scholarly journals 100% Single-Patient Rooms and Environmental Contamination With Highly Resistant Microorganisms: The MOVE Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s91-s92
Author(s):  
nne S. van der Schoor ◽  
t holt ◽  
tte A. Severin ◽  
Diederik Gommers ◽  
Marco J. Bruno ◽  
...  
Keyword(s):  
Environmental Contamination ◽  
Medical Center ◽  
Hospital Environment ◽  
Clinical Samples ◽  
Environmental Sampling ◽  
Single Patient ◽  
Long Term Effect ◽  
Number Of Patients ◽  
Vancomycin Resistant

Background: Studies have shown that patients colonized with highly resistant microorganisms (HRMO) contaminate the hospital environment, and that transmission from contaminated environments to patients occurs. In May 2018, the Erasmus MC University Medical Center, Rotterdam, moved from a hospital with mostly multiple-occupancy rooms to a new hospital with 100% single-patient rooms with private bathrooms. This move provided the unique opportunity to determine environmental contamination before the new hospital was open for admissions and thereafter and to compare the environmental contamination to the number of patients colonized with HRMO. Method: Environmental sampling took place twice in the old building and 12 times in the new building, from 2 weeks before to 15 months after relocating patients. At each moment, ~306 samples were taken from 13 locations (eg, nightstands, sinks) in 40 patient rooms. Samples were screened for Staphylococcus aureus (methicillin-susceptible [MSSA] and methicillin resistant [MRSA]) and highly resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus faecium, and Enterobacteriales. During the study period, January 1, 2018, until August 31, 2019, all clinical samples positive for HRMO were included. Results: Environmental sampling revealed that 29 of 724 (4.0%) locations were positive for HRMO in the old building, whereas 4 of 3,358 (0.1%) samples in the new building were positive for HRMO (P < .001). In the old building, 14 of 29 locations were positive for extended-spectrum β-lactamase (ESBL)–producing bacteria and 15 were positive for carbapenemase-producing bacteria. In the new building, 3 of 4 positive samples were positive for vancomycin-resistant E. faecium (VRE), 1 was positive for ESBL-producing K. pneumoniae. For both HRMO, no carriers were detected. In the old building, 145 of 12,256 adult patients (1.2%) had clinical samples positive for HRMO, compared to 561 of 38,397 (1.5%) in the new building, a small but significant increase (P = .02). Conclusions: The transition from mainly 2- and 4-person rooms to 100% single-patient rooms resulted in a significant decrease in environmental contamination, even though the number of patients colonized with HRMO slightly increased. No molecular typing to determine transfer from environment to patients and vice versa has yet been performed. Future sampling is needed to determine whether the low environmental contamination is a long-term effect of the transition to single rooms.Funding: NoneDisclosures: None

scholarly journals Species Diversity of Environmental GIM-1-Producing Bacteria Collected during a Long-Term Outbreak

2016 ◽  
Vol 82 (12) ◽  
pp. 3605-3610 ◽  
Author(s):  
Andreas F. Wendel ◽  
Sofija Ressina ◽  
Susanne Kolbe-Busch ◽  
Klaus Pfeffer ◽  
Colin R. MacKenzie
Keyword(s):  
Resistance Genes ◽  
Multidrug Resistant ◽  
Hospital Environment ◽  
Resistant Bacteria ◽  
Environmental Sampling ◽  
Gram Negative Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Negative ◽  
Content Type

