Posts filed under ‘Health Care-Associated Infections’

Rapid and Accurate Molecular Identification of the Emerging Multidrug-Resistant Pathogen Candida auris

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2445-2452

Milena Kordalewska, Yanan Zhao, Shawn R. Lockhart, Anuradha Chowdhary, Indira Berrio, and David S. Perlin

aPublic Health Research Institute, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA

bMycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

cDepartment of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

dClínica El Rosario, Medellín, Colombia

eMedical and Experimental Mycology Group, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia

fHospital General de Medellin Luz Castro de Gutiérrez ESE, Medellín, Colombia

Candida auris is an emerging multidrug-resistant fungal pathogen causing nosocomial and invasive infections associated with high mortality. C. auris is commonly misidentified as several different yeast species by commercially available phenotypic identification platforms. Thus, there is an urgent need for a reliable diagnostic method. In this paper, we present fast, robust, easy-to-perform and interpret PCR and real-time PCR assays to identify C. auris and related species: Candida duobushaemulonii, Candida haemulonii, and Candida lusitaniae. Targeting rDNA region nucleotide sequences, primers specific for C. auris only or C. auris and related species were designed. A panel of 140 clinical fungal isolates was used in both PCR and real-time PCR assays followed by electrophoresis or melting temperature analysis, respectively. The identification results from the assays were 100% concordant with DNA sequencing results. These molecular assays overcome the deficiencies of existing phenotypic tests to identify C. auris and related species.

PDF

http://jcm.asm.org/content/55/8/2445.full.pdf+html

July 26, 2017 at 9:29 am

Molecular Diagnosis of Orthopedic-Device-Related Infection Directly from Sonication Fluid by Metagenomic Sequencing

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2334-2347

Teresa L. Street, Nicholas D. Sanderson, Bridget L. Atkins, Andrew J. Brent, Kevin Cole, Dona Foster, Martin A. McNally, Sarah Oakley, Leon Peto, Adrian Taylor, Tim E. A. Peto, Derrick W. Crook, and David W. Eyre

aNuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom

bBone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

cMicrobiology Laboratory, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

dDepartment of Infectious Diseases and Microbiology, Royal Sussex County Hospital, Brighton, United Kingdom

ePublic Health England, Microbiology, Royal Sussex County Hospital, Brighton, United Kingdom

fNational Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom

Culture of multiple periprosthetic tissue samples is the current gold standard for microbiological diagnosis of prosthetic joint infections (PJI). Additional diagnostic information may be obtained through culture of sonication fluid from explants. However, current techniques can have relatively low sensitivity, with prior antimicrobial therapy and infection by fastidious organisms influencing results. We assessed if metagenomic sequencing of total DNA extracts obtained direct from sonication fluid can provide an alternative rapid and sensitive tool for diagnosis of PJI. We compared metagenomic sequencing with standard aerobic and anaerobic culture in 97 sonication fluid samples from prosthetic joint and other orthopedic device infections. Reads from Illumina MiSeq sequencing were taxonomically classified using Kraken. Using 50 derivation samples, we determined optimal thresholds for the number and proportion of bacterial reads required to identify an infection and confirmed our findings in 47 independent validation samples. Compared to results from sonication fluid culture, the species-level sensitivity of metagenomic sequencing was 61/69 (88%; 95% confidence interval [CI], 77 to 94%; for derivation samples 35/38 [92%; 95% CI, 79 to 98%]; for validation samples, 26/31 [84%; 95% CI, 66 to 95%]), and genus-level sensitivity was 64/69 (93%; 95% CI, 84 to 98%). Species-level specificity, adjusting for plausible fastidious causes of infection, species found in concurrently obtained tissue samples, and prior antibiotics, was 85/97 (88%; 95% CI, 79 to 93%; for derivation samples, 43/50 [86%; 95% CI, 73 to 94%]; for validation samples, 42/47 [89%; 95% CI, 77 to 96%]). High levels of human DNA contamination were seen despite the use of laboratory methods to remove it. Rigorous laboratory good practice was required to minimize bacterial DNA contamination. We demonstrate that metagenomic sequencing can provide accurate diagnostic information in PJI. Our findings, combined with the increasing availability of portable, random-access sequencing technology, offer the potential to translate metagenomic sequencing into a rapid diagnostic tool in PJI.

