scholarly journals Dois Surtos de Escabiose num Hospital Terciário em Portugal

2020 ◽  
Vol 33 (12) ◽  
pp. 803
Author(s):  
Nuno Gomes ◽  
Pedro Moura Guedes ◽  
Pedro Norton ◽  
Filomena Azevedo ◽  
Cármen Lisboa
Keyword(s):  
Attack Rate ◽  
Management Strategy ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Best Management ◽  
Infection Control Measures ◽  
Global Cost ◽  
Environmental Measures ◽  
Institutionalized Patients ◽  
Index Cases

Introduction: Scabies outbreaks in healthcare institutions are an emerging problem. To determine the best management strategy is a topical matter. We analyzed two hospital scabies outbreaks and reviewed the management strategy of institutional scabies outbreaks.Material and Methods: We performed an observational retrospective study of two independent scabies outbreaks that occurred in a Portuguese tertiary hospital in 2018. Following the identification of the index cases, scabies cases and exposed individuals, we calculated the attack rate in patients and professionals. We also evaluated the treatment and infection control measures, as well as the global cost of each outbreak.Results: The hospital outbreaks of scabies occurred in two wards of Internal Medicine. Both had as index cases institutionalized patients with dermatosis at the time of admission. In the Ward 1, there have been identified 409 exposed individuals, 14 cases of scabies and the attack rate was 3.4%. In the Ward 2, there have been identified 254 exposed individuals, 17 cases and the attack rate was 6.7%. Topical treatment was prescribed to the cases and environmental measures were implemented.Discussion: In our analysis, both outbreaks had as index cases institutionalized patients and had a significant impact, with hundreds of exposed individuals and considerable costs. The analysis of hospital scabies outbreaks is mostly retrospective and represents an opportunity to review its best management strategy.Conclusion: Implementation of guidelines on tackling scabies outbreaks in institutional settings is urgent.

scholarly journals Healthcare-Associated SARS-CoV-2 Transmission—Experiences from a German University Hospital

2020 ◽  
Vol 8 (9) ◽  
pp. 1378 ◽  
Author(s):  
Carlos L. Correa-Martínez ◽  
Vera Schwierzeck ◽  
Alexander Mellmann ◽  
Marc Hennies ◽  
Stefanie Kampmeier
Keyword(s):  
Infection Control ◽  
Attack Rate ◽  
Hospital Setting ◽  
Quantitative Measure ◽  
Control Measures ◽  
University Hospital ◽  
Infection Control Measures ◽  
Northwest Germany ◽  
Healthcare Associated ◽  
Index Cases

During the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, healthcare systems worldwide have to prevent nosocomial SARS-CoV-2 transmission while maintaining duty of care. In our study, we characterize the transmission dynamic of SARS-CoV-2 in inpatients and healthcare workers (HCWs) at the University Hospital Münster (UHM) in northwest Germany. We identified 27 cases of healthcare-associated SARS-CoV-2 infections (4 inpatients and 23 HCWs) who had contact with patients and/or HCWs without the use of adequate PPE. The contacts of these index cases were followed up for SARS-CoV-2 infection after unprotected exposure and a quantitative measure of probability of becoming infected, the attack rate, was calculated. In addition, transmission was evaluated in the context of infection control measures established during the pandemic and we compared the epidemiological data of all index cases, including symptoms and Ct values of virology test results. The overall attack rate in the hospital setting was 1.3% (inpatients 0.9%, HCWs 1.6%). However, during an outbreak, the attack rate was 25.5% (inpatients 20.0%, HCWs 29.6%). For both scenarios, HCWs had a higher attack rate illustrating their role in healthcare-associated SARS-CoV-2 transmission. Taken together, our experiences demonstrate how infection control measures can minimize the transmission of SARS-CoV-2 in the healthcare setting.

scholarly journals Epidemiology and contact tracing assessment of COVID-19 and potential risk of transmission at different exposure settings: A prospective cohort study