ABSTRACTReports of outbreaks concerning carbapenemase-producing Gram-negative bacteria in which the main source of transmission is the hospital environment are increasing. This study describes the results of environmental sampling in a protracted polyspecies metallo-beta-lactamase GIM-1 outbreak driven by plasmids and bacterial clones ofEnterobacter cloacaeandPseudomonas aeruginosain a tertiary care center. Environmental sampling targeting wet locations (especially sinks) was carried out on a surgical intensive care unit and on a medical ward on several occasions in 2012 and 2013. We were able to demonstrate 43blaGIM-1-carrying bacteria (mainly nonfermenters but alsoEnterobacteriaceae) that were either related or unrelated to clinical strains in 30 sinks and one hair washbasin. GIM-1 was found in 12 different species, some of which are described here as carriers of GIM-1. Forty out of 43 bacteria displayed resistance to carbapenems and, in addition, to various non-beta-lactam antibiotics. Colistin resistance was observed in twoE. cloacaeisolates with MICs above 256 mg/liter. TheblaGIM-1gene was harbored in 12 different class 1 integrons, some without the typical 3′ end. TheblaGIM-1gene was localized on plasmids in five isolates.In vitroplasmid transfer by conjugation was successful in one isolate. The environment, with putatively multispecies biofilms, seems to be an important biological niche for multidrug-resistant bacteria and resistance genes. Biofilms may serve as a “melting pot” for horizontal gene transfer, for dissemination into new species, and as a reservoir to propagate future hospital outbreaks.IMPORTANCEIn Gram-negative bacteria, resistance to the clinically relevant broad-spectrum carbapenem antibiotics is a major public health concern. Major reservoirs for these resistant organisms are not only the gastrointestinal tracts of animals and humans but also the (hospital) environment. Due to the difficulty in eradicating biofilm formation in the latter, a sustained dissemination of multidrug-resistant bacteria from the environment can occur. In addition, horizontal transfer of resistance genes on mobile genetic elements within biofilms adds to the total “resistance gene pool” in the environment. To gain insight into the transmission pathways of a rare and locally restricted carbapenemases resistance gene (blaGIM-1), we analyzed the genetic background of theblaGIM-1gene in environmental bacteria during a long-term polyspecies outbreak in a German hospital.

scholarly journals Genetic typing of Enterococcus faecium VRE strains isolated in three hospitals in Warsaw and Siedlce in 2015-2016

2019 ◽  
pp. 49-60
Author(s):  
Wanda Kamińska ◽  
Monika Grochowska ◽  
Agnieszka Chmielarczyk ◽  
Anna Olszewska ◽  
Grażyna Skolimowska ◽  
...  
Keyword(s):  
Selective Pressure ◽  
Horizontal Transmission ◽  
Pulsed Field Gel Electrophoresis ◽  
Clinical Samples ◽  
Genetic Typing ◽  
Pfge Typing ◽  
Vancomycin Resistant Enterococci ◽  
Number Of Patients ◽  
Rectal Swabs ◽  
Vancomycin Resistant

INTRODUCTION. Since the first report of vancomycin-resistant enterococci (VRE) in Poland, in 1996, these strains have spread in Polish hospitals, mainly due to selective pressure associated with increased use of vancomycin in the treatment of infections caused by methicillin-resistant staphylococci and Clostridium difficile. At the beginning of 2016 a growing number of patients colonized with VRE in the gastrointestinal tract was observed in the Children’s Memorial Health Institute (IPCZD). Some of these patients were transferred from other hospitals, and VRE colonization was found on admission. AIM. To analyze genetic similarity of VRE strains isolated from patients hospitalized in IPCZD and two other hospitals in Mazovian district, genetic typing by pulsed field gel electrophoresis (PFGE) was performed. MATERIALS AND METHODS. VRE strains were isolated from rectal swabs, and other clinical samples such as blood, cerebrospinal fluid, other body fluids, and environmental samples. A total of 56 VRE strains from IPCZD, 20 strains from Siedlce and 4 strains from patients from Grochowski Hospital in Warsaw were typed by PFGE. RESULTS. PFGE typing revealed 4 VRE clones containing several strains with identical restriction patterns. Among VRE strains isolated from neonates hospitalized in IPCZD, two clones with 24 and 20 identical strains were found. Respectively, 16 (67%) and 12 (60%) isolates were originated from rectal swabs from patients at admission to the hospital. Clonal strains were identified in all three hospitals included in the study. CONCLUSIONS. Our results showed that VRE strains had spread in the region. Isolation of clonal strains on admission to the hospital suggested independent VRE introductions from environment or other hospitals. Identification of clonal strains obtained from rectal swabs and other clinical samples during hospitalization indicated horizontal transmission.

