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Kameyama K, Mizutani K, Miyake Y, Iwase T, Mizutani Y, Yamada M, Ito Y, Ishihara S, Deguchi T. Evaluation of physical and psychological status of health care workers infected with COVID-19 during a hospital outbreak in Japan. J Infect Chemother 2023; 29:126-130. [PMID: 36241127 PMCID: PMC9553961 DOI: 10.1016/j.jiac.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE COVID-19 causes physical and psychological impacts on health care workers (HCWs), especially when it occurs during an outbreak. As there are few reports on outcomes of HCWs infected with COVID-19 during a hospital outbreak, we investigated the physical and psychological impacts on HCWs infected with COVID-19 during an outbreak in our hospital. METHODS During the outbreak in our hospital, 231 people were infected with COVID-19 including patients, HCWs and their families. Among them, 83 HCWs were enrolled in this study. Current quality of life (QOL) was assessed with the EuroQol-visual analogue scales (EQ-VAS), and motivation to keep on working was evaluated by a 10-point analogue scale. Physiological recovery rates including return to work (RTW) period were also analyzed. RESULTS One nurse quit work due to anxiety regarding re-infection with COVID-19. The median period to RTW from the diagnosis was 14.0 (12.0-17.0) days. Motivation to keep on working was slightly reduced, and the EQ-VAS was 75.0 (65.0-83.6). There were no significant differences in QOL and motivation between male and female HCWs, nurses and other HCWs, treatment and non-treatment group, and supplemental and non-supplemental oxygen group. The most frequent persistent symptoms at 1,3 and 6 months after infection were anosmia followed by fatigue. CONCLUSION Although QOL and motivation to keep on working were slightly reduced, only one HCW quit work. No severe persistent symptoms were observed, and the RTW period was relatively short.
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Affiliation(s)
- Koji Kameyama
- Department of Urology, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan,Corresponding author. 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
| | - Kosuke Mizutani
- Department of Urology, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
| | - Yukiko Miyake
- Department of Nursing, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
| | - Toma Iwase
- Department of Emergency Medicine, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
| | - Yoshio Mizutani
- Department of Emergency Medicine, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
| | - Mikito Yamada
- Department of Emergency Medicine, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
| | - Yoshiki Ito
- Department of Orthopedic Surgery, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
| | - Satoshi Ishihara
- Department of Urology, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
| | - Takashi Deguchi
- Department of Urology, Central Japan International Medical Center, 1-1 Kenkonomati, Minokamo, Gifu, 505-8510, Japan
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O'Connell L, Asad H, Hall G, Jones T, Walters J, Manchipp-Taylor L, Barry J, Keighan D, Jones H, Williams C, Cronin M, Hughes H, Morgan M, Connor TR, Healy B. Detailed analysis of in-hospital transmission of SARS-CoV-2 using whole genome sequencing. J Hosp Infect 2023; 131:23-33. [PMID: 36240955 PMCID: PMC9554319 DOI: 10.1016/j.jhin.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Hospital transmission of SARS-CoV-2 has proved difficult to control, with healthcare-associated infections troublesome throughout. AIM To understand factors contributing to hospital transmission of infections, which is necessary for containing spread. METHODS An outbreak of 56 staff and patient cases of COVID-19 over a 31-day period in a tertiary referral unit is presented, with at least a further 29 cases identified outside of the unit and the hospital by whole genome sequencing (WGS). FINDINGS Transmission is documented from staff to staff, staff to patients, and patients to staff, showing disruption of a tertiary referral service, despite implementation of nationally recommended control measures, superior ventilation, and use of personal protective equipment. There was extensive spread from the index case, despite this patient spending only 10 h bed bound on the ward in strict cubicle isolation and with an initial single target low level (CT = 32) polymerase chain reaction test. CONCLUSION This investigation highlights how effectively and rapidly SARS-CoV-2 can spread in certain circumstances. It raises questions about infection control measures in place at the time and calls into question the premise that transmissibility can be reliably detected by using lower sensitivity rapid antigen lateral flow tests. We also highlight the value of early intervention in reducing impact as well as the value of WGS in understanding outbreaks.
