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Kitaya S, Kanamori H, Ishii R, Katsumi M, Ikeda R, Higashi K, Kakuta R, Ohkoshi A, Katori Y. Clinical characteristics and outcomes of persistent bacteremia in patients with head and neck cancer in a tertiary care hospital. Front Med (Lausanne) 2024; 11:1406983. [PMID: 38983366 PMCID: PMC11232632 DOI: 10.3389/fmed.2024.1406983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/07/2024] [Indexed: 07/11/2024] Open
Abstract
Introduction Compared to other cancers, research on bloodstream infection in head and neck cancer is scarce, lacking comparative studies on persistent versus transient bacteremia outcomes. Methods This retrospective survey examined patients with head and neck cancer undergoing blood culture at our center from June 2009 to May 2023. Blood culture-positive cases suspected of infection were divided into persistent bacteremia and transient bacteremia groups. We investigated their clinical, epidemiological, and microbiological features, including risk factors for persistent bacteremia and mortality. The primary outcome was 90-day mortality. Results In this 97-patient cohort, 14 (14%) cases were assigned to the persistent bacteremia group. Catheter-related bloodstream infections were the leading cause of infection in both groups, consistently contributing to a high proportion of overall bloodstream infections. The mortality rate was generally higher in the persistent bacteremia group than in the transient bacteremia group (odds ratio [OR], 2.6; 95% confidence interval [CI], 0.6-11.1), particularly in the non-clearance subgroup (OR, 9; 95% CI, 0.5-155.2). Pyogenic spondylitis was a key risk factor for persistent bacteremia, while hypoalbuminemia increased mortality. Conclusion In patients with bacteremia and head and neck cancer, persistent bacteremia was associated with higher mortality than was transient bacteremia. Adittionally, bacteremia clearance in persistent bacteremia is thus crucial for prognostic improvement.
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Affiliation(s)
- Shiori Kitaya
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ishii
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Makoto Katsumi
- Department of Laboratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Ryoukichi Ikeda
- Department of Otolaryngology, Head and Neck Surgery, School of Medicine, Iwate Medical University, Shiwa, Iwate, Japan
| | - Kenjiro Higashi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Risako Kakuta
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology, Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Vaivoothpinyo S, Sathitakorn O, Jantarathaneewat K, Weber DJ, Apisarnthanarak P, Rutjanawech S, Tantiyavarong P, Apisarnthanarak A. The impact of environmental cleaning protocol featuring PX-UV in reducing the incidence of multidrug-resistant gram-negative healthcare-associated infection and colonization in intensive care units in Thailand. Infect Control Hosp Epidemiol 2024; 45:684-687. [PMID: 38088177 DOI: 10.1017/ice.2023.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
In this quasi-experimental study, implementing PX-UV to the standard environmental cleaning protocol was associated with a reduction in the overall incidence of multidrug-resistant (MDR) gram-negative organisms (P = .01) and MDR Acinetobacter baumannii (P = .001) in intervention intensive care units. However, the intervention did not reduce patient length of stay and 30-day mortality.
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Affiliation(s)
- Supavit Vaivoothpinyo
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Ornnicha Sathitakorn
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Kittiya Jantarathaneewat
- Department of Pharmaceutical Care, Faculty of Pharmacy, Thammasat University, Pathum Thani, Thailand
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - David J Weber
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
| | - Piyaporn Apisarnthanarak
- Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sasinuch Rutjanawech
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Pichaya Tantiyavarong
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Research Group in Infectious Diseases Epidemiology and Prevention, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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Crall VD, Lewis CL, Dickman DJ, Grinage DW, George T, Ayres AM, Ciccone C, Snyder GM. Strategies for deployment of ultraviolet disinfection in an acute care facility: A quality improvement initiative. Am J Infect Control 2023; 51:1230-1236. [PMID: 37116712 DOI: 10.1016/j.ajic.2023.04.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Mobile ultraviolet (UV) disinfection uses UV-C light to render microorganisms nonviable and reduce environmental transmission of pathogens in hospital settings. Optimal strategies for deployment must consider the cost, physical layout, and staffing resources. The aim of this quality improvement study was to increase UV disinfection utilization by developing novel deployment strategies without adding resources. METHODS A novel deployment strategy and tools were developed by a multidisciplinary group that included infection prevention, environmental services, and nursing unit staff. Utilization was tracked via a manufacturer-supported database. The infection prevention team analyzed the weekly UV disinfection minutes, cycles, and proportions of cycles completed in defined areas across 4 periods: baseline, pilot, baseline 2, and intervention. RESULTS The median (range) disinfection cycle times per week during a geographically confined pilot (4,985 minutes [3,476-6,551] minutes) and the intervention period (1,454 [512-3,085] minutes) were lower than either baseline period (5,394 [3,953-6,987] and 6,641 [2,830-7,276] minutes, respectively). Cycles per week were lower in the intervention period than in the preceding 3 periods. CONCLUSIONS Use of UV disinfection in acute care settings should be guided by multidisciplinary groups balancing resources against efficacy and using tailored tools to promote efficiency.