Skin and Environmental Contamination With Vancomycin-Resistant Enterococci in Patients Receiving Oral Metronidazole or Oral Vancomycin Treatment forClostridium difficile–Associated Disease

2009 ◽  
Vol 30 (1) ◽  
pp. 13-17 ◽  
Author(s):  
Ajay K. Sethi ◽  
Wafa N. Al-Nassir ◽  
Michelle M. Nerandzic ◽  
Curtis J. Donskey
Keyword(s):  
Fecal Incontinence ◽  
Environmental Contamination ◽  
Prospective Observational Study ◽  
Medical Center ◽  
Veterans Affairs ◽  
Vancomycin Resistant Enterococci ◽  
Before And After ◽  
Vancomycin Resistant ◽  
Vancomycin Treatment ◽  
Oral Metronidazole

Background.Oral metronidazole has been recommended for treatment of mild-to-moderateClostridium difficile–associated disease (CDAD), in part because of concern that use of vancomycin may be more likely to promote colonization and transmission of vancomycin-resistant enterococci (VRE). The objective of our study was to compare the frequency of skin and environmental VRE contamination associated with metronidazole treatment for CDAD with such frequency associated with vancomycin treatment for CDAD.Design.Prospective, observational study. This study was performed at the Cleveland Veterans Affairs Medical Center (Cleveland, OH). For patients with CDAD who had concurrent VRE colonization, stool, skin, and environmental samples were cultured for VRE before, during, and up to 3 weeks after therapy with metronidazole or vancomycin. The proportions of skin and environmental contamination were compared before and after resolution of diarrhea and during treatment with metronidazole or vancomycin.Results.Of the 34 patients, 17 were treated with vancomycin and 17 were treated with metronidazole. The proportion of environmental cultures that were positive for VRE was significantly higher during resolution of diarrhea than it was after resolution of diarrhea (38% vs 28%;P= .025), whereas the proportion of skin cultures positive was not different during and after resolution of diarrhea (78% vs 71%;P= .60). There were no differences between patients who received metronidazole and patients who received vancomycin in the proportions of skin culture results (73% vs 77%;P= .80) or environmental culture results (37% vs 32%;P= .359) that were positive for VRE. Eleven patients (32%) had chronic fecal incontinence, and 28 (82%) had incontinence at least once during their CDAD episode.Conclusions.In VRE-colonized patients with CDAD who experienced frequent fecal incontinence, skin and environmental VRE contamination was common during and after resolution of diarrhea. The frequency of VRE contamination was similar between patients treated with metronidazole and patients treated with vancomycin.

scholarly journals Long term effect of external pituitary irradiation on IGF1 levels in patients with acromegaly free of adjunctive treatment

2009 ◽  
Vol 161 (4) ◽  
pp. 547-551 ◽  
Author(s):  
K Mullan ◽  
C Sanabria ◽  
W P Abram ◽  
E M McConnell ◽  
H C Courtney ◽  
...  
Keyword(s):  
Medical Records ◽  
Term Effect ◽  
Adjunctive Treatment ◽  
Reference Ranges ◽  
Age Related ◽  
Long Term Effect ◽  
Number Of Patients ◽  
Pituitary Irradiation ◽  
Serum Gh

ObjectiveIt is established that external pituitary irradiation (EPI) effectively reduces serum GH levels in acromegaly. However, its effect in normalising serum IGF1 has been disputed. We looked at the number of our patients who achieved persistently normal IGF1 levels whilst free of adjunctive treatment for at least 1 year after EPI.Patients and designWe identified 63 acromegalic patients between 1964 and 2004 who received EPI. Six were excluded: three had surgery after EPI, two had no medical records available, and one had a pituitary Yttrium implant.MeasurementsPatients received 4500–5000 cGy in fractionated doses. IGF1 levels were correlated with their respective age-related reference ranges.ResultsAfter EPI, the number of patients with normal IGF1 and free of adjunctive medical treatment for at least 1 year were four patients by 3 years, nine patients by 5 years and seventeen by 10 years, with the current number of 25/57 (44%). Concordance between IGF1 levels and random GH dropped from 90% at the time of EPI to 65% at 3 years, 66% at 5 years and 71% at 10 years.ConclusionsWe have demonstrated that, with time, EPI achieves a normal IGF1 in significant numbers of patients with acromegaly, thus obviating the need for life-long expensive medical therapy. For each patient this benefit has to be weighed against the possibility of new hypopituitarism as a result of the treatment. Any decision to use EPI is easier in the context of pre-existent hypopituitarism.