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Affiliation(s)
- L O'Connell
- Public Health Wales and Swansea Bay University Health Board, Swansea, UK. lorcan.o'
| | - H Asad
- Health Protection Communicable Disease Surveillance Centre (CDSC), Public Health Wales, Swansea, UK
| | - G Hall
- Swansea Bay University Health Board, Swansea, UK
| | - T Jones
- Swansea Bay University Health Board, Swansea, UK
| | - J Walters
- Quality Improvement Infection Prevention & Control, Infection Prevention & Control Team, Swansea Bay University Health Board, Swansea, UK
| | | | - J Barry
- Swansea Bay University Health Board, Swansea, UK
| | - D Keighan
- Estates, Swansea Bay University Health Board, Swansea, UK
| | - H Jones
- Health Protection CDSC, Public Health Wales, Carmarthen, UK
| | - C Williams
- Health Protection CDSC, Public Health Wales, Carmarthen, UK
| | - M Cronin
- Health Protection CDSC, Public Health Wales, Cardiff, UK
| | - H Hughes
- Public Health Wales and Cardiff University Health Board, Cardiff, UK
| | - M Morgan
- Healthcare Associated Infection, Antimicrobial Resistance & Prescribing Programme, Public Health Wales, Cardiff, UK
| | - T R Connor
- Public Health Wales and Cardiff University, Cardiff, UK
| | - B Healy
- Public Health Wales and Swansea Bay University Health Board, Swansea, UK
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Itoh N, Akazawa N, Ishikane M, Kawabata T, Kawamura D, Chikusa T, Kodama EN, Ohmagari N. Lessons learned from an outbreak of COVID-19 in the head and neck surgery ward of a Japanese cancer center during the sixth wave by Omicron. J Infect Chemother 2022; 28:1610-1615. [PMID: 35995417 PMCID: PMC9389781 DOI: 10.1016/j.jiac.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
Abstract
Introduction We describe a coronavirus disease (COVID-19) outbreak in a cancer center's head and neck surgery ward and the interventions to halt ongoing exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among healthcare workers and patients with cancer. Methods Case definition included all healthcare workers and all patients associated to the ward from January 27 to January 31, 2022 with a positive SARS-COV-2 antigen test. This retrospective descriptive study was conducted between January 27, 2022, and February 14, 2022. Results From January 28, 2022, to February 9, 2022, 84 cases (36 healthcare workers, 48 patients) were screened, and 26 (12 healthcare workers, 14 patients) were identified as SARS-CoV-2-positive. The proportion of healthcare providers who performed aerosol generating procedures on positive patients was 91% for positive cases and 49% for non-cases. Room sharing with patients with COVID-19 was 64% for positive cases and 21% for non-cases (57% vs. 21% with positive tracheostomy patients; 43% vs. 9% with positive cases using a nebulizer; 50% vs. 15% with positive cases requiring sputum suctioning, respectively). Compliance with the universal masking policy for patients was 36% of positive cases and 79% of non-cases. Conclusions This is the first report of a nosocomial outbreak of COVID-19 in a head and neck surgery ward during the Omicron pandemic. Notably, there were a high number of positive cases among healthcare workers who performed aerosol generating procedures for positive patients and patients who shared the room with a patient with COVID-19 with the potential to generate aerosols.
