#38: Bacteremia Analysis of Three Hospitals in Hispaniola Island

2021 ◽  
Vol 10 (Supplement_2) ◽  
pp. S19-S19
Author(s):  
Johanny Contreras ◽  
Karina Rivera ◽  
María Castillo ◽  
Genara Santana ◽  
María Dolores Gil ◽  
...  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Mucosal Barrier ◽  
Infection Prevention And Control ◽  
Coagulase Negative Staphylococcus ◽  
Case Definitions ◽  
Culture Methods ◽  
Isolation And Identification ◽  
Infection Surveillance ◽  
Prophylactic Measures ◽  
Healthcare Associated

Abstract Background In October 2018, the Hispaniola Project was initiated to build local expertise in infection care and prevention at three pediatric oncology units (POUs) in Haiti and the Dominican Republic. Surveillance of healthcare-associated infections (HAI) was a central aim. Severe and prolonged neutropenia is a frequent risk factor for infections in oncology patients. Among HAIs, bacteremia is one of the most serious; bacteremia requires timely isolation and identification of the offending microorganism and the antimicrobial susceptibility. These diagnostic interventions allow informed therapeutic and prophylactic measures. Here, we report our experience in bacteremia in these 3 POUs. Methods We conducted prospective infection surveillance of all patients admitted to three POUs in Hispaniola Island. Blood culture methods followed standard national procedures. We used the 2018 US Centers for Disease Control National Healthcare Safety Network case definitions for primary laboratory-confirmed bloodstream infections (LCBI), and we categorized infections as healthcare-associated or present on admission (POA). We reviewed data collected from January 2019 to December 2020 and used descriptive statistics to report our results. Results Our review identified 66 LCBIs with an overall rate of 3.52 infections per 1000 patient-days. Of these, 40 (61%) were healthcare-associated, and 26 were POA. The majority (41, 62%) of patients were undergoing chemotherapy at the time of the infection, with induction being the most common phase (23). The most common oncologic diagnosis was acute lymphoblastic leukemia (43, 65%), followed by solid tumor (12, 18%). Fifty-three (80%) of the infections met the LCBI-1 criteria, with the other 13 categorized as LBCI-2. Of the 53 LCBI-1, 7 (13%) were considered related to mucosal barrier injury (MBI-LCBI 1 definition). The most commonly identified organisms were Klebsiella spp. (13, 19%) and coagulase-negative Staphylococcus (13, 19%). Antibiotic resistance was observed in many of the identified pathogens, with nearly half (25, 44%) of the 57 bacterial isolates having any resistance and a quarter (14, 25%) with resistance to multiple classes, including cephalosporins, fluoroquinolones, and aminoglycosides. Eleven (17%) patients were admitted to the Intensive Care Unit as a result of the LCBI. Thirteen deaths were recorded among the patients with LCBIs, with 6 (46%) associated with the HAI and 7 (54%) related to disease progression. Conclusions Our findings demonstrate that resistant pathogens were frequent among the LCBI isolates. Our preliminary results are guiding clinical management to be vigilant in our care of patients at high risk for bacteremia and poor clinical response by initiating more effective antimicrobials sooner. Importantly, reviewing reasons for antimicrobial resistance and implementing best antimicrobial use practices will protect our fragile antibiotic arsenal. Infection surveillance programs, such as ours, and other initiatives which promote infection prevention and control in POU will increase the quality of care for these vulnerable patients.

scholarly journals Medicolegal Causation Investigation of Bacterial Endocarditis Associated with an Oral Surgery Practice Using the INFERENCE Approach

2021 ◽  
Vol 18 (14) ◽  
pp. 7530
Author(s):  
Putri Dianita Ika Meilia ◽  
Maurice P. Zeegers ◽  
Herkutanto ◽  
Michael D. Freeman
Keyword(s):  
Oral Surgery ◽  
Invasive Procedure ◽  
Bacterial Endocarditis ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infection ◽  
Department Of Health ◽  
The Individual ◽  
Healthcare Associated ◽  
And Control ◽  
Causation Analysis

