Publications by authors named "Priya Sampathkumar"

71 Publications

Lessons From India's Second Wave: Real World Effectiveness of Health Care Worker Vaccination.

Mayo Clin Proc 2021 09;96(9):2301-2302

Division of Infectious Diseases, Mayo Clinic, Rochester, MN. Electronic address:

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http://dx.doi.org/10.1016/j.mayocp.2021.07.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408746PMC
September 2021

Diffuse C4d staining of peritubular capillaries in renal allograft following bamlanivimab therapy.

Am J Transplant 2021 Aug 6. Epub 2021 Aug 6.

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.

Neutralizing monoclonal antibodies such as bamlanivimab emerged as promising agents in treating kidney transplant recipients with COVID-19. However, the impact of bamlanivimab on kidney allograft histology remains unknown. We report a case of a kidney transplant recipient who received bamlanivimab for COVID-19 with subsequent histologic findings of diffuse peritubular capillary C4d staining. A 33-year-old man with end-stage kidney disease secondary to hypertension who received an ABO compatible kidney from a living donor, presented for his 4-month protocol visit. He was diagnosed with COVID-19 44 days prior to his visit and had received bamlanivimab with an uneventful recovery. His 4-month surveillance biopsy showed diffuse C4d staining of the peritubular capillaries without other features of antibody-mediated rejection (ABMR). Donor-specific antibodies were negative on repeat evaluations. ABMR gene expression panel was negative. His creatinine was stable at 1.3 mg/dl, without albuminuria. Given the temporal relationship between bamlanivimab and our observations of diffuse C4d staining of the peritubular capillaries, we hypothesize that bamlanivimab might bind to angiotensin-converting enzyme 2, resulting in classical complement pathway and C4d deposition. We elected to closely monitor kidney function which has been stable at 6 months after the biopsy. In conclusion, diffuse C4d may present following bamlanivimab administration without any evidence of ABMR.
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http://dx.doi.org/10.1111/ajt.16783DOI Listing
August 2021

Quantifying the Importance of COVID-19 Vaccination to Our Future Outlook.

Mayo Clin Proc 2021 07 27;96(7):1890-1895. Epub 2021 Apr 27.

Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.

Predictive models have played a critical role in local, national, and international response to the COVID-19 pandemic. In the United States, health care systems and governmental agencies have relied on several models, such as the Institute for Health Metrics and Evaluation, Youyang Gu (YYG), Massachusetts Institute of Technology, and Centers for Disease Control and Prevention ensemble, to predict short- and long-term trends in disease activity. The Mayo Clinic Bayesian SIR model, recently made publicly available, has informed Mayo Clinic practice leadership at all sites across the United States and has been shared with Minnesota governmental leadership to help inform critical decisions during the past year. One key to the accuracy of the Mayo Clinic model is its ability to adapt to the constantly changing dynamics of the pandemic and uncertainties of human behavior, such as changes in the rate of contact among the population over time and by geographic location and now new virus variants. The Mayo Clinic model can also be used to forecast COVID-19 trends in different hypothetical worlds in which no vaccine is available, vaccinations are no longer being accepted from this point forward, and 75% of the population is already vaccinated. Surveys indicate that half of American adults are hesitant to receive a COVID-19 vaccine, and lack of understanding of the benefits of vaccination is an important barrier to use. The focus of this paper is to illustrate the stark contrast between these 3 scenarios and to demonstrate, mathematically, the benefit of high vaccine uptake on the future course of the pandemic.
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http://dx.doi.org/10.1016/j.mayocp.2021.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075811PMC
July 2021

Prevalence of SARS-CoV-2 Antibodies in a Multistate Academic Medical Center.

Mayo Clin Proc 2021 05 26;96(5):1165-1174. Epub 2021 Mar 26.

Mayo Clinic, Phoenix, AZ.

Objective: To estimate the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in health care personnel.

