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1.
JAMA Netw Open ; 4(2): e210202, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1858185

ABSTRACT

Importance: Owing to concerns of coronavirus disease 2019 (COVID-19) outbreaks, many congregant settings are forced to close when cases are detected because there are few data on the risk of different markers of transmission within groups. Objective: To determine whether symptoms and laboratory results on the first day of COVID-19 diagnosis are associated with development of a case cluster in a congregant setting. Design, Setting, and Participants: This cohort study of trainees with COVID-19 from May 11 through August 24, 2020, was conducted at Joint Base San Antonio-Lackland, the primary site of entry for enlistment in the US Air Force. Symptoms and duration, known contacts, and cycle threshold for trainees diagnosed by reverse transcription-polymerase chain reaction were collected. A cycle threshold value represents the number of nucleic acid amplification cycles that occur before a specimen containing the target material generates a signal greater than the predetermined threshold that defines positivity. Cohorts with 5 or more individuals with COVID-19 infection were defined as clusters. Participants included 10 613 trainees divided into 263 parallel cohorts of 30 to 50 people arriving weekly for 7 weeks of training. Exposures: All trainees were quarantined for 14 days on arrival. Testing was performed on arrival, on day 14, and anytime during training when indicated. Protective measures included universal masking, physical distancing, and rapid isolation of trainees with COVID-19. Main Outcomes and Measures: Association between days of symptoms, specific symptoms, number of symptoms, or cycle threshold values of individuals diagnosed with COVID-19 via reverse transcription-polymerase chain reaction and subsequent transmission within cohorts. Results: In this cohort study of 10 613 US Air Force basic trainees in 263 cohorts, 403 trainees (3%) received a diagnosis of COVID-19 in 129 cohorts (49%). Among trainees with COVID-19 infection, 318 (79%) were men, and the median (interquartile range [IQR]) age was 20 (19-23) years; 204 (51%) were symptomatic, and 199 (49%) were asymptomatic. Median (IQR) cycle threshold values were lower in symptomatic trainees compared with asymptomatic trainees (21.2 [18.4-27.60] vs 34.8 [29.3-37.4]; P < .001). Cohorts with clusters of individuals with COVID-19 infection were predominantly men (204 cohorts [89%] vs 114 cohorts [64%]; P < .001), had more symptomatic trainees (146 cohorts [64%] vs 53 cohorts [30%]; P < .001), and had more median (IQR) symptoms per patient (3 [2-5] vs 1 [1-2]; P < .001) compared with cohorts without clusters. Within cohorts, subsequent development of clusters of 5 or more individuals with COVID-19 infection compared with those that did not develop clusters was associated with cohorts that had more symptomatic trainees (31 of 58 trainees [53%] vs 43 of 151 trainees [28%]; P = .001) and lower median (IQR) cycle threshold values (22.3 [18.4-27.3] vs 35.3 [26.5-37.8]; P < .001). Conclusions and Relevance: In this cohort study of US Air Force trainees living in a congregant setting during the COVID-19 pandemic, higher numbers of symptoms and lower cycle threshold values were associated with subsequent development of clusters of individuals with COVID-19 infection. These values may be useful if validated in future studies.


Subject(s)
COVID-19 Nucleic Acid Testing/methods , COVID-19/transmission , Military Personnel/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , Carrier State/diagnosis , Carrier State/epidemiology , Carrier State/transmission , Cohort Studies , Cough/physiopathology , Female , Headache/physiopathology , Humans , Male , Myalgia/physiopathology , Pharyngitis/physiopathology , Residence Characteristics , Risk Factors , SARS-CoV-2 , Severity of Illness Index , United States/epidemiology , Young Adult
3.
Open forum infectious diseases ; 8(Suppl 1):S157-S157, 2021.
Article in English | EuropePMC | ID: covidwho-1564484

ABSTRACT

Background Critically ill patients receiving extracorporeal membrane oxygenation (ECMO) are at elevated risk for nosocomial infection. Physiological responses to infection on ECMO are difficult to interpret as many clinical characteristics are controlled by the circuit including temperature. This study aimed to determine the culture positivity rates in patients receiving ECMO with influenza or COVID-19. Methods A single center retrospective study was performed on all patients who received ECMO support at a single institution between December 2014 and December 2020 with influenza or COVID-19. All cultures ordered were reviewed for indication. Patients with fever without specific clinical syndrome or signs of decompensation, such as increasing vasopressor requirement were included. Infections and contaminants were defined by treatment team. Results A total of 45 patients received ECMO with an admission diagnosis of influenza or COVID-19 during the study period. This cohort had a median age of 44 (interquartile range (IQR): 36-53) and was predominantly male (84%). The median time on ECMO was 360 hours (IQR: 183-666). 43/137 (31%) of infectious workups were ordered for isolated fever. The most common workup ordered for fever was combination blood cultures (BC) and urine cultures (UC) (13, 30%), followed by combination BC, UC, and respiratory cultures (RC) (11, 26%). Four (9%) infections were identified (3 blood stream, 1 respiratory) and five (12%) cultures grew contaminants (1 blood, 1 respiratory, 2 urine). Culture positivity rate was greatest for BC (3/35, 9%) followed by RC (1/19, 5%), and lowest for UC (0/26, 0%). Conclusion Although cultures are commonly ordered for isolated fever in patients with influenza and COVID-19 receiving ECMO, culture positivity rate is low. In particular, no urinary tract infections were identified and the screening for urinary tract infection in patients receiving ECMO with isolated fever is not beneficial. Further work identifying signs and symptoms associated with infection is needed to improve diagnostic stewardship in this population that is high risk for nosocomial infections. Disclosures All Authors: No reported disclosures