scholarly journals Arrowroot as a treatment for diarrhoea in irritable bowel syndrome patients: a pilot study

2000 ◽  
Vol 37 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Caroline COOKE ◽  
Irene CARR ◽  
Keith ABRAMS ◽  
John MAYBERRY
Keyword(s):  
Irritable Bowel Syndrome ◽  
Abdominal Pain ◽  
Pilot Study ◽  
Term Effect ◽  
Treatment Results ◽  
Long Term Effect ◽  
Number Of Patients ◽  
Bowel Action ◽  
Irritable Bowel

Objectives - Arrowroot is an old-fashioned remedy for diarrhoea, but no clinical studies have been done to evaluate its effectiveness. The aim of this pilot study was to assess its efficacy as a treatment for diarrhoea in 11 patients, all of whom had irritable bowel syndrome with diarrhoea as a feature. Methods - The patients were interviewed and a questionnaire completed on entry into the trial. They then took 10 mL arrowroot powder three times a day for one month and discontinued the treatment for the subsequent month. Questionnaires were completed after one month on treatment and at the end of the trial after one month off treatment. Results - Arrowroot reduced diarrhoea and had a long-term effect on constipation. It also eased abdominal pain. Conclusion - Arrowroot is an effective treatment for diarrhoea. Its action could be explained by several theories which relate to an increase in faecal bulk and thus a more efficient bowel action. The number of patients was small, and further studies are needed to substantiate preliminary results.

scholarly journals Value of Nontargeted Screening for Highly Resistant Microorganisms: The MOVE Study

2020 ◽  
Vol 41 (S1) ◽  
pp. s429-s430
Author(s):  
Adriënne S. van der Schoor ◽  
Anne F. Voor in ‘t holt ◽  
Juliëtte A. Severin ◽  
Diederik Gommers ◽  
Marco J. Bruno ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Clinical Sample ◽  
Medical Center ◽  
Clinical Samples ◽  
Research Initiative ◽  
True Number ◽  
Number Of Patients ◽  
Targeted Screening ◽  
Additional Value

Background: In the Erasmus MC University Medical Center, Rotterdam, the Netherlands, patients considered at risk for carrying highly resistant microorganisms (HRMO) are placed in isolation on admission, until tested negative for HRMO (ie, targeted screening). Patients without risk factors are not routinely screened (ie, nontargeted screening). However, nontargeted screening could identify patients colonized with HRMO missed by targeted screening. To determine the additional value of nontargeted screening, we compared the outcomes of the nontargeted screening approach with all available clinical cultures. Objective: We aim to identify patients colonized with HRMO, but missed by targeted screening, and to determine whether non-targeted screening has additional value. Methods: For the MOVE study, nontargeted admission and discharge cultures (nose and perianal) were obtained from randomly selected patients admitted to specific wards, regardless of HRMO risk factors. This study was part of a research initiative to identify the relation of a contaminated environment with the risk of becoming infected or colonized on a patient level. All bacteriological clinical samples positive for at least 1 HRMO from January 1, 2018, until August 31, 2019, were compared with the nontargeted screening samples. Samples were screened for methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) as well as highly resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Enterococcus faecium, and Enterobacteriales. Broth enrichment was used for all cultures. Results: During the study period, 50,653 patients were admitted. 706 patients (1%) had a clinical sample positive for at least 1 HRMO during their hospital stay. 936 (1.8%) patients were included in the nontargeted screening for the MOVE study, and 40 patients were found to have at least 1 culture positive for HRMO (4.3%). Among these 40 patients, 28 were positive at admission and 12 were positive at discharge. Extended-spectrum β-lactamase (ESBL)–producing Enterobacteriales were most prevalent (n = 36, 90.0%) both at admission and discharge (n = 26 and n = 10, respectively). At admission, 1 patient was identified with MRSA and 1 patient was positive for vancomycin-resistant E. faecium (VRE). At discharge, 1 patient was identified with VRE and 1 had Verona Integron-encoded Metallo-β-lactamase (VIM)–positive P. aeruginosa. Conclusions: Our results show that the current targeted screening does not identify all HRMO carriers. Furthermore, patients who acquire an HRMO during admission are missed. The nontargeted screening identified 40 unknown carriers (4.3%). The limitations of the study are the restricted number of sample sites and the fact that we were unable to culture all patients. Therefore, it is likely that our study shows an underestimation of the true number of patients with HRMO.Funding: NoneDisclosures: None

