Archive for February 9, 2018

Adenovirus Type 4 Respiratory Infections among Civilian Adults, Northeastern United States, 2011–2015

Emerg Infect Dis. 2018 V.24 N.2 P.201-209

Adriana E. KajonComments to Author , Daryl M. Lamson, Camden R. Bair, Xiaoyan Lu, Marie L. Landry, Marilyn Menegus2, Dean D. Erdman, and Kirsten St. George

Author affiliations: Lovelace Respiratory Research Institute, Albuquerque, New Mexico, USA (A.E. Kajon, C.R. Bair); New York State Department of Health, Albany, New York, USA (D.M. Lamson, K. St. George); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (X. Lu, D.D. Erdman); Yale University School of Medicine, New Haven, Connecticut, USA (M.L. Landry); University of Rochester Medical Center, Rochester, New York, USA (M. Menegus)

Abstract

Human adenovirus type 4 (HAdV-4) is most commonly isolated in military settings. We conducted detailed molecular characterization on 36 HAdV-4 isolates recovered from civilian adults with acute respiratory disease (ARD) in the northeastern United States during 2011–2015.

Specimens came from college students, residents of long-term care facilities or nursing homes, a cancer patient, and young adults without co-morbidities.

HAdV-4 genome types 4a1 and 4a2, the variants most frequently detected among US military recruits in basic training before the restoration of vaccination protocols, were isolated in most cases.

Two novel a-like variants were recovered from students enrolled at a college in Tompkins County, New York, USA, and a prototype-like variant distinguishable from the vaccine strain was isolated from an 18-year-old woman visiting a physician’s office in Ulster County, New York, USA, with symptoms of influenza-like illness. Our data suggest that HAdV-4 might be an underestimated causative agent of ARD among civilian adults.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/24/2/17-1407_article

PDF

https://wwwnc.cdc.gov/eid/article/24/2/pdfs/17-1407.pdf

 

 

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February 9, 2018 at 6:47 pm

Staphylococcus saprophyticus: Which beta-lactam?

International Journal of Infectious Diseases December 2017 V.65 N. P.63–66

Hélène Pailhoriès, Viviane Cassisa, Rachel Chenouard, Marie Kempf, Matthieu Eveillard, Carole Lemarié

Highlights

  • The treatment of Staphylococcus saprophyticus urinary tract infections is difficult.
  • This study analysed the epidemiology of S. saprophyticus urinary tract infections.
  • Susceptibility of S. saprophyticus to ceftriaxone was studied.
  • A high rate of ineffective empirical antibiotic therapy for S. saprophyticus was noted.
  • High ceftriaxone minimum inhibitory concentrations were noted for methicillin-susceptible S. saprophyticus.

Background

Staphylococcus saprophyticus is resistant to the drugs most often used for the empirical treatment of urinary tract infections (UTI). The adequacy of antimicrobial treatments prescribed for UTI due to S. saprophyticus is not usually questioned. This study described the epidemiology of such infections and assessed the susceptibility of S. saprophyticus to ceftriaxone and amoxicillin–clavulanic acid.

Methods

Methicillin-susceptible S. saprophyticus (MSSS) isolated from clinical samples between November 2014 and July 2016 were included. Clinical data were recorded. The minimum inhibitory concentrations (MICs) of amoxicillin–clavulanic acid and ceftriaxone were measured for these MSSS strains and for 17 randomly selected methicillin-susceptible Staphylococcus aureus (MSSA) strains.

Results

Of the S. saprophyticus isolates from urine, 59.5% were associated with a diagnosis of cystitis and 33.3% with pyelonephritis. Sixty percent of S. saprophyticus cystitis cases and 25% of pyelonephritis cases were given an inappropriate antibiotic regimen. The MICs of ceftriaxone ranged from 4 to >32 μg/ml for MSSS, and from 1.5 to 4 μg/ml for MSSA.

Conclusions

Many UTIs were treated with an empirical antibiotic therapy that was ineffective for S. saprophyticus, revealing that S. saprophyticus is an aetiology that is insufficiently considered in UTI. High MICs for ceftriaxone in MSSS were observed, which raises questions about the use of this antibiotic in UTIs due to S. saprophyticus.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30252-7/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30252-7/pdf

February 9, 2018 at 1:27 pm

Emerging group C and group G streptococcal endocarditis: A Canadian perspective

International Journal of Infectious Diseases December 2017 V.65 N. P.128–132

Sylvain A. Lother, Davinder S. Jassal, Philippe Lagacé-Wiens, Yoav Keynan

Objectives

The aim of this study was to determine the incidence of infective endocarditis (IE) in patients with bacteremia caused by group C and group G streptococci (GCGS) and to characterize the burden of disease, clinical characteristics, and outcomes through a case series of patients with GCGS IE.

