Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of blaKPC-carbapenemase-producing Enterobacterales in a hospital setting

Background Healthcare-associated wastewater reservoirs and asymptomatic gastrointestinal patient colonisation by carbapenemase-producing Enterobacterales (CPE) can be important in nosocomial CPE dissemination and infection. We characterised these niches and within-niche diversity in a blaKPC-associated CPE (KPC-E) endemic healthcare setting, to better understand transmission potential. Methods We systematically sampled wastewater sites and patients across three units (six wards) over 6-12 months in 2016 in a KPC-E endemic hospital. We used Illumina sequencing to characterise up to five isolates per sample. Recombination-adjusted phylogenies were used to define genetically related strains; assembly and mapping-based typing approaches were used to characterise antimicrobial resistance gene and insertion sequence profiles, and Tn4401 types/target site sequences. The wider accessory genome was evaluated in a subset of the largest clusters, and those crossing niches. Findings Wastewater site KPC-E-positivity was substantial (101/349 sites [28.9%] positive, 319/4,488 [7.1%] sampling events positive); 183/4,425 (4.1%) of patients were CPE culture-positive over the same timeframe. 13 species and 109 KPC-E strains were observed across niches, and 24% of wastewater and 26% of patient KPC-E-positive samples harboured ≥1 strain. Most diversity was explained by the individual niche, suggesting highly localised factors are important in selection and spread. Tn4401+target site sequence (TSS) diversity was greater in wastewater sites (p<0.001), suggesting these might favour Tn4401-associated transposition/evolution and dissemination. Shower/bath and sluice/mop-associated sites were more likely to be KPC-E-positive (Adjusted Odds Ratio [95% CI]: 2.69 [1.44-5.01], p=0.0019 and 2.60 [1.04-6.52], p=0.0410, respectively). Different strains had different transmission and blaKPC dissemination dynamics. Interpretation There may be substantial KPC-E colonisation of wastewater sites and patients in KPC-E-endemic healthcare settings. Niche-specific factors, and different strains with different transmission dynamics influence carbapenemase gene dissemination. New transmission models incorporating complex, multi-level dynamics are needed to better quantify CPE dissemination to inform interventions and reduce transmission. Funding This study was supported by the National Institute for Health Research, UK.

Download Full-text

A 6-Year Review of Carbapenemase-Producing Organisms in Alberta, Canada

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.608 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s104-s105

Author(s):

Ye Shen ◽

Jennifer Ellison ◽

Uma Chandran ◽

Sumana Fathima ◽

Jamil Kanji ◽

...

Keyword(s):

Acute Care ◽

Management Practices ◽

Hospital Setting ◽

Data Sources ◽

Infection Prevention And Control ◽

Term Care ◽

Carbapenemase Gene ◽

Care Facilities ◽

Hospital Acquired ◽

Alberta Health

Background: This review describes the epidemiology of carbapenemase-producing organisms (CPO) in both the community and hospitalized populations in the province of Alberta. Methods: Newly identified CPO-positive individuals from April 1, 2013, to March 31, 2018, were retrospectively reviewed from 3 data sources, which shared a common provincial CPO case definition: (1) positive CPO results from the Provincial Laboratory for Public Health, which provides all referral and confirmatory CPO testing, (2) CPO cases reported to Alberta Health, and (3) CPO surveillance from Alberta Health Services Infection Prevention and Control (IPC). The 3 data sources were collated, and initial CPO cases were classified according to their likely location of acquisition: hospital-acquired, hospital-identified, on admission, and community-identified. Risk factors and adverse outcomes were obtained from linkage to administrative data. Results: In total, 171 unique individuals were newly identified with a first-time CPO case. Also, 15% (25 of 171) were hospital-acquired (HA), 21% (36 of 171) were hospital-identified (HI), 33% (57 of 171) were on admission, and 31% (53 of 171) were community identified. Overall, 9% (5 of 171) resided in long-term care facilities. Of all patients in acute-care facilities, 30% (35 of 118) had infections and 70% were colonized. Overall, 38% (65 of 171) had an acute-care admission in the 1 year prior to CPO identification; 59% (63 of 106) of those who did not have a previous admission had received healthcare outside Alberta. A large proportion of on-admission cases (81%, 46 of 57) and community-identified (66%, 33 of 53) cases did not have any acute-care admissions in Alberta in the previous year. Overall, 10% (14 of 171) had ICU admissions in Alberta within 30 days of CPO identification, and 5% (8 of 171) died within 30 days. The most common carbapenemase gene identified was NDM-1 (53%, 90 of 171). Conclusions: These findings highlight the robust nature of Alberta’s provincial CPO surveillance network. We reviewed 3 different databases (laboratory, health ministry, IPC) to obtain comprehensive data to better understand the epidemiology of CPO in both the community and hospital settings. More than half of the individuals with CPO were initially identified in the community or on admission. Most had received healthcare outside Alberta, and no acute-care admissions occurred in Alberta in the previous year. It is important to be aware of the growing reservoir of CPO outside the hospital setting because it could impact future screening and management practices.Funding: NoneDisclosures: None