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Affiliation(s)
- Naoya Itoh
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan.
| | - Nana Akazawa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | | | - Daichi Kawamura
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Tomoyuki Chikusa
- Division of Infectious Diseases, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Japan
| | - Eiichi N Kodama
- Division of Infectious Diseases, International Research Institute of Disaster Science, Graduate School of Medicine, Tohoku University and Tohoku Medical Megabank Organization, Sendai, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Miyagi, Japan
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Menekşe Ş, Tanrıverdi ES, Oğuş H, Altınay E, Kaya Ç, Çağlayan E, Aydoğan AA, Otlu B, Kırali MK. Stenotrophomonas maltophilia outbreak with a commercial blood gas injector as the culprit and interventions for source and prevention: a possible passage between patient and ECMO water heater device. Am J Infect Control 2022; 51:533-538. [PMID: 35868456 DOI: 10.1016/j.ajic.2022.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite low virulence of Stenotrophomonas maltophilia, it represents one of the leading drug-resistant bacteria. We report a large outbreak of S. maltophilia infection associated with an unexpected source, which turned out to be a commercial needleless blood gas injector. METHODS Over a period from 1th January to 10th December, 2021, 113 patients were identified to have S. maltophilia infection as documented by positive cultures from the clinical samples, extracorporeal membrane oxygenation (ECMO) water heater devices and commercial needleless blood gas injectors. RESULTS Sixty-seven isolates (59 clinical, 4 ECMO, 4 blood gas injectors) were sent for molecular analysis. Both AP-PCR and PFGE analyses showed 12 distinct genotypes. Of 67 isolates, 58 were clonally related (86.6%), with 52 indistinguishable strains from four blood gas needleless injectors, 46 patients' samples (78%) and 2 ECMO samples (50%). Two ECMO samples and one clinical sample were clonally identical. CONCLUSION In the event that eradication of infections would not be possible despite taking all environmental disinfection measures including the ECMO devices, unexpected sources, such as a commercial needleless blood gas injector, should not be omitted from the list for surveillance. In addition, obtaining surveillance cultures of ECMO water reservoirs should be placed in the routine clinical practice.
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Affiliation(s)
- Şirin Menekşe
- Infection Control Unit, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Turkey.
| | - Elif Seren Tanrıverdi
- Department of Medical Microbiology, Molecular Microbiology Laboratory, İnonu University Faculty of Medicine, Turgut Özal Medical Centre, Malatya, Turkey
| | - Halide Oğuş
- Department of Anesthesia, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Turkey
| | - Ece Altınay
- Department of Anesthesia, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Turkey
| | - Çiğdem Kaya
- Infection Control Unit, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Turkey
| | - Elif Çağlayan
- Department of Medical Microbiology, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Turkey
| | - Arzu Ateşoğlu Aydoğan
- Infection Control Unit, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Turkey
| | - Barış Otlu
- Department of Medical Microbiology, Molecular Microbiology Laboratory, İnonu University Faculty of Medicine, Turgut Özal Medical Centre, Malatya, Turkey
| | - Mehmet Kaan Kırali
- Department of Cardiovascular Surgery, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Turkey
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SOSA-HERNÁNDEZ OSCAR, MATÍAS-TÉLLEZ BERNARDINA, GONZÁLEZ-MARTÍNEZ JUANA, JUÁREZ-VARGAS ROCIO, GONZÁLEZ-GONZÁLEZ NORMAELIZABETH, ESTRADA-HERNÁNDEZ ABRIL, RUÍZ-SANTANA MONSERRAT, BRAVATA-ALCÁNTARA JUANCARLOS, BELLO-LÓPEZ JUANMANUEL. Implementation of control measures against an outbreak due to Clostridioides difficile producing toxin B in a tertiary hospital in Mexico. J Prev Med Hyg 2021; 62:E508-E513. [PMID: 34604593 PMCID: PMC8451347 DOI: 10.15167/2421-4248/jpmh2021.62.2.1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/03/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To describe the outbreak of Clostridioides difficile infection (CDI), and the impact of the prevention and control measures that were implemented in the "Hospital Juárez de México" (HJM) for its control. METHODS A cross-sectional, descriptive, observational, and retrospective study was designed. All information on the hospital outbreak and on health care-associated infections (HCAI) was obtained from the files of the Hospital Epidemiological Surveillance Unit (HESU) of the HJM. RESULTS A total of 15 cases of CDI were detected from February 20th to May 22nd, 2018, which represented 55.6% and 44.4% for the male and female gender, respectively, with an average age of 56 years and a range of 24 to 86 years old. It was possible to identify six failures and deficiencies that involved health personnel and hospital logistics through analyses based on the situational diagnosis in the services involved and through the construction of cause-effect diagrams. Additionally, through the detection of the outbreak by means of laboratory tests and timeline, the HESU team implemented measures and prospective surveillance to control and prevent the emergence of new cases. CONCLUSIONS The implementation of basic quality tools, control measures, and the prospective epidemiological surveillance had a positive impact on the control against the outbreak of C. difficile producing toxin B.