4.
Open forum infectious diseases ; 8(Suppl 1):218-218, 2021.
Article in English | EuropePMC | ID: covidwho-1563197

ABSTRACT

Background Background: Extracorporeal membrane oxygenation (ECMO) is a growing modality of life support that is subject to a high rate of nosocomial infections. There is a paucity of data to guide treatment for infections on ECMO, which can lead to vastly different practice patterns at different centers. This case series describes the outcomes of patients with Enterococcus bacteremia at a single center. Methods A retrospective chart review was performed on all patients who received ECMO support at a tertiary academic medical center with ECMO capabilities between October 2012 and May 2020 with positive blood cultures for Enterococcus species. Results A total of 10 patients had Enterococcus bacteremia during the study period with E. faecalis (n=7, 70%) more commonly than E. faecium (n=3, 30%). Infections occurred more often in men (n=6, 60%) than women (n=4, 40%) with median age 36 (IQR: 31-42). Infections occured late in the hospitalization (median: 33 days (IQR: 26-59)) and after several weeks on the ECMO circuit (median: 24 days (22-52)). Infections were often polymicrobial (n=5, 50%). There were no cases of infective endocarditis. Infections were treated with 7-14 days of therapy with ampicillin being the most common antibiotic prescribed (n=5, 50%). Four (40%) patients were decannulated before completion of therapy. No patients had cannulas removed due to bacteremia. There were no cases of recurrence. Mortality was 20% in this cohort. Clinical Characteristics of Patients with Enterococcus Bacteremia Conclusion Enterococcus is a common cause of blood stream infections in patients with prolonged courses on ECMO circuit. In this cohort of patients, Enterococcus did not cause any metastatic infections and was generally treated with 7-14 days of antibiotics without recurrence, despite many patients remaining on ECMO for extended periods after clearance. As ECMO use continues to expand, there will need to be more data on treatment outcomes of infections to establish best practices. Disclosures All Authors: No reported disclosures

6.
Mil Med ; 186(9-10): 984-987, 2021 08 28.
Article in English | MEDLINE | ID: covidwho-1276195

ABSTRACT

INTRODUCTION: Basic Military Training at Joint Base San Antonio-Lackland implemented several sequential non-pharmaceutical interventions in response to coronavirus disease-2019 (COVID-19). One measure, arrival quarantine, has not been studied as a modern military disease prevention strategy. This study aimed to determine the effect of a 14-day arrival quarantine on symptomatic COVID-19 testing. MATERIAL AND METHODS: A retrospective cohort study compared symptomatic COVID-19 testing among all trainees who entered Basic Military Training between March 17, 2020, and April 17, 2020, before the implementation of universal arrival COVID-19 testing, during their first 2 weeks in arrival quarantine compared to the rest of their training. Furthermore, symptomatic COVID-19 testing in the last 5 weeks of training in those who completed arrival quarantine was compared to testing in the last 5 weeks for trainees who arrived between February 16, 2020, and March 16, 2020, and did not undergo arrival quarantine. Nominal variables were compared by chi-square test, and continuous variables were compared by Mann-Whitney U test. This study was approved as a public health surveillance project by the 59th Medical Wing Institutional Review Board. RESULTS: Five thousand five hundred and seventy-six trainees started training between February 16, 2020, and April 17, 2020, with 2,573 trainees undergoing an arrival quarantine compared to 3,003 trainees who did not. Trainees who underwent arrival quarantine had higher rates of COVID-19 testing while in arrival quarantine (10.5 tests per 1,000 trainee-weeks vs. 2.3, P ≤ .001) and higher rates of concomitant influenza testing (74% vs. 38%, P = .001) compared to after they completed quarantine. Trainees that completed quarantine had less symptomatic COVID-19 testing after day 14 of training (2.3 tests per 1,000 trainee-weeks vs. 14.3, P ≤ .001) and influenza testing (38% vs. 74%, P = .001) compared to trainees that did not undergo arrival quarantine. CONCLUSION: Arrival quarantine appears to be an effective non-pharmaceutical intervention associated with fewer symptomatic COVID-19 tests, especially after completion of quarantine.


Subject(s)
COVID-19 , Military Personnel , COVID-19 Testing , Cohort Studies , Humans , Quarantine , Retrospective Studies , SARS-CoV-2
8.
MMWR Morb Mortal Wkly Rep ; 69(22): 685-688, 2020 Jun 05.
Article in English | MEDLINE | ID: covidwho-526226

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has resulted in substantial morbidity and mortality since it was first described in December 2019 (1). Based on epidemiologic data showing spread in congregate settings (2-4), national, state, and local governments instituted significant restrictions on large gatherings to prevent transmission of disease in early March 2020. This and other nonpharmaceutical interventions (NPIs) have shown initial success in slowing the pandemic across the country (5). This report examines the first 7 weeks (March 1-April 18) of implementation of NPIs in Basic Military Training (BMT) at a U.S. Air Force base. In a population of 10,579 trainees, COVID-19 incidence was limited to five cases (47 per 100,000 persons), three of which were in persons who were contacts of the first patient. Transmission of symptomatic COVID-19 was successfully limited using strategies of quarantine, social distancing, early screening of trainees, rapid isolation of persons with suspected cases, and monitored reentry into training for trainees with positive test results after resolution of symptoms.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Military Personnel/education , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Humans , Male , Patient Isolation , Pneumonia, Viral/transmission , Texas/epidemiology
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