874. Pseudo-outbreak of Adenovirus in Bronchoscopy Suite

Abstract Background Adenoviruses (Adv) are non-enveloped viruses that can survive for long periods on environmental surfaces. However, only 1 prior publication describes an adenovirus pseudo-outbreak associated with bronchoscopes. In 1/ 2020 infectious disease physicians noted a cluster of Adv PCR-positive bronchiolar lavage (BAL) samples, which prompted an outbreak investigation. Methods We reviewed medical charts, clinical microbiology, procedure logs, bronchoscope reprocessing logs, bronchoscope cleaning, and high-level disinfection (HLD) practices. Results On 1/28/20 an infectious diseases physician alerted infection prevention to a cluster of 5 lung transplant patients diagnosed with Adv positive BAL samples. Four out of the 5 patients had the bronchoscopy in the same bronchoscopy suite. We reviewed BAL results from all bronchoscopies performed in this suite from 11/1/19 to 1/24/20 and found a total of 10 patients with positive Adv PCR results. Eight out of the 10 patients had bronchoscopies with one of two bronchoscopes. Of all patients who had a bronchoscopy with the bronchoscope from 11/1/19 to 1/24/20 and had respiratory viral panel sent at that time, 6 of 11 (55%) who underwent procedure with Scope A and 4 of 24 (17%) who underwent procedure with Scope B had positive Adv PCR results. Sham BALs were performed on both bronchoscopes and testing for Adv was negative. However, on inspection by the manufacturer, one scope failed both wet and dry leak tests and had several physical defects. Following removal of both bronchoscopes from service we did not find any positive Adv samples from the bronchoscopy unit. Conclusion Previously, very few pseudo-outbreaks of Adv have been linked to bronchoscopes. We identified a pseudo-outbreak of Adv associated with 2 bronchoscopes in a hospital-based bronchoscopy suite that stopped once we removed the associated bronchoscopes from the procedural unit. Bronchoscopy-related pseudo-outbreaks occur despite standardized procedures for HLD. Bronchoscopy clinics, particularly those with a high volume of immunocompromised patients, should prospectively review BAL cultures to identify unusual pathogen trends. These trends may be a sign of damaged equipment that would otherwise go undetected. Disclosures All Authors: No reported disclosures

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Improved Outcomes Amongst High Risk Lung Transplant Patients at High Volume Centers: A Case for Regionalization in the US

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2015.01.673 ◽

2015 ◽

Vol 34 (4) ◽

pp. S243

Author(s):

J.C. Grimm ◽

J. Magruder ◽

A. Kilic ◽

V. Valero ◽

S.P. Dungan ◽

...

Keyword(s):

High Risk ◽

Lung Transplant ◽

High Volume ◽

Transplant Patients ◽

Improved Outcomes ◽

The Us

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Adenovirus Type 21 Outbreak Among Lung Transplant Patients at a Large Tertiary Care Hospital

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy188 ◽

2018 ◽

Vol 5 (8) ◽

Cited By ~ 1

Author(s):

Sarah E Philo ◽

Benjamin D Anderson ◽

Sylvia F Costa ◽

Nancy Henshaw ◽

Sarah S Lewis ◽

...

Keyword(s):

Intensive Care Unit ◽

Lung Transplant ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Human Adenovirus ◽

Adenovirus Type ◽

Care Hospital ◽

Immunocompromised Patients ◽

Transplant Patients ◽

Large Tertiary Care

Abstract Here we summarize an April 2016, 7-patient cluster of human adenovirus (HAdV) infections in a cardiothoracic surgery intensive care unit. We show that the patients were infected with a single HAdV21b type. Rapid HAdV typing diagnostics and effective antiviral interventions are needed for immunocompromised patients suffering from HAdV infections.

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Susceptibility of Candida auris and Candida albicans to 21 germicides used in healthcare facilities

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.1 ◽

2019 ◽

Vol 40 (3) ◽

pp. 380-382 ◽

Cited By ~ 18

Author(s):

William A. Rutala ◽

Hajime Kanamori ◽

Maria F. Gergen ◽

Emily E. Sickbert-Bennett ◽

David J. Weber

Keyword(s):

Fungal Pathogen ◽

Infection Prevention ◽

Antifungal Drugs ◽

Prevention Strategies ◽

Candida Auris ◽

Healthcare Facilities ◽

Surface Disinfection ◽

Environmental Surfaces ◽

Severe Infections ◽

High Level

Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it can cause severe infections with frequent mortality in more than a dozen countries. It can survive on healthcare environmental surfaces for at least 7 days and can cause outbreaks in healthcare facilities. Clearly, infection prevention strategies, such as surface disinfection, will be essential to controlling Candida transmission. Unfortunately, data on the activity of antiseptics and disinfectants used in healthcare to inactivate this pathogen are limited.1–5 In this study, we investigated 12 different disinfectants (ie, 8 low- and intermediate-level disinfectants in 2 dilutions of sodium hypochlorite and 5 high-level disinfectants/chemical sterilants) and 9 antiseptics commonly used in healthcare facilities for their antimicrobial activity against C. auris and C. albicans.