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Affiliation(s)
- OSCAR SOSA-HERNÁNDEZ
- Unidad de Vigilancia Epidemiológica Hospitalaria, Hospital Juárez de México
- Correspondence: Oscar Sosa Hernández, Unidad de Vigilancia Epidemiológica Hospitalaria, Hospital Juárez de México, Av. Instituto Politécnico Nacional 5160, Magdalena de las Salinas, 07760 Ciudad de México, México - Tel.: +52 57477560 - E-mail:
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Cortés-Ortíz IA, Juárez-Gómez JC, Cu-Quijano C, Flores-Paz R, Durán-Manuel EM, Cruz-Cruz C, Gutiérrez-Muñoz VH, Sosa-Hernández O, Escobar-Escamilla N, Bravata-Alcántara JC, Delgado-Balbuena L, Ibáñez-Cervantes G, Bello-López JM. Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron causing a hospital outbreak in a Mexican attention center. J Infect Dev Ctries 2021; 15:657-664. [PMID: 34106889 DOI: 10.3855/jidc.12996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 04/07/2021] [Indexed: 10/31/2022] Open
Abstract
INTRODUCTION Infections acquired in hospitals are the cause of high morbidity and mortality and with the emergence of resistant bacteria, the problem is greater. The aim of this work was to determine the genetic characteristics and timeline of Klebsiella pneumoniae blaNDM-1 carrying a class 1 integron involved in an intrahospital outbreak. METHODOLOGY Investigation was made from the first detection of K. pneumoniae blaNDM-1, strain "466", and the last clone "423". 16S rRNA gene analysis showed that 466 strain and clones were related to K. pneumoniae. Extended-spectrum β-lactamases (ESBL) was detected according to the Clinical and Laboratory Standards Institute (CLSI) and real time-PCR. Typing of K. pneumoniae blaNDM-1 strains was carried by ERIC-PCR and sequencing the variable region of the integrons were performed. RESULTS A cluster of six resistant isolates of K. pneumoniae blaNDM-1 was detected in intensive care unit (ICU), internal medicine (IM) and orthopedics (OT). Timeline revealed that the first bacterial identification was in ICU and the last clone in OT service. The array genetic of variable region was "IntI/aadA5-drfA17/qacEΔ1-Sul1". CONCLUSIONS The evidences highlight the importance of the epidemiological surveillance of Extended-spectrum β-lactamases (ESBL) strains, as well as the need for molecular epidemiological studies to identify the routes of transmission and the contamination sources within health personnel.
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Affiliation(s)
| | - Julio Cesar Juárez-Gómez
- Laboratory of Bacteriology, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Concepción Cu-Quijano
- Laboratory of Bacteriology, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Rocio Flores-Paz
- Laboratory of Bacteriology, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Clemente Cruz-Cruz
- Research Unit, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Victor Hugo Gutiérrez-Muñoz
- Hospital Epidemiological Surveillance Unit, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Oscar Sosa-Hernández
- Hospital Epidemiological Surveillance Unit, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico
| | - Noé Escobar-Escamilla
- Instituto de Diagnóstico y Referencia Epidemiológicos "Dr. Manuel Martínez Báez", Francisco de P. Miranda, Mexico City, Mexico
| | | | - Laura Delgado-Balbuena
- Research Unit, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Juan Manuel Bello-López
- Research Unit, Hospital Juárez de México, Instituto Politécnico Nacional, Mexico City, Mexico.