2021 ◽  
Author(s):  
Abu Shadat M Noman ◽  
Mohammed Rezaul Karim ◽  
ASM Zahed ◽  
ATM Rezaul Karim ◽  
Syed S Islam
Keyword(s):  
Risk Ratio ◽  
Attack Rate ◽  
Close Contact ◽  
Household Contact ◽  
Control Measures ◽  
Effective Control ◽  
Secondary Contact ◽  
Epidemiological Characteristics ◽  
Index Cases ◽  
Close Contacts

Abstract Background: Transmission risk of coronavirus disease 2019 (COVID-19) to close contacts and at different exposure settings are yet to be fully understood for the evaluation of effective control measures. Methods: We traced 1171 close contact cases who were linked to 291 index cases between July 3, 2020 and September 3, 2020. Clinical and epidemiological characteristics of all index cases, close contacts, and secondary contact cases were collected and analyzed the secondary attack rate and risk of transmission at different exposure settings. Results: Median age of 291 index cases were 43.0 years (range 18.5-82.3) including 213 male and 78 females. Among all 1171 close contact cases, 39(3.3%) cases were identified as secondary infected cases. Among 39 secondary cases, 33(84.62%) cases were symptomatic and 3 (7.69%) cases were asymptomatic. Of the 33 symptomatic cases, 31(86.1%) male and 5(13.9%) female. Of these 36 symptomatic cases, 24(66.7%) cases between age 20-59 and remaining 12(33.3%) cases were age 60 and over. Of the 36 symptomatic cases, 11(30.6%) cases were identified as severe, 19(52.8%) as moderate and 6(16.7%) as mild. The overall secondary clinical attack rate was 3.07% (95% CI 2.49-3.64). The attack rate was higher among those aged between 50 to 69 years and shows higher risk of transmission than age below 50 years. The attack rate was higher among household contact (6.17%(95%CI 4.7-7.6; risk ratio 2.44[95%CI1.5-3.4]), and lower in hospital facility (2.29%,95%CI0.58-3.40; [risk ratio 0.91,95%CI 0.17-1.9]), funeral ceremony (2.53%,95%CI 0.32-4.73), work places (3.95%,95% CI2.5-5.42 [risk ratio 1.56,95%CI 0.63-2.5]), family contacts (3.87%,95%CI 2.4-5.3; risk ratio 1.53,95%CI 0.61-2.45]). Conclusions: Among all exposure settings analyzed, household contact exposure setting remained the highest transmission probability and risk of transmission of COVID-19 with the increase of age and disease severity.

scholarly journals Impact of Changes in Infection Control Measures on the Dynamics of COVID-19 Infections in Schools and Pre-schools

2021 ◽  
Vol 9 ◽  
Author(s):  
Martina Sombetzki ◽  
Petra Lücker ◽  
Manja Ehmke ◽  
Sabrina Bock ◽  
Martina Littmann ◽  
...  
Keyword(s):  
Infection Control ◽  
Regression Model ◽  
Multivariate Regression ◽  
Face Mask ◽  
Multivariate Model ◽  
Control Measures ◽  
Infection Control Measures ◽  
Factors Influencing ◽  
The Impact ◽  
Index Cases

Introduction: With the increased emergence of SARS-CoV-2 variants, the impact on schools and preschools remains a matter of debate. To ensure that schools and preschools are kept open safely, the identification of factors influencing the extent of outbreaks is of importance.Aim: To monitor dynamics of COVID-19 infections in schools and preschools and identify factors influencing the extent of outbreaks.Methods: In this prospective observational study we analyzed routine surveillance data of Mecklenburg-Western Pomerania, Germany, from calendar week (CW) 32, 2020 to CW19, 2021 regarding SARS-CoV-2 infection events in schools and preschools considering changes in infection control measures over time. A multivariate linear regression model was fitted to evaluate factors influencing the number of students, teachers and staff tested positive following index cases in schools and preschools. Due to an existing multicollinearity in the common multivariate regression model between the variables “face mask obligation for children” and “face mask obligation for adults”, two further separate regression models were set up (Multivariate Model Adults and Multivariate Model Children).Results: We observed a significant increase in secondary cases in preschools in the first quarter of 2021 (CW8 to CW15, 2021), and simultaneously a decrease in secondary cases in schools. In multivariate regression analysis, the strongest predictor of the extent of the outbreaks was the teacher/ caregiver mask obligation (B = −1.9; 95% CI: −2.9 to −1.0; p < 0.001). Furthermore, adult index cases (adult only or child+adult combinations) increased the likelihood of secondary cases (B = 1.3; 95% CI: 0.9 to 1.8; p < 0.001). The face mask obligation for children also showed a significant reduction in the number of secondary cases (B = −0.6; 95% CI: −0.9 to −0.2; p = 0.004.Conclusion: The present study indicates that outbreak events at schools and preschools are effectively contained by an obligation for adults and children to wear face masks.