Methods: The Mayo Clinic Serology Screening Program was created to provide a voluntary, two-stage testing program for SARS-CoV-2 antibodies to health care personnel. The first stage used a dried blood spot screening test initiated on June 15, 2020. Those participants identified as reactive were advised to have confirmatory testing via a venipuncture. Venipuncture results through August 8, 2020, were considered. Consent and authorization for testing was required to participate in the screening program. This report, which was conducted under an institutional review board-approved protocol, only includes employees who have further authorized their records for use in research.

Results: A total of 81,113 health care personnel were eligible for the program, and of these 29,606 participated in the screening program. A total of 4284 (14.5%) of the dried blood spot test results were "reactive" and warranted confirmatory testing. Confirmatory testing was completed on 4094 (95.6%) of the screen reactive with an overall seroprevalence rate of 0.60% (95% CI, 0.52% to 0.69%). Significant variation in seroprevalence was observed by region of the country and age group.

Conclusion: The seroprevalence for SARS-CoV-2 antibodies through August 8, 2020, was found to be lower than previously reported in other health care organizations. There was an observation that seroprevalence may be associated with community disease burden.
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http://dx.doi.org/10.1016/j.mayocp.2021.03.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7997730PMC
May 2021

Providing safe care for patients in the coronavirus disease 2019 (COVID-19) era: A case series evaluating risk for hospital-associated COVID-19.

Infect Control Hosp Epidemiol 2021 Apr 5:1-7. Epub 2021 Apr 5.

Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.

Objective: We evaluated the risk of patients contracting coronavirus disease 2019 (COVID-19) during their hospital stay to inform the safety of hospitalization for a non-COVID-19 indication during this pandemic.

Methods: A case series of adult patients hospitalized for 2 or more nights from May 15 to June 15, 2020 at large tertiary-care hospital in the midwestern United States was reviewed. All patients were screened at admission with the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test. Selected adult patients were also tested by IgG serology. After dismissal, patients with negative serology and PCR at admission were asked to undergo repeat serologic testing at 14-21 days after discharge. The primary outcome was healthcare-associated COVID-19 defined as a new positive SARS-CoV-2 PCR test on or after day 4 of hospital stay or within 7 days of hospital dismissal, or seroconversion in patients previously established as seronegative.

Results: Of the 2,068 eligible adult patients, 1,778 (86.0%) completed admission PCR testing, while 1,339 (64.7%) also completed admission serology testing. Of the 1,310 (97.8%) who were both PCR and seronegative, 445 (34.0%) repeated postdischarge serology testing. No healthcare-associated COVID-19 cases were detected during the study period. Of 1,310 eligible PCR and seronegative adults, no patients tested PCR positive during hospital admission (95% confidence interval [CI], 0.0%-0.3%). Of the 445 (34.0%) who completed postdischarge serology testing, no patients seroconverted (0.0%; 95% CI, 0.0%-0.9%).

Conclusion: We found low likelihood of hospital-associated COVID-19 with strict adherence to universal masking, physical distancing, and hand hygiene along with limited visitors and screening of admissions with PCR.
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http://dx.doi.org/10.1017/ice.2021.38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027545PMC
April 2021

Adherence to Public Health Measures Mitigates the Risk of COVID-19 Infection in Older Adults: A Community-Based Study.

Mayo Clin Proc 2021 04 28;96(4):912-920. Epub 2020 Dec 28.

Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN. Electronic address:

Objective: To assess the prevalence and characteristics of coronavirus disease 2019 (COVID-19) cases during the reopening period in older adults, given that little is known about the prevalence of COVID-19 after the stay-at-home order was lifted in the United States, nor the actual effects of adherence to recommended public health measures (RPHM) on the risk of COVID-19.

Patients And Methods: This was a cross-sectional study nested in a parent prospective cohort study, which followed a population-based sample of 2325 adults 50 years and older residing in southeast Minnesota to assess the incidence of viral infections. Participants were instructed to self-collect both nasal and oropharyngeal swabs, which were tested by reverse transcription polymerase chain reaction-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) assay between May 8, 2020, and June, 30, 2020. We assessed the prevalence of COVID-19 cases and characteristics of study subjects.