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The Effect of Early Treatment of PC945 on Aspergillus Fumigatus Lung Infection in Lung Transplant Patients.

Case Medical Research ◽

10.31525/ct1-nct03905447 ◽

2019 ◽

Author(s):

Keyword(s):

Aspergillus Fumigatus ◽

Early Treatment ◽

Lung Transplant ◽

Lung Infection ◽

Transplant Patients

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Morbidity and Mortality after General Surgery in Heart and Lung Transplant Patients

SSRN Electronic Journal ◽

10.2139/ssrn.3456898 ◽

2019 ◽

Author(s):

Alek Zywot ◽

Amber L. Turner ◽

Joanna Sesti ◽

Russell C. Langan ◽

Andrew Nguyen ◽

...

Keyword(s):

General Surgery ◽

Lung Transplant ◽

Morbidity And Mortality ◽

Transplant Patients

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Benefit of a pharmacist-led intervention for medication management of renal transplant patients: a controlled before-and-after study

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211005275 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110052

Author(s):

Jeremy Chambord ◽

Lionel Couzi ◽

Pierre Merville ◽

Karine Moreau ◽

Fabien Xuereb ◽

...

Keyword(s):

Medication Adherence ◽

Immunosuppressive Therapy ◽

Medication Management ◽

Intervention Group ◽

Knowledge Score ◽

Control Group ◽

Patient Knowledge ◽

Transplant Patients ◽

Before And After ◽

High Level

Aims: To assess the effect of a pharmacist-led intervention, using Barrows cards method, during the first year after renal transplantation, on patient knowledge about their treatment, medication adherence and exposure to treatment in a French cohort. Methods: We conducted a before-and-after comparative study between two groups of patients: those who benefited from a complementary pharmacist-led intervention [intervention group (IG), n = 44] versus those who did not [control group (CG), n = 48]. The pharmacist-led intervention consisted of a behavioral and educational interview at the first visit (visit 1). The intervention was assessed 4 months later at the second visit (visit 2), using the following endpoints: treatment knowledge, medication adherence [proportion of days covered (PDC) by immunosuppressive therapy] and tacrolimus exposure. Results: At visit 2, IG patients achieved a significantly higher knowledge score than CG patients (83.3% versus 72.2%, p = 0.001). We did not find any differences in treatment exposure or medication adherence; however, the intervention tended to reduce the proportion of non-adherent patients with low knowledge scores. Using the PDC by immunosuppressive therapy, we identified 10 non-adherent patients (10.9%) at visit 1 and six at visit 2. Conclusions: Our intervention showed a positive effect on patient knowledge about their treatment. However, our results did not show any improvement in overall medication adherence, which was likely to be because of the initially high level of adherence in our study population. Nevertheless, the intervention appears to have improved adherence in non-adherent patients with low knowledge scores.

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317: Does Ciclosporine C2 Levels Determine Outcome in De Novo Heart and Lung Transplant Patients: Results from the NOCTURNE Nordic Multi Centre Study

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2008.11.324 ◽

2009 ◽

Vol 28 (2) ◽

pp. S176

Author(s):

F. Nilsson ◽

S. Simonsen ◽

J. Sipponen ◽

H. Eiskjaer ◽

L. Mared ◽

...

Keyword(s):

Lung Transplant ◽

De Novo ◽

Multi Centre Study ◽

Centre Study ◽

Transplant Patients

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Inactivation of Candida auris and Candida albicans by Ultraviolet-C

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.868 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s292-s292

Author(s):

William Rutala ◽

Hajime Kanamori ◽

Maria Gergen ◽

Emily Sickbert-Bennett ◽

David Jay Weber

Keyword(s):

