Archive for April 16, 2016

The Potential Trajectory of Carbapenem-Resistant Enterobacteriaceae, an Emerging Threat to Health-Care Facilities, and the Impact of the Centers for Disease Control and Prevention Toolkit

Am. J. Epidemiol. February 8, 2016 V.183 N.5 P.471-479

Bruce Y. Lee, Sarah M. Bartsch, Kim F. Wong, James A. McKinnell, Rachel B. Slayton, Loren G. Miller, Chenghua Cao, Diane S. Kim, Alexander J. Kallen, John A. Jernigan, and Susan S. Huang

Carbapenem-resistant Enterobacteriaceae (CRE), a group of pathogens resistant to most antibiotics and associated with high mortality, are a rising emerging public health threat.

Current approaches to infection control and prevention have not been adequate to prevent spread. An important but unproven approach is to have hospitals in a region coordinate surveillance and infection control measures.

Using our Regional Healthcare Ecosystem Analyst (RHEA) simulation model and detailed Orange County, California, patient-level data on adult inpatient hospital and nursing home admissions (2011–2012), we simulated the spread of CRE throughout Orange County health-care facilities under 3 scenarios: no specific control measures, facility-level infection control efforts (uncoordinated control measures), and a coordinated regional effort. Aggressive uncoordinated and coordinated approaches were highly similar, averting 2,976 and 2,789 CRE transmission events, respectively (72.2% and 77.0% of transmission events), by year 5.

With moderate control measures, coordinated regional control resulted in 21.3% more averted cases (n = 408) than did uncoordinated control at year 5.

Our model suggests that without increased infection control approaches, CRE would become endemic in nearly all Orange County health-care facilities within 10 years.

While implementing the interventions in the Centers for Disease Control and Prevention’s CRE toolkit would not completely stop the spread of CRE, it would cut its spread substantially, by half.



April 16, 2016 at 7:37 pm

Detection of Zika Virus in Semen

Emerging Infectious Diseases May 2016 V.22 N.5


To the Editor: As an increasing number of autochthonous Zika virus infections are reported from several South America countries (1), we read with interest the report from Musso et al. on the potential sexual transmission of Zika virus (2). We report additional evidence for this potential route of transmission after identification of an imported case of infection into the United Kingdom….


April 16, 2016 at 12:12 pm

Severe Sepsis and Septic Shock Associated with Chikungunya Virus Infection, Guadeloupe, 2014

Emerging Infectious Diseases May 2016 V.22 N.5

Amélie Rollé, Kinda Schepers, Sylvie Cassadou, Elodie Curlier, Benjamin Madeux, Cécile Hermann-Storck, Isabelle Fabre, Isabelle Lamaury, Benoit Tressières, Guillaume Thiery, and Bruno HoenComments to Author

Centre Hospitalier Universitaire, Pointe-à-Pitre, France (A. Rollé, K. Schepers, E. Curlier, B. Madeux, C. Hermann-Storck, I. Fabre, I. Lamaury, G. Thiery, B. Hoen); Cellule Interrégionale d’Epidémiologie Antilles-Guyane, Institut de Veille Sanitaire, Gourbeyre, France (S. Cassadou); Centre d’Investigation Clinique 1424, Institut National de la Santé et de la Recherche Médicale, Pointe-à-Pitre (B. Tressières, B. Hoen); Université des Antilles, Faculté de Médecine Hyacinthe Bastaraud, Pointe-à-Pitre (G. Thiery, B. Hoen)

During a 2014 outbreak, 450 patients with confirmed chikungunya virus infection were admitted to the University Hospital of Pointe-à-Pitre, Guadeloupe.

Of these, 110 were nonpregnant adults; 42 had severe disease, and of those, 25 had severe sepsis or septic shock and 12 died.

Severe sepsis may be a rare complication of chikungunya virus infection.


April 16, 2016 at 12:11 pm

Serum procalcitonin measurement and viral testing to guide antibiotic infections in hospitalized adults: a randomized controlled trial.