Investigating causation is a primary goal in forensic/legal medicine, aiming to establish the connection between an unlawful/negligent act and an adverse outcome. In malpractice litigation involving a healthcare-associated infection due to a failure of infection prevention and control practices, the medicolegal causal analysis needs to quantify the individual causal probabilities to meet the evidentiary requirements of the court. In this paper, we present the investigation of the most probable cause of bacterial endocarditis in a patient who underwent an invasive procedure at a dental/oral surgical practice where an outbreak of bacterial endocarditis had already been identified by the state Department of Health. We assessed the probability that the patient’s endocarditis was part of the outbreak versus that it was an unrelated sporadic infection using the INFERENCE (Integration of Forensic Epidemiology and the Rigorous Evaluation of Causation Elements) approach to medicolegal causation analysis. This paper describes the step-by-step application of the INFERENCE approach to demonstrate its utility in quantifying the probability of causation. The use of INFERENCE provides the court with an evidence-based, transparent, and reliable guide to determine liability, causation, and damages.

scholarly journals Profile of Nursing Homes Enrolled in the National Health Safety Network: Focus on Interfacility Communication

2020 ◽  
Vol 41 (S1) ◽  
pp. s523-s524
Author(s):  
Karen Jones ◽  
John Mills ◽  
Sarah Krein ◽  
Ana Montoya ◽  
Jennifer Meddings ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Infection Prevention ◽  
Phase 1 ◽  
Infection Prevention And Control ◽  
Internal Quality ◽  
Resistant Organism ◽  
Fisher Exact Test ◽  
Stewardship Program ◽  
Infection Surveillance ◽  
Communication Methods

Background: A robust infection prevention infrastructure is critical for creating a safe resident environment in nursing homes. The CDC NHSN provides a standardized approach to infection surveillance and analysis, which can drive internal quality improvement efforts in nursing homes and could serve as an indicator of facilities’ infection prevention aptitude. The purpose of this study was to compare the characteristics of nursing homes enrolled to those not enrolled in the NHSN, including interfacility communication methods, as an essential part of reducing resident infection-related risks. Methods: Over a 2-year period, 50 nursing homes participated in a 12-month program designed to reduce healthcare-associated infections (HAIs) by enhancing relationships between nursing homes and hospitals. Overall, 11 demographic surveys were administered to nursing homes prior to the start of the phase 1 pilot year between January and March 2018, and another 39 were administered prior to beginning phase 2 in January–February 2019. The survey consisted of 36 questions on facility characteristics, including NHSN enrollment, infection prevention and control (IPC) program and infection preventionist characteristics, and communication methods related to interfacility transfer of care. We compared facility, IPC program characteristics, and communication methods between nursing homes stratified based on NHSN enrollment. These were compared using the Fisher exact test. Results: In total, 50 nursing homes, varying in size and services provided, completed the demographic survey (Table 1). Of these 50 nursing homes, 11 (22%) were enrolled in the NHSN. Nursing homes enrolled in the NHSN were more likely to use a telephone report prior to resident transfer in and out of the facility (P = .04) and to disseminate infection data to all facility nursing staff (P = .02). Overall, less than half of nursing homes included a telephone report as part of their routine hand-off communication, and most nursing homes relied only on written transfer forms or discharge documentation. Moreover, 65% of the nursing homes reported use of a standardized method to accept new residents with history of multidrug-resistant organism (MDRO), including a review of infection or MDRO type, antibiotic orders, and ambulation status. NHSN-enrolled nursing homes were also more likely to have an antibiotic stewardship program and to use the electronic health record (EHR) to facilitate infection surveillance, though these differences were not statistically significant. Conclusions: A higher percentage of nursing homes enrolled in the NHSN engaged in activities connected with resident safety including verbal report prior to interfacility transfer and antimicrobial stewardship programs. Dedicating resources for nursing homes to enhance their IPC program including NHSN enrollment should be encouraged.Funding: This study was supported by a grant from the AHRQ (grant no. RO1HS25451).Disclosures: None

scholarly journals N-CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N-CDAD Prevalence Surveillance Project

2001 ◽  
Vol 12 (2) ◽  
pp. 81-88 ◽  
Author(s):  
Meaghen Hyland ◽  
Marianna Ofner-Agostini ◽  
Mark Miller ◽  
Shirley Paton ◽  
Marie Gourdeau ◽  
...  
Keyword(s):  
Health Care ◽  
Nosocomial Infection ◽  
Toxin Production ◽  
Health Care Facilities ◽  
Surveillance Program ◽  
Prevention Measures ◽  
Case Definitions ◽  
Infection Surveillance ◽  
Positive Stool ◽  
The Impact