scholarly journals Vancomycin-resistant enterococci colonization and bacteremia in patients with hematological malignancies

2014 ◽  
Vol 8 (09) ◽  
pp. 1113-1118 ◽  
Author(s):  
Habip Gedik ◽  
Taner Yıldırmak ◽  
Funda Şimşek ◽  
Arzu Kantürk ◽  
Deniz Arıca ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Infection Control Measures ◽  
Vancomycin Resistant Enterococci ◽  
Study Results ◽  
Hematological Cancers ◽  
Training And Research ◽  
The Mean ◽  
Vancomycin Resistant

Introduction: We retrospectively evaluated the rates of vancomycin-resistant enterococci (VRE) colonization and VRE-related infections in patients with hematological malignancies. Methodology: All patients in the hematology department of the Ministry of Health Okmeydanı Training and Research Hospital, an 800-bed tertiary hospital in İstanbul, Turkey, older than 14 years of age and who developed febrile neutropenia during chemotherapy for hematological cancers between November 2010 and November 2012 were evaluated in this retrospective observational study. Results: A total of 282 neutropenic episodes in 126 patients who met the inclusion criteria were analyzed. The mean patient age was 51.73 ± 14.4 years (range: 17–82 years), and 66 cases occurred in male patients. The mean Multinational Association for Supportive Care in Cancer score of patients with hematological malignancies was 17.18 ± 8.27. Fifty (39.68%) patients were colonized with VRE, and the mean number of VRE colonization days per patient was 34.27 ± 13.12 days. Only two patients developed VRE bacteremia: a male patient with non-Hodgkin’s lymphoma who survived the infection, and a female patient with acute myeloid leukemia who died from VRE bacteremia. Conclusions: Patients with hematological malignancies accompanied by VRE colonization should be expected to develop VRE- or vancomycin-sensitive enterococci-related bacteremia under certain conditions, which include the development of severe mucositis, invasive procedures, and the use of intensive broad-spectrum antibiotics, even if infection control measures are implemented properly.

scholarly journals Epidemiology and control measures of an OXA-48-producing Enterobacteriaceae hospital-wide oligoclonal outbreak

2018 ◽  
Vol 146 (5) ◽  
pp. 656-662 ◽  
Author(s):  
V. Pérez-Blanco ◽  
L. Redondo-Bravo ◽  
G. Ruíz-Carrascoso ◽  
J. R. Paño-Pardo ◽  
R. Gómez-Gil ◽  
...  
Keyword(s):  
Infection Control ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Clinical Samples ◽  
Significant Drop ◽  
Contact Precautions ◽  
Infection Control Measures ◽  
Electronic Alerts ◽  
Initial Control ◽  
Incident Cases

