ABSTRACT
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.
ABSTRACT
Objective: Despite the rapid growth of virtual health services in response to COVID-19, people affected by traumatic brain injury (TBI) experience symptoms that can undermine their ability to access and benefit from such services. This study assessed the feasibility, usability, and acceptability of LoveYourBrain Mindset, a manualized, 6-week yoga, mindfulness, and psychoeducation program delivered online to people with TBI and caregivers. To enhance accessibility, participants choose between two interactive tracks, either a weekly 75-min gentle yoga class or a 45-min group discussion on Zoom. Participants also receive weekly pre-recorded tools by email (1-min psychoeducational videos, 45-min yoga classes, 10-min meditations, 25-min yoga nidra meditations). Methods: LoveYourBrain Foundation recruited prospective participants from October 2020-March 2021 through clinical, advocacy, and social media outreach. People were eligible if they were a TBI survivor or caregiver, age 15 to 70, able to participate in gentle exercise and/or group discussion, and consented for their data to be used for research. Self-reported survey data were collected electronically in eligibility and feedback forms. We assessed feasibility by describing the number of people enrolled, number of programs successfully offered, and mean attendance;usability by examining use of the tools;and acceptability by analyzing satisfaction measures. Results: A total of 62 programs were offered by LoveYourBraintrained Facilitators during the study period. No programs were canceled from low enrollment. Eight hundred and nine eligible people enrolled, including 733 people with TBI and 76 caregivers. Participants were majority white (n = 654, 80.8%), non- Hispanic (n = 690, 85.3%), female (n = 640, 79.1%), educated (college graduate/equivalent or higher) (n = 657, 81.2%), and had a median age of 43 years (range 18-80 years). TBI severity ranged from mild (n = 272, 38.1%), moderate (n = 247, 34.6%), to severe (n = 195, 27.3%). Participants were located mostly in 47 states in the US (n = 601, 74.1%) or 8 Canadian provinces (n = 192, 23.7%). A majority (n = 584, 72.2%) attended ≥1 interactive classes, while 26.8% were 'no-shows' (n = 217) and 1.0% withdrew (n = 8). Mean attendance in the interactive classes was 7 (SD 1) people per program. Most participants (n = 263, 74.0%) completed some tools in 5 or all 6 weeks of their program, most often the videos (n = 256, 72.1%), meditations (n = 142, 40.0%), yoga classes (n = 133, 37.5%), and yoga nidras (n = 105, 29.6%). Participants reported high satisfaction (M = 9.1 out of 10, SD 1.4) and a majority (n = 308, 86.7%) would 'Definitely, yes' recommend it to a friend or family. Conclusion: High attendance, engagement, and satisfaction with LoveYourBrain Mindset suggests that online delivery of yoga, mindfulness, and psychoeducation is feasible and acceptable for people with TBI and caregivers. The program's scalability has implications on expanding access to holistic health services for this marginalized community, yet greater efforts are needed to reach minority groups with disproportionately worse access to care, particularly Black, Indigenous and People of Color.
ABSTRACT
Background. Long-term care facilities (LTCFs) are at high risk for severe COVID-19 outbreaks due to their congregate nature and vulnerable population. Oregon Health Authority (OHA) deployed point-of-care antigen (Ag) tests to promptly identify COVID-19 cases in LTCFs. However, their performance in identifying vaccine breakthrough cases has not been evaluated. Methods. During 2/25/21-5/25/21, OHA supported testing of residents and staff for two outbreaks at a single LTCF. Paired nasal swabs were collected and tested for SARS-CoV-2 by CDC Influenza SARS-CoV-2 Multiplex PCR Assay (molecular test) and Abbott BinaxNOW COVID-19 Ag Card (Ag test) twice weekly during the outbreaks. Participants were considered fully vaccinated if ≥ 14 days had passed since completion of a vaccine series;all others were deemed unvaccinated. A vaccine breakthrough case was defined as a positive Ag or molecular test from a fully vaccinated person's specimen. Performance characteristics of the Ag test were assessed, with molecular test as the reference standard. Cycle threshold (Ct) values were compared by one-sided independent t-tests. Results. 94 unvaccinated residents and staff provided 563 paired samples;SARSCoV-2 was detected in 21 (12 by Ag and molecular test, 6 by molecular test only, 3 by Ag test only), yielding Ag test sensitivity of 66.7% (95% CI: 43.8-83.7%) and specificity of 99.4% (95% CI: 98.4-99.8%). Mean Ct values were higher for specimens positive by PCR but negative by Ag than those positive by both (30.0 vs. 20.7, P < .01). 81 vaccinated persons provided 925 paired samples;SARS-CoV-2 was detected in 5 (1 by Ag and molecular test, 4 by molecular test only), yielding Ag test sensitivity of 20% (95% CI: 3.6-62.5%) and specificity of 100% (95% CI: 99.6-100%). Mean Ct values for specimens from vaccinated cases were higher than those from unvaccinated cases (30.2 vs. 23.8, P < .05). The lone Ag-positive breakthrough case had a Ct of 20;all others had Ct > 29. Conclusion. Ag test performance and reduced sensitivity on specimens with high Ct values found in this population are consistent with published data. Molecular testing maximizes identification of vaccine breakthrough cases. More studies are needed to estimate the proportion of breakthrough cases missed by Ag testing and their risk of transmitting the virus in LTCFs.