BACKGROUND:A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance ofClostridium difficile-associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada.OBJECTIVE:To establish national prevalence rates of N-CDAD.METHODS:For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for eitherC difficiletoxin orC difficilebacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions.RESULTS:Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N-CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N-CDAD cases were 66.3 cases/100,000 patient days (95% CI

scholarly journals Feasible Surgical Site Infection Surveillance in Resource-Limited Settings: A Pilot in Sierra Leone

2020 ◽  
Vol 41 (S1) ◽  
pp. s38-s38
Author(s):  
Matthew Westercamp ◽  
Aqueelah Barrie ◽  
Christiana Conteh ◽  
Danica Gomes ◽  
Hassan Benya ◽  
...  
Keyword(s):  
Data Collection ◽  
Cesarean Delivery ◽  
Sierra Leone ◽  
Clinical Decision Making ◽  
Case Finding ◽  
Surveillance Strategy ◽  
Case Definitions ◽  
Patient Interviews ◽  
Resource Limited ◽  
Infection Surveillance

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs) in low- and middle-income countries (LMICs). SSI surveillance can be challenging and resource-intensive to implement in LMICs. To support feasible LMIC SSI surveillance, we piloted a multisite SSI surveillance protocol using simplified case definitions and methodology in Sierra Leone. Methods: A standardized evaluation tool was used to assess SSI surveillance knowledge, capacity, and attitudes at 5 proposed facilities. We used simplified case definitions restricted to objective, observable criteria (eg, wound purulence or intentional reopening) without considering the depth of infection. Surveillance was limited to post-cesarean delivery patients to control variability of patient-level infection risk and to decrease data collection requirements. Phone-based patient interviews at 30-days facilitated postdischarge case finding. Surveillance activities utilized existing clinical staff without monetary incentives. The Ministry of Health provided training and support for data management and analysis. Results: Three facilities were selected for initial implementation. At all facilities, administration and surgical staff described most, or all, infections as “preventable” and all considered SSIs an “important problem” at their facility. However, capacity assessments revealed limited staff availability to support surveillance activities, limited experience in systematic data collection, nonstandardized patient records as the basis for data collection, lack of unique and consistent patient identifiers to link patient encounters, and no quality-assured microbiology services. To limit system demands and to maximize usefulness, our surveillance data collection elements were built into a newly developed clinical surgical safety checklist that was designed to support surgeons’ clinical decision making. Following implementation and 2 months of SSI surveillance activities, 77% (392 of 509) of post-cesarean delivery patients had a checklist completed within the surveillance system. Only 145 of 392 patients (37%) under surveillance were contacted for final 30-day phone interview. Combined SSI rate for the initial 2-months of data collection in Sierra Leone was 8% (32 of 392) with 31% (10 of 32) identified through postdischarge case finding. Discussion: The surveillance strategy piloted in Sierra Leone represents a departure from established HAI strategies in the use of simplified case definitions and implementation methods that prioritize current feasibility in a resource-limited setting. However, our pilot implementation results suggest that even these simplified SSI surveillance methods may lack sustainability without additional resources, especially in postdischarge case finding. However, even limited phone-based patient interviews identified a substantial number of infections in this population. Although it was not addressed in this pilot study, feasible laboratory capacity building to support HAI surveillance efforts and promote appropriate treatment should be explored.Funding: NoneDisclosures: None

scholarly journals INFECTIOUS RISKS AND COMPLICATIONS IN ADULT LEUKEMIC PATIENTS RECEIVING BLINATUMOMAB

2018 ◽  
Vol 10 (1) ◽  
pp. 2018029 ◽  
Author(s):  
Wonhee So ◽  
Shuchi Pandya ◽  
Rod Quilitz ◽  
Rod Quilitz ◽  
John Greene
Keyword(s):  
Lymphoblastic Leukemia ◽  
Patient Characteristics ◽  
Underlying Disease ◽  
Mucosal Barrier ◽  
Cancer Center ◽  
Antibacterial Prophylaxis ◽  
Lower Baseline ◽  
Included Patient ◽  
Mucosal Barrier Injury ◽  
Cell Acute Lymphoblastic Leukemia

