A Bundle of Measures to Control an Outbreak of Pseudomonas aeruginosa Associated With P-Trap Contamination

OBJECTIVETo describe an outbreak of multidrug-resistant Pseudomonas aeruginosa in which the hospital waste-pipe system was the likely source of contamination and to report the bundle of measures that facilitated the long-term control of the outbreak.DESIGNOutbreak investigation.SETTINGThe hematology unit of a tertiary-care referral center.PATIENTSPatients who were colonized or infected with P. aeruginosa belonging to the clonal outbreak.METHODSPatients admitted to our 15-bed stem-cell transplantation hematology unit were screened for P. aeruginosa carriage. Pseudomonas aeruginosa isolates were also obtained from diagnostic samples. We assessed the microbiological contamination of P-traps, water and toilets for 42 months. Extended-spectrum β-lactamases (ESBLs) and metallo-β-lactamases (MBLs) were screened and identified by polymerase chain reaction (PCR) and sequencing. Molecular typing of ESBL- or MBL-producing isolates was carried out using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).RESULTSFrom 2009 to 2013, a biclonal outbreak of IMP-19–producing ST235 (11 cases) and IMP-29–producing ST111 (10 cases) of P. aeruginosa occurred. The environmental investigation strongly suggested that P-traps were the reservoirs for the outbreak strains. A bundle of infection control measures, including engineering interventions on water outlets and disinfection of P-traps, controlled the outbreak.CONCLUSIONSWe report a prolonged outbreak of IMP-producing high-risk clones of P. aeruginosa, for which P-traps seems to play a major role in cross-transmission. It appears essential to implement proactive measures to limit the bacterial load in water fittings of high-risk units.Infect Control Hosp Epidemiol 2018;39:164–169

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Direct costs and clinical impact of adenovirus genotype 8 conjunctivitis outbreak in a neonatology unit

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.404 ◽

2020 ◽

pp. 1-7

Author(s):

María Florencia Angueyra ◽

Débora Natalia Marcone ◽

Florencia Escarrá ◽

Noelia Soledad Reyes ◽

Yamile Rubies ◽

...

Keyword(s):

High Risk ◽

Infection Control ◽

Median Duration ◽

Tertiary Care ◽

Productivity Loss ◽

High Risk Pregnancy ◽

Control Measures ◽

Viral Spread ◽

Infection Control Measures ◽

Risk Pregnancy

Abstract Objective: To report a conjunctivitis outbreak in a neonatology intensive care unit (NICU) and determine the associated economic impact. Design: Prospective observational study. Setting: Centro de Educación Médica e Investigaciones Clínicas (CEMIC) University Hospital, a private, tertiary-care healthcare institution in Buenos Aires, Argentina. Participants: The study included 52 NICU neonates and 59 NICU-related healthcare workers (HCWs) from CEMIC hospital. Methods: Neonates and HCWs were swabbed for real-time polymerase chain reaction (PCR) testing, viral culture, and typing by sequencing. Infection control measures, structural and logistic changes were implemented. Billing records were analyzed to determine costs. Results: From January 30 to April 28, 2018, 52 neonates were hospitalized in the NICU. Among them, 14 of 52 (21%) had bilateral conjunctivitis with pseudomembranes. Symptomatic neonates and HCWs were HAdV-D8 positive. Ophthalmological symptoms had a median duration of 18 days (IQR, 13–24.5). PCR positivity and infectious range had a median duration of 18.5 days. As part of containment measures, the NICU and the high-risk pregnancy unit were closed to new patients. The NICU was divided into 2 areas for symptomatic and asymptomatic patients; a new room was assigned for the general nursery, and all deliveries from the high-risk pregnancy unit were redirected to other hospitals. The outbreak cost the hospital US$205,000: implementation of a new nursery room and extra salaries cost US$30,350 and estimated productivity loss during 1 month cost US$175,000. Conclusions: Laboratory diagnosis confirmed the cause of this outbreak as HAdV-D8. The immediate adoption and reinforcement of rigorous infection control measures limited the nosocomial viral spread. This outbreak represented a serious institutional problem, causing morbidity, significant economic loss, and absenteeism.

