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Point of Care Molecular Testing: Current State and Opportunities for Diagnostic Stewardship

Otto, Caitlin; Chen, Dan
Inappropriate ordering practices, either under or over ordering of diagnostic tests, are recognized problems with possible negative downstream consequences. As the menu of clinical tests, especially molecular tests grows, it is becoming increasingly important to provide guidance to providers on the appropriate utilization. Diagnostic stewardship programs have been established at many institutions to help direct the appropriate utilization of laboratory testing to ultimately guide patient management and treatment decisions. Many molecular tests have now received Clinical Laboratory Improvement Amendments (CLIA)-waived status for use in a point-of-care (POC) setting; however, parallel diagnostic stewardship programs have not been established to help guide providers on how best to use these tests. In this article, we will discuss the available molecular POC tests and opportunities and challenges for establishing diagnostic stewardship programs for molecular testing performed in the POC setting.
PMID: 38280795
ISSN: 1557-9832
CID: 5627712

Epidemiology and Outcomes of Non-albicans Candida Bloodstream Infections in Transplant Recipients and Cancer Patients

Otto, Caitlin; Babady, N Esther
We performed a retrospective survey of non-Candida albicans candidemia in patients with cancer, including those with solid tumors and those with hematological malignancies as well as transplants patients both, solid-organ transplant recipients and hematopoietic stem cell transplant recipients. The study was performed at two healthcare centers in New York City and covered the years 2018-2022. A total of 292 patients (318 isolates) were included in the study. In order of frequency, C. glabrata (38%) was the most common species recovered, followed by C. parapsilosis (19.2%), C. tropicalis (12.6%), C. krusei (10.7%), C. lusitaniae (5.7%), and C. guilliermondii (4.4%). Micafungin was the most common antifungal treatment and 18.5% of patients were on antifungal prophylaxis. The 30-day crude mortality was 40%. 4.5% of patients had more than one non-albicans species detected. In conclusion, this study represents one of the largest surveys of non-albicans species in cancer and transplant patients and provides data on the current epidemiology of these Candida species in this patient population.
PMID: 37365379
ISSN: 1573-0832
CID: 5540162

Point of Care Molecular Testing: Current State and Opportunities for Diagnostic Stewardship

Otto, Caitlin; Chen, Dan
SCOPUS:85177068599
ISSN: 0272-2712
CID: 5615502

Longitudinal Viral Load Monitoring Using Home-Collected Dried Blood Spot Specimens of MSM Living with HIV: Results from a Feasibility Pilot Study

Teran, Richard A; Sobieszczyk, Magdalena E; Chiasson, Mary Ann; Uhlemann, Anne-Catrin; Weidler, Jessica; Shah, Jayesh G; Chang, Jennifer Y; Otto, Caitlin; Hirshfield, Sabina
Novel viral load monitoring strategies are needed to help individuals maintain an undetectable viral load (UVL). In 2018, U.S. MSM living with HIV with a past detectable VL received a dried blood spot (DBS) kit at baseline and 3-month follow-up and returned specimens to a research laboratory. Of 56 consenting participants, 91% returned specimens at baseline and 77% at 3-month follow-up; 74% who returned two specimens had UVL at both time points. At-home DBS collection and longitudinal VL monitoring is feasible among U.S. MSM with fluctuating viral load. This complementary approach to clinical care could improve viral suppression maintenance.
PMCID:7480630
PMID: 32909080
ISSN: 1573-3254
CID: 5191462

Head and neck infections in children due to Eikenella corrodens: Report of three cases and review of literature [Case Report]

Penton, Manuel; Oraa, Silvia Schibeci; Abdelhemid, Ashraf; Otto, Caitlin; Hammerschlag, Margaret R
INTRODUCTION/BACKGROUND:Eikenella corrodens is a small, nonmotile Gram-negative rod that is part of the normal flora in the mouth, upper respiratory, gastrointestinal, and genitourinary tracts. It is classically found in human bite (fist to mouth) infections but is also seen in respiratory tract and head and neck infections. METHODS:We describe three cases of E. corrodens causing head and neck infections in children seen in our institution between 2013 and 2019. We also reviewed the available literature on pediatric head and neck infections caused by E. corrodens. RESULTS:All 3 children recovered and fit the trends identified in the 58 patients published in the literature from 1976 to 2019. CONCLUSIONS:E. corrodens is responsible for a range of head and neck infections in pediatric patients. It is a not infrequent cause of head and neck infections in children and should be considered when selecting presumptive antibiotic therapy.
PMID: 32805496
ISSN: 1872-8464
CID: 5191452

Outsourcing Microbiology Services in Medical Centers: Is It Worth It?

Penton, Manuel E; Otto, Caitlin; Hammerschlag, Margaret R
BACKGROUND:Outsourcing of microbiology laboratory services is a growing trend in US medical centers. Data on the actual impact of outsourcing on patient care, safety, and medical education, including costs, are limited. The objective of this study was to examine the published literature on the potential benefits and harms when medical centers outsource common microbiology services. METHODS:We conducted a 16-step literature search of PubMed and Embase. Articles were selected for full-text review if their content matched our key questions: (1) What are the potential benefits of outsourcing core microbiology laboratory testing? (2) What are the potential harms to patient care and medical education when medical centers outsource essential microbiology services? RESULTS:The initial search yielded 6111 unique published articles; 36 were selected for full-text review, which resulted in the identification of 8 articles that addressed our key questions (2 editorials, 3 editorials with observational data, 1 survey, 1 case series, and 1 study of blood culture transport). These articles described a variety of issues, including longer turnaround times for blood cultures that resulted in delays in diagnosis and treatment, errors that resulted in patient morbidity, limited cost savings, and communication barriers. CONCLUSIONS:In this study, with the exception of the blood culture transport study, we found no published prospective studies that quantified the effects of outsourcing microbiology services on patient care, patient safety, or medical education. However, these largely anecdotal reports suggest that outsourcing microbiology services may have a detrimental impact on medical education, especially infectious disease training programs.
PMID: 30989191
ISSN: 2048-7207
CID: 5191432