Results: A total of 1505 eligible subjects participated in the study whose mean age was 68 years, with 885 (59%) women, 32 (2%) racial/ethnic minorities, and 906 (60%) with high-risk conditions for influenza. The prevalence of other Coronaviridae (human coronavirus [HCoV]-229E, HCoV-NL63, and HCoV-OC43) during the 2019 to 2020 flu season was 109 (7%), and none tested positive for SARS-CoV-2. Almost all participants reported adhering to the RPHM (1,488 [99%] for social distancing, 1,438 [96%] for wearing mask in a public space, 1,476 [98%] for hand hygiene, and 1,441 (96%) for staying home mostly). Eighty-six percent of participants resided in a single-family home.

Conclusion: We did not identify SARS-COV-2 infection in our study cohort. The combination of participants' behavior in following the RPHM and their living environment may considerably mitigate the risk of COVID-19.
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http://dx.doi.org/10.1016/j.mayocp.2020.12.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7768210PMC
April 2021

Deployment of an Interdisciplinary Predictive Analytics Task Force to Inform Hospital Operational Decision-Making During the COVID-19 Pandemic.

Mayo Clin Proc 2021 03 30;96(3):690-698. Epub 2020 Dec 30.

Department of Health Sciences Research and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN.

In March 2020, our institution developed an interdisciplinary predictive analytics task force to provide coronavirus disease 2019 (COVID-19) hospital census forecasting to help clinical leaders understand the potential impacts on hospital operations. As the situation unfolded into a pandemic, our task force provided predictive insights through a structured set of visualizations and key messages that have helped the practice to anticipate and react to changing operational needs and opportunities. The framework shared here for the deployment of a COVID-19 predictive analytics task force could be adapted for effective implementation at other institutions to provide evidence-based messaging for operational decision-making. For hospitals without such a structure, immediate consideration may be warranted in light of the devastating COVID-19 third-wave which has arrived for winter 2020-2021.
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http://dx.doi.org/10.1016/j.mayocp.2020.12.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833949PMC
March 2021

Outcomes of COVID-19 With the Mayo Clinic Model of Care and Research.

Mayo Clin Proc 2021 03 26;96(3):601-618. Epub 2020 Dec 26.

Division of Infectious Diseases, Mayo Clinic, Rochester, MN.

Objective: To report the Mayo Clinic experience with coronavirus disease 2019 (COVID-19) related to patient outcomes.

Methods: We conducted a retrospective chart review of patients with COVID-19 diagnosed between March 1, 2020, and July 31, 2020, at any of the Mayo Clinic sites. We abstracted pertinent comorbid conditions such as age, sex, body mass index, Charlson Comorbidity Index variables, and treatments received. Factors associated with hospitalization and mortality were assessed in univariate and multivariate models.

Results: A total of 7891 patients with confirmed COVID-19 infection with research authorization on file received care across the Mayo Clinic sites during the study period. Of these, 7217 patients were adults 18 years or older who were analyzed further. A total of 897 (11.4%) patients required hospitalization, and 354 (4.9%) received care in the intensive care unit (ICU). All hospitalized patients were reviewed by a COVID-19 Treatment Review Panel, and 77.5% (695 of 897) of inpatients received a COVID-19-directed therapy. Overall mortality was 1.2% (94 of 7891), with 7.1% (64 of 897) mortality in hospitalized patients and 11.3% (40 of 354) in patients requiring ICU care.

Conclusion: Mayo Clinic outcomes of patients with COVID-19 infection in the ICU, hospital, and community compare favorably with those reported nationally. This likely reflects the impact of interprofessional multidisciplinary team evaluation, effective leveraging of clinical trials and available treatments, deployment of remote monitoring tools, and maintenance of adequate operating capacity to not require surge adjustments. These best practices can help guide other health care systems with the continuing response to the COVID-19 pandemic.
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http://dx.doi.org/10.1016/j.mayocp.2020.12.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7831394PMC
March 2021

Reducing Broad-Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation: Reduce AMMO Study.