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Metallo-Beta-Lactamase-Producing Acinetobacter spp. from Clinical Isolates at a Tertiary Care Hospital in Ghana

BioMed Research International ◽

10.1155/2020/3852419 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Michael A. Olu-Taiwo ◽

Japheth A. Opintan ◽

Francis Samuel Codjoe ◽

Akua Obeng Forson

Keyword(s):

Tertiary Care ◽

Multidrug Resistant ◽

Control Measures ◽

Clinical Isolates ◽

Diffusion Method ◽

Resistance Pattern ◽

Care Hospital ◽

Beta Lactamase ◽

Infection Control Measures ◽

Significant Difference

Metallo-beta-lactamase-producing Acinetobacter spp. is a major challenge for therapeutic treatment of nosocomial infections. This study is aimed at determining the prevalence of MBL-producing Acinetobacter spp. among 87 clinical isolates of Acinetobacter spp. from the Korle-Bu Teaching Hospital, Accra, between August 2014 and July 2015. Acinetobacter spp. was identified by standard bacteriological method, and resistance to different antibiotics was assessed with the Kirby–Bauer disc diffusion method. Meropenem-resistant Acinetobacter isolates were screened for enzyme activity using the modified Hodge test (MHT) and combined disc test (CDT). Additionally, multiplex PCR was used to determine MBL genes presence (blaVIM,blaIMP, and blaNDM). All Acinetobacter isolates showed high resistance to cefotaxime (90.8%), ceftazidime (75.9%), cotrimoxazole (70.1%), ciprofloxacin (64.4%), gentamicin (72.4%), levofloxacin (67.8%), and meropenem (59.8%). A total of 54 (62.1%) of Acinetobacter isolates were multidrug-resistant. Out of 52 (59.8%) meropenem-resistant Acinetobacter, 3 (5.8%) were carbapenemase producers by MHT, whilst, 23 (44.2%) were CDT positive. There was no significant difference between the resistance pattern of amikacin, ceftazidime, cotrimoxazole, ciprofloxacin, and meropenem amongst CDT-positive and CDT-negative isolates (p>0.05). A total of 7/87 (8.1%) CDT-positive Acinetobacter isolates harboured blaNDM; of these, 4 (57.1%) were from wound swabs, urine (n=2) (28.6%), and ear swab (n=1) (14.3%). The study revealed that less than 9% of Acinetobacter spp. contained blaNDM encoding genes. Strict antibiotics usage plan and infection control measures are required to prevent the spread of these resistance genes.

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Association between Pseudomonas aeruginosa O-antigen serotypes, resistance profiles and high-risk clones: results from a Spanish nationwide survey

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz346 ◽

2019 ◽

Vol 74 (11) ◽

pp. 3217-3220 ◽

Cited By ~ 3

Author(s):

Ester del Barrio-Tofiño ◽

Irina Sánchez-Diener ◽

Laura Zamorano ◽

Sara Cortes-Lara ◽

Carla López-Causapé ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

High Risk ◽

Nationwide Survey ◽

Control Measures ◽

The Novel ◽

O Antigen ◽

Infection Control Measures ◽

Specific Antisera ◽

Healthcare Associated ◽

Semi Empirical

Abstract Objectives To evaluate the correlation of O-antigen serotypes with resistance profiles and high-risk clones in a Spanish nationwide survey. Methods Up to 30 consecutive healthcare-associated Pseudomonas aeruginosa isolates were collected during October 2017 from each of 51 hospitals (covering all Spanish regions) with a total of 1445 isolates studied. MICs of 13 antipseudomonal agents and MDR/XDR profiles had been previously determined, as well as whole-genome sequences of 185 representative XDR isolates. O-antigen serotypes (O1–O16) were determined by agglutination using serotype-specific antisera (BioRad). The Pseudomonas aeruginosa serotyper (PAst) program was used for in silico serotyping. Results The most frequent serotypes were O6 (17.8%), O1 (15.4%) and O11 (13.3%). In contrast, the most frequent serotype among XDR isolates (17.3%) was O4 (34.1%), distantly followed by O11 (15.9%). Within serotypes, XDR phenotypes were more frequent for O12 (60.0%) and O4 (57.3%). The most frequent clone among the XDR isolates was ST175 (40.9%), followed by CC235 (10.7%), ST308 (5.2%) and CC111 (3.6%). Up to 81.6% of XDR ST175 isolates typed O4, whereas 18.4% were non-typeable. O4 genotype was detected in all sequenced (n=55) ST175 isolates. On the other hand, CC235 and ST308 were associated with O11, whereas CC111 was linked to serotype O12. Conclusions O4 serotype is linked to the MDR/XDR profile of widespread ST175 (typically only susceptible to colistin, amikacin and the novel combinations ceftolozane/tazobactam and ceftazidime/avibactam) and therefore, after local validation, its detection in the microbiology laboratory might be useful for guiding semi-empirical antipseudomonal therapies and infection control measures in Spanish hospitals.