Architect i2000 SR has improved turnaround time for infectious disease serology testing over Vitros ECiQ

Cheng, Cindy; Hauser, Jocelyn R; Otto, Caitlin; Tang, Yi-Wei
BACKGROUND:Vitros ECiQ and Architect i2000 SR are two automated instruments used to detect serology biomarkers of hepatitis A, B and C viruses, and HIV infections. We compared performance of the Architect to the Vitro EciQ after implementation at our institution. METHODS:A retrospective review was performed to compare patient samples tested on the Vitros ECiQ or Architect for hepatitis and HIV serological assays. The positivity rate, frequency of equivocal results, turnaround times (TAT), and hands-on time (HOT) were analyzed. RESULTS:There was no statistical difference in the positivity rate between the two instruments, with the exception of two assays. An increase in equivocal results was observed for the Architect (0.2% vs 0.5%). Notably, the TAT for the Architect i2000 was shorter for all except one assay (31.6 vs 33.7 hours) and demonstrated improved workflow. CONCLUSIONS:Overall, both instruments performed comparably. Architect had shorter TAT over Vitros.
PMID: 32340767
ISSN: 1879-0070
CID: 5191442

Achromobacter endocarditis in native cardiac valves - an autopsy case report and review of the literature [Case Report]

Xia, Rong; Otto, Caitlin; Zeng, Jianying; Momeni-Boroujeni, Amir; Kagan, Joshua; Meleney, Katharine; Libien, Jenny
PMID: 29906520
ISSN: 1879-1336
CID: 5191422

Rapid Molecular Detection and Differentiation of Influenza Viruses A and B

Otto, Caitlin C; Kaplan, Samuel E; Stiles, Jeffrey; Mikhlina, Albina; Lee, Cindy; Babady, N Esther; Tang, Yi-Wei
Influenza is a contagious respiratory illness caused by influenza viruses A and B in humans and causes a significant amount of morbidity and mortality every year. The Influenza A and B assay was the first CLIA-waived molecular rapid flu test available. The Influenza A and B test works by employing isothermal amplification with influenza-specific primers followed by target detection with molecular beacon probes. Here, the performance of the Influenza A and B assay on frozen, archived nasopharyngeal swab (NPS) specimens stored in viral transport medium (VTM) were compared to a respiratory panel assay. The performance of the Influenza A and B assay was evaluated by comparing the results to the respiratory panel reference method. The sensitivity for total influenza virus A was 67.5% (95% CI (CI), 56.6-78.5) and the specificity was 86.9% (CI, 71.0-100). For influenza virus B testing, the sensitivity and specificity were 90.2% (CI, 68.5-100) and 98.8% (CI, 68.5-100), respectively. This system has the advantage of a significantly shorter test time than any other currently available molecular assay and the simple, pipette-free procedure runs on a fully integrated, closed, small-footprint system. Overall, the Influenza A and B assay evaluated in this study has the potential to serve as a point-of-care rapid influenza diagnostic test.
PMCID:5352307
PMID: 28190065
ISSN: 1940-087x
CID: 5191412

Natural and ion-exchanged illite clays reduce bacterial burden and inflammation in cutaneous meticillin-resistant Staphylococcus aureus infections in mice

Otto, Caitlin C; Kilbourne, Jacquelyn; Haydel, Shelley E
Discoveries associated with antibacterial activity of hydrated clays necessitate assessments of in vivo efficacy, practical use and safety. Surface properties of clays can lead to variations in the composition and abundance of bound compounds or ions, thus affecting antibacterial activity. Since exchangeable metal ions released from the clay surface are responsible for in vitro antibacterial activity, we evaluated the in vivo antibacterial efficacy of four natural clays (one illite clay, two montmorillonite clays and one kaolinite clay) and three ion-exchanged, antibacterial clays against superficial, cutaneous meticillin-resistant Staphylococcus aureus (MRSA) infections in mice. Superficial, cutaneous wounds on the back of SKH1-Elite mice were generated and subsequently infected with MRSA. Following twice daily applications of a hydrated clay poultice to infected wounds for 7  days, we observed significant differences in the in vivo antibacterial efficacy between different types of clays. The natural and ion-exchanged illite clays performed best, as measured by bacterial load, inflammatory response and gross wound morphology with significant decreases in bacterial viability and dermatitis. Topical application of kaolinite clay was the least effective, resulting in the lowest decrease in bacterial load and exhibiting severe dermatitis. These data suggest that specific types of clays may offer a complementary and integrative strategy for topically treating MRSA and other cutaneous infections. However, since natural clays exhibit in vitro antibacterial variability and vary vastly in surface chemistries, adsorptive/absorptive characteristics and structural composition, the properties and characteristics of illite clays could aid in the development of standardized and customized aluminosilicates for topical infections.
PMCID:4756756
PMID: 26508716
ISSN: 1473-5644
CID: 5191402