Clin Infect Dis 2021 08;73(4):e988-e996

Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Background: The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across 3 time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol.

Methods: In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and National Healthcare Safety Network-reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we reevaluated the same metrics.

Results: Our study population included 338 intensive care unit patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol, we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad-spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates.

Conclusions: Our final protocol significantly reduces broad-spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.Summary: There are no guidelines for antimicrobial prophylaxis in patients on extracorporeal membrane oxygenation (ECMO). A rational approach employing concepts of antimicrobial stewardship can drive logical antimicrobial selection for prophylaxis in patients on ECMO without adversely impacting outcomes.
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http://dx.doi.org/10.1093/cid/ciab118DOI Listing
August 2021

Direct Detection from Surveillance Swabs, Blood, and Urine Using a Laboratory-Developed PCR Method.

J Fungi (Basel) 2020 Oct 15;6(4). Epub 2020 Oct 15.

Division of Clinical Microbiology, Mayo Clinic, Rochester, MN 55902, USA.

is an emerging fungal pathogen with cases reported in countries around the world and in 19 states within the United States as of August 2020. The CDC has recommended that hospitals perform active surveillance upon admission for patients with the appropriate risk factors. Currently, active surveillance requires that local hospitals send surveillance swabs to a public health laboratory for analysis. In this work, a real-time PCR assay was developed for the specific detection of from surveillance swabs, blood, and urine to enable rapid detection of this pathogen. The assay uses commercially available primers and reporter probes and it was verified on the LightCycler 480 PCR platform. Contrived specimens and prospectively collected composite groin/axilla surveillance swabs were used to validate the assay. The performance of the PCR assay on surveillance swabs was also compared to a second PCR assay targeting that was performed at the Minnesota Department of Health-Public Health Laboratory (MDH-PHL). Our PCR assay is able to detect and differentiate from closely related species such as , , and on the basis of melting curve temperature differences.
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http://dx.doi.org/10.3390/jof6040224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7711490PMC
October 2020

Occupational exposure to varicella zoster in a tertiary-care healthcare setting.

Infect Control Hosp Epidemiol 2021 06 25;42(6):793-795. Epub 2020 Sep 25.

Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.

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http://dx.doi.org/10.1017/ice.2020.351DOI Listing
June 2021

A quality improvement project to decrease utilization of multilumen peripherally inserted central catheters.

Infect Control Hosp Epidemiol 2021 02 25;42(2):222-224. Epub 2020 Sep 25.

Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.

We performed a quality improvement project to decrease utilization of multilumen peripherally inserted central catheters (PICCs) in favor of single-lumen PICCs and midline catheters. Through optimization of electronic orders, education and decision support, we decreased utilization of multilumen PICCs, changed provider ordering patterns, and showed a downward trend in CLABSIs.
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http://dx.doi.org/10.1017/ice.2020.411DOI Listing
February 2021

Revisiting the Safety of Health Care Workers.

Mayo Clin Proc 2020 09 7;95(9S):S14-S16. Epub 2020 Jul 7.

Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, Rochester, MN; Occupational Health Services, Mayo Clinic, Rochester, MN.

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http://dx.doi.org/10.1016/j.mayocp.2020.06.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340055PMC
September 2020

Precautions, Utilization of Personal Protective Equipment, and Conservation Strategies During the COVID-19 Pandemic.

Mayo Clin Proc 2020 09 22;95(9S):S11-S13. Epub 2020 Jun 22.

Division of Infectious Diseases, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

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http://dx.doi.org/10.1016/j.mayocp.2020.05.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306719PMC
September 2020

Deactivation of SARS-CoV-2 with pulsed-xenon ultraviolet light: Implications for environmental COVID-19 control.

