Publications by authors named "Lora L Pless"

We report 2 outbreaks comprising a cluster of 18 group A Streptococcal infections across 2 nursing facilities. Point prevalence surveillance testing identified 8 of 18 cases, and whole genome sequencing validated transmission pathways. Infection prevention interventions at the facility level comprised symptomatic and asymptomatic carriage-based case finding, transmission-based precautions, and treatment to eradicate colonization.

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Article Synopsis
  • Current outbreak detection methods in hospitals are inadequate on their own; a new program called the Enhanced Detection System for Healthcare-associated Transmission (EDS-HAT) uses real-time genomic surveillance to identify outbreaks.
  • The study, conducted at UPMC Presbyterian Hospital from November 2021 to October 2023, involved weekly whole genome sequencing of bacterial isolates, leading to the identification of 172 outbreaks and successful intervention strategies that prevented further transmission in over 95% of cases.
  • Results revealed significant benefits: 62 infections were avoided, translating to over $1 million in gross savings and a net savings of nearly $700,000, showing that integrating genomic surveillance can greatly enhance infection control and patient safety.
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Objective: Prior studies evaluating the impact of discontinuation of contact precautions (DcCP) on methicillin-resistant (MRSA) outcomes have characterized all healthcare-associated infections (HAIs) rather than those likely preventable by contact precautions. We aimed to analyze the impact of DcCP on the rate of MRSA HAI including transmission events identified through whole genome sequencing (WGS) surveillance.

Design: Quasi experimental interrupted time series.

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  • VRE infections are a major healthcare challenge due to their complex transmission dynamics, which involve patient colonization and spread through various healthcare settings.
  • Whole genome sequencing (WGS) was used to analyze 352 clinical and 891 rectal screening VRE isolates, revealing that the majority (87.3%) of VRE infections were acquired through rectal carriage.
  • The study identified significant genetic relatedness among isolates and hotspots for VRE transmission, emphasizing the importance of WGS in infection control and highlighting the impact on patient outcomes, including ICU admissions and mortality rates.
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  • NDM (New Delhi metallo-β-lactamase) is a significant threat due to its role in carbapenem resistance, leading to high mortality and few treatment options.
  • An outbreak at an acute care hospital was detected using traditional infection prevention methods and supplemented with weekly whole genome sequencing (WGS), which revealed complex plasmid transfer dynamics between various bacterial species.
  • The investigation identified 15 patients with NDM-5-producing Enterobacterales, illustrating the effectiveness of combining traditional and genomic approaches in tracking and controlling outbreaks involving plasmid transfer and bacterial spread.
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Background: New Delhi metallo-β-lactamase (NDM) represents an emergent mechanism of carbapenem resistance associated with high mortality and limited antimicrobial treatment options. Because the resistance gene is often carried on plasmids, traditional infection prevention and control (IP&C) surveillance methods like speciation, antimicrobial resistance testing, and reactive whole genome sequencing (WGS) may not detect plasmid transfer in multispecies outbreaks.

Methods: Initial outbreak detection of NDM-producing Enterobacterales identified at an acute care hospital occurred via traditional IP&C methods and was supplemented by real-time WGS surveillance, which was performed weekly using the Illumina platform.

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