Archive for December, 2018

Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit

Infect Control Hosp Epidemiol. December 12, 2018


Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated.


We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods.


Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%–14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change.


Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.


December 31, 2018 at 1:03 pm

The Complex Interpretation and Management of Zika Virus Test Results.

J Am Board Fam Med. Nov-Dec 2018 V.31 N.6 P.924-930.    

Lin KW1, Kraemer JD2, Piltch-Loeb R2, Stoto MA2.

Author information

1 From the Department of Family Medicine, Georgetown University Medical Center, Washington, DC (KWL); Department of Health Systems Administration, Georgetown University, Washington (JDK, MAS); New York University College of Global Public Health, New York, NY (RP-L).

2 From the Department of Family Medicine, Georgetown University Medical Center, Washington, DC (KWL); Department of Health Systems Administration, Georgetown University, Washington (JDK, MAS); New York University College of Global Public Health, New York, NY (RP-L).

Zika virus disease provides the latest example of a critical nexus between public health and clinical practice.

Interpreting Zika virus test results is complicated by the absence of a single testing approach with superior validity across contexts and populations.

Molecular tests are highly specific, variably sensitive, and have a short window period. Serologic tests identify antibodies against Zika virus and are more likely than molecular tests to cross-react with other related viruses, reducing specificity.

The type of test performed and timing relative to possible Zika virus exposure depend on public health guidance, testing algorithms, test availability, and capacity.

Guidance from the Centers for Disease Control and Prevention and local health departments have changed throughout the course of the US epidemic based on prevalence, geography, and clinical concerns. Women with a low pretest probability of infection should be counseled against testing.

Women with a high pretest probability of Zika virus infection should still receive enhanced prenatal monitoring and newborn evaluation, regardless of the test result. An appropriate interpretation of results depends on what tests are used, patient characteristics, and reasons for testing.

Clinicians should take these factors into account in shared decision making discussions with pregnant women about Zika virus testing.



December 31, 2018 at 10:11 am

Candida auris Sternal Osteomyelitis in a Man from Kenya Visiting Australia, 2015

Emerging Infectious Diseases January 2019 V.25  N.1

H. Heath et al.

In Australia in 2015, Candida auris sternal osteomyelitis was diagnosed in a 65-year-old man with a history of intensive care treatment in Kenya in 2012 and without a history of cardiac surgery.

The isolate was South Africa clade III.

Clinicians should note that C. auris can cause low-grade disease years after colonization.


December 26, 2018 at 3:48 pm

Clinical and Radiologic Characteristics of Human Metapneumovirus Infections in Adults, South Korea

Emerging Infectious Diseases January 2019 V.25  N.1

Koo et al.

Clinical features of human metapneumovirus (HMPV) infection have not been well documented for adults.

We investigated clinical and radiologic features of HMPV infection in 849 adults in a tertiary hospital in South Korea.

We classified patients into groups on the basis of underlying diseases:

immunocompetent patients,

solid tumor patients,

solid organ transplantation recipients,

hematopoietic stem cell transplant recipients,

hematologic malignancy patients, and

patients receiving long-term steroid treatment.

Of 849 HMPV-infected patients, 756 had community-acquired infections, 579 had pneumonia, and 203 had infections with other pathogens.

Mortality rates were highest in hematopoietic stem cell transplantation recipients (22% at 30 days).

Older age, current smoking, and underlying disease were associated with HMPV pneumonia.

Body mass index and an immunocompromised state were associated with 30-day mortality rates in HMPV-infected patients.

Bronchial wall thickening, ground-glass opacity, and ill-defined centrilobular nodules were common computed tomography findings for HMPV pneumonia.

Macronodules and consolidation were observed in <50% of patients.


December 26, 2018 at 3:45 pm

Deadly Marburg Virus Found in Sierra Leone Bats

Centers for Disease Control and Prevention (Estados Unidos)

First time this Ebola-like virus identified in West Africa

Scientists have discovered live Marburg virus in fruit bats in Sierra Leone – the first time the deadly virus has been found in West Africa.

Five Egyptian rousette fruit bats tested positive for active Marburg virus infection. Scientists caught the bats separately at locations in three health districts: Moyamba, Koinadugu and Kono.

There have been no reported cases of people sick with Marburg in Sierra Leone, but the virus’s presence in bats means people nearby could be at risk for contracting Marburg virus.

Marburg virus is a cousin to Ebola virus that causes a similar, often fatal disease in people….


December 26, 2018 at 8:54 am

Infections After Receipt of Bacterially Contaminated Umbilical Cord Blood–Derived Stem Cell Products for Other Than Hematopoietic or Immunologic Reconstitution — United States, 2018

Morbidity and Mortality Weekly Report December 21, 2018  V.67 N.50 P.1397–1399

Infections After Receipt of Bacterially Contaminated Umbilical Cord Blood–Derived Stem Cell Products for Other Than Hematopoietic or Immunologic Reconstitution — United States, 2018

The only Food and Drug Administration (FDA)–approved stem cell products are derived from umbilical cord blood, and their only approved use is hematopoietic and immunologic reconstitution (1).

On September 17, 2018, the Texas Department of State Health Services received notification of Enterobacter cloacae and Citrobacter freundii bloodstream infections in three patients who had received injections or infusions of non-FDA–approved umbilical cord blood-derived stem cell products processed by Genetech, Inc., and distributed by Liveyon, LLC, for other than hematopoietic or immunologic reconstitution at an outpatient clinic on September 12.

