Posts filed under ‘Prevencion y Control de Infecciones’

Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population

Clinical Infectious Diseases September 15, 2018 V.67 N.6 P.837–844

Lona Mody; Betsy Foxman; Suzanne Bradley; Sara McNamara; Bonnie Lansing …

We sampled 651 recently admitted nursing facility patients and collected clinical and microbiological data over 1629 visits. We found that more than 57% were colonized with 1 or more multidrug-resistant organisms on enrollment, and 56% were colonized at discharge from the facility.

Background

The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post–acute populations. We estimate the prevalence of MDRO colonization in NF patients on enrollment and discharge to community settings, risk factors for colonization, and rates of acquiring MDROs during the stay.

Methods

We conducted a prospective, longitudinal cohort study of newly admitted patients in 6 NFs in southeast Michigan using active microbial surveillance of multiple anatomic sites sampled at enrollment, days 14 and 30, and monthly thereafter for up to 6 months.

Results

We enrolled 651 patients and collected 7526 samples over 1629 visits, with an average of 29 days of follow-up per participant. Nearly all participants were admitted for post–acute care (95%). More than half (56.8%) were colonized with MDROs at enrollment: methicillin-resistant Staphylococcus aureus (MRSA), 16.1%; vancomycin-resistant enterococci (VRE), 33.2%; and resistant gram-negative bacilli (R-GNB), 32.0%. Risk factors for colonization at enrollment included prolonged hospitalization (>14 days), functional disability, antibiotic use, or device use. Rates per 1000 patient-days of acquiring a new MDRO were MRSA, 3.4; VRE, 8.2; and R-GNB, 13.6. MDRO colonization at discharge was similar to that at enrollment (56.4%): MRSA, 18.4%; VRE, 30.3%; and R-GNB, 33.6%.

Conclusions

Short-stay NF patients exhibit a high prevalence of MDROs near the time of admission, as well as at discharge, and may serve as a reservoir for spread in other healthcare settings. Future interventions to reduce MDROs should specifically target this population.

FULL TEXT

https://academic.oup.com/cid/article/67/6/837/4965240

PDF (CLIC en PDF)

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September 2, 2018 at 5:39 pm

Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada

Emerging Infectious Diseases September 2018 V.24 N.9

P. Kohler et al.

Roberto G. Melano, Samir N. Patel, Shumona Shafinaz, Amna Faheem, Brenda L. Coleman, Karen Green, Irene Armstrong, Huda Almohri, Sergio Borgia, Emily Borgundvaag, Jennie Johnstone, Kevin Katz, Freda Lam, Matthew P. Muller, Jeff Powis, Susan M. Poutanen, David Richardson, Anu Rebbapragada, Alicia Sarabia, Andrew Simor, Allison McGeer, and for the Toronto Invasive Bacterial Diseases Network (TIBDN)

We analyzed population-based surveillance data from the Toronto Invasive Bacterial Diseases Network to describe carbapenemase-producing Enterobacteriaceae (CPE) infections during 2007–2015 in south-central Ontario, Canada. We reviewed patients’ medical records and travel histories, analyzed microbiologic and clinical characteristics of CPE infections, and calculated incidence. Among 291 cases identified, New Delhi metallo-β-lactamase was the predominant carbapenemase (51%). The proportion of CPE-positive patients with prior admission to a hospital in Canada who had not received healthcare abroad or traveled to high-risk areas was 13% for patients with oxacillinase-48, 24% for patients with New Delhi metallo-β-lactamase, 55% for patients with Klebsiella pneumoniae carbapenemase, and 67% for patients with Verona integron-encoded metallo-β-lactamase. Incidence of CPE infection increased, reaching 0.33 cases/100,000 population in 2015. For a substantial proportion of patients, no healthcare abroad or high-risk travel could be established, suggesting CPE acquisition in Canada. Policy and practice changes are needed to mitigate nosocomial CPE transmission in hospitals in Canada.

PDF

https://wwwnc.cdc.gov/eid/article/24/9/pdfs/18-0164.pdf

August 24, 2018 at 6:11 pm

Spread of mcr-1–Driven Colistin Resistance on Hospital Surfaces, Italy

Emerging Infectious Diseases September 2018 V.24 N.9

Caselli et al.

Università Degli Studi di Ferrara, Ferrara, Italy

Plasmid-mediated colistin resistance driven by the mcr-1 gene is of great clinical concern. Its diffusion in the hospital environment is unknown. We detected mcr-1–driven resistance in 8.3% of Enterobacteriaceae isolates from hospital surfaces in Italy, which might represent a reservoir of threatening nosocomial pathogens.

PDF

https://wwwnc.cdc.gov/eid/article/24/9/pdfs/17-1386.pdf

August 24, 2018 at 6:09 pm

Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices.