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Affiliation(s)
- Victoria D Crall
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Casey L Lewis
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Daniel J Dickman
- Department of Environmental Services, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Darnell W Grinage
- Department of Environmental Services, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Trish George
- Department of Patient Safety and Innovation, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Ashley M Ayres
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Carl Ciccone
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA
| | - Graham M Snyder
- Department of Infection Control and Hospital Epidemiology, UPMC Presbyterian-Shadyside, Pittsburgh, PA; Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
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Knobling B, Franke G, Belmar Campos C, Büttner H, Christner M, Klupp EM, Maurer PM, Knobloch JK. Tolerance of clinical vancomycin-resistant Enterococcus faecium isolates against UV-C light from a mobile source. Antimicrob Resist Infect Control 2023; 12:63. [PMID: 37403134 PMCID: PMC10320914 DOI: 10.1186/s13756-023-01259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Admission to a room previously occupied by patients carrying environmentally robust pathogens implies an increased risk of acquiring those pathogens. Therefore, 'No-touch' automated room disinfection systems, including devices based on UV-C irradiation, are discussed to improve terminal cleaning. It is still unclear if clinical isolates of relevant pathogens behave differently under UV-C irradiation compared to laboratory strains used in the approval process of disinfection procedures. In this study we analysed the susceptibility of well characterized clonally divergent vancomycin-resistant enterococci (VRE) strains, including a linezolid-resistant isolate, against UV-C radiation. METHODS Susceptibility against UV-C of ten clonally divergent clinical isolates of VRE was determined in comparison to the commonly used test organism Enterococcus hirae ATCC 10541. Ceramic tiles contaminated with 105 to 106 colony forming units/25 cm² of the different enterococci were positioned at a distance of 1.0 and 1.5 m and irradiated for 20 s, resulting in a UV-C dose of 50 and 22 mJ/cm², respectively. Reduction factors were calculated after quantitative culture of the bacteria recovered from treated and untreated surfaces. RESULTS Susceptibility to UV-C varied considerably among the strains studied, with the mean value of the most robust strain being up to a power of ten lower compared to the most sensitive strain at both UV-C doses. The two most tolerant strains belonged to MLST sequence types ST80 and ST1283. The susceptibility of the laboratory strain E. hirae ATCC 10541 ranged between the most sensitive and most tolerant isolates for both irradiation doses. However, for UV-C dose of 22 mJ/cm², the reduction of the most tolerant isolate of ST1283 was statistically significantly lower compared to E. hirae ATCC 10541. The most susceptible strains belonged to the MLST sequence types ST117 and ST203. CONCLUSIONS These results indicate that UV-C doses reported in the literature are sufficient for the reduction of commonly used reference strains of enterococci but could be insufficient for the reduction of tolerant patient VRE-isolates in a hospital setting. Therefore, for future studies, the most tolerant clinical isolates should be used to validate automated UV-C devices or longer exposure times should be expected to ensure efficacy in the real world.
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Affiliation(s)
- B Knobling
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Franke
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Belmar Campos
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Büttner
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Christner
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E M Klupp
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P M Maurer
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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A randomized trial of ultraviolet-C (UV-C) light versus sodium hypochlorite delivered by an electrostatic sprayer for adjunctive decontamination of hospital rooms. Infect Control Hosp Epidemiol 2022:1-4. [DOI: 10.1017/ice.2022.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
In a randomized trial, adjunctive ultraviolet-C light treatment with a room decontamination device and sodium hypochlorite delivered via an electrostatic sprayer were similarly effective in significantly reducing residual healthcare-associated pathogen contamination on floors and high-touch surfaces after manual cleaning and disinfection. Less time until the room was ready to be occupied by another patient was required for electrostatic spraying.
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Hospital and Long-Term Care Facility Environmental Service Workers' Training, Skills, Activities, and Effectiveness in Cleaning and Disinfection: A Systematic Review. J Hosp Infect 2022; 124:56-66. [DOI: 10.1016/j.jhin.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/19/2022]
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