(meta)Genomic Pathogen Surveillance and Detection
Antibiotic Resistance
Antibiotic resistance is one of the biggest public health challenges of our time. Each year in the U.S., at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die. Next-generation sequencing technologies represent fundamental shift in how we diagnose infectious disease, curb the spread of antibiotic resistance, prevent life threatening infections. PMD members have initiated a large-scale study applying high-throughput genomic surveillance to detect potential hospital transmission clusters. Further, we are extending genomic analysis to understand the transmission of antibiotic resistance and genomic variants that correlate with clinical outcomes. These approaches may ultimately serve as useful diagnostics.
Hightlighted Publications
- The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome
- The Nursing Home Older Adult Gut Microbiome Composition Shows Time-dependent Dysbiosis and is Influenced by Medication Exposures, Age, Environment, and Frailty
- Integration of genomic and clinical data augments surveillance of healthcare-acquired infections
- Metagenomic Sequencing with Strain-Level Resolution Implicates Uropathogenic E. coli in Necrotizing Enterocolitis and Mortality in Preterm Infants
- Strain-level microbial epidemiology and population genomics from shotgun metagenomics
- Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients
- Center Variation in Intestinal Microbiota Prior to Late-Onset Sepsis in Preterm Infants
MDRO
Multidrug resistant organisms (MDROs) are bacteria that have become resistant to more than one antimicrobial agent. Intestinal MDROs constitute a major threat to public health because they are increasingly difficult to treat and result in increased costs, morbidity, and mortality. Clostridium difficile shares many of the same characteristics as MDROs and along with MDROs has been labeled a national priority as defined by the Infectious Diseases Society of America, Centers for Medicare and Medicaid Services, and the Centers for Disease Control and Prevention. An individual’s microbiome influences the likelihood of de novo colonization and whether the MDRO persists over time leading to spread and eventual symptomatic infection. In elders, the high prevalence of MDRO colonization indicates a need to better understand how the intestinal microbiome may be used to predict and prevent the spread of these pathogens. Approaches being developed by PMD members target elder microbiome health in a way that will translate to improved pathogen screening and risk prediction, thus reducing the burden of this healthcare menace.
Hightlighted Publications
- The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome
- Anaerobic Antibiotics and the Risk of Graft-versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation
- Gut Colonization Preceding Mucosal Barrier Injury Bloodstream Infection in Pediatric Hematopoietic Stem Cell Transplantation Recipients
- The High Prevalence of Clostridioides difficile among Nursing Home Elders Associates with a Dysbiotic Microbiome
- Reduction of inappropriate antibiotic use and improved outcomes by implementation of an algorithm based clinical guideline for non-purulent skin and soft tissue infections.
- Proton pump inhibitors and 180-day mortality in the elderly after Clostridium difficiletreatment.
- Deviating from IDSA treatment guidelines for non-purulent skin infections increases the risk of treatment failure in emergency department patients.
- Macrolide resistance in cases of community-acquired bacterial pneumonia in the emergency department.
- Medication exposure and the risk of recurrent Clostridium difficile Infection in community-dwelling older people and nursing home residents.
- Elderly patients are at increased risk for treatment failure in outpatient management of purulent skin infections.
- Antibiotic-associated diarrhoea in emergency department observation unit patients.
- Treatment of bacterial skin infections in ED observation units: factors influencing prescribing practice.
- Factors Influencing the Development of Antibiotic Associated Diarrhea in ED Patients Discharged Home: Risk of Administering Intravenous Antibiotics.
SARS-CoV-2
The seriousness, global scale and rapid spread of the SARS-CoV-2 virus has clearly demonstrated the need for active, real-time genomic surveillance of emerging pathogens. It was due to the early public release of genomic data from the first COVID-19 cases that enabled the deployment of the new generation of messenger RNA-based vaccines. As genetic variants of the virus emerged, their regional and global dissemination is tracked through a network of genomic sequencing laboratories. PMD members work with our UMass Memorial Health Network and Departments of Public health to provide real-time, genomic surveillance of the SARS-CoV-2 epidemic; and we are working to develop the laboratory and informatic infrastructure to prepare for future events as well.
Hightlighted Publications
- Inflammation-type dysbiosis of the oral microbiome associates with the duration of COVID-19 symptoms and long-COVID
- Clinical Studies to Assess the Natural History and Impact of Gut Microbiome Modulation in Non-Hospitalized Patients with Mild to Moderate COVID-19 a Randomized, Open-Label, Prospective Study with a Parallel Group Study Evaluating the Physiologic Effects of KB109 on Gut Microbiota Structure and Function: A Structured Summary of a Study Protocol for a randomized controlled study
- Vaccine Effectiveness Among Healthcare Personnel Study Team. Interim Estimates of Vaccine Effectiveness of Pfizer-BioNTech and Moderna COVID-19 Vaccines Among Health Care Personnel
- Symptoms of anxiety, burnout, and PTSD and the mitigation effect of serologic testing in emergency department personnel during the COVID-19 pandemic
- Diagnosed and Undiagnosed COVID-19 in US Emergency Department Health Care Personnel: A Cross-sectional Analysis.
- Vaccination rates and acceptance of SARS-CoV-2 vaccination among U.S. emergency department health care personnel