in 10 U.S. sites, 2020

Background. The Centers for Disease Control and Prevention's Emerging Infections Program (EIP) conducts active laboratory- and population-based surveillance for carbapenem-resistant Enterobacterales (CRE), extended spectrum beta-lactamase-producing Enterobacterales (ESBL-E), and carbapenem-resistant Acinetobacter baumannii (CRAB) in 10 U.S. sites. To describe the impact of the COVID-19 pandemic on the epidemiology of these antibiotic-resistant gram-negative bacteria (AR-GNB), we assessed characteristics of AR-GNB patients with and without a prior SARS-CoV-2 positive (SC2+) viral test. Methods. In 2020 among EIP catchment-area residents, an incident CRAB or CRE case was defined as the first isolation of A. baumannii complex, Escherichia coli, Enterobacter cloacae complex, Klebsiella aerogenes, K. oxytoca, K. pneumonia, or K. variicola in a 30-day period resistant to >=1 carbapenem (excluding ertapenem for CRAB) from a normally sterile site or urine. An incident ESBL-E case was defined as the first isolation of E. coli, K. pneumonia, or K. oxytoca in a 30-day period resistant to any third-generation cephalosporin and non-resistant to all carbapenems from a normally sterile site or urine. Patient charts were reviewed. Results. Of 3904 AR-GNB cases with data available, 163 (4%) had a prior SC2+ test (85 ESBL-E, 70 CRE, and 8 CRAB). Median time from the most recent SC2+ test to AR-GNB culture date was 20 days (IQR 1-48 days). AR-GNB cases with a SC2+ test versus those without were more likely to be Black, non-Hispanic than another race/ ethnicity (31% vs 15%;P< 0.0001), aged >=65 years (62% vs 52%;P=0.0139), and to have prior healthcare exposures (63% vs 49%;P=0.0003) and indwelling devices (51% vs 28%;P< 0.0001). They were also more likely to have bacteremia (24% vs 11%;P< 0.0001), pneumonia (6% vs 1%;P< 0.0001) and be hospitalized around the time of their AR-GNB culture (67% vs 36%;P< 0.0001);median time from SC2 + test to hospital admission was 0.5 day (IQR 0-29.5 days). Conclusion. AR-GNB infections preceded by a SC2+ test were rare but more severe and associated with more healthcare risk factors. This underscores the need for continued infection prevention and control practices and monitoring of these infections during the COVID-19 pandemic.

A Family-based Child Health Education Curriculum for Refugee Families

Background: Refugees are at risk for low health literacy and high rates of illness and hospitalization. A partnership between medical professionals at Yale and two New-Haven, CT-based refugee resettlement organizations aimed to create and implement a family-based, interactive pediatric healthcare curriculum with a goal of increasing childhood health knowledge among refugee families. Methods: Seven 1-hour, in-person classes and 1 virtual class were taught by pediatric residents with real-time translation in Pashto, Dari, Arabic, Swahili, and Kinyarwanda on the topics of child nutrition, safety, parenting, and oral health. Each class incorporated play-based activities for toddlers-a My Healthy Plate puzzle, street-crossing simulation, teeth-brushing demonstration, and block play-which were integrated into parental discussion with visual aids. Knowledge acquisition and satisfaction was assessed using pre- and posttests. Results: 67 adult participants had an 85% response rate. Average knowledge test scores increased in 5 of 7 classes, reaching significance in a class on parenting (mean 52% vs 90%, paired t-test p = 0.03) and child safety (mean 80% vs 97%, p = 0.04). 100% of respondents (67% response rate) reported increased understanding of the topic and would recommend the class to a friend. There were 5 participants for the virtual class. Conclusion: Child health education classes conducted for refugee families can improve knowledge of pediatric healthcare topics and provide positive experiences. A close relationship between healthcare providers and community refugee organizations has the potential to improve health education in refugee families. Future studies will assess efficacy and satisfaction of virtual classes during the COVID-19 pandemic.