AbstractThe main objective of our study was to describe the epidemiological and microbiological features of an oligoclonal hospital-wide outbreak caused by OXA-48-producing Enterobacteriaceae (OXA-48-PE). OXA-48 is a carbapenemase belonging to Ambler class D beta-lactamases, identified frequently in the Mediterranean and Southern European countries, and associated with several Enterobacteriaceae species. An outbreak of OXA-48-PE with a complex epidemic pattern was detected in January 2011. Initial control measures included contact precautions and the reinforcement of infection control practices, but despite all efforts made, the epidemiological situation hardly changed and new measures were implemented during 2013. An observational retrospective study was performed to describe the main features of the outbreak and to analyse the cumulative incidence (CI) trends. Eight hundred and 16 patients colonised or infected by OXA-48-PE were identified during the 2-year period (January 2013–December 2014), female 46%, mean age (s.d.), 71.6 (15.2). The samples isolated in the incident cases were rectal swabs (80%), urine samples (10.7%), blood samples (2.8%) and other clinical samples (6.6%). The most frequent OXA-48-PE was Klebsiella pneumoniae. Eleven different clones were identified, but K. pneumoniae sequence types 11 and 405 were predominant: ST11 (64.2%) and ST405 (29.3%). OXA-48-PE CI trend suffered a statistically significant change in August 2013, which continued the following months. Though we could not eradicate the outbreak, we observed a statistically significant drop in CI after an intervention for OXA-48-PE control, based on patient cohort, active surveillance, electronic alerts and reinforcement of infection control measures in a tertiary hospital.

scholarly journals Microbiological and molecular characteristics of carbapenemase-producing Klebsiella pneumoniae endemic in a tertiary Greek hospital during 2004-2010

2012 ◽  
Vol 17 (7) ◽  
Author(s):  
A Zagorianou ◽  
E Sianou ◽  
E Iosifidis ◽  
V Dimou ◽  
E Protonotariou ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Antibiotic Use ◽  
The United States ◽  
Tertiary Hospital ◽  
Control Measures ◽  
Molecular Characteristics ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics ◽  
Infection Control Measures

We report 570 carbapenemase-producing Klebsiella pneumoniae (CPKP) clinical isolates in a 1,040-bed Greek tertiary hospital during 2004 to 2010. The first CPKP (VIM-producing) was isolated in September 2004. Despite initial containment, VIM producers have become endemic since 2006. KPC-producing K. pneumoniae was first isolated in August 2007 from a patient who came from Israel, spread rapidly, and outcompeted VIM. Overall, 267 (47%) VIM-producing and 301 (53%) KPC-producing strains were isolated, including 141 (24.7%) from patients with bacteraemia. Two isolates carrying both VIM and KPC were isolated in two consecutive months in 2009, but not since. The prevalence of CPKP increased from 0% in 2003 to 38.3% in 2010 (p<0.0001). All genotyped KPC producers harboured blaKPC-2 and belonged to two clones, among which the hyperepidemic Greek clone, related to those from the United States and Israel, predominated. Most metallo-beta-lactamase (MBL) producers carried the blaVIM-1 gene and belonged to several clones, whereas all but one isolate with blaVIM-12 were clustered within a five-month period, arising from one clone. Resistance to non-beta-lactam antibiotics was also increased among CPKP. They were almost invariably resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. Resistance to colistin increased from 3.5% (4/115) in 2008 to 20.8% (25/120) in 2010, and resistance to tigecycline also increased. Following reinforcement of infection control measures, prevalence of CPKP (mainly KPC) has been reduced since mid-2009 (from 46% in 2009 to 38.3% in 2010). In view of the exhaustion of available therapies, investment in infection control resources and optimal antibiotic use is urgently required.

scholarly journals Emergence and Clonal Spread of KPC-2 Producing Clinical Klebsiella Aerogenes Isolates From a Teaching Hospital in Tucuman, Argentina.

2020 ◽  
Author(s):  
Juan Martín Vargas ◽  
María Paula Moreno Mochi ◽  
Juan Manuel Nuñez ◽  
Silvana Mochi ◽  
Mariel Cáceres ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Antimicrobial Treatment ◽  
Control Measures ◽  
Molecular Characteristics ◽  
Klebsiella Aerogenes ◽  
Adult Intensive Care Unit ◽  
Infection Control Measures ◽  
Potential Risk Factors ◽  
Clonal Spread ◽  
Healthcare Associated

