1
|
Rosenthal A, Prati A, Kushner LE, Valencia A, Mathew R. Impact of cell-free DNA fungal polymerase chain reaction panels on healthcare-associated infection mould investigations. J Infect Prev 2023; 24:223-227. [PMID: 37736124 PMCID: PMC10510659 DOI: 10.1177/17571774231197603] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/17/2023] [Indexed: 09/23/2023] Open
Abstract
Launch of in-house sensitive cell-free deoxyribonucleic acid (cfDNA) mould polymerase chain reaction (PCR) assays increased detection of moulds meeting suspected healthcare-associated infection (HAI) criteria. Definition was based on time from admission and mould detection in culture or via molecular methods. We created a modified mould HAI algorithm incorporating clinical context into the case definition, which allowed for better capture of possible mould HAIs, decreased number of investigations, and improved utilization of Infection Prevention and Control (IPC) resources.
Collapse
Affiliation(s)
- Ayelet Rosenthal
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University Medical School, Stanford, CA, USA
| | - Alison Prati
- Center for Pediatric and Maternal Value, Department of Infection Prevention & Control, Stanford Medicine Children’s Health, Palo Alto, CA, USA
| | - Lauren E Kushner
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University Medical School, Stanford, CA, USA
| | - Amy Valencia
- Center for Pediatric and Maternal Value, Department of Infection Prevention & Control, Stanford Medicine Children’s Health, Palo Alto, CA, USA
| | - Roshni Mathew
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Stanford University Medical School, Stanford, CA, USA
| |
Collapse
|
2
|
Sebillotte M, Boutoille D, Declerck C, Talarmin JP, Lemaignen A, Piau C, Revest M, Tattevin P, Gousseff M. Non-HACEK gram-negative bacilli endocarditis: a multicentre retrospective case-control study. Infect Dis (Lond) 2023; 55:599-606. [PMID: 37353977 DOI: 10.1080/23744235.2023.2226212] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) caused by non-HACEK gram-negative bacilli (GNB) is poorly characterised and may be emerging as a consequence of medical progress. METHODS We performed an observational retrospective case-control study. Cases were non-HACEK GNB IE, definite or possible (modified Duke criteria), diagnosed in adults between 2007 and 2020 in six French referral hospitals. Two controls were included for each case (IE due to other bacteria, matched by sites and diagnosis date). RESULTS Non-HACEK GNB were identified in 2.4% (77/3230) of all IE during the study period, with a mean age of 69.2 ± 14.6 years, and a large male predominance (53/77, 69%). Primary pathogens were Escherichia coli (n = 33), Klebsiella sp. (n = 12) and Serratia marcescens (n = 9), including eight (10%) multidrug-resistant GNB. Compared to controls (n = 154: 43% Streptococcus sp., 41% Staphylococcus sp. and 12% Enterococcus sp.), non-HACEK GNB IE were independently associated with intravenous drug use (IVDU, 8% vs. 2%, p = .003), active neoplasia (15% vs. 6%, p = .009), haemodialysis (9% vs. 3%, p = .007) and healthcare-associated IE (36% vs. 18%, p = .002). Urinary tract was the main source of infection (n = 25, 33%) and recent invasive procedures were reported in 29% of cases. Non-HACEK GNB IE were at lower risk of embolism (31% vs. 47%, p = .002). One-year mortality was high (n = 28, 36%). Comorbidities, particularly malignant hemopathy and cirrhosis, were associated with increased risk of death. CONCLUSIONS Non-HACEK GNB are rarely responsible for IE, mostly as healthcare-associated IE in patients with complex comorbidities (end-stage renal disease, neoplasia), or in IVDUs.