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Corcorran MA, Olin S, Rani G, Nasenbeny K, Constantino-Shor C, Holmes C, Quinnan-Hostein L, Solan W, Snoeyenbos Newman G, Roxby AC, Greninger AL, Jerome KR, Neme S, Lynch JB, Dellit TH, Cohen SA. Prolonged persistence of PCR-detectable virus during an outbreak of SARS-CoV-2 in an inpatient geriatric psychiatry unit in King County, Washington. Am J Infect Control 2021; 49:293-298. [PMID: 32827597 PMCID: PMC7438365 DOI: 10.1016/j.ajic.2020.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND We describe key characteristics, interventions, and outcomes of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak within an inpatient geriatric psychiatry unit at the University of Washington Medical Center - Northwest. METHODS After identifying 2 patients with SARS-CoV-2 infection on March 11, 2020, we conducted an outbreak investigation and employed targeted interventions including: screening of patients and staff; isolation and cohorting of confirmed cases; serial testing; and enhanced infection prevention measures. RESULTS We identified 10 patients and 7 staff members with SARS-CoV-2 infection. Thirty percent of patients (n = 3) remained asymptomatic over the course of infection. Among SARS-CoV-2 positive patients, fever (n = 5, 50%) and cough (n = 4, 40%) were the most common symptoms. Median duration of reverse transcription polymerase chain reaction (RT-PCR) positivity was 25.5 days (interquartile range [IQR] 22.8-41.8) among symptomatic patients and 22.0 days (IQR 19.5-25.5) among asymptomatic patients. Median initial (19.0, IQR 18.7-25.7 vs 21.7, IQR 20.7-25.6) and nadir (18.9, IQR 18.2-20.3 vs 19.8, IQR 17.0-20.7) cycle threshold values were similar across symptomatic and asymptomatic patients, respectively. CONCLUSIONS Asymptomatic infection was common in this cohort of hospitalized, elderly individuals despite similar duration of SARS-CoV-2 RT-PCR positivity and cycle threshold values among symptomatic and asymptomatic patients.
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Elliott TM, Lee XJ, Foeglein A, Harris PN, Gordon LG. A hybrid simulation model approach to examine bacterial genome sequencing during a hospital outbreak. BMC Infect Dis 2020; 20:72. [PMID: 31973703 PMCID: PMC6979342 DOI: 10.1186/s12879-019-4743-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 12/27/2019] [Indexed: 12/21/2022] Open
Abstract
Background Hospital infection control requires timely detection and identification of organisms, and their antimicrobial susceptibility. We describe a hybrid modeling approach to evaluate whole genome sequencing of pathogens for improving clinical decisions during a 2017 hospital outbreak of OXA-181 carbapenemase-producing Escherichia coli and the associated economic effects. Methods Combining agent-based and discrete-event paradigms, we built a hybrid simulation model to assess hospital ward dynamics, pathogen transmission and colonizations. The model was calibrated to exactly replicate the real-life outcomes of the outbreak at the ward-level. Seven scenarios were assessed including genome sequencing (early or late) and no sequencing (usual care). Model inputs included extent of microbiology and sequencing tests, patient-level data on length of stay, hospital ward movement, cost data and local clinical knowledge. The main outcomes were outbreak size and hospital costs. Model validation and sensitivity analyses were performed to address uncertainty around data inputs and calibration. Results An estimated 197 patients were colonized during the outbreak with 75 patients detected. The total outbreak cost was US$318,654 with 6.1% of total costs spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients costing US$531,109. Microbiology tests were the largest cost component across all scenarios. Conclusion A hybrid simulation approach using the advantages of both agent-based and discrete-event modeling successfully replicated a real-life bacterial hospital outbreak as a foundation for evaluating clinical outcomes and efficiency of outbreak management. Whole genome sequencing of a potentially serious pathogen appears effective in containing an outbreak and minimizing hospital costs.