Abstract IntroductionKlebsiella aerogenes is a nosocomial pathogen associated with drug resistance and healthcare-associated infections. We pursued this study to investigate an outbreak of clinical carbapenem-resistant K. aerogenes(CRKA) in an argentinian tertiary hospital which persisted for 4 months despite aggressive infection control measures. The primary goals aimed to evaluate the molecular characteristics and the clonal relationships among the CRKA isolates.MethodsWe characterized CRKA isolates by multiplex PCR and PFGE. The information was integrated with clinical and epidemiologic data.ResultsThe 14 CRKA strains were disseminated in an adult intensive care unit (50%) and five different wards. In patients who received antimicrobial treatment, 8 staggered to directed treatment, mainly with amikacin(6/8) and/or carbapenemes(5/8). The overall mortality was 42.8%, and the attributed mortality to CRKA infection was 21.4%, strains showed high rates of resistance to most of the antimicrobials without resistance to Amikacin and Tigecycline, and carried the blaKPC-2, blaSHV-2 and blaCTXM-15 genes. The PFGE indicated 2 distinct groups; 12/14 CRKA isolatesassociated with the dominant subgroup A and likely to be primarily responsible for the first isolation and subsequent dissemination in the hospital.ConclusionThe outbreak characteristics data showed prolonged hospitalization and previous use of broad-spectrum antibiotics as potential risk factors for the acquisition of CRKA.

scholarly journals Characterization of a clinical Enterobacter hormaechei strain belonging to epidemic clone ST418 co-carrying blaNDM-1, blaIMP-4 and mcr-9.1

2020 ◽  
Author(s):  
Wei Chen ◽  
Zhiliang Hu ◽  
Shiwei Wang ◽  
Doudou Huang ◽  
Weixiao Wang ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Control Measures ◽  
High Rate ◽  
Clinical Settings ◽  
Evolutionary Trajectory ◽  
Epidemic Clone ◽  
Single Strain ◽  
Disastrous Consequence ◽  
Infection Control Measures ◽  
Enterobacter Hormaechei

AbstractAn Enterobacter hormaechei isolate (ECL-90) simultaneously harboring blaNDM-1, blaIMP-4 and mcr-9.1 was recovered from the secretion specimen of a 24-year-old male patient in a tertiary hospital in China. The whole genome sequencing of this isolate was complete, and 4 circular plasmids with variable sizes were detected. MLST analysis assigned the isolate to ST418, known as a carbapenemase-producing epidemic clone in China. blaIMP-4 and mcr-9.1 genes were co-carried on an IncHI2/2A plasmid (pECL-90-2) and blaNDM-1 was harbored by an IncX3 plasmid (pECL-90-3). The genetic context of mcr-9.1 was identified as a prevalent structure, “rcnR-rcnA-pcoE-pcoS-IS903-mcr-9-wbuC”, which is a relatively unitary model involved in the mobilization of mcr-9. Meanwhile, blaNDM-1 gene was detected within a globally widespread structure known as NDM-GE-U.S (“ISAba125– blaNDM-1–blaMBL”). Our study warrants that the convergence of genes mediating resistance to last-resort antibiotics in epidemic clones would largely facilitate their widespread in clinical settings, thus representing a potential challenge to clinical treatment and public health.ImportanceCarbapenemase-producing Enterobacteriaceae (CPE) spread at a high rate and colistin is the last-resort therapeutic for the infection caused by CPE. However, the emergence of plasmid-borne mcr genes highly facilitates the wide dissemination of colistin resistance, thus largely threatens the clinical use of colistin. Here, we for the first time characterized a clinical Enterobacter hormaechei strain co-producing blaNDM-1, blaIMP-4 and mcr-9.1 belonging to an epidemic clone (ST418). The accumulation of genes mediating resistance to last-resort antibiotics in epidemic clones would largely facilitate their widespread in clinical settings, which may cause disastrous consequence with respect to antimicrobial resistance. Understanding how resistance genes were accumulated in a single strain could help us to track the evolutionary trajectory of drug resistance. Our finding highlights the importance of surveillance on the epidemic potential of colistin-resistant CPE, and effective infection control measures to prevent the resistance dissemination.

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