scholarly journals Long Term Effect of VATS Sympathectomy for the Management of Primary Hyperhidrosis, Our Experience at King Hussein Medical Center

2020 ◽  
Vol 8 (10) ◽  
pp. 2402-2404
Author(s):  
Ala Mohammad Qayet ◽  
Mutaz Fawaz Haddadin ◽  
Qasim Mohammad Al-Qaisi ◽  
Rami Ahmad Al-Qatameen ◽  
Amany Abdullah Al-Mashagebah ◽  
...  
Keyword(s):  
Medical Center ◽  
Term Effect ◽  
Long Term Effect ◽  
Primary Hyperhidrosis

scholarly journals Virulence factors and beta-lactamase production among vancomycin-resistant Enterococcus faecalis isolated from clinical samples and hospital environment

2016 ◽  
Vol 5 (1) ◽  
pp. 1 ◽  
Author(s):  
Moses David ◽  
Kennedy Imonitie ◽  
Richard Osuntoyinbo ◽  
Adetunji Olawale
Keyword(s):  
Enterococcus Faecalis ◽  
Virulence Factors ◽  
Test Organism ◽  
Opportunistic Pathogen ◽  
Hospital Environment ◽  
Clinical Samples ◽  
Beta Lactamase ◽  
Vana Gene ◽  
Surgical Ward ◽  
Vancomycin Resistant

Enterococcus faecalis, though opportunistic pathogen has emerged as one of the leading nosocomial pathogens and has been implicated in different human infections. The severity of the infections caused by this organism is largely due to its complex pathogenic process. The objective of this study was to determine the carriage of virulence factors and vanA gene among the strains of vancomycin-resistant E. faecalis isolated from hospitals. Standard methods were used for isolation, antibiotic susceptibility and detection of virulence factors in the isolates. A total of one hundred and twenty three (123) samples were screened out of which 69 (45.70 %) yielded E. faecalis. The highest percentage of the isolates was recovered from the environment followed by the clinical samples. Children surgical ward had the highest occurrence of the test organism followed by male surgical ward. All the isolates were resistant to both amoxycillin/clavulanic acid and ceftazidime, while 98.55%, 89.86% and 53.62% were resistant to ampicillin, cefuroxime and gentamicin respectively. Only twenty seven (39.13%) of the isolates were resistant to the vancomycin. Among the vancomycin-resistant isolates, haemolysin had the highest occurrence (60.29%) followed by caseinase (55.88%). A total of 16 (59.26%) were beta-lactamase positive while 8 (29.63%) out of the isolates (vancomycin-resistant) were non-biofilm former while vanA genes was detected in 9 (33.33%) of the isolates. This study gives an insight to antibiotic resistant pattern of circulating Enterococcus faecalis and also the isolate showed varying patterns of virulent factors.

scholarly journals Comparison of Fully Coated Anti-Reflux Metal Stenting and Per-Oral Endoscopic Myotomy in Patients with Achalasia: A Propensity Score- Matched Retrospective Study

2021 ◽  
Author(s):  
yufen tang ◽  
Peng Jin ◽  
Yu-rong Tao ◽  
Hui Xie ◽  
Xin Wang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Medical Center ◽  
Operation Time ◽  
Previous Treatment ◽  
Term Effect ◽  
Esophageal Motility Disorder ◽  
Long Term Effect ◽  
Hospitalization Costs ◽  
Remission Rates