Download Full-text

Multi-Method Vs Single Method Appraisal of Clinical Quality Indicators for the Emergency Medical Services

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa171 ◽

2020 ◽

Author(s):

Ian Howard ◽

Peter Cameron ◽

Maaret Castrén ◽

Lee Wallis ◽

Veronica Lindström

Keyword(s):

Group Discussion ◽

Rank Correlation ◽

Healthcare Setting ◽

Prehospital Emergency Care ◽

Spearman’S Rank Correlation ◽

Prehospital Emergency ◽

Single Method ◽

Multi Method Approach ◽

The Individual ◽

Method Approach

ABSTRACT Background Quality Indicator (QI) appraisal protocols are a novel methodology that combines multiple appraisal methods to comprehensively assess the "appropriateness" of QIs for a particular healthcare setting. However, they remain inadequately explored compared to the single appraisal method approach. This paper aimed to describe and test a QI appraisal protocol versus the single method approach, against a series of QIs potentially relevant to the South African Prehospital Emergency Care setting. Methods An appraisal protocol was developed consisting of two categorical-based appraisal methods, combined with the qualitative analysis of the discussion generated during the consensus application of each method. The output of the protocol was assessed and compared with the application and output of each method. Inter-rater reliability of each particular method was evaluated prior to group consensus rating. Variation in the number of non-valid QIs and the proportion of non-valid QIs identified between each method and the protocol were compared and assessed. Results There was mixed IRR of the individual methods. There was similarly low to moderate correlation of the results obtained between the particular methods (Spearman’s rank correlation=0.42,p<0.001). From a series of 104 QIs, 11 non-valid QIs were identified that were shared between the individual methods. A further 19 non-valid QIs were identified and not shared by each method, highlighting the benefits of a multi-method approach. The outcomes were additionally evident in the group discussion analysis, which in and of itself added further input that would not have otherwise been captured by the individual methods alone. Conclusion The utilization of a multi-method appraisal protocol offers multiple benefits, when compared to the single appraisal approach, and can provide the confidence that the outcomes of the appraisal will ensure a strong foundation on which the QI framework can be successfully implemented.

Download Full-text

Contrasting population genetics of cattle- and buffalo-derived Theileria annulata causing tropical theileriosis

10.1101/2020.01.10.902031 ◽

2020 ◽

Author(s):

Umer Chaudhry ◽

Qasim Ali ◽

Lynn Zheng ◽

Imran Rashid ◽

Muhammad Zubair Shabbir ◽

...

Keyword(s):

Cytochrome B ◽

Water Buffalo ◽

Theileria Annulata ◽

Tropical Theileriosis ◽

Multiple Introductions ◽

Individual Host ◽

Mitochondrial Cytochrome B ◽

Different Strains ◽

The Individual ◽

High Level

AbstractThe present study was designed to improve understanding of Theileria annulata in sympatric water buffalo and cattle in the Punjab province of Pakistan. The prevalence of tropical theileriosis is high, buparvaquone resistance is widespread, and vaccine protection is poor in the field. Better understanding is, therefore, needed of the factors that influence the genetics of T. annulata populations both within its hosts and in its overall populations. Here we utilise a panel of six satellites and a mitochondrial cytochrome b marker to explore the multiplicity of T. annulata infection and patterns of emergence and spread of different parasite genotypes. Parasite materials were collected from infected animals in defined regions, where water buffalo and cattle are kept together. Our results show that T. annulata is genetically more diverse in cattle- than in water buffalo-derived populations (the mean numbers of unique satellite alleles were 13.3 and 1.8 and numbers of unique cytochrome b locus alleles were 65 and 27 in cattle- and water buffalo-derived populations, respectively). The data show a high level of genetic diversity among the individual host-derived populations (the overall heterozygosity (He) indices were 0.912 and 0.931 in cattle, and 0.874 and 0.861 in buffalo, based on satellite and cytochrome b loci, respectively). When considered in the context of high parasite transmission rates and frequent animal movements between different regions, the predominance of multiple T. annulata genotypes, with multiple introductions of infection in the hosts from which the parasite populations were derived, may have practical implications for the spread of parasite genetic adaptations; such as those conferring vaccine cross-protection against different strains affecting cattle and buffalo, or resistance to antiprotozoal drugs.

