Prevalence and predictors of MRSA carriage among employees in a non-outbreak setting: a cross-sectional study in an acute care hospital

Background

Health care workers have an increased risk of being infected with Methicillin-resistant Staphylococcus aureus (MRSA), though little information is available about how prevalent (dormant) MRSA colonization is among health care workers. The aim of this study was to estimate the prevalence and predictors of MRSA carriage in a non-outbreak setting in a university hospital in Germany.

Methods

The entire staff of a university hospital heart center for cardiologic maximum medical care and cardiac surgery were invited to participate in a cross-sectional study (N = 575). The sampled population included health care workers as well as employees with no close patient contact.

A questionnaire concerning personal and occupational risk factors as well as lifestyle and demographic factors was applied and nasal swabs were taken. In total 180 persons (31.3%) participated in the study.

Results

The majority of study participants had close contact to patients at work (n = 149, 82.8%). Thereof, about one-third had contact to MRSA-patients (n = 53, 35.6%), and most reported wearing protective clothing (n = 44, 83.0%). None of the administrative staff tested positive for MRSA and only one in 149 persons (0.7%, CI 0.00–0.02) with close patient contact carried MRSA (strain CC1-MRSA-IV). This person had close contact to patients with MRSA, less than 1 year of work experience, and had been treated with antibiotics within the last 12 months.

Conclusion

The results of our study suggest low point prevalence rates of MRSA colonization in health care workers in a non-outbreak setting.

[Late effects following childhood cancer treatment : A special challenge for transition medicine]

BACKGROUND

Childhood cancer survivors are at risk of cancer- and treatment-related chronic health conditions. Since these sequelae may occur years after the end of treatment, many patients are already adults and have completed pediatric oncological care. Thus, successful transition is essential in order to ensure long-term surveillance.

OBJECTIVES

The present review outlines the most frequent late effects of childhood cancer treatment. Moreover, difficulties in transition of these patients are discussed and interdisciplinary models of care are presented.

RESULTS

Late effects following childhood cancer treatment occur in over two thirds of patients 30 years after the end of the oncological treatment and can affect different organs. The most frequent sequelae are endocrine disturbances, cardiac conditions, and subsequent neoplasms. Many late effects are effectively manageable if detected early. This necessitates an interdisciplinary approach as well as life-long surveillance.

CONCLUSIONS

Transition from pediatric to internal medicine care as well as a change in the focus of care, shifting from relapse centered follow-up to late-effects centered surveillance, constitute a special challenge for a successful transition of long-term childhood cancer survivors. Specialized late-effects survivorship clinics offering interdisciplinary care from pediatric oncologists, specialists of internal medicine, and further disciplines enable the early diagnosis and treatment of late-effects.

Beyond second-line therapy in patients with metastatic colorectal cancer: a systematic review

Background

The optimal chemotherapeutic regimen for use beyond the second line for patients with metastatic colorectal cancer (mCRC) remains unclear.

Materials and methods

We systematically searched the Cochrane Database of Systematic Reviews, EMBASE and Medline for records published between January 2002 and May 2017, and cancer congress databases for records published between January 2014 and June 2017. Eligible studies evaluated the efficacy, safety and patient-reported outcomes of monotherapies or combination therapies at any dose and number of treatment cycles for use beyond the second line in patients with mCRC. Studies were assessed for design and quality, and a qualitative data synthesis was conducted to understand the impact of treatment on overall survival and other relevant cancer-related outcomes.

Results

The search yielded 938 references of which 68 were included for qualitative synthesis. There was limited evidence to support rechallenge with chemotherapy, targeted therapy or both. Compared with placebo, an overall survival benefit for trifluridine/tipiracil (also known as TAS-102) or regorafenib has been shown for patients previously treated with conventional chemotherapy and targeted therapy. There was no evidence to suggest a difference in efficacy between these treatments. Patient choice and quality of life at this stage of treatment should also be considered when choosing an appropriate therapy.

Conclusions

These findings support the introduction of an approved agent such as trifluridine/tipiracil or regorafenib beyond the second line before any rechallenge in patients with mCRC who have failed second-line treatment.

Liquid Formulation of AbobotulinumtoxinA Exhibits a Favorable Efficacy and Safety Profile in Moderate to Severe Glabellar Lines: A Randomized, Double-Blind, Placebo- and Active Comparator-Controlled Trial

BACKGROUND

In most countries, approved botulinum toxin type A formulations require reconstitution before injection.

OBJECTIVES

To evaluate the efficacy and safety of a ready-to-use liquid formulation of abobotulinumtoxinA (abobotulinumtoxinA solution for injection, ASI) in subjects with moderate to severe glabellar lines (GL).