Collapse
Affiliation(s)
- Marine Sebillotte
- Maladies infectieuses et Réanimation médicale, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France
| | - David Boutoille
- Maladies Infectieuses, CIC 1413 INSERM, Hôtel Dieu, Centre Hospitalier Universitaire, Nantes, Nantes, France
| | - Charles Declerck
- Maladies Infectieuses, Hôpital Larrey, Centre Hospitalier Universitaire, Angers, Angers, France
| | | | - Adrien Lemaignen
- Maladies Infectieuses, EA 7505 Education-Ethics-Health, Hôpital Bretonneau, Centre Hospitalier Universitaire, Tours, Tours, France
| | - Caroline Piau
- Bactériologie, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France
| | - Matthieu Revest
- Maladies infectieuses et Réanimation médicale, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France
| | - Pierre Tattevin
- Maladies infectieuses et Réanimation médicale, Hôpital Pontchailllou, Centre Hospitalier Universitaire, Rennes, Rennes, France
| | - Marie Gousseff
- Maladies infectieuses, Centre Hospitalier Bretagne-Atlantique, Vannes, France
| |
Collapse
|
3
|
Østergaard L, Voldstedlund M, Bruun NE, Bundgaard H, Iversen K, Køber N, Dahl A, Chamat-Hedemand S, Petersen JK, Jensen AD, Christensen JJ, Rosenvinge FS, Jarløv JO, Moser C, Andersen CØ, Coia J, Marmolin ES, Søgaard KK, Lemming L, Køber L, Fosbøl EL. Prevalence and Mortality of Infective Endocarditis in Community-Acquired and Healthcare-Associated Staphylococcus aureus Bacteremia: A Danish Nationwide Registry-Based Cohort Study. Open Forum Infect Dis 2022; 9:ofac647. [PMID: 36540385 PMCID: PMC9757695 DOI: 10.1093/ofid/ofac647] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/15/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Staphylococcus aureus bacteremia (SAB) can be community-acquired or healthcare-associated, and prior small studies have suggested that this mode of acquisition impacts the subsequent prevalence of infective endocarditis (IE) and patient outcomes. METHODS First-time SAB was identified from 2010 to 2018 using Danish nationwide registries and categorized into community-acquired (no healthcare contact within 30 days) or healthcare-associated (SAB >48 hours of hospital admission, hospitalization within 30 days, or outpatient hemodialysis). Prevalence of IE (defined from hospital codes) was compared between groups using multivariable adjusted logistic regression analysis. One-year mortality of S aureus IE (SAIE) was compared between groups using multivariable adjusted Cox proportional hazard analysis. RESULTS We identified 5549 patients with community-acquired SAB and 7491 with healthcare-associated SAB. The prevalence of IE was 12.1% for community-acquired and 6.6% for healthcare-associated SAB. Community-acquired SAB was associated with a higher odds of IE as compared with healthcare-associated SAB (odds ratio, 2.12 [95% confidence interval {CI}, 1.86-2.41]). No difference in mortality was observed with 0-40 days of follow-up for community-acquired SAIE as compared with healthcare-associated SAIE (HR, 1.07 [95% CI, .83-1.37]), while with 41-365 days of follow-up, community-acquired SAIE was associated with a lower mortality (HR, 0.71 [95% CI, .53-.95]). CONCLUSIONS Community-acquired SAB was associated with twice the odds for IE, as compared with healthcare-associated SAB. We identified no significant difference in short-term mortality between community-acquired and healthcare-associated SAIE. Beyond 40 days of survival, community-acquired SAIE was associated with a lower mortality.