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Control of an Outbreak of Multidrug-ResistantAcinetobacter baumannii-calcoaceticusColonization and Infection in an Intensive Care Unit (ICU) Without Closing the ICU or Placing Patients in Isolation

Infection Control and Hospital Epidemiology ◽

10.1086/507011 ◽

2006 ◽

Vol 27 (7) ◽

pp. 654-658 ◽

Cited By ~ 66

Author(s):

Mark Wilks ◽

Anne Wilson ◽

Simon Warwick ◽

Elizabeth Price ◽

Daniel Kennedy ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Tertiary Care ◽

Multidrug Resistant ◽

Control Measures ◽

Outbreak Strain ◽

Suction System ◽

Infection Control Measures ◽

Large Tertiary Care ◽

Cleaning Equipment

Objective.To describe the control of multidrug-resistantAcinetobacter baumannii-calcoaceticus(MDRABC) colonization and infection in an intensive care unit (ICU).Setting.An 18-bed ICU in a large tertiary care teaching hospital in London.Interventions.After recognition of the outbreak, a range of infection control measures were introduced over several months that were primarily aimed at reducing environmental contamination with the outbreak strain. Strategies included use of a closed tracheal suction system for all patients receiving mechanical ventilation, use of nebulized colistin for patients with evidence of mild to moderate ventilator-associated pneumonia, improved availability of alcohol for hand decontamination, and clearer designation of responsibilities and strategies for cleaning equipment and the environment in the proximity of patients colonized or infected with MDRABC.Results.The outbreak lasted from June 2001 through November 2002 and involved 136 new cases of MDRABC infection or colonization. The number of newly diagnosed cases per month reached a maximum of 15 in February 2002, and the number of new cases slowly decreased over the next 9 months.Conclusion.This outbreak was controlled by emphasizing the control of environmental reservoirs and did not require recourse to ward closure or placement of affected patients in isolation.

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Infection control measures in times of antimicrobial resistance: a matter of solidarity

Bioethics News ◽

10.1007/s40592-020-00119-9 ◽

2020 ◽

Vol 38 (S1) ◽

pp. 47-55 ◽

Cited By ~ 1

Author(s):

Babette Rump ◽

Aura Timen ◽

Marlies Hulscher ◽

Marcel Verweij

Keyword(s):

Well Being ◽

Multidrug Resistant ◽

Additional Benefit ◽

Control Measures ◽

Individual Autonomy ◽

Compensation Policy ◽

Public Interests ◽

Infection Control Measures ◽

Baseline Levels ◽

The One

AbstractControl measures directed at carriers of multidrug-resistant organisms are traditionally approached as a trade-off between public interests on the one hand and individual autonomy on the other. We propose to reframe the ethical issue and consider control measures directed at carriers an issue of solidarity. Rather than asking “whether it is justified to impose strict measures”, we propose asking “how to best care for a person’s carriership and well-being in ways that do not imply an unacceptable risk for others?”. A solidarity approach could include elevating baseline levels of precaution measures and accepting certain risks in cases where there is exceptionally much at stake. A generous national compensation policy that also covers for costs related to dedicated care is essential in a solidarity approach. An additional benefit of reframing the questions is that it helps to better acknowledge that being subjected to control measures is a highly personal matter.