Journal Infectious Diseases  2015 V.212 N.11 P.1692-1700

Angela R. Branche1, Edward E. Walsh1,3, Roberto Vargas4, Barbara Hulbert4, Maria A. Formica3, Andrea Baran2, Derick R. Peterson2 and Ann R. Falsey1,3

1Department of Medicine, University of Rochester

2Department of Biostatistics and Computational Biology, University of Rochester

3Department of Medicine, Rochester General Hospital, New York

4Department of Laboratory Sciences, Rochester General Hospital, New York



Viral lower respiratory tract illness (LRTI) frequently causes adult hospitalization and is linked to antibiotic overuse. European studies suggest that the serum procalcitonin (PCT) level may be used to guide antibiotic therapy. We conducted a trial assessing the feasibility of using PCT algorithms with viral testing to guide antibiotic use in a US hospital.



Three hundred patients hospitalized with nonpneumonic LRTI during October 2013–April 2014 were randomly assigned at a ratio of 1:1 to receive standard care or PCT-guided care and viral PCR testing. The primary outcome was antibiotic exposure, and safety was assessed at 1 and 3 months.



Among the 151 patients in the intervention group, viruses were identified in 42% (63), and 83% (126) had PCT values of <0.25 µg/mL. There were no significant differences in antibiotic use or adverse events between intervention patients and those in the nonintervention group. Subgroup analyses revealed fewer subjects with positive results of viral testing and low PCT values who were discharged receiving antibiotics (20% vs 45%; P = .002) and shorter antibiotic durations among algorithm-adherent intervention patients versus nonintervention patients (2.0 vs 4.0 days; P = .004). Compared with historical controls (from 2008–2011), antibiotic duration in nonintervention patients decreased by 2 days (6.0 vs 4.0 days; P < .001), suggesting a study effect.



Although antibiotic use was similar in the 2 arms, subgroup analyses of intervention patients suggest that physicians responded to viral and biomarker data. These data can inform the design of future US studies.


Clinical Trials Registration.NCT01907659.






April 16, 2016 at 9:46 am

Male-to-Male Sexual Transmission of Zika Virus — Texas, January 2016

MMWR Weekly April 15, 2016 V.65 N.14 P.372–4

Trew Deckard, PA-C; Wendy M. Chung, MD; John T. Brooks, MD; et al

1Medical office of Steven M. Pounders, MD, Dallas, Texas; 2Acute Communicable Disease Epidemiology Division, Dallas County Health and Human Services, Texas; 3Division of HIV/AIDS Prevention, National Center for HIV, Hepatitis, TB and STD Prevention, CDC; 4Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Ft. Collins, Colorado; 5Epidemic Intelligence Service, CDC.

Zika virus infection has been linked to increased risk for Guillain-Barré syndrome and adverse fetal outcomes, including congenital microcephaly. In January 2016, after notification from a local health care provider, an investigation by Dallas County Health and Human Services (DCHHS) identified a case of sexual transmission of Zika virus between a man with recent travel to an area of active Zika virus transmission (patient A) and his nontraveling male partner (patient B). At this time, there had been one prior case report of sexual transmission of Zika virus (1). The present case report indicates Zika virus can be transmitted through anal sex, as well as vaginal sex. Identification and investigation of cases of sexual transmission of Zika virus in nonendemic areas present valuable opportunities to inform recommendations to prevent sexual transmission of Zika virus.


April 16, 2016 at 9:44 am

Patterns in Zika Virus Testing and Infection, by Report of Symptoms and Pregnancy Status — United States, January 3–March 5, 2016

MMWR Morb Mortal Wkly Rep April 15, 2016 V.65 (Early Release)

Sharoda Dasgupta, PhD; Sarah Reagan-Steiner, MD; Dana Goodenough, MPH; et al.

During January 3–March 5, 2016, Zika virus testing was performed in the United States for 4,534 people who traveled to or moved from areas with active Zika virus transmission; 3,335 (73.6%) were pregnant women. Among 1,541 people who received testing and reported symptoms, 182 (11.8%) had confirmed Zika virus infection. Only seven asymptomatic pregnant women (0.3%) had confirmed Zika virus infection. These data suggest that in the current U.S. setting, the likelihood of Zika virus infection among asymptomatic people is low.


April 16, 2016 at 9:42 am


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