PDF

http://jcm.asm.org/content/55/8/2334.full.pdf+html

July 26, 2017 at 9:27 am

Is This the Carbapenemase Test We’ve Been Waiting for? A Multicenter Evaluation of the Modified Carbapenem Inactivation Method

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2309-2312

Susan M. Butler-Wu and April N. Abbott

aDepartment of Pathology and Laboratory Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA

bDepartment of Pathology, Deaconess Health System, Evansville, Indiana, USA

ABSTRACT

A plethora of phenotypic methods exist for the detection of carbapenemases; however, clinical laboratories have struggled for years with accurate, objective phenotypic detection of carbapenemase activity in Enterobacteriaceae. In this issue of the Journal of Clinical Microbiology, V. M. Pierce et al. (J Clin Microbiol 55:2321–2333, 2017, https://doi.org/10.1128/JCM.00193-17) report on a multicenter evaluation of the modified carbapenem inactivation method (mCIM). The high sensitivity, specificity, reproducibility, and ease of interpretation associated with the mCIM for Enterobacteriaceae will likely lead to its adoption by clinical laboratories.

PDF

http://jcm.asm.org/content/55/8/2309.full.pdf+html

 

Journal of Clinical Microbiology August 2017 V.55 N.8 P.2321-2333

Modified Carbapenem Inactivation Method for Phenotypic Detection of Carbapenemase Production among Enterobacteriaceae

Virginia M. Pierce, Patricia J. Simner, David R. Lonsway, Darcie E. Roe-Carpenter, J. Kristie Johnson, William B. Brasso, April M. Bobenchik, Zabrina C. Lockett, Angella Charnot-Katsikas, Mary Jane Ferraro, Richard B. Thomson Jr., Stephen G. Jenkins, Brandi M. Limbago, and Sanchita Das

aDepartment of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA

bDepartment of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

cDivision of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA

dBeckman Coulter Diagnostics, Inc., West Sacramento, California, USA

eDepartment of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA

fBD Life Sciences–Diagnostic Systems, Sparks, Maryland, USA

gDepartment of Pathology and Laboratory Medicine, Lifespan Academic Medical Center, Providence, Rhode Island, USA

hDepartment of Pathology, University of Chicago Medical Center, Chicago, Illinois, USA

iDepartment of Pathology, NorthShore University HealthSystem, Evanston, Illinois, USA

jDepartment of Pathology and Laboratory Medicine, Weill-Cornell Medical College, New York, New York, USA

The ability of clinical microbiology laboratories to reliably detect carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is an important element of the effort to prevent and contain the spread of these pathogens and an integral part of antimicrobial stewardship. All existing methods have limitations. A new, straightforward, inexpensive, and specific phenotypic method for the detection of carbapenemase production, the carbapenem inactivation method (CIM), was recently described. Here we describe a two-stage evaluation of a modified carbapenem inactivation method (mCIM), in which tryptic soy broth was substituted for water during the inactivation step and the length of this incubation was extended. A validation study was performed in a single clinical laboratory to determine the accuracy of the mCIM, followed by a nine-laboratory study to verify the reproducibility of these results and define the zone size cutoff that best discriminated between CP-CRE and members of the family Enterobacteriaceae that do not produce carbapenemases. Bacterial isolates previously characterized through whole-genome sequencing or targeted PCR as to the presence or absence of carbapenemase genes were tested for carbapenemase production using the mCIM; isolates with Ambler class A, B, and D carbapenemases, non-CP-CRE isolates, and carbapenem-susceptible isolates were included. The sensitivity of the mCIM observed in the validation study was 99% (95% confidence interval [95% CI], 93% to 100%), and the specificity was 100% (95% CI, 82% to 100%). In the second stage of the study, the range of sensitivities observed across nine laboratories was 93% to 100%, with a mean of 97%; the range of specificities was 97% to 100%, with a mean of 99%. The mCIM was easy to perform and interpret for Enterobacteriaceae, with results in less than 24 h and excellent reproducibility across laboratories.

PDF

http://jcm.asm.org/content/55/8/2321.full.pdf+html

 

July 26, 2017 at 9:25 am

Preventing Methicillin-Resistant Staphylococcus aureus (MRSA) Disease in Urban US Hospitals—Now for the Hard Part: More Evidence Pointing to the Community as the Source of MRSA Acquisition

Journal of Infectious Diseases June 1, 2017 V.215 N.11 P.1631-1633

EDITOR’S CHOICE

Susan M. Ray

Methicillin-resistant Staphylococcus aureus (MRSA) first emerged in the 1960s, shortly after the introduction of methicillin for therapeutic use [1].