Infect Control Hosp Epidemiol 2021 02 3;42(2):127-130. Epub 2020 Aug 3.

Xenex Disinfection Services, San Antonio, Texas.

Objectives: Prolonged survival of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on environmental surfaces and personal protective equipment may lead to these surfaces transmitting this pathogen to others. We sought to determine the effectiveness of a pulsed-xenon ultraviolet (PX-UV) disinfection system in reducing the load of SARS-CoV-2 on hard surfaces and N95 respirators.

Methods: Chamber slides and N95 respirator material were directly inoculated with SARS-CoV-2 and were exposed to different durations of PX-UV.

Results: For hard surfaces, disinfection for 1, 2, and 5 minutes resulted in 3.53 log10, >4.54 log10, and >4.12 log10 reductions in viral load, respectively. For N95 respirators, disinfection for 5 minutes resulted in >4.79 log10 reduction in viral load. PX-UV significantly reduced SARS-CoV-2 on hard surfaces and N95 respirators.

Conclusion: With the potential to rapidly disinfectant environmental surfaces and N95 respirators, PX-UV devices are a promising technology to reduce environmental and personal protective equipment bioburden and to enhance both healthcare worker and patient safety by reducing the risk of exposure to SARS-CoV-2.
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http://dx.doi.org/10.1017/ice.2020.399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443558PMC
February 2021

Leaks of Clinical Trial Data and Research Integrity.

Mayo Clin Proc 2020 07;95(7):1318-1319

Division of Infectious Diseases, Mayo Clinic, Rochester, MN.

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http://dx.doi.org/10.1016/j.mayocp.2020.05.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328550PMC
July 2020

COVID-19 Testing: The Threat of False-Negative Results.

Mayo Clin Proc 2020 06 11;95(6):1127-1129. Epub 2020 Apr 11.

Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN.

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http://dx.doi.org/10.1016/j.mayocp.2020.04.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151274PMC
June 2020

Guide to Understanding the 2019 Novel Coronavirus.

Mayo Clin Proc 2020 04 28;95(4):646-652. Epub 2020 Feb 28.

Division of Infectious Diseases, Mayo Clinic, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Mayo Clinic, Rochester, MN.

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http://dx.doi.org/10.1016/j.mayocp.2020.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094318PMC
April 2020

Clostridioides difficile Whole-genome Sequencing Differentiates Relapse With the Same Strain From Reinfection With a New Strain.

Clin Infect Dis 2021 03;72(5):806-813

Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.

Background: Current approaches in tracking Clostridioides difficile infection (CDI) and individualizing patient management are incompletely defined.

Methods: We recruited 468 subjects with CDI at Mayo Clinic Rochester between May and December 2016 and performed whole-genome sequencing (WGS) on C. difficile isolates from 397. WGS was also performed on isolates from a subset of the subjects at the time of a recurrence of infection. The sequence data were analyzed by determining core genome multilocus sequence type (cgMLST), with isolates grouped by allelic differences and the predicted ribotype.

Results: There were no correlations between C. difficile isolates based either on cgMLST or ribotype groupings and CDI outcome. An epidemiologic assessment of hospitalized subjects harboring C. difficile isolates with ≤2 allelic differences, based on standard infection prevention and control assessment, revealed no evidence of person-to-person transmission. Interestingly, community-acquired CDI subjects in 40% of groups with ≤2 allelic differences resided within the same zip code. Among 18 subjects clinically classified as having recurrent CDI, WGS revealed 14 with initial and subsequent isolates differing by ≤2 allelic differences, suggesting a relapse of infection with the same initial strain, and 4 with isolates differing by >50 allelic differences, suggesting reinfection. Among the 5 subjects classified as having a reinfection based on the timing of recurrence, 3 had isolates with ≤2 allelic differences between them, suggesting a relapse, and 2 had isolates differing by >50 allelic differences, suggesting reinfection.