Patient isolates of E. cloacae had identical pulsed-field gel electrophoresis patterns, suggesting a common source …


December 26, 2018 at 8:52 am

Hantavirus pulmonary syndrome in Buenos Aires, 2009-2014.

Medicina (B Aires). 2016;76(1):1-9.

[Article in Spanish]

Iglesias AA1, Bellomo CM, Martínez VP.

Author information

1 Laboratorio de Hantavirus, Servicio de Biología Molecular, Departamento de Virología, Instituto Nacional de Enfermedades Infecciosas, ANLIS Dr. Carlos G. Malbrán, Buenos Aires, Argentina. E-mail:


Andes virus is the causative agent of hantavirus pulmonary syndrome (HPS) in Argentina and neighboring countries. In our country four different areas are affected: Northwest, Southwest, Central and Northeast, where distinct Andes virus genotypes were characterized. Three genotypes were described in Buenos Aires province (Central area): AND-Buenos Aires, AND-Lechiguanas and AND-Plata. In this work, we considered all HPS cases confirmed by ELISA and real time RT-PCR during the period 2009-2014 in Buenos Aires province. The annual distribution, fatality rate and geographic distribution were analyzed. We also analyzed the genotypes involved by RT-PCR and nucleotide sequencing. Finally we evaluated epidemiological data in order to establish the route of transmission. We analyzed 1386 suspect cases of hantavirus infection from Buenos Aires province and we confirmed 88 cases of Hantavirus Pulmonary Syndrome during 2009-2014. The overall average was 14.3 cases per year. The occurrence of a HPS outbreak was confirmed in Buenos Aires province during 2013, showing a 3 fold increase in case number compared to the annual average between 2009 and 2012, tending to normalize during 2014. The overall lethality was 25.6%, with a maximum value of 45.5% in 2011. Genotype analysis was performed in 30.7% of confirmed cases, AND-BsAs show the highest incidence, it was characterized in 72% of the studied cases. Epidemiological data and results of viral genome comparison strongly suggest person-to-person transmission in the three clusters of two cases described in our study.


December 21, 2018 at 11:20 am

Person-to-person household and nosocomial transmission of andes hantavirus, Southern Chile, 2011.

Emerg Infect Dis. October 2014 V.20 N.10 P.1629-36.

Martinez-Valdebenito C, Calvo M, Vial C, Mansilla R, Marco C, Palma RE, Vial PA, Valdivieso F, Mertz G, Ferrés M.


Andes hantavirus (ANDV) causes hantavirus cardiopulmonary syndrome in Chile and is the only hantavirus for which person-to-person transmission has been proven. We describe an outbreak of 5 human cases of ANDV infection in which symptoms developed in 2 household contacts and 2 health care workers after exposure to the index case-patient. Results of an epidemiologic investigation and sequence analysis of the virus isolates support person-to-person transmission of ANDV for the 4 secondary case-patients, including nosocomial transmission for the 2 health care workers. Health care personnel who have direct contact with ANDV case-patients or their body fluids should take precautions to prevent transmission of the virus. In addition, because the incubation period of ANDV after environmental exposure is longer than that for person-to-person exposure, all persons exposed to a confirmed ANDV case-patient or with possible environmental exposure to the virus should be monitored for 42 days for clinical symptoms.


December 21, 2018 at 11:18 am

HANTAVIRUS – Person-to-person transmission of Andes virus.

Emerg Infect Dis. December 2005 V.11 N.12 P.1848-53.

Martinez VP1, Bellomo C, San Juan J, Pinna D, Forlenza R, Elder M, Padula PJ.

Author information

1 Instituto Nacional de Enfermedades Infecciosas ANLIS Dr. C.G. Malbrán, Buenos Aires, Argentina.


Despite the fact that rodents are considered to be the infectious source of hantavirus for humans, another route of transmission was demonstrated. Andes virus (ANDV) has been responsible for most of the cases recorded in Argentina. Person-to-person transmission of ANDV Sout lineage was described during an outbreak of hantavirus pulmonary syndrome in southwest Argentina. In this study, we analyzed 4 clusters that occurred in 2 disease-endemic areas for different ANDV lineages. We found new evidence of interhuman transmission for ANDV Sout lineage and described the first event in which another lineage, ANDV Cent BsAs, was implicated in this mechanism of transmission. On the basis of epidemiologic and genetic data, we concluded that person-to-person spread of the virus likely took place during the prodromal phase or shortly after it ended, since close and prolonged contact occurred in the events analyzed here, and the incubation period was 15-24 days



December 21, 2018 at 11:16 am

2018 IDSA clinical practice guideline for the management of outpatient parenteral antimicrobial therapy.

Clin Infect Dis November 18, 2018

Norris AH et al.

A panel of experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2004 clinical practice guideline on outpatient parenteral antimicrobial therapy (OPAT) [1]. This guideline is intended to provide insight for healthcare professionals who prescribe and oversee the provision of OPAT. It considers various patient features, infusion catheter issues, monitoring questions, and antimicrobial stewardship concerns. It does not offer recommendations on the treatment of specific infections. The reader is referred to disease- or organism-specific guidelines for such support.



December 21, 2018 at 9:11 am

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