Download Full-text

“Time's Up”: The Experience of Entering Residential Aged Care for Young People with Acquired Neurological Disorders and Their Families

Brain Impairment ◽

10.1017/brimp.2018.13 ◽

2018 ◽

Vol 20 (1) ◽

pp. 37-48 ◽

Cited By ~ 6

Author(s):

Sandra Barry ◽

Lucy Knox ◽

Jacinta M. Douglas

Keyword(s):

Young People ◽

Lived Experience ◽

Neurological Disorders ◽

Healthcare Setting ◽

Aged Care ◽

Residential Aged Care ◽

Health Crisis ◽

Complex Process ◽

The Individual ◽

Key Events

Background and aims: Previous research has highlighted that living in residential aged care (RAC) is associated with a range of negative outcomes for adults with acquired neurological disorders. This study sought to understand the lived experience of entering RAC for young people and their family members and characterise their needs during this process.Method: Data included 64 written and verbal submissions to the 2015 Senate Inquiry into the Adequacy of existing residential care arrangements available for young people with severe physical, mental or intellectual disabilities in Australia. In line with hermeneutic tradition, text was analysed using thematic analysis.Results: Entry to RAC was experienced as a complex process that coalesced around three key events: an unexpected health crisis, a directive that time's up and the individual is required to leave the healthcare setting, with a subsequent decision to move into RAC. This decision was made in the absence of time, knowledge of options or adequate support.Conclusions: Findings suggest that there are both immediate practice changes and longer term policy responses that can support the health and disability systems to uphold the rights of people with acquired disability to choose where and how they will live their lives.

Download Full-text

A problem-solving routine for improving hospital operations

Journal of Health Organization and Management ◽

10.1108/jhom-09-2013-0191 ◽

2015 ◽

Vol 29 (2) ◽

pp. 252-270 ◽

Cited By ~ 6

Author(s):

Manimay Ghosh ◽

Durward K Sobek II

Keyword(s):

Problem Solving ◽

Process Improvement ◽

Hospital Setting ◽

Improve Patient Care ◽

Healthcare Setting ◽

Theory Approach ◽

Structured Interviews ◽

Short Term ◽

Content Type ◽

Hospital Operations

Purpose – The purpose of this paper is to examine empirically why a systematic problem-solving routine can play an important role in the process improvement efforts of hospitals. Design/methodology/approach – Data on 18 process improvement cases were collected through semi-structured interviews, reports and other documents, and artifacts associated with the cases. The data were analyzed using a grounded theory approach. Findings – Adherence to all the steps of the problem-solving routine correlated to greater degrees of improvement across the sample. Analysis resulted in two models. The first partially explains why hospital workers tended to enact short-term solutions when faced with process-related problems; and tended not seek longer-term solutions that prevent problems from recurring. The second model highlights a set of self-reinforcing behaviors that are more likely to address problem recurrence and result in sustained process improvement. Research limitations/implications – The study was conducted in one hospital setting. Practical implications – Hospital managers can improve patient care and increase operational efficiency by adopting and diffusing problem-solving routines that embody three key characteristics. Originality/value – This paper offers new insights on why caregivers adopt short-term approaches to problem solving. Three characteristics of an effective problem-solving routine in a healthcare setting are proposed.

Download Full-text

Healthcare Workers Training Courses on Vaccinations: A Flexible Format Easily Adaptable to Different Healthcare Settings

Vaccines ◽

10.3390/vaccines8030514 ◽

2020 ◽

Vol 8 (3) ◽

pp. 514

Author(s):

Laura Serino ◽

Massimo Maurici ◽

Gian Loreto D’Alò ◽

Fabiana Amadori ◽

Elisa Terracciano ◽

...

Keyword(s):

Healthcare Setting ◽

Training Model ◽

Local Health ◽

Lazio Region ◽

Healthcare Settings ◽

Immunization Services ◽

Training Courses ◽

Knowledge And Attitude ◽

The Individual ◽

University Of Rome

Since 2017, Italy has expanded the compulsory vaccination from 4 to 10 for those aged 0 to 16 years. Because of the great organizational effort required for the immunization services, minor attention was given to the vaccinations not included among the mandatory ones. This situation led to a real difficulty in harmonizing the vaccination procedures even inside a single region. In the Lazio region, the Laboratory of Vaccinology of the University of Rome Tor Vergata established a working group to create a new training model for healthcare professionals. The course program proposed an update of three vaccinations which are not mandatory but actively offered. It included the same part of scientific updating and a variable part based on local experiences. A specific anonymous questionnaire on knowledge and attitude was administered. The study aimed to propose a general format of training courses for vaccination centers adaptable to the individual local health units (ASLs) and to evaluate through questionnaires. The results show differences in knowledge and attitudes toward non-mandatory vaccinations among the ASLs of Lazio, confirming the usefulness of a support to make knowledge and procedures homogeneous. This model could be adapted to any healthcare setting and exported to other services.