Conclusions: Our findings point to potential transmission of C. difficile in the community. WGS better differentiates relapse from reinfection than do definitions based on the timing of recurrence.
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http://dx.doi.org/10.1093/cid/ciaa159DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7935391PMC
March 2021

Injection Safety in the United States: Miles to Go?

Mayo Clin Proc 2020 02;95(2):216-217

Division of Infectious Diseases, Mayo Clinic, Rochester, MN. Electronic address:

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http://dx.doi.org/10.1016/j.mayocp.2019.12.024DOI Listing
February 2020

The Mayo Clinic Proceedings Thematic Review on Vaccines.

Mayo Clin Proc 2019 10 9;94(10):1931-1933. Epub 2019 Sep 9.

Infectious Diseases, Mayo Clinic, Rochester, MN. Electronic address:

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http://dx.doi.org/10.1016/j.mayocp.2019.04.001DOI Listing
October 2019

Fungal Diagnostic Stewardship in Bronchoscopy Specimens for Immunocompetent Patients in the Intensive Care Unit.

Mayo Clin Proc 2019 09 7;94(9):1781-1785. Epub 2019 Aug 7.

Division of Infectious Diseases, Mayo Clinic, Rochester, MN.

Objective: To evaluate the diagnostic yield of fungal smears and cultures from bronchial lavage and wash specimens obtained from immunocompetent patients in the intensive care unit (ICU) because respiratory tract samples from patients in the ICU often undergo extensive microbiological testing.

Patients And Methods: In total, we enrolled 112 immunocompetent adult patients treated in the medical and surgical ICU between July 1, 2016, and June 30, 2017. We evaluated whether the results of fungal smears and cultures of specimens obtained from bronchoscopy and bronchoalveolar lavage changed patient care.

Results: In total, 131 bronchoscopic specimens and 31 bronchoalveolar lavage specimens were tested for fungi. Cultures were held for an estimated 4680 culture-days. Two results changed patient therapy. In both cases, other routine tests provided the same information as fungal culture before these results were returned.

Conclusion: In immunocompetent, critically ill patients, fungal culture of respiratory tract specimens does not add diagnostic value. Routine fungal culture of respiratory tract specimens should be discouraged in this population.
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http://dx.doi.org/10.1016/j.mayocp.2019.02.020DOI Listing
September 2019

The 2019 immunization schedules for children, adolescents and adults. What's New?

Vaccine 2019 06 11;37(26):3379-3380. Epub 2019 May 11.

Mayo Vaccine Research Group and Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA. Electronic address:

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http://dx.doi.org/10.1016/j.vaccine.2019.05.001DOI Listing
June 2019

Pulmonary artery catheter epidemiology of risk in pre-heart-transplant recipients.

Infect Control Hosp Epidemiol 2019 06 30;40(6):632-638. Epub 2019 Apr 30.

Division of Infectious Diseases, Mayo Clinic, Rochester,Minnesota.

Objective: Central-line-associated bloodstream infections (CLABSIs) are a known complication of central venous access. Pulmonary artery catheters (PAC) are frequently used in pre-heart-transplant patients, but the rate of CLABSI in this population is unknown. We sought to estimate the rate of CLABSI and identify factors associated with development of infection in patients actively listed for heart transplantation with a PAC.

Design: Retrospective cohort study.

Setting: This study was conducted in 3 intensive care units at an academic tertiary-care center in Minnesota.

Patients: 61 pre-heart-transplant patients in an intensive care unit with a PAC in place from January 2013 to December 2016, totaling 219 PACs.

Methods: At-risk patients, pertinent risk factors, and demographic data were obtained using Mayo Clinic's Unified Data Platform. CLABSIs were identified through internal infection prevention and control data. Characteristics of PAC use and infection rate were collected and analyzed using Kaplan-Meier estimates and time-dependent Cox models.