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Epidemiology and clinical outcome of ventilator-associated events at a tertiary care hospital from North India

Tropical Doctor ◽

10.1177/0049475520982457 ◽

2020 ◽

pp. 004947552098245

Author(s):

Pooja Kumari ◽

Priya Datta ◽

Satinder Gombar ◽

Deepak Sharma ◽

Jagdish Chander

Keyword(s):

Mechanical Ventilation ◽

Tertiary Care Hospital ◽

Late Onset ◽

Tertiary Care ◽

Control Measures ◽

North India ◽

Ventilator Associated Pneumonia ◽

Care Hospital ◽

Infection Control Measures ◽

Utilisation Rate

The aim of our study was to determine the incidence, microbiological profile, risk factors and outcomes of patients diagnosed with ventilator-associated events in our tertiary care hospital. In this prospective study, intensive care patients put on mechanical ventilation for >48 h were enrolled and monitored daily for ventilator-associated event according to Disease Centre Control guidelines. A ventilator-associated event developed in 33/250 (13.2%); its incidence was 3.5/100 mechanical ventilation days. The device utilisation rate was 0.86, 36.4% of patients had early and 63.6% late-onset ventilator-associated pneumonia whose most common causative pathogen was Acinetobacter sp. (63.6%). Various factors were significantly associated with a ventilator-associated event: male gender, COPD, smoking, >2 underlying diseases, chronic kidney disease and elevated acute physiological and chronic health evaluation II scores. Therefore, stringent implementation of infection control measures is necessary to control ventilator-associated pneumonia in critical care units.

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Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.265 ◽

2021 ◽

pp. 1-7

Author(s):

Katharina R. Rynkiewich ◽

Jinal Makhija ◽

Mary Carl M. Froilan ◽

Ellen C. Benson ◽

Alice Han ◽

...

Keyword(s):

Infection Control ◽

Multidrug Resistant ◽

Control Measures ◽

Healthcare Personnel ◽

Skilled Nursing ◽

Infection Control Measures ◽

Carbapenem Resistant ◽

Resident Care ◽

Semistructured Interviews ◽

Self Protection

Abstract Objective: Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. Design: A qualitative study involving semistructured interviews. Setting: One vSNF in the Chicago, Illinois, metropolitan region. Participants: The study included 17 healthcare personnel representing management, nursing, and nursing assistants. Methods: We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. Results: Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were ‘invisible’ and potentially ‘threatening.’ Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. Conclusions: Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

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Molecular and Epidemiological Characterization of IMP-Type Metallo-β-Lactamase-Producing Enterobacter cloacae in a Large Tertiary Care Hospital in Japan

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02652-13 ◽

2014 ◽

Vol 58 (6) ◽

pp. 3441-3450 ◽

Cited By ~ 35

Author(s):

Kayoko Hayakawa ◽

Tohru Miyoshi-Akiyama ◽

Teruo Kirikae ◽

Maki Nagamatsu ◽

Kayo Shimada ◽

...

Keyword(s):

Hospital Mortality ◽

Tertiary Care ◽

Enterobacter Cloacae ◽

Control Measures ◽

Care Hospital ◽

Invasive Procedures ◽

Content Type ◽

Infection Control Measures ◽

Large Tertiary Care ◽

Close Relationship

ABSTRACTIMP-type metallo-β-lactamase enzymes have been reported in different geographical areas and in various Gram-negative bacteria. However, the risk factors and epidemiology pertaining to IMP-type metallo-β-lactamase-producingEnterobacter cloacae(IMP-producingE. cloacae) have not been systematically evaluated. We conducted a retrospective, matched case-control study of patients from whom IMP-producingE. cloacaeisolates were obtained, in addition to performing thorough molecular analyses of the clinically obtained IMP-producingE. cloacaeisolates. Unique cases with IMP-producingE. cloacaeisolation were included. Patients with IMP-producingE. cloacaewere matched to uninfected controls at a ratio of 1 to 3. Fifteen IMP-producingE. cloacaecases were identified, with five of the isolates being obtained from blood, and they were matched to 45 uninfected controls. All (100%) patients from whom IMP-producingE. cloacaeisolates were obtained had indwelling devices at the time of isolation, compared with one (2.2%) uninfected control. Independent predictors for isolation of IMP-producingE. cloacaewere identified as cephalosporin exposure and invasive procedures within 3 months. Although in-hospital mortality rates were similar between cases and controls (14.3% versus 13.3%), the in-hospital mortality of patients with IMP-producingE. cloacae-caused bacteremia was significantly higher (40%) than the rate in controls. IMP-producingE. cloacaeisolates were frequently positive for other resistance determinants. The MICs of meropenem and imipenem were not elevated; 10 (67%) and 12 (80%) of the 15 IMP-producingE. cloacaeisolates had a MIC of ≤1 μg/ml. A phylogenetic tree showed a close relationship among the IMP-producingE. cloacaesamples. Indwelling devices, exposure to cephalosporin, and a history of invasive procedures were associated with isolation of IMP-producingE. cloacae. Screening for carbapenemase production is important in order to apply appropriate clinical management and infection control measures.