Download Full-text

Issues and Challenges in Implementing Care Coordinator in Primary Healthcare in Malaysia: A Qualitative Study

Journal of Primary Care & Community Health ◽

10.1177/2150132720956478 ◽

2020 ◽

Vol 11 ◽

pp. 215013272095647

Author(s):

Zalilah Abdullah ◽

Siti Hajar Abdul Aziz ◽

Nur Aliyah Sodri ◽

Ainul Nadziha Mohd Hanafiah ◽

Nor Idawaty Ibrahim ◽

...

Keyword(s):

Primary Healthcare ◽

Resource Constraints ◽

Clinical Skill ◽

Healthcare Providers ◽

Healthcare Setting ◽

Care Coordinator ◽

Good Communication ◽

Increasing Demand ◽

The Individual ◽

Inner Setting

Background: Primary healthcare is the earliest gateway for patient care, and improvisations are often needed to accommodate the ever-increasing demand in public health. The Enhanced Primary Healthcare (EnPHC) initiative is aimed at improving such needs, and one core intervention is the introduction of a care coordinator (CC). The purpose of this study was to identify barriers and facilitators in implementing a new intervention in primary healthcare clinics. Methods: This qualitative exploration study. All healthcare providers who were involved in EnPHC at the intervention clinics were selected as participants. In-depth interviews and focus group discussions were carried out among healthcare providers working in the intervention clinic. Thematic analysis was used to categorize data, based on the consolidated framework for implementation research (CFIR) theoretical framework domains. Results: A total of 61 healthcare providers participated. All 5 domains with 19 CFIR constructs emerged from the analysis. Inner setting played a significant role in facilitating CC intervention, in which culture, networking, and collaboration and leadership engagement played an essential role in supporting CC activities. Although CC tasks are complex, concerns of losing clinical skill and resource constraints were identified as potential barriers in CC implementations. Criteria for appointing new CCs emerged from the characteristics of individual constructs, in which the individual must be familiar and interested in community health, have good communication skills, and at least 3 years’ experience in the primary healthcare setting. Conclusion: The implementation of the CC intervention faces varying challenges in different settings. This is partially resolved through teamwork, guidance from mentors, and support from superiors. The complexity of the responsibility of the CC intervention is perceived as both a validation and a burden. Above all, it is seen as paramount in EnPHC intervention.

Download Full-text

Comparative Study On Nursing Of Different Strains Of Tilapia (Oreochromis niloticus) In Bangladesh

International Journal of Natural Sciences ◽

10.3329/ijns.v5i2.28633 ◽

2016 ◽

Vol 5 (2) ◽

pp. 98-106

Author(s):

MA Hossain ◽

MJ Islam ◽

MM Uddin ◽

MM Hossain ◽

M Kunda

Keyword(s):

Growth Rate ◽

Body Weight ◽

Survival Rate ◽

Body Weight Gain ◽

Stocking Density ◽

Experimental Period ◽

Mustard Oil ◽

Feed Conversion ◽

Different Strains ◽

The Individual

This study was conducted to investigate and compare the growth performance of four Tilapia strains in hapa nursing with the aim to find out the best strain of tilapia. The research was conducted by four treatments with five replicates each. The tilapia fry were collected from, BFRI source from BFRI HQ, Mymensingh stocked in Treatment-1; unknown source from Hi-Tech Tilapia Hatchery Dagoanbhuiya, Feni in Treatment-2, Philipine strain from Green Field Tilapia Hatchery, Laxmipur in Treatment-3 and fry from Breeding Cohort, Sonar Bangla Hatchery, Bamna, Barguna in Treatment-4. The Individual stocking weight (g) of fry was average 0.01g. The fries were stocked in 12 hapa at same stocking density of 1200 fish/m2. Each of the hapa was 2m × 1m × 1m size and fixed in an earthen ponds. Supplementary feed with 31.29% of protein level consisting of rice bran (25%), mustard oil cake (15%), wheat flour (30%) and fish meal (30%) was given at the rate of 40% of their body weight per day manually, four times a day at the beginning of the experimental period and reduced to 25% of their body weight and continued up to harvesting period. The results showed that fry of Treatment-4 strain was the best strain and had significantly (p < 0.05) higher final mean body weight (FMBW), mean body weight gain (MBWG), specific growth rate (SGR) (9.75%), gross yield (GY) (2.13) and Net yield (NY) (2.12) than the Treatment-1 , Treatment-2 strains and Treatemnt-3 strain. Treatment-4 strain had the fastest growth rate, whereas the lowest performing strain was that from Treatment-2. We also analyzed survival rate of the fish from stocking to harvest, survival rate was highest in Treatment-4 strain (80%) where lowest is Treatment-3. Treatment-4 stain also showed the best feed conversion ratio (FCR) 1.62 than others. Considering the overall performance it can be concluded that tilapia strain collected from Breeding Cohort source is best among the four strains. However, further research may still be needed to compare more strains from different water body to evaluate the genetic potential for Tilapia.International Journal of Natural Sciences (2015), 5(2) 98-106