METHODS

In this Phase II, double-blind, placebo-controlled, randomized study, 176 female subjects (aged 30 to 60 years) were randomized into five treatment groups: ASI 20, 50, or 75 U, reconstituted abobotulinumtoxinA (aboBoNT-A) 50 U, and placebo. GL severity was assessed at maximum frown using a 4-point grading scale. Responders were subjects with severity grade of moderate [2] or severe [3] at baseline improving to none [0] or mild [1], evaluated at each time-point by Investigator's Live Assessment (ILA) or Subject's Self-Assessment (SSA). Safety profiles were also determined.

RESULTS

Baseline characteristics were similar across groups. Responder rates on Day 29 by ILA were significantly greater for ASI 20, 50, and 75 U versus placebo (88.9%, 91.4%, and 87.9% vs. 0%, respectively; P < 0.0001). Similar results were observed by SSA. A greater proportion of responders was observed in ASI groups vs placebo from Day 8 to 113 for ILA and SSA (P < 0.001). AboBoNT-A responder rate on Day 29 for ILA was 77.1% (P < 0.1006 vs ASI 50 U); with comparable results by SSA. The ASI safety profile was comparable to that of aboBoNT-A.

CONCLUSIONS

Ready-to-use liquid formulation of abobotulinumtoxinA was shown to be efficacious, with comparable results to reconstituted abobotulinumtoxinA, and to have a favorable safety profile in subjects with severe to moderate GL.

Abstract P6-13-02: Increased mortality risk among elderly patients with early stage triple negative breast cancer who did not receive adjuvant or neoadjuvant therapy

Background: Worldwide, breast cancer (BC) is the most frequently diagnosed cancer and the leading cause of cancer death in women. The triple negative (TN) subtype accounts for up to 20% of BC and has a poorer prognosis compared to other subtypes. We set out to evaluate treatment patterns and survival associated with receiving adjuvant or neo-adjuvant therapy in an older, demographically diverse population of patients with TNBC.

Methods: The analysis included 10,694 patients with first primary TNBC from the linked SEER-Medicare database. Patients were diagnosed with Stage I-III disease between January 1, 2001-December 31, 2011, ≥66 years, continuously enrolled in Medicare Parts A and B in the year prior to diagnosis, and underwent breast cancer surgery within 6 months after diagnosis. Unadjusted Kaplan Meier analyses and time-varying Cox proportional hazards regression adjusting for patient characteristics assessed overall survival. Date of last follow-up was December 31, 2013.

Results: There were 4,807 (45%) patients treated with adjuvant/neo-adjuvant chemotherapy and 5,887 (55%) untreated. Treatment rates increased over the study time-period from 45% in 2001 to 52% in 2011 (p&lt;.0001). Compared to treated patients, untreated patients were older (78 vs. 73 years), had earlier stage disease (57% vs. 31% Stage I), lower tumor grade (34% vs. 23% grade 1/2), smaller tumors (57 vs.40% &lt;2cm), poorer performance (13% vs. 6%), higher comorbidity burden (45% vs. 37% NCI Comorbidity Score ≥ 1) and were less likely to receive radiotherapy (47% vs. 65%; p&lt;0.0001). The median unadjusted overall survival was 94.3 months for the overall population and was longer for treated patients (101.5 months) compared to untreated patients (88.4 months; log rank p &lt;.0001). In the adjusted Cox model, there was a 28% higher risk of death in untreated compared to treated patients (HR=1.28; 95% CI=1.19-1.38). The model also showed that as age, stage, tumor size, tumor grade, and comorbidity score increased, mortality risk also significantly increased. Having poor performance indicators was also significantly associated with higher mortality risks, while prior radiotherapy was associated with lower risks.

Conclusions: Although therapy use has increased over time, this large observational study confirmed that 55% of elderly patients with Stage I-III TNBC are not receiving adjuvant/neo-adjuvant therapy following diagnosis. As a result, untreated patients exhibited a significantly elevated risk of death compared to those who received treatment. The results of this study highlight the unmet need in this patient population and provide an important context to optimize disease management in real-world settings.

Citation Format: Satram-Hoang S, Bajaj PS, Stein A, Hoang KQ, Momin F, Cortazar P, Reyes C. Increased mortality risk among elderly patients with early stage triple negative breast cancer who did not receive adjuvant or neoadjuvant therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-13-02.