Background: Blinatumomab is an anti-CD19 immunotherapy approved for relapsed/refractory B-cell acute lymphoblastic leukemia (ALL) with significantly increased survival rate. While blinatumomab showed lower rates of infection, neutropenia and mucosal barrier injury versus chemotherapy, its infection risks are not well described. Methods: All patients who received blinatumomab for ≥ 7 days at an academic cancer center from May 2015 to April 2017 were included. Patient characteristics pertinent to infectious risks and complications were examined.Results: Twenty patients with refractory (25%), relapsed (70%), or remitted (5%) B-ALL who received a total of 35 cycles were included. Ten of the 35 cycles were interrupted, none of which were due to infections. Twenty six infections (n) were observed with lower respiratory (9), gastrointestinal (6) and bacteremia (5) being most common. Compared to patients without nodular, possible mold pneumonia (n=16), patients with nodular pneumonia (n=4) had significantly lower baseline absolute neutrophil count (ANC) (2319 v. 208/µL, p=0.011). There were no differences in baseline characteristics including ANC between bacteremic and non-bacteremic patients. One patient was discharged with no antibacterial prophylaxis since ANC recovered to >500cells/µL, but developed Pseudomonal bacteremia within a week with ANC ~100cells/µL. Conclusion: Despite blinatumomab’s relatively modest myelosuppression and the lack of mucotoxicity, host factors (e.g., duration and degree of neutropenia/lymphopenia) play a key role and should be considered when choosing anti-microbial prophylaxis. In relapsed/refractory disease, the ANC should be monitored closely post blinatumomab since neutropenia can unexpectedly develop after treatment which may be compounded by the underlying disease and recent chemotherapy effects.

scholarly journals Intrathecal Methotrexate-Induced Necrotizing Myelopathy: A Case Report and Review of Histologic Features

2018 ◽  
Vol 11 ◽  
pp. 117955571880907 ◽  
Author(s):  
Hamza Tariq ◽  
Andrea Gilbert ◽  
Francis E Sharkey
Keyword(s):  
Spinal Cord ◽  
Lymphoblastic Leukemia ◽  
Marrow Transplant ◽  
Intrathecal Methotrexate ◽  
Lumbar Spinal Cord ◽  
Vacuolar Degeneration ◽  
Cns Relapse ◽  
Prophylactic Measures ◽  
Transverse Myelopathy ◽  
Lymphocytic Infiltrates

Central nervous system (CNS) relapse of acute lymphoblastic leukemia (ALL) is associated with a poor prognosis. However, prophylactic measures, including intrathecal (IT) methotrexate, reduce the incidence of CNS relapse in these patients considerably. Unfortunately, IT methotrexate can cause several neurologic complications, including transverse myelopathy; ie, the development of isolated spinal cord dysfunction over hours or days following the IT infusion of methotrexate, but in the absence of a compressive lesion. Transverse myelopathy following IT methotrexate is a well-established clinical phenomenon, but the histologic features have been described only very rarely. We report the autopsy findings from a 31-year-old man with a history of T-cell ALL who received prophylactic IT methotrexate in anticipation of a bone marrow transplant. Microscopic examination showed transverse necrosis of the thoracic cord, with massive infiltration by macrophages and lymphocytes, and perivascular lymphocytic infiltrates. There was cavitary necrosis of cervical and lumbar spinal cord involving the entire gray matter and focal white matter, as well as extensive subpial vacuolar degeneration of the dorsal and lateral columns.

scholarly journals A nosocomial cluster of vancomycin resistant enterococci among COVID-19 patients in an intensive care unit

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Stefanie Kampmeier ◽  
Hauke Tönnies ◽  
Carlos L. Correa-Martinez ◽  
Alexander Mellmann ◽  
Vera Schwierzeck
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Prevention ◽  
Control Measures ◽  
Whole Genome Sequence ◽  
Infection Prevention And Control ◽  
Healthcare Associated Infections ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Healthcare Associated

Abstract Background Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. Methods Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). Results WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. Conclusions Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.

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