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Affiliation(s)
- Thomas M Elliott
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Brisbane, Q4006, Australia.
| | - Xing J Lee
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Brisbane, 4059, Australia
| | - Anna Foeglein
- Heisenberg Analytics, Indooroopilly, QLD, 4068, Australia
| | - Patrick N Harris
- Central Microbiology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,Faculty of Medicine, UQ Centre for Clinical Research, The University of Queensland, Herston, QLD, Australia
| | - Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, Brisbane, Q4006, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, Brisbane, Q4059, Australia
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Pereira EC, Anacker M, Houseman J, Horn ME, Johnson TJ, Lynfield R, Vagnone PS, Witwer M, Kline S. A cluster of carbapenemase-producing Enterobacter cloacae complex ST171 at a tertiary care center demonstrating an ongoing regional threat. Am J Infect Control 2019; 47:767-72. [PMID: 30711349 DOI: 10.1016/j.ajic.2018.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND In Minnesota and North Dakota, a clonal strain of blaKPC-3-producing Enterobacter cloacae complex has been reported with increasing frequency. METHODS Between July 2015 and February 2016, 13 carbapenem-resistant E. cloacae complex isolates were identified at our institution. Five blaKPC-positive isolates were identified by polymerase chain reaction and underwent pulsed-field gel electrophoresis and whole genome sequencing. Medical records of these patients were reviewed. RESULTS All 5 case-isolates belonged to sequence type 171 and were blaKPC-3-positive. Three pulsed-field gel electrophoresis patterns with >90% similarity were identified in the 5 case-isolates. We identified overlaps in time and location between case patients. Plasmid types and resistance genes were nearly identical between the isolates. Whole genome sequencing showed isolates A, B, and D to be closely related with <10 core single-nucleotide polymorphisms differences. Isolates C and E were also closely related to each other, but more distantly to A, B, and D; all belonged to the clonal lineage of the major circulating E. cloacae complex strain in Minnesota and North Dakota. Despite having overlapping hospital stays, isolates for patients C and D were not identical. CONCLUSIONS Isolates A and D were nearly identical, indicating possible transmission during hospitalization. Transmission of the other isolates may have occurred elsewhere. This report highlights the importance of using both epidemiologic and molecular data to track the spread of carbapenemase-producers.
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Leclère B, Buckeridge DL, Lepelletier D. Evaluation of a web-based tool for labelling potential hospital outbreaks: a mixed methods study. J Hosp Infect 2019; 103:210-216. [PMID: 31096015 DOI: 10.1016/j.jhin.2019.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Labelling outbreaks in surveillance data is necessary to train advanced analytical methods for outbreak detection, but there is a lack of software tools dedicated to this task. AIM To evaluate the usability of a web-based tool by infection control practitioners for labelling potential outbreaks. METHODS A mixed methods design was used to evaluate how 25 experts from France and Canada interacted with a web-based application to identify potential outbreaks. Each expert used the application to retrospectively review 11-12 1-year incidence time series from 23 different types of micro-organism. The interactions between the users and the application were recorded and analysed using mixed effect models. The users' comments were analysed via qualitative methods. FINDINGS From the 240 reviews completed, 439 potential outbreaks were labelled, approximately half with a high probability. Significant heterogeneity was observed between users regarding their answers and behaviours (evaluation time, usage of the different options). A significant learning effect was also observed for the experts' interactions with the tool, but this did not seem to impact their answers. The content analysis of the comments highlighted the difficulty of early outbreak identification for practitioners, but also the potential utility of web applications such as that evaluated for routine surveillance. CONCLUSION The interactive web application was both usable and useful for infection control practitioners. Its implementation in routine practice could help professionals to identify potential outbreaks while creating data to train automated detection algorithms.