Over the next 4 decades, MRSA spread worldwide and became endemic in hospitals in many countries [2].

In the 1990s, community- associated MRSA emerged as an epidemic of skin and soft-tissue infections in patients without any prior healthcare contact and was associated with serious morbidity and mortality [3, 4].

Although the earliest reports of community-associated MRSA disease in the United States were due to both USA400 and USA300, it was soon clear that USA300 was the epidemic community-associated MRSA clone of greatest importance in the United States, and it has persisted for well over a decade [5, 6].

By the mid-2000s, USA300 was noted to cause healthcare-associated disease [7], and in some urban centers it now accounts for up to 50% of nosocomial MRSA bacteremias [8] and a high proportion of cases of MRSA disease and colonization in long-term-care facilities [9, 10]….

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/11/10.1093_infdis_jix109/5/jix109.pdf?Expires=1500037938&Signature=M0o6aaG1nA-QKa5cEmLj56MsouSnLNTmXn-rFt5eerqIhGRsOgr7M9TVLV3yPaZdHI9nXHLygHt02IoXRNC52maaY~kOam~1c1TuDdfcfJ4RwkUOAUOBkKsyEGuzyllVW6j-okbFuBgALwX4MnyilQz~XvqeWt0e7z3JKg4bmLgEj2a5swrFQJHO8t37Jz70wwFyXG4G4mbsUFUuvvRe6UYs6m2MFutBvChhUUPfYlqzW7Y6BL-FZ~F7xLX2PeulV4xZ4ag7AYF8iwDGTLykI~hEkiIgXy7lLZqUsctiu~38reEjq-9Y2GmDmw8GtJeU~lWzyPorY2qcwEY9UhjKqg__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

 

July 13, 2017 at 4:07 pm

Preventing Methicillin-Resistant Staphylococcus aureus (MRSA) Disease in Urban US Hospitals—Now for the Hard Part: More Evidence Pointing to the Community as the Source of MRSA Acquisition

Journal of Infectious Diseases June 1, 2017 V.215 N.11 P.1631-1633

EDITOR’S CHOICE

Susan M. Ray

Methicillin-resistant Staphylococcus aureus (MRSA) first emerged in the 1960s, shortly after the introduction of methicillin for therapeutic use [1].

Over the next 4 decades, MRSA spread worldwide and became endemic in hospitals in many countries [2]. In the 1990s, community- associated MRSA emerged as an epidemic of skin and soft-tissue infections in patients without any prior healthcare contact and was associated with serious morbidity and mortality [3, 4].

Although the earliest reports of community-associated MRSA disease in the United States were due to both USA400 and USA300, it was soon clear that USA300 was the epidemic community-associated MRSA clone of greatest importance in the United States, and it has persisted for well over a decade [5, 6].

By the mid-2000s, USA300 was noted to cause healthcare-associated disease [7], and in some urban centers it now accounts for up to 50% of nosocomial MRSA bacteremias [8] and a high proportion of cases of MRSA disease and colonization in long-term-care facilities [9, 10]….

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jid/215/11/10.1093_infdis_jix109/5/jix109.pdf?Expires=1500037938&Signature=M0o6aaG1nA-QKa5cEmLj56MsouSnLNTmXn-rFt5eerqIhGRsOgr7M9TVLV3yPaZdHI9nXHLygHt02IoXRNC52maaY~kOam~1c1TuDdfcfJ4RwkUOAUOBkKsyEGuzyllVW6j-okbFuBgALwX4MnyilQz~XvqeWt0e7z3JKg4bmLgEj2a5swrFQJHO8t37Jz70wwFyXG4G4mbsUFUuvvRe6UYs6m2MFutBvChhUUPfYlqzW7Y6BL-FZ~F7xLX2PeulV4xZ4ag7AYF8iwDGTLykI~hEkiIgXy7lLZqUsctiu~38reEjq-9Y2GmDmw8GtJeU~lWzyPorY2qcwEY9UhjKqg__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

July 13, 2017 at 8:20 am

SOMANZ guidelines for the investigation and management sepsis in pregnancy.