Accuracy of the intra-operative radioauided localization of the sentinel lymph node (SLN) 24 hours after lymphoscintigraphy in patients with malignant melanoma

Aim: For optimized logistics for the sentinel lymph-adenectomy (SL) it might be helpful for the clinics involved if a longer time period between the lymphoscintigraphy (LS) and surgery is possible. Therefore, we investigated if a precise localization of the sentinel lymph node is possible 24 hours after LS. Methods: 78 patients with primary malignant melanoma (MM; η = 44) or with MM pre-operated by excisional biopsy (n = 34) were investigated. In 40 cases the tumor was localized on the trunk and in 38 cases on the extremities. Mean MM thickness was 2.68 mm (range: 0.29 to 12 mm). In all patients a lymphoscintigraphy (LS) with an average of 85 MBq of Tc-99m nanocolloid was performed one day prior to surgery. Immediately after tracer application dynamic data acquisition was started at a LFOV gamma camera followed by a whole body scan. With a hand-held gamma detector (C-Trak®) 2,4,6,8, and 24 hours after tracer administration the SLN was identified and the counts registered. Results: 94 SLNs were identified in 87 lymphatic basins from which 86 could be resected. Nine MM showed two draining channels. After 24 hours 15.5% (as an average) of the initial counts could be measured in the SLN. The uptake in the SLN in pre-operated versus patients with primary tumor was statistically not significant (p = 0.4). In 16 cases (20.5%) the SLN was tumor positive. Four of those patients developed distant metastases and two died within the first year. None of the patients with negative SLN developed distant metastases or died. Conclusion: The remaining activity in the SLN up to 24 hours after administration is sufficient for their intra operative localization. The method of lymphoscintigraphy and localization of the SLN by a hand-held gamma detector optimizes the intra operative identification of the SLN in patients with malignant melanoma.

Outlier Detection in Urban Air Quality Sensor Networks

Low-cost urban air quality sensor networks are increasingly used to study the spatio-temporal variability in air pollutant concentrations. Recently installed low-cost urban sensors, however, are more prone to result in erroneous data than conventional monitors, e.g., leading to outliers. Commonly applied outlier detection methods are unsuitable for air pollutant measurements that have large spatial and temporal variations as occur in urban areas. We present a novel outlier detection method based upon a spatio-temporal classification, focusing on hourly NO₂ concentrations. We divide a full year's observations into 16 spatio-temporal classes, reflecting urban background vs. urban traffic stations, weekdays vs. weekends, and four periods per day. For each spatio-temporal class, we detect outliers using the mean and standard deviation of the normal distribution underlying the truncated normal distribution of the NO₂ observations. Applying this method to a low-cost air quality sensor network in the city of Eindhoven, the Netherlands, we found 0.1-0.5% of outliers. Outliers could reflect measurement errors or unusual high air pollution events. Additional evaluation using expert knowledge is needed to decide on treatment of the identified outliers. We conclude that our method is able to detect outliers while maintaining the spatio-temporal variability of air pollutant concentrations in urban areas.

First Dark Matter Search Results from the XENON1T Experiment

We report the first dark matter search results from XENON1T, a ∼2000-kg-target-mass dual-phase (liquid-gas) xenon time projection chamber in operation at the Laboratori Nazionali del Gran Sasso in Italy and the first ton-scale detector of this kind. The blinded search used 34.2 live days of data acquired between November 2016 and January 2017. Inside the (1042±12)-kg fiducial mass and in the [5,40]  keV_{nr} energy range of interest for weakly interacting massive particle (WIMP) dark matter searches, the electronic recoil background was (1.93±0.25)×10^{-4}  events/(kg×day×keV_{ee}), the lowest ever achieved in such a dark matter detector. A profile likelihood analysis shows that the data are consistent with the background-only hypothesis. We derive the most stringent exclusion limits on the spin-independent WIMP-nucleon interaction cross section for WIMP masses above 10  GeV/c^{2}, with a minimum of 7.7×10^{-47}  cm^{2} for 35-GeV/c^{2} WIMPs at 90% C.L.

Spatio-temporal analysis of small-area intestinal parasites infections in Ghana

Intestinal parasites infection is a major public health burden in low and middle-income countries. In Ghana, it is amongst the top five morbidities. In order to optimize scarce resources, reliable information on its geographical distribution is needed to guide periodic mass drug administration to populations of high risk. We analyzed district level morbidities of intestinal parasites between 2010 and 2014 using exploratory spatial analysis and geostatistics. We found a significantly positive Moran’s Index of spatial autocorrelation for each year, suggesting that adjoining districts have similar risk levels. Using local Moran’s Index, we found high-high clusters extending towards the Guinea and Sudan Savannah ecological zones, whereas low-low clusters extended within the semi-deciduous forest and transitional ecological zones. Variograms indicated that local and regional scale risk factors modulate the variation of intestinal parasites. Poisson kriging maps showed smoothed spatially varied distribution of intestinal parasites risk. These emphasize the need for a follow-up investigation into the exact determining factors modulating the observed patterns. The findings also underscored the potential of exploratory spatial analysis and geostatistics as tools for visualizing the spatial distribution of small area intestinal worms infections.