MMWR Recomm Rep. 2018 Jan 12;67(1):1-31.

Schillie S1, Vellozzi C1, Reingold A2, Harris A1, Haber P3, Ward JW1, Nelson NP1.

Author information

1 Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

2 University of California, Berkeley School of Public Health, Berkeley, California.

3 Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

Abstract

HEPATITIS B VIRUS (HBV) IS TRANSMITTED VIA BLOOD OR SEXUAL CONTACT. PERSONS WITH CHRONIC HBV INFECTION ARE AT INCREASED RISK FOR CIRRHOSIS AND LIVER CANCER AND REQUIRE MEDICAL CARE. THIS REPORT UPDATES AND SUMMARIZES PREVIOUSLY PUBLISHED RECOMMENDATIONS FROM THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (ACIP) AND CDC REGARDING THE PREVENTION OF HBV INFECTION IN THE UNITED STATES. ACIP RECOMMENDS TESTING ALL PREGNANT WOMEN FOR HEPATITIS B SURFACE ANTIGEN (HBSAG), AND TESTING HBSAG-POSITIVE PREGNANT WOMEN FOR HEPATITIS B VIRUS DEOXYRIBONUCLEIC ACID (HBV DNA); ADMINISTRATION OF HEPB VACCINE AND HEPATITIS B IMMUNE GLOBULIN (HBIG) FOR INFANTS BORN TO HBV-INFECTED WOMEN WITHIN 12 HOURS OF BIRTH, FOLLOWED BY COMPLETION OF THE VACCINE SERIES AND POSTVACCINATION SEROLOGIC TESTING; UNIVERSAL HEPATITIS B VACCINATION WITHIN 24 HOURS OF BIRTH, FOLLOWED BY COMPLETION OF THE VACCINE SERIES; AND VACCINATION OF CHILDREN AND ADOLESCENTS AGED <19 YEARS WHO HAVE NOT BEEN VACCINATED PREVIOUSLY. ACIP RECOMMENDS VACCINATION OF ADULTS AT RISK FOR HBV INFECTION, INCLUDING UNIVERSAL VACCINATION OF ADULTS IN SETTINGS IN WHICH A HIGH PROPORTION HAVE RISK FACTORS FOR HBV INFECTION AND VACCINATION OF ADULTS REQUESTING PROTECTION FROM HBV WITHOUT ACKNOWLEDGMENT OF A SPECIFIC RISK FACTOR. THESE RECOMMENDATIONS ALSO PROVIDE CDC GUIDANCE FOR POSTEXPOSURE PROPHYLAXIS FOLLOWING OCCUPATIONAL AND OTHER EXPOSURES. THIS REPORT ALSO BRIEFLY SUMMARIZES PREVIOUSLY PUBLISHED AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASEST GUIDELINES FOR MATERNAL ANTIVIRAL THERAPY TO REDUCE PERINATAL HBV TRANSMISSION

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837403/pdf/rr6701a1.pdf

August 2, 2018 at 8:10 am

Carbapenemases in the UCI: A constant challenge

International Journal of Infectious Diseases August 2018 V.73 Supplement P.29

Cornistein, W. Cox, M. Torres Boden, C. Cozzani, G. Cueto, L. Lopez Moral, N. Gomez, M. Badia, C. Rodriguez

Background

Carbapenemase-producing enterobacteria (CPE) infections increase morbi-mortality and hospital costs,becoming a serious problem for public health and a constant challenge for the health team.

Argentina has a prevalence of 10%, including the three classes of carbapenemases (OXA, NDM and KPC) with different patterns of sensitivity and geographical distribution.

In the last decade we have observed an exponential increase in CPE infections mainly in the ICU, hence affecting empirical treatments (ET)and limiting de-escalation and therapeutic options.

Objective

To analyze the CPE infections in the ICU and the impact of the ET.

Methods & Materials

Retrospective analysis of case series from January-September 2017 in 2 intensive care unit medical surgical (UCIA – UCIB) in a general hospital in Buenos Aires city (20 beds). We analyzed the episodes of CPE infections, demographic characteristics of the affected population, adequate ET, in vitro sensitivity and evolution. Adequate ET was defined when at least one drug was sensitive in vitro.