Collapse
Affiliation(s)
- Lauge Østergaard
- Correspondence: Lauge Østergaard, MD, PhD, The Heart Centre, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark ()
| | | | - Niels Eske Bruun
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark,Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark,Clinical Institutes, Copenhagen and Aalborg University, Aalborg, Denmark
| | - Henning Bundgaard
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nana Køber
- Department of Cardiology, Regionshospital Nord, Hjørring, Denmark
| | - Anders Dahl
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sandra Chamat-Hedemand
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark,Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jens Jørgen Christensen
- Regional Department of Clinical Microbiology, Zealand University Hospital, Køge and Institute of Clinical Medicine, University of Copenhagen, Køge, Denmark
| | - Flemming Schønning Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Claus Moser
- Department of Clinical Microbiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Denmark and Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - John Coia
- Department of Clinical Microbiology, Hospital of South-west Jutland and Institute for Regional Health Research University of South Denmark, Esbjerg, Denmark
| | | | - Kirstine K Søgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Lemming
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
4
|
Omar R, Mahjom M, Haron NH, Mat Lazim R, Kamal FSQ. Factors Associated with COVID-19 among Healthcare Workers in Kedah in 2021: A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:15601. [PMID: 36497673 PMCID: PMC9740113 DOI: 10.3390/ijerph192315601] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
This study aimed to examine the characteristics of HCWs infected with COVID-19 and factors associated with healthcare-associated infection. A cross-sectional study, using secondary data of COVID-19 HCW cases from a registry developed by the Occupational and Environmental Health Unit (OEHU) in Kedah State Health Department, Malaysia, was analysed using Excel and STATA version 14.0. Descriptive analysis and multiple logistic regression were conducted to identify the factors for healthcare-associated COVID-19 infection. A total of 1679 HCWs tested positive for COVID-19 between 1 January 2021 and 19 September 2021. The infection was mainly non-healthcare-associated (67.0%), with healthcare-associated cases contributing to only 33% of the cases. The significant factors associated with healthcare-associated transmission were the following: doctor (aOR = 1.433; 95% CI = 1.044, 1.968), hospital setting (aOR = 1.439; 95% CI = 1.080, 1.917), asymptomatic (aOR = 1.848; 95% CI = 1.604, 2.130), incompletely or not vaccinated (aOR = 1.400; 95% CI = 1.050, 1.866) and CT-value ≥ 30 (aOR = 2.494; 95% CI = 1.927, 3.226). Identifying factors of healthcare-associated infection would help in planning control measures preventing healthcare-associated transmission in the workplace. However, more than half of COVID-19 cases among HCWs involved non-healthcare-associated COVID-19 infection, and, thus, requires further study to identify high-risk behaviours.
Collapse
Affiliation(s)
- Rosidah Omar
- Occupational and Environmental Health Unit, Kedah State Health Department, Jalan Kuala Kedah, Simpang Kuala, Alor Setar 05400, Kedah, Malaysia
| | - Maznieda Mahjom
- Centre for Occupational Health Research, Institute for Public Health, Blok B5 & B6, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, Shah Alam 40170, Selangor, Malaysia
| | - Nur Haryanie Haron
- Occupational and Environmental Health Unit, Kedah State Health Department, Jalan Kuala Kedah, Simpang Kuala, Alor Setar 05400, Kedah, Malaysia
| | - Rosmanajihah Mat Lazim
- Centre for Occupational Health Research, Institute for Public Health, Blok B5 & B6, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, Shah Alam 40170, Selangor, Malaysia
| | - Fadhlin Saffiya Qistina Kamal
- Centre for Occupational Health Research, Institute for Public Health, Blok B5 & B6, Kompleks NIH, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, Shah Alam 40170, Selangor, Malaysia
| |
Collapse
|
5
|
Seagle EE, Jackson BR, Lockhart SR, Jenkins EN, Revis A, Farley MM, Harrison LH, Schaffner W, Markus TM, Pierce RA, Zhang AY, Lyman MM. Recurrent Candidemia: Trends and Risk Factors Among Persons Residing in 4 US States, 2011-2018. Open Forum Infect Dis 2022; 9:ofac545. [PMID: 36324324 PMCID: PMC9620433 DOI: 10.1093/ofid/ofac545] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Candidemia is a common healthcare-associated infection with high mortality. Estimates of recurrence range from 1% to 17%. Few studies have focused on those with recurrent candidemia, who often experience more severe illness and greater treatment failure. We describe recurrent candidemia trends and risk factors. Methods We analyzed population-based candidemia surveillance data collected during 2011-2018. Persons with >1 episode (defined as the 30-day period after a positive Candida species) were classified as having recurrent candidemia. We compared factors during the initial episode between those who developed recurrent candidemia and those who did not. Results Of the 5428 persons identified with candidemia, 326 (6%) had recurrent infection. Recurrent episodes occurred 1.0 month to 7.6 years after any previous episode. In multivariable logistic regression controlling for surveillance site and year, recurrent candidemia was associated with being 19-44 years old (vs ≥65 years; adjusted odds ratio [aOR], 3.05 [95% confidence interval {CI}, 2.10-4.44]), being discharged to a private residence (vs medical facility; aOR, 1.53 [95% CI, 1.12-2.08]), hospitalization in the 90 days prior to initial episode (aOR, 1.66 [95% CI, 1.27-2.18]), receipt of total parenteral nutrition (aOR, 2.08 [95% CI, 1.58-2.73]), and hepatitis C infection (aOR, 1.65 [95% CI, 1.12-2.43]). Conclusions Candidemia recurrence >30 days after initial infection occurred in >1 in 20 persons with candidemia. Associations with younger age and hepatitis C suggest injection drug use may play a modifiable role. Prevention efforts targeting central line care and total parenteral nutrition use may help reduce the risk of recurrent candidemia.