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Affiliation(s)
- B Leclère
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France; MiHAR Laboratory, University of Nantes, Nantes, France; Department of Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada.
| | - D L Buckeridge
- Department of Epidemiology and Biostatistics, McGill University, Montreal, Québec, Canada
| | - D Lepelletier
- MiHAR Laboratory, University of Nantes, Nantes, France; Department of Bacteriology and Infection Control, Nantes University Hospital, Nantes, France
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11
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Sansone M, Wiman Å, Karlberg ML, Brytting M, Bohlin L, Andersson LM, Westin J, Nordén R. Molecular characterization of a nosocomial outbreak of influenza B virus in an acute care hospital setting. J Hosp Infect 2018; 101:30-37. [PMID: 29909095 PMCID: PMC7114871 DOI: 10.1016/j.jhin.2018.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/04/2018] [Indexed: 01/21/2023]
Abstract
Aim To describe a hospital outbreak of influenza B virus (InfB) infection during season 2015/2016 by combining clinical and epidemiological data with molecular methods. Methods Twenty patients diagnosed with InfB from a hospital outbreak over a four-week-period were included. Nasopharyngeal samples (NPS) positive for InfB by multiplex real-time polymerase chain reaction were sent for lineage typing and whole genome sequencing (WGS). Medical records were reviewed retrospectively for data regarding patient characteristics, localization, exposure and outcome, and assembled into a timeline. In order to find possible connections to the hospital outbreak, all patients with a positive NPS for influenza from the region over an extended time period were also reviewed. Findings All 20 cases of InfB were of subtype B/Yamagata, and 17 of 20 patients could be linked to each other by either shared room or shared ward. WGS was successful or partially successful for 15 of the 17 viral isolates, and corroborated the epidemiological link supporting a close relationship. In the main affected ward, 19 of 75 inpatients were infected with InfB during the outbreak period, resulting in an attack rate of 25%. One probable case of influenza-related death was identified. Conclusion InfB may spread within an acute care hospital, and advanced molecular methods may facilitate assessment of the source and extent of the outbreak. A multi-faceted approach, including rapid diagnosis, early recognition of outbreak situations, simple rules for patient management and the use of regular infection control measures, may prevent nosocomial transmission of influenza virus.
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Affiliation(s)
- M Sansone
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Å Wiman
- Public Health Agency of Sweden, Solna, Sweden
| | | | - M Brytting
- Public Health Agency of Sweden, Solna, Sweden
| | - L Bohlin
- Department of Internal Medicine, Kungalv Hospital, Kungalv, Sweden
| | - L-M Andersson
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Westin
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - R Nordén
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Protonotariou E, Poulou A, Politi L, Sgouropoulos I, Metallidis S, Kachrimanidou M, Pournaras S, Tsakris A, Skoura L. Hospital outbreak due to a Klebsiella pneumoniae ST147 clonal strain co-producing KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital in Northern Greece. Int J Antimicrob Agents 2018; 52:331-337. [PMID: 29654892 DOI: 10.1016/j.ijantimicag.2018.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/25/2018] [Accepted: 04/04/2018] [Indexed: 01/27/2023]
Abstract
Here we present the characteristics of a large outbreak caused by a clonal Klebsiella pneumoniae strain producing both KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital. Between January 2013 and January 2015, 45 carbapenem-resistant K. pneumoniae isolates that gave a positive modified Hodge test and were phenotypically suspected of metallo-β-lactamase (MBL) and K. pneumoniae carbapenemase (KPC) co-production were recovered from 25 patients hospitalised in AHEPA University Hospital (Thessaloniki, Greece). All of the patients were hospitalised in the three intensive care units of the hospital and 17 (68%) of them developed bloodstream infections; the overall mortality of the patients involved in the outbreak was 48% (12/25). Molecular testing verified that all 45 K. pneumoniae isolates co-harboured blaKPC-2 and blaVIM-1 genes and were associated with OmpK35 deficiency and OmpK36 porin loss. The blaTEM-1 gene was also present in 18 isolates. Pulsed-field gel electrophoresis (PFGE) clustered all of the isolates into a single clonal type, and multilocus sequence typing (MLST) assigned them to the emerging high-risk ST147 clonal lineage. Following recognition of the outbreak, infection control measures were implemented in the affected areas. The outbreak continued for ca. 2 years and since then only sporadic cases of K. pneumoniae harbouring both carbapenemases have been detected.