Cardiopulmonary Exercise Performance in the Pediatric and Young Adult Population Before and During the COVID-19 Pandemic.

Physical activity (PA) decreased and sedentary behavior (SB) increased in the pediatric population during the Coronavirus Disease 2019 (COVID-19) pandemic. We examined the effects of PA and SB on cardiopulmonary exercise performance in children, adolescents and young adults both with and without underling cardiac disease, and hypothesized that there will be a change in aerobic and physical working capacity during the pandemic. This was a single-center retrospective longitudinal cohort study in patients age 6-22 years who underwent serial maximal cardiopulmonary exercise stress testing before and during the COVID-19 pandemic. Metabolic variables were obtained; PA and SB data were extracted from clinic notes. A total of 122 patients (60% male) underwent serial exercise testing with a median age of 14 years at the first CPET. Predicted peak aerobic capacity significantly decreased among both females and males during the pandemic, even after adjusting for changes in somatic growth. There was no significant change in physical working capacity during the pandemic. Patients who were more aerobically fit experienced a greater decrease in aerobic capacity during the pandemic compared to those less fit. In conclusion, cardiopulmonary exercise performance, notably aerobic activity, decreased during the COVID-19 pandemic in children, adolescents and young adults compared to pre-pandemic values. This decline was most notable in those with the highest pre-pandemic aerobic capacity values and was independent of somatic growth or changes in BMI. This study has public health implications and demonstrates the importance of PA on overall cardiovascular health.

A MULTIMODAL MOBILE SLEEP INTERVENTION TO REDUCE DRINKING AND ALCOHOL-RELATED HARM AMONG HEAVY-DRINKING YOUNG ADULTS

Purpose: Young adults report the highest rates of heavy drinking and are a priority population for alcohol prevention and early intervention. Yet, current alcohol interventions for young adults have modest effects, and young adults rarely self-identify for help with their drinking. Thus, other onramps to alcohol preventive services are needed. Young adults are concerned about sleep and health so embedding alcohol-related content within other health programs and connecting alcohol use to health outcomes may be a useful strategy. We conducted a randomized-controlled trial to test 3 sleep intervention components for promoting alcohol and sleep behavior change. Methods & Data: We randomized 120 young adults (18-25 years) who reported recent heavy drinking using a 1:1:2 ratio to 1 of 3, 2-week interventions: (1) 2-module mobile sleep hygiene advice (A;n = 30), (2) advice + sleep/alcohol daily diary self-monitoring (A+SM;n = 30), or (3) advice, selfmonitoring, personalized sleep/alcohol feedback (A+SM+F;n = 60). All wore sleep and alcohol biosensors. At intake, week 4, and week 12, participants completed the Timeline Followback Interview for alcohol use, measures of sleep disturbance, sleep-related impairment, and alcohol-related consequences. Nearly half (44%) completed enrollment and/or follow-up during the COVID-19 pandemic, but results are summarized for the whole sample. Results: The sample included 51% female, 80% white, 16% Hispanic, and 73% students. Over the past 4 weeks at intake, they consumed 86.58 ± 43.21 total drinks (primary outcome) and drank a maximum of 11.82 ± 4.84 drinks. All subjects significantly reduced total number of drinks over time, but there was no significant group effect on this outcome. There were group effects on sleep disturbance [p = 0.05] and sleep-related impairment [p = 0.02], which favored A+SM+F vs. A (d = 0.53 and d = 0.67, respectively). An overall group effect approached significance (p = 0.069) for alcohol related consequences driven by fewer consequences observed in A+SM+F vs. A (d = 0.52). Treatment satisfaction (0-4 scale) (3.53 ± 0.61), treatment completion (98%), and follow-up retention were high (96%) and did not vary by group. Conclusions: Results provide support for the feasibility and acceptability of brief sleep interventions that integrate alcohol content in heavy-drinking young adults. Findings also suggest that personalized feedback about sleep, alcohol use, and their association may be promising for improving sleep and alcohol-related harmin this high-risk group.