Methods

Individuals with blood cultures growing GCGS in Manitoba, Canada, between January 2012 and December 2015 were included. Clinical and echocardiographic parameters were collected retrospectively. IE was suspected or confirmed according to the modified Duke criteria.

Results

Two hundred and nine bacteremic events occurred in 198 patients. Transthoracic echocardiography (TTE) was performed in 33%. Suspected or confirmed IE occurred in 6% of all patients and in 18% of those with TTE. Native valve infection was more common than prosthetic valve and device-related infections (75%, 17%, and 8%, respectively). Metastatic infection was observed in 64%, primarily to the lungs (57%), skin (43%), osteoarticular system (29%), and central nervous system (29%). Sepsis occurred in 58% and streptococcal toxic shock syndrome in 50% of those with IE, with overall mortality of 17%.

Conclusions

IE from GCGS bacteremia is common and is frequently associated with severe disease, embolic events, and mortality. In the appropriate clinical context, GCGS bacteremic events should prompt investigation for IE.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30274-6/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30274-6/pdf

February 9, 2018 at 1:25 pm

Review – Approaches to hand hygiene monitoring: From low to high technology approaches

International Journal of Infectious Diseases December 2017 V.65 N. P.101–104

Nadia Masroor, Michelle Doll, Michael Stevens, Gonzalo Bearman

Highlights

  • Hand hygiene is a critical infection prevention practice in all healthcare settings.
  • Direct observation and product usage are appropriate methods to measure compliance in resource-limited facilities.
  • Advanced electronic hand hygiene monitoring systems are currently being assessed for accuracy and feasibility.
  • Current literature suggests a multimodal approach supplemented with ongoing education to enhance hand hygiene performance.

Abstract

Hand hygiene is a global and critical infection prevention practice across all healthcare settings. Approaches to monitoring hand hygiene compliance vary from simple methods such as direct observation and product usage to more advanced methods such as automated electronic monitoring systems. Current literature supports a multimodal approach, supplemented by education, to enhance hand hygiene performance.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30258-8/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30258-8/pdf

February 9, 2018 at 1:24 pm

Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality

International Journal of Infectious Diseases November 2017 V.64 N. P.69–73

Yuho Horikoshi, Junichi Suwa, Hiroshi Higuchi, Tetsuji Kaneko, Mihoko Furuichi, Yuta Aizawa, Kahoru Fukuoka, Kaoru Okazaki, Kenta Ito, Takayo Shoji

Highlights

  • An antimicrobial stewardship program in consultation with the infectious disease service reduced resistance in Pseudomonas aeruginosa.
  • Carbapenem use was correlated with carbapenem resistance in P. aeruginosa.
  • This pediatric antimicrobial stewardship program reduced the length of hospitalization and infection-related mortality.

Objective

The impact of pediatric antimicrobial stewardship programs (ASP) on antimicrobial resistance (AMR) remains largely unknown. This study aimed to evaluate the AMR for carbapenem of Gram-negative bacilli (GNB) and carbapenem use with infectious diseases consultation after the implementation of an ASP.

Methods

This quasi-experimental study was conducted at Tokyo Metropolitan Children’s Medical Center in Japan. The pre- and post-intervention periods were April 2010 to September 2011 and October 2011 to March 2017, respectively. The pre-intervention phase consisted of consultations with the infectious diseases service alone. The ASP was implemented during the post-intervention phase. The carbapenem resistance rates of GNB were calculated. The correlation between carbapenem resistance rates and carbapenem day of therapy (DOT) was examined. The outcome metrics were compared by average length of hospitalization, all-cause mortality, and infection-related mortality.

Results

A positive correlation was observed between the carbapenem resistance rate in Pseudomonas aeruginosa and DOT (0.76, p = 0.04). The carbapenem resistance rate in P. aeruginosa (p < 0.01) and DOT (p < 0.01) decreased significantly in the post-intervention period. The length of hospitalization (p < 0.01) and infection-related mortality (p = 0.05) decreased in the post-intervention period.