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Affiliation(s)
- Efthymia Protonotariou
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece.
| | - Aggeliki Poulou
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece
| | - Lida Politi
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Ioannis Sgouropoulos
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece
| | - Simeon Metallidis
- First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Melania Kachrimanidou
- First Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Pournaras
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Lemonia Skoura
- Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece
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13
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Alioua MA, Labid A, Amoura K, Bertine M, Gacemi-Kirane D, Dekhil M. Emergence of the European ST80 clone of community-associated methicillin-resistant Staphylococcus aureus as a cause of healthcare-associated infections in Eastern Algeria. Med Mal Infect 2014; 44:180-3. [PMID: 24556453 DOI: 10.1016/j.medmal.2014.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 11/29/2013] [Accepted: 01/15/2014] [Indexed: 11/26/2022]
Abstract
AIMS The authors had for aim to assess whether an in-hospital spread of the European community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone was on-going in Annaba, Eastern Algeria. MATERIAL AND METHODS We carried out a molecular epidemiological study of S. aureus strains causing infections in 4 hospitals located in Annaba, between February and October 2010. RESULTS Our study revealed a very low healthcare-associated MRSA (HCA-MRSA) infection incidence rate of 0.34 per 1000 patient-days. However, the rates of HCA-MRSA strains (85/119) and CA-MRSA (7/29) among S. aureus strains are much higher than those found in France. The European CA-MRSA clone (clonal complex 80, Staphylococcal Cassette Chromosome mec IVc, spa type t044, lukS/F-PV-positive) accounted for 14.1% of all healthcare-associated (HCA) MRSA infections. CONCLUSION This study confirmed the emerging role of CA-MRSA as HCA pathogens in North-African Africa.
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Affiliation(s)
- M A Alioua
- Departement of biochemistry, Badji Mokhtar University, Annaba, Algeria; Laboratoire central de microbiologie, hôpital Dorban, centre hospitalier universitaire d'Annaba, rue Bicha-Youcef 23000 Annaba RP, Annaba, Algeria.
| | - A Labid
- Departement of biochemistry, Badji Mokhtar University, Annaba, Algeria
| | - K Amoura
- Laboratoire central de microbiologie, hôpital Dorban, centre hospitalier universitaire d'Annaba, rue Bicha-Youcef 23000 Annaba RP, Annaba, Algeria
| | - M Bertine
- Department of microbiology, Bichat-Claude-Bernard university hospital, Assisstance publique-Hôpitaux de Paris, Paris, France
| | - D Gacemi-Kirane
- Departement of biochemistry, Badji Mokhtar University, Annaba, Algeria
| | - M Dekhil
- Laboratoire central de microbiologie, hôpital Dorban, centre hospitalier universitaire d'Annaba, rue Bicha-Youcef 23000 Annaba RP, Annaba, Algeria
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Lee S, Han SW, Kim G, Song DY, Lee JC, Kwon KT. An outbreak of Burkholderia cenocepacia associated with contaminated chlorhexidine solutions prepared in the hospital. Am J Infect Control 2013; 41:e93-6. [PMID: 23608047 DOI: 10.1016/j.ajic.2013.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 11/25/2022]
Abstract
From October to December 2007, an outbreak of Burkholderia cenocepacia occurred in a secondary care hospital. The 19 B cenocepacia isolated from the patients, the chlorhexidine solutions of each different ward, and the purified water that diluted these solutions exhibited an identical pulsed-field gel electrophoresis pattern. Inadequate preparation of chlorhexidine solutions diluted with contaminated purified water may have resulted in an outbreak of B cenocepacia. Adequate preparation of chlorhexidine solutions should be emphasized.
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