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Antimicrobial drug sensitivity pattern of Pseudomonas aeruginosa in respiratory infections

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20172635 ◽

2017 ◽

Vol 6 (7) ◽

pp. 1591

Author(s):

Syed S. Ameen ◽

Shanmukananda Prakash ◽

Laxminarayana Bairy K. ◽

Shahabuddin Soherwardi

Keyword(s):

Pseudomonas Aeruginosa ◽

Respiratory Infections ◽

Tertiary Care ◽

Empirical Therapy ◽

Multidrug Resistant ◽

Resistance Rate ◽

Mortality And Morbidity ◽

Antimicrobial Susceptibility Pattern ◽

Sensitivity Pattern ◽

Male Preponderance

Background: Pseudomonas aeruginosa, a gram-negative pathogen commonly associated with nosocomial infections is the most widespread multidrug-resistant pathogen causing pneumonia in hospitalized patients. Inadequate empirical therapy has been associated with high mortality and morbidity. Objective: To evaluate and analyze the antimicrobial susceptibility pattern of P. aeruginosa in respiratory infections in a tertiary care hospital.Methods: The study was carried out at Kasturba Hospital, Manipal from Jan 2011 to Dec 2011. Specimens of 63 in-patients were analyzed who were culture positive for P. aeruginosa.Results: Majority of patients were aged above 40yrs with a male preponderance. Specimens were taken from patients who were diagnosed with bronchiectasis, pneumonia, COPD, bronchial asthma etc. Overall the organism was most sensitive to carbapenems (87.3%) followed by cefoperazone-sulbactam combination (85.7%). Sensitivity to ceftazidime and cefepime was equal (82.5%) and was more when compared to piperacillin-tazobactam (81.5%). Overall resistance rate was highest for fluoroquinolones (23.8%) followed by aztreonam (22.2%).Conclusions: Hence we would like to recommend cefoperazone-sulbactam as the preferred antipseudomonal agent and carbapenems as reserved drugs in treating pseudomonal lung infections. Use of fluoroquinolones and aztreonam as monotherapy in resistant P. aeruginosa infections should be restricted.

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The interplay of SARS-CoV-2 and Clostridioides difficile infection

Future Microbiology ◽

10.2217/fmb-2020-0275 ◽

2021 ◽

Vol 16 (6) ◽

pp. 439-443

Author(s):

Sahil Khanna ◽

Colleen S Kraft

Keyword(s):

High Risk ◽

Infection Control ◽

Gastrointestinal Symptoms ◽

Control Measures ◽

Antibiotic Exposure ◽

Hospital Acquired Infections ◽

Infection Control Measures ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Hospital Acquired

The COVID-19 pandemic has changed the way we practice medicine and lead our lives. In addition to pulmonary symptoms; COVID-19 as a syndrome has multisystemic involvement including frequent gastrointestinal symptoms such as diarrhea. Due to microbiome alterations with COVID-19 and frequent antibiotic exposure, COVID-19 can be complicated by Clostridioides difficile infection. Co-infection with these two can be associated with a high risk of complications. Infection control measures in hospitals is enhanced due to the COVID-19 pandemic which in turn appears to reduce the incidence of hospital-acquired infections such as C. difficile infection. Another implication of COVID-19 and its potential transmissibility by stool is microbiome-based therapies. Potential stool donors should be screened COVID-19 symptoms and be tested for COVID-19.

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