Results

There were 485 discharges (3934 patient days) during the analyzed period, episodes of infections 45.7% (222) with 19%(42) by CPE. The number of patients with CPE infections was 36; 61% men, mean age 55 and reason for admission was distributed as follows: liver disease or transplant 19%, neurology 19%, intraabdominal 17%, respiratory 14%; mean APACHE 20, mortality 52.7% (47% related to CPE infection). KPC Colonization 70%. CPE infections were urinary 55%, bloodstream 31%, abdominal 14.4%, respiratory 9.5%. Time from admission to CPE infections was 21 days. Treatment analysis showed: adequate empirical treatment 57%, two or more drugs 63% (24) (mero-col 45.8%, mero-amika 12.5%), definitive treatment combined amikacin 46%, fosfomycin 46%, tigeciclin 21.4%, colistin 25%, monotherapy 39% (mainly in urinary infection). In vitro results: Sensible (S) phosphomycin 78.5%, amikacin 52%, Tigecycline 90%, colistin 21%, meropenem (MIC <16) 4.7%.

Conclusion

CPE infections is one of most important challenges in ICU patients with prolonged stay who are seriously ill and colonized by KPC. Half received adequate combined empirical treatment, with fosfomycin and tigecycline being the most active drugs in vitro. The mortality associated to the infection continues being high, so this data analysis is very useful to improve initial treatments.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33572-0/pdf

July 29, 2018 at 12:00 pm

Novel Enterobacter Lineage as Leading Cause of Nosocomial Outbreak Involving Carbapenemase-Producing Strains

Emerging Infectious Diseases August 2018 V.24 N.8

Racha Beyrouthy, Marion Barets, Elodie Marion, Cédric Dananché, Olivier Dauwalder, Frédéric Robin, Lauraine Gauthier, Agnès Jousset, Laurent Dortet, François Guérin, Thomas Bénet, Pierre Cassier, Philippe Vanhems1, and Richard Bonnet1

Author affiliations: Centre Hospitalier Universitaire, Clermont-Ferrand, France (R. Beyrouthy, F. Robin, R. Bonnet); Centre National de Référence de la Résistance aux Antibiotiques, Clermont-Ferrand (R. Beyrouthy, F. Robin, R. Bonnet); Université Clermont Auvergne, Clermont-Ferrand (R. Beyrouthy, F. Robin, R. Bonnet); Institut National de la Santé et de la Recherche Médicale, Clermont-Ferrand (R. Beyrouthy, F. Robin, R. Bonnet); Institut National de la Recherche Agronomique, Clermont-Ferrand (R. Beyrouthy, F. Robin, R. Bonnet); Hôpital Édouard Herriot, Hospices Civils de Lyon, Lyon, France (M. Barets, E. Marion, C. Dananché, T. Bénet, P. Cassier, P. Vanhems); Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon (O. Dauwalder); Centre International de Recherche en Infectiologie, Lyon (O. Dauwalder, T. Bénet, P. Vanhems),; Centre Hospitalier Universitaire Bicêtre, Paris, France (L. Gauthier, A. Jousset, L. Dortet); Centre National de Référence Associé de la Résistance aux Antibiotiques, Paris (L. Gauthier, A. Jousset, L. Dortet); Centre Hospitalier Universitaire, Caen, France (F. Guérin)

We investigated unusual carbapenemase-producing Enterobacter cloacae complex isolates (n = 8) in the novel sequence type (ST) 873, which caused nosocomial infections in 2 hospitals in France.

Whole-genome sequence typing showed the 1-year persistence of the epidemic strain, which harbored a blaVIM-4 ST1-IncHI2 plasmid, in 1 health institution and 2 closely related strains harboring blaCTX-M-15 in the other.

These isolates formed a new subgroup in the E. hormaechei metacluster, according to their hsp60 sequences and phylogenomic analysis.

The average nucleotide identities, specific biochemical properties, and pangenomic and functional investigations of isolates suggested isolates of a novel species that had acquired genes associated with adhesion and mobility.

The emergence of this novel Enterobacter phylogenetic lineage within hospitals should be closely monitored because of its ability to persist and spread.

PDF

https://wwwnc.cdc.gov/eid/article/24/8/pdfs/18-0151.pdf

July 23, 2018 at 3:36 pm

The Standardized Antimicrobial Administration Ratio: A New Metric for Measuring and Comparing Antibiotic Use

Clinical Infectious Diseases July 15, 2018 V.67 N.2 P.179-185

EDITOR’S CHOICE

Katharina L van Santen; Jonathan R Edwards; Amy K Webb; Lori A Pollack; Erin O’Leary …

Los Centros para el Control y la Prevención de Enfermedades han desarrollado una nueva métrica, la tasa de administración antimicrobiana estandarizada, que utiliza datos de administración antimicrobiana en el punto de atención informados electrónicamente a un sistema de vigilancia nacional para permitir comparaciones de uso de antibióticos ajustadas al riesgo en varios hospitales y sistemas de salud.

FULL TEXT

https://academic.oup.com/cid/article/67/2/179/4835069

PDF (CLIC en PDF)

July 15, 2018 at 5:02 pm

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