Aust N Z J Obstet Gynaecol. July 3, 2017    

Bowyer L1, Robinson HL2, Barrett H3, Crozier TM4, Giles M5,6, Idel I7, Lowe S8, Lust K9, Marnoch CA10, Morton MR11, Said J12,13, Wong M14, Makris A15,16.

Author information

1 Maternal Fetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia.

2 Department of Medicine, Ipswich Hospital, Ipswich, Queensland, Australia.

3 Department of Obstetric Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia.

4 Intensive Care, Monash Medical Health, Melbourne, Victoria, Australia.

5 Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia.

6 Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.

7 Department of Nephrology, Eastern Health, Melbourne, Victoria, Australia.

8 Royal Hospital for Women, Sydney, New South Wales, Australia.

9 Department of Obstetrics and Gynaecology, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia.

10 Auckland District Health Board, Auckland, New Zealand.

11 Women’s and Babies Division, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia.

12 Department of Maternal Fetal Medicine, Sunshine Hospital, Melbourne, Victoria, Australia.

13 Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.

14 Department of Anaesthesia, Royal Women’s Hospital, Melbourne, Victoria, Australia.

15 Department of Nephrology, Liverpool Hospital, Liverpool, New South Wales, Australia.

16 Department of Medicine, Western Sydney University, Sydney, New South Wales, Australia.

Abstract

SOMANZ (Society of Obstetric Medicine Australia and New Zealand) has written a guideline to provide evidence-based guidance for the investigation and care of women with sepsis in pregnancy or the postpartum period.

The guideline is evidence-based and incorporates recent changes in the definition of sepsis. The etiology, investigation and treatment of bacterial, viral and non-infective causes of sepsis are discussed.

Obstetric considerations relevant to anaesthetic and intensive care treatment in sepsis are also addressed. A multi-disciplinary group of clinicians with experience in all aspects of the care of pregnant women have contributed to the development of the guidelines.

This is an executive summary of the guidelines.

abstract

http://onlinelibrary.wiley.com/doi/10.1111/ajo.12646/abstract

PDF

http://onlinelibrary.wiley.com/doi/10.1111/ajo.12646/epdf

July 11, 2017 at 3:42 pm

Recomendaciones para la prevención de infecciones asociadas a artoplastia electiva en adultos

Medicina (B. Aires) Abril 2017 V.77 N.2

Juan Carlos Chuluyán1*, Andrea Vila2*, Ana Laura Chattás3*, Marcelo Montero3*, Claudia Pensotti4*+, Claudia Tosello5*, Marisa Sánchez6*, Cecilia Vera Ocampo7*, Guillermina Kremer8*, Rodolfo Quirós8*, Guillermo A. Benchetrit9*, Carolina Fernanda Pérez10*, Ana Laura Terusi11*, Francisco Nacinovich12*

1Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. Álvarez,

2Servicio de Infectología, Hospital Italiano de Mendoza,

3Hospital General de Agudos Dr. Pirovano,

4Clínica Monte Grande,

5Hospital de Clínicas José de San Martín, UBA,

6Hospital Italiano de Buenos Aires,

7Sanatorio Dupuytren,

8Hospital Universitario Austral,

9Instituto de Investigaciones Médicas A. Lanari, UBA,

10Policlínico del Docente-Centro Médico Huésped,

11Instituto César Milstein,

12Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina

*En representación del grupo de trabajo en infecciones osteoarticulares de la Sociedad Argentina de Infectología

+In memoriam

Dirección postal: Juan Carlos Chuluyan, Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. Álvarez, J. F. Aranguren 2701, 1406 Buenos Aires, Argentina

e-mail: jcchulu@gmail.com

Resumen

Las infecciones del sitio quirúrgico que complican las cirugías ortopédicas con implante prolongan la estadía hospitalaria y aumentan tanto el riesgo de readmisión como el costo de la internación y la mortalidad.

Las presentes recomendaciones están dirigidas a:

(i) optimizar el cumplimiento de normas y la incorporación de hábitos en cada una de las fases de la cirugía, detectando factores de riesgo para infecciones del sitio quirúrgico potencialmente corregibles o modificables; y

(ii) adecuar la profilaxis antibiótica preoperatoria y el cuidado intra y postoperatorio.

FULL TEXT

http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802017000200014

 

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July 9, 2017 at 3:50 pm

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