Association between self-reported signs and symptoms and SARS-CoV-2 antibody detection in UK key workers.

BACKGROUND: Screening for SARS-CoV-2 antibodies is under way in some key worker groups; how this adds to self-reported COVID-19 illness is unclear. In this study, we investigate the association between self-reported belief of COVID-19 illness and seropositivity. METHODS: Cross-sectional study of three key worker streams comprising (A) Police and Fire & Rescue (2 sites) (B) healthcare workers (1 site) and (C) healthcare workers with previously positive PCR result (5 sites). We collected self-reported signs and symptoms of COVID-19 and compared this with serology results from two SARS-CoV-2 immunoassays (Roche Elecsys® and EUROIMMUN). RESULTS: Between 01 and 26 June, we recruited 2847 individuals (Stream A: 1,247, Stream B: 1,546 and Stream C: 154). Amongst those without previous positive PCR tests, 687/2,579 (26%) reported belief they had COVID-19, having experienced compatible symptoms; however, only 208 (30.3%) of these were seropositive on both immunoassays. Both immunoassays had high sensitivities relative to previous PCR positivity (>93%); there was also limited decline in antibody titres up to 110 days post symptom onset. Symptomatic but seronegative individuals had differing symptom profiles and shorter illnesses than seropositive individuals. CONCLUSION: Non-COVID-19 respiratory illness may have been mistaken for COVID-19 during the outbreak; laboratory testing is more specific than self-reported key worker beliefs in ascertaining past COVID-19 disease.

Molecular epidemiology and antimicrobial resistance pattern of extended-spectrum-ß-lactamase-producing Enterobacteriaceae in Glasgow, Scotland.

OBJECTIVES: To establish the molecular epidemiology and antimicrobial resistance pattern of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae harbouring bla(CTX-M) in Glasgow, Scotland. METHODS: During a 12 week period, Enterobacteriaceae isolates obtained from urine samples were collected and susceptibility testing performed. Isolates were screened for the presence of bla(CTX-M) by multiplex PCR and selected Escherichia coli genes were subsequently sequenced. PFGE analysis was performed on selected E. coli isolates in order to identify clonal relationships. RESULTS: There were 155 phenotypically confirmed non-duplicate Enterobacteriaceae isolates obtained from urine samples. bla(CTX-M) was identified in 131/155 (84.5%) of the ESBL-producing isolates, with CTX-M group 1 enzymes accounting for 103/131 (78.6%) of these. The remaining 24 isolates carried other bla(CTX-M) types, including CTX-M group 2, CTX-M group 9 and an unidentifiable combination designated CTX-M group G2/Gx. A sample of 46/97 (47.4%) CTX-M-positive E. coli isolates was chosen for PFGE and demographic information regarding the source of the isolates was collated. Eight E. coli clusters were identified by PFGE; however, they did not achieve the 85% cut-off to demonstrate clonality. Nitrofurantoin resistance was significantly greater in the E. coli isolates expressing a non-CTX-M group 1 ESBL when compared with the E. coli isolates expressing a CTX-M group 1 ESBL. CONCLUSIONS: As seen in other British studies, bla(CTX-M) has become the predominant ESBL type in Glasgow, Scotland. The PFGE results show that four different CTX-M groups appear to be circulating in the community and within all four hospitals in the locality. There is little correlation between strain genotype and CTX-M group, thus it is unlikely that cross-infection alone is the driver. It is possible that plasmid migration of CTX-M genes within the E. coli population is occurring.

Strategies for managing imaging utilization.

Imaging represents a substantial and growing portion of the costs of American health care. When performed correctly and for the right reasons, medical imaging facilitates quality medical care that brings value to both patients and payers. When used incorrectly because of inappropriate economic incentives, unnecessary patient demands, or provider concerns for medical-legal risk, imaging costs can increase without increasing diagnostic yields. A number of methods have been tried to manage imaging utilization and achieve the best medical outcomes for patients without incurring unnecessary costs. The best method should combine a prospective approach; be transparent, evidence based, and unobtrusive to the doctor-patient relationship and provide for education and continuous quality improvement. Combining the proper utilization of imaging and its inherent cost reduction, with improved quality through credentialing and accreditation, achieves the highest value and simultaneous best outcomes for patients.