Conclusions

A sustained ASP with additional consultation with the infectious disease service reduced carbapenem use and resistance in P. aeruginosa, leading to favorable outcomes in terms of length of hospitalization and infection-related mortality.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30236-9/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30236-9/pdf

February 9, 2018 at 1:23 pm

Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis

International Journal of Infectious Diseases November 2017 V.64 N. P.58–66

Andre N.H. Bulabula, Angela Dramowski, Shaheen Mehtar

Highlights

  • The prevalence of colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant and/or post-partum women in Africa is 17% (95% confidence interval 10–23%).
  • The pooled proportions from reviewed studies suggest a greater proportion of ESBL-E colonization in pregnant women compared to post-partum women.
  • The rate of maternal colonization with ESBL-E is greater in community settings than in hospital settings.
  • The most frequently reported ESBL-encoding gene in Africa is CTX-M.

Objective

To summarize published studies on the prevalence of and risk factors for maternal bacterial colonization and/or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant and/or post-partum women in Africa.

Methods

A systematic review was conducted using the PubMed, Scopus, and Google Scholar databases. Bibliographies of included eligible studies were manually searched to identify additional relevant articles. No language restriction was applied. The timeframe of the search included all records from electronic database inception to July 15, 2017. A random-effects meta-analysis was performed to summarize the prevalence and the 95% confidence intervals (CI) of ESBL-E colonization or infection in pregnant or post-partum women in Africa. The meta-analysis was conducted using STATA IC 13.1 software and the metaprop function/plugin.

Results

Ten studies (seven on pregnant women and three on post-partum women) were included, documenting a 17% prevalence of maternal colonization with ESBL-E in Africa (95% CI 10–23%). The prevalence of ESBL-E in community isolates exceeded that in isolates from the hospital setting (22% vs. 14%). The most frequently reported ESBL-encoding gene was CTX-M (cefotaxime hydrolyzing capabilities). Data on risk factors for maternal ESBL-E colonization and infection are very limited.

Conclusions

The prevalence of colonization and/or infection with ESBL-E in pregnant and post-partum women in Africa exceeds that reported from high- and middle-income settings, representing a risk for subsequent neonatal colonization and/or infection with ESBL-E.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30221-7/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30221-7/pdf

February 9, 2018 at 1:21 pm

 Clinical evaluation of early acquisition of Staphylococcus aureus carriage by newborns

International Journal of Infectious Diseases November 2017 V.64 N. P.9–14

Ayala Maayan-Metzger, Tzipora Strauss, Carmit Rubin, Hanaa Jaber, Mordechai Dulitzky,

Aylana Reiss-Mandel, Eyal Leshem, Galia Rahav, Gili Regev-Yochay

Abstract

Background

Little is known about neonatal Staphylococcus aureus carriage. Sites and clinical outcomes of S. aureus colonization during the first month of life were evaluated in this study.

Methods

A cohort of 279 infants born at term to 277 mothers was included. Maternal S. aureus colonization status was examined before labor. Newborns were screened for nasal, auricular, umbilical, and rectal colonization, one to three times within 100 h after birth, and infants of carrier mothers were re-screened at 1 month. Medical data were recorded from the medical charts at discharge and at the 1-month follow-up interview.

Results

Overall 43 out of 279 (15.4%) infants acquired S. aureus within the first days of life. The only two predictors of S. aureus carriage in the postnatal period were maternal S. aureus carriage (odds ratio 7.905, 95% confidence interval 3.182–19.638) and maternal antibiotic treatment during labor (odds ratio 0.121, 95% confidence interval 0.016–0.949). Among colonized children, the nose (56%) and rectum (40%) were more frequently colonized, while ear (26%) and umbilicus (16%) colonization were less common. Co-colonization at two sites was rare (4%), but always predicted carriage at 1 month of age. Maternal and neonatal characteristics, including neonatal outcomes, were similar between S. aureus carrier and non-carrier infants during the first month of life.

Conclusions

Maternal carriage is the major predictor of neonatal S. aureus carriage. The nose and rectum are the main sites of neonatal carriage. S. aureus carriage was not associated with neonatal complications throughout the first month of life. The long-term significance of early S. aureus carriage is yet to be determined.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30219-9/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30219-9/pdf

February 9, 2018 at 1:20 pm

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