Infection Prevention ◽

Antifungal Drugs ◽

Candida Auris ◽

Healthcare Facilities ◽

Environmental Surfaces ◽

Route Of Transmission ◽

Indirect Exposure ◽

Ultraviolet C ◽

Severe Infections ◽

Uv C

Background:Candida auris is an emerging fungal pathogen that is often resistant to major classes of antifungal drugs. It is considered a serious global health threat because it has caused severe infections with frequent mortality in over a dozen countries. C. auris can survive on healthcare environmental surfaces for at least 7 days, and it causes outbreaks in healthcare facilities. C. auris has an environmental route of transmission. Thus, infection prevention strategies, such as surface disinfection and room decontamination technologies (eg, ultraviolet [UV-C] light), will be essential to controlling transmission. Unfortunately, data are limited regarding the activity of UV-C to inactivate this pathogen. In this study, a UV-C device was evaluated for its antimicrobial activity against C. auris and C. albicans. Methods: We tested the antifungal activity of a single UV-C device using the vegetative bacteria cycle, which delivers a reflected dose of 12,000 µW/cm2. This testing was performed using Formica sheets (7.6 × 7.6 cm; 3 × 3 inches). The carriers were inoculated with C. auris or C. albicans and placed horizontal on the surface or vertical (ie, perpendicular) to the vertical UV-C lamp and at a distance from 1. 2 m (~4 ft) to 2.4 m (~8 ft). Results: Direct UV-C, with or without FCS (log10 reduction 4.57 and 4.45, respectively), exhibited a higher log10 reduction than indirect UV-C for C. auris (log10 reduction 2.41 and 1.96, respectively), which was statistically significant (Fig. 1 and Table 1). For C. albicans, although direct UV-C had a higher log10 reduction (log10 reduction with and without FCS, 5.26 and 5.07, respectively) compared to indirect exposure (log10 reduction with and without FCS, 3.96 and 3.56, respectively), this difference was not statistically significant. The vertical UV had statistically higher log10 reductions than horizontal UV against C. auris and C. albicans with FCS and without FCS. For example, for C. auris with FCS the log10 reduction for vertical surfaces was 4.92 (95% CI 3.79, 6.04) and for horizontal surfaces the log10 reduction was 2.87 (95% CI, 2.36–3.38). Conclusions:C. auris can be inactivated on environmental surfaces by UV-C as long as factors that affect inactivation are optimized (eg, exposure time). These data and other published UV-C data should be used in developing cycle parameters that prevent contaminated surfaces from being a source of acquisition by staff or patients of this globally emerging pathogen.Funding: NoneDisclosures: None

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Twelve-month effects of everolimus on renal and lung function in lung transplantation: differences in chronic lung allograft dysfunction phenotypes

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622321993441 ◽

2021 ◽

Vol 12 ◽

pp. 204062232199344

Author(s):

Filippo Patrucco ◽

Elias Allara ◽

Massimo Boffini ◽

Mauro Rinaldi ◽

Cristina Costa ◽

...

Keyword(s):

Renal Function ◽

Lung Function ◽

Lung Transplant ◽

Bronchiolitis Obliterans Syndrome ◽

Forced Expiratory Volume ◽

Chronic Lung Allograft Dysfunction ◽

Allograft Dysfunction ◽

Transplant Patients ◽

Restrictive Allograft Syndrome ◽

Trend Data

Background: Chronic lung allograft dysfunction (CLAD), a complication affecting the survival of lung transplanted patients, includes two clinical phenotypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Everolimus is used in CLAD because of its antiproliferative mechanism. In lung transplant patients treated with everolimus, the clinical course of renal and lung function has not yet been assessed systematically in CLAD, BOS and RAS patients for more than 6 months. Methods: We retrospectively evaluated the 12-month follow-up of renal and lung function of lung-transplanted patients switched to everolimus and evaluated the reduction in immunosuppressant dosage (ISD) and mortality. Subgroups were based on indication for everolimus treatment: CLAD and non-CLAD patients, BOS and RAS among CLAD patients. Results: We included 26 patients, 17 with CLAD (10 BOS, seven RAS). After 1 year from the everolimus switch, we observed renal function improvement (serum creatinine −17%, estimated glomerular filtration rate +24%) and stable pulmonary function [forced expiratory volume in the first second (FEV1) −0.5%, forced vital capacity (FVC) +0.05%]. RAS patients had progressive functional loss, whereas BOS patients had FEV1 improvement and FVC stability. All-cause mortality was higher in the CLAD versus non-CLAD group (41% versus 11%), without differences between BOS and RAS patients ( p > 0.05). All patients had significant and persistent ISD reduction. Conclusion: Lung transplant patients treated with everolimus had improvements in renal function and reduced ISD. We observed sustained improvements in lung function for CLAD related to BOS subgroup results, whereas RAS confirmed the 1-year worsening functional trend. Data seem to suggest one more piece of the puzzle in CLAD phenotyping.

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