Collapse
Affiliation(s)
- Emma E Seagle
- ASRT, Inc, Atlanta, Georgia, USA,Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shawn R Lockhart
- Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily N Jenkins
- Correspondence: Emily N. Jenkins, MPH, ASRT, Inc, Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-9, Atlanta, GA, 30329 ()
| | - Andrew Revis
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA,Foundation for Atlanta Veterans Education and Research, Atlanta, Georgia, USA,Georgia Emerging Infections Program, Atlanta, Georgia, USA
| | - Monica M Farley
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA,Georgia Emerging Infections Program, Atlanta, Georgia, USA,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Rebecca A Pierce
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | - Alexia Y Zhang
- Oregon Public Health Division, Oregon Health Authority, Portland, Oregon, USA
| | | |
Collapse
|
6
|
Kontula KS, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. Early deaths associated with community-acquired and healthcare-associated bloodstream infections: a population-based study, Finland, 2004 to 2018. Euro Surveill 2022; 27. [PMID: 36082683 PMCID: PMC9461309 DOI: 10.2807/1560-7917.es.2022.27.36.2101067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Bloodstream infections (BSI) cause substantial morbidity and mortality. Aim We explored the role of causative pathogens and patient characteristics on the outcome of community-acquired (CA) and healthcare-associated (HA) BSI, with particular interest in early death. Methods We used national register data to identify all BSI in Finland during 2004–18. We determined the origin of BSI, patients´ underlying comorbidities and deaths within 2 or 30 days from specimen collection. A time-dependent Cox model was applied to evaluate the impact of patient characteristics and causative pathogens on the hazard for death at different time points. Results A total of 173,715 BSI were identified; 22,474 (12.9%) were fatal within 30 days and, of these, 6,392 (28.4%) occurred within 2 days (7.9 deaths/100,000 population). The 2-day case fatality rate of HA-BSI was higher than that of CA-BSI (5.4% vs 3.0%). Patients who died within 2 days were older than those alive on day 3 (76 vs 70 years) and had more severe comorbidities. Compared with other BSI, infections leading to death within 2 days were more often polymicrobial (11.8% vs 6.3%) and caused by Pseudomonas aeruginosa (6.2% vs 2.0%), fungi (2.9% vs 1.4%) and multidrug-resistant (MDR) pathogens (2.2% vs 1.8%), which were also predictors of death within 2 days in the model. Conclusions Overrepresentation of polymicrobial, fungal, P. aeruginosa and MDR aetiology among BSI leading to early death is challenging concerning the initial antimicrobial treatment. Our findings highlight the need for active prevention and prompt recognition of BSI and appropriate antimicrobial treatment.
Collapse
Affiliation(s)
- Keiju Sk Kontula
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kirsi Skogberg
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Ollgren
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Asko Järvinen
- Division of Infectious Diseases, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Health Security, Finnish Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
7
|
Callebaut K, Stoefs A, Stylemans D, Soetens O, Crombé F, Vancutsem E, Imamura H, Wybo I, De Geyter D, Piérard D, Muyldermans A, Demuyser T. Healthcare-Associated SARS-CoV-2 Reinfection after 3 Months with a Phylogenetically Distinct Omicron Variant: A Case Report. Viruses 2022; 14:1852. [PMID: 36146659 PMCID: PMC9506013 DOI: 10.3390/v14091852] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/08/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022] Open
Abstract
This case report describes a 60-year-old female patient suffering from systemic sclerosis, for which she received immunomodulatory drugs. Her first SARS-CoV-2-positive nasopharyngeal sample was obtained in the emergency department, on 31 January 2022. Whole genome sequencing confirmed infection with Omicron BA.1