Download Full-text

Challenge of drug resistance in Pseudomonas aeruginosa: clonal spread of NDM-1-positive ST-308 within a tertiary hospital

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz169 ◽

2019 ◽

Vol 74 (8) ◽

pp. 2220-2224 ◽

Cited By ~ 4

Author(s):

Ka Lip Chew ◽

Sophie Octavia ◽

Oon Tek Ng ◽

Kalisvar Marimuthu ◽

Indumathi Venkatachalam ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Drug Resistance ◽

Virulence Factors ◽

Acquired Resistance ◽

Hospital Setting ◽

Tertiary Hospital ◽

Secretion System ◽

Type Vi Secretion System ◽

Genomic Epidemiology ◽

Global Threat

Abstract Objectives MDR Pseudomonas aeruginosa is a serious global threat to healthcare institutions. The mechanism by which drug resistance can be acquired is variable, but acquired carbapenemase production has been reported in P. aeruginosa. An investigation was performed to determine the rate and genomic epidemiology of New Delhi MBL (NDM) in β-lactam-non-susceptible isolates. Methods P. aeruginosa isolates from a tertiary hospital in Singapore between January 2015 and February 2018 were investigated for the presence of NDM genes. Results Out of 298 pan-β-lactam-non-susceptible isolates, 31 were found to be NDM positive (10.4%). WGS demonstrated that all 31 NDM-positive isolates were clonal, belonging to ST-308. blaNDM was chromosomally inserted within an integrative and conjugative element (ICE), ICETn43716385. The NDM-P. aeruginosa isolates possessed an extensive repertoire of both cell-associated [flagella, pili, alginate/biofilm, LPS, type III secretion system (T3SS) and type VI secretion system (T6SS)] and secreted virulence factors. Antibiograms revealed higher rates of drug resistance in NDM-positive isolates compared with their non-NDM counterparts. The NDM isolates remained 100% susceptible only to colistin. Conclusions The combination of chromosomal mutations, acquired resistance genes and virulence factors likely facilitated the persistent and ongoing spread of the ST-308 clade of P. aeruginosa within the hospital. Our study illustrates the particular threat of NDM-positive P. aeruginosa in a tertiary hospital setting in the era of antimicrobial resistance.

Download Full-text

Sex-specific constitutive expression of the pre-neoplastic marker glutathione S-transferase, YfYf, in mouse liver

Biochemical Journal ◽

10.1042/bj2450399 ◽

1987 ◽

Vol 245 (2) ◽

pp. 399-406 ◽

Cited By ~ 40

Author(s):

L I McLellan ◽

J D Hayes

Keyword(s):

Mouse Liver ◽

Constitutive Expression ◽

Strain Differences ◽

Inbred Strains ◽

Glutathione S Transferase ◽

Enzyme Form ◽

Apparent Homogeneity ◽

Different Strains ◽

The Individual ◽

A Minor

Hepatic glutathione S-transferase isoenzyme content has been investigated in both sexes of three inbred strains of mice (DBA/2, C3H/He, C57BL6). A polypeptide (Mr 24,800), which is immunologically related to Yf purified from rat lung, was found to be expressed as a major form in all male mouse livers but represented only a minor enzyme form in female mouse liver. Glutathione S-transferases comprising subunits with molecular masses of 25,800 (Ya) or 26,400 (Yb) were present in males and females of the three strains under investigation. Cytosolic isoenzymes from all strains and sexes were purified to apparent homogeneity and no significant inter-strain differences in the properties of the individual forms were observed. In addition, no differences were detected in the microsomal glutathione S-transferase content of the different strains or sexes.

Download Full-text