Abstract Background: Achalasia is a rare primary esophageal motility disorder disease. It is reported that the long-term effect of fully coated anti-reflux metal stent (FCARMS) implantation is satisfactory. Operated by a skilled and experienced endoscopist, the effect of POEM treatment is equivalent to that of surgical myotomy. So far, there is still few evidence to prove stent implantation or POEM which is better for achalasia. The choice of treatment for achalasia is still controversial. Therefore, the aim of this study is to find a more suitable therapy for achalasia by comparing the efficacy of FCARMS implantation and POEM.Methods: A propensity score (PS) matching (1:2) was used in this retrospective cohort study. Data collected from consecutive patients of Achalasia, receiving FCARMS implantation or POEM therapy at the department of gastroenterology, the Seventh Medical Center of the Chinese People’s Liberation Army General Hospital from May 2007 to May 2018. According to their previous treatment, they are divided into two groups, FCARMS group and POEM group. Clinical efficacy and complications were compared between the two groups.Results: A total of 166 cases were collected, including 113 cases of FCARMS and 53 cases of POEM. By PS matching, 150 patients were enrolled (100 cases of FCARMS and 50 cases of POEM). By comparison, the FCARMS group has shorter operation time, shorter fasting time and lower hospitalization costs than the POEM group (p<0.05). Common complications in the FCARMS group are nausea, vomiting, and stent shift. Repetitions of gastroscopy in the FCARMS group was more often, which were 3.8±2.4（vs 2.1±1.8 of POEM）(p=0.00<0.05) The 6-month remission rates of the FCARMS combination POEM group were 89% and 94%, respectively (p=0.39), and the 2-year remission rates were 61% and 90%, respectively (p=0.00).Conclusions: Stent placement is a cost-effective and safe treatment option for achalasia. The short-term effect (less than 6 mons) of FCARMS is similar to that of POEM, the long-term effect (more than 2 years)，POEM is better than FCARMS. HRMⅡis most suitable for POEM treatment. It indicate that Patients can choose treatment methods according to their own conditions.

DETECTION AND CHARACTERISATION OF VANCOMYCIN RESISTANT ENTEROCOCCAL ISOLATES OF CLINICAL SAMPLES FROM A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 76-79
Author(s):  
R.Beaula Lilly ◽  
V.K.M. Banu
Keyword(s):  
Multiple Drug Resistance ◽  
Tertiary Care ◽  
Vancomycin Resistance ◽  
Therapeutic Options ◽  
Hospital Environment ◽  
Clinical Samples ◽  
Multiple Drug ◽  
Care Hospital ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

The emergence of Vancomycin resistant enterococci (VRE) has posed serious threats to the community because they exhibit multiple drug resistance, thus limiting the therapeutic options for the clinicians. As Vancomycin resistant enterococci (VRE) also have ampicillin resistance and high level aminoglycoside resistance, they are the most difcult to treat. The therapeutic options are limited by elimination of the synergy between aminoglycoside and the beta lactum drugs which is the treatment of choice for enterococcal infections which is of great concern. More antibiotic resistance makes these pathogens excellent survivors in hospital environment and cause nosocomial infections. Atotal of 142 enterococcal isolates from various clinical samples were identied to their species level and subjected to antimicrobial susceptibility testing to various antibiotics. Initial screening for Vancomycin resistance was done using the Vancomycin Screen Agar and the isolates showing resistance were subjected to Vancomycin and Teicoplanin MIC and later these isolates showing resistance were conrmed by genotypic methods for Vancomycin resistant genes.Total VRE isolates as per Vancomycin MIC value were 19 and the prevalence rate was 13.3% (19/142).In PCR assay, a total of 16 isolates including 13 E.faecium and 3 E.faecalis were found to be of Van B genotype and the remaining 3 isolates including 2 E.faecium and 1 E.faecalis were found to be of Van A genotype. In this study, the prevalence of Vancomycin resistance in Enterococcal species is 13.3% as per vancomycin MIC by Micro broth dilution technique. The phenotypic detection of Vancomycin resistance by MIC of Vancomycin and Teicoplanin correlates with the genotypic method of detection of Vancomycin resistant genes (VanA, VanB).

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