Results: Among pre-heart-transplant patients with a PAC, there were 14 CLABSIs, for an infection rate of 5.46 of 1,000 PAC days (95% confidence interval [CI], 2.98-9.15). The most common causative organism was coagulase-negative Staphylococcus (79%). In unadjusted analyses, CLABSI was associated with shorter time to transplant (hazard ratio [HR], 2.49; P = .027), but not mortality (HR, 1.79; P = .355).

Conclusions: The rate of CLABSI with PAC is high. Prolonged PAC use in the pre-heart-transplant population should be revisited.
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http://dx.doi.org/10.1017/ice.2019.94DOI Listing
June 2019

Comparison of intravenous and oral definitive antibiotic regimens in hospitalised patients with Gram-negative bacteraemia from a urinary tract infection.

J Glob Antimicrob Resist 2019 09 26;18:243-248. Epub 2019 Mar 26.

Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.

Objectives: Transitioning patients from intravenous (IV) to oral antibiotic therapy has been shown to be a successful approach for several infections. However, minimal data exist evaluating outcomes following transition from to oral antibiotics for patients with bacteraemia secondary to a urinary tract infection (UTI). This study compared treatment failures between patients treated exclusively with IV antibiotics and those transitioned from IV to oral antibiotics for bacteraemia secondary to UTI.

Methods: This single-centre, retrospective cohort study included hospitalised, non-critically ill adult patients treated with culture-susceptible antibiotic therapy for 7-21 days. Patients were divided into two cohorts based on the route of definitive antibiotic administration. Treatment failure was a composite outcome of death and recurrence of the index micro-organism within 21 days following negative blood cultures.

Results And Discussion: Among the 346 patients enrolled, 82 (23.7%) were in the IV cohort and 264 (76.3%) were in the IV-to-oral cohort. A total of six treatment failures occurred; 2 (2.4%) in the IV cohort and 4 (1.5%) in the oral transition cohort (hazard ratio=0.62, 95% confidence interval 0.11-3.39; P=0.58). All failures were due to recurrence of the index organism. Secondary outcomes demonstrated a significantly higher rate of IV line-associated complications in the IV cohort (P=0.03) and a favourable hospital length of stay in the oral cohort (P<0.001). Patients transitioned from IV to oral antibiotics based on culture-susceptibility data experienced similarly low rates of treatment failure as those who received exclusive IV therapy.
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http://dx.doi.org/10.1016/j.jgar.2019.03.013DOI Listing
September 2019

Global Village, International Travel, and Risk of Communicable Disease.

Mayo Clin Proc 2019 03 21;94(3):383-384. Epub 2019 Feb 21.

Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN. Electronic address:

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http://dx.doi.org/10.1016/j.mayocp.2019.01.028DOI Listing
March 2019

A trial of pulsed xenon ultraviolet disinfection to reduce Clostridioides difficile infection.

Am J Infect Control 2019 04 28;47(4):406-408. Epub 2018 Nov 28.

Mayo Clinic, Rochester, MN.

Background: An intervention was designed to test whether the addition of an ultraviolet (UV) disinfection step after terminal cleaning would be helpful in reducing Clostridium difficile infection (CDI) rates in a real-world situation.

Methods: This study was a quasi-experimental design using 3 units as intervention units for the intervention and 3 similar units as control units. Intervention units 2 hematology and bone marrow transplant units and one medical-surgical unit at a large teaching hospital in the Midwest. UV disinfection was added after patient discharge and terminal cleaning in the intervention units.

Results: At baseline, CDI rates in the intervention and control arms were similar. During the 6 months of UV disinfection, the CDI rate in the intervention units decreased to 11.2 per 10,000 patient days, compared with 28.7 per 10,000 patient days in the control units (P = .03). In addition, the intervention units also saw a reduction in vancomycin-resistant enterococci acquisition.

Conclusions: The addition of UV disinfection to the terminal cleaning resulted in a reduction in CDI that has been sustained over several months 2 years.
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http://dx.doi.org/10.1016/j.ajic.2018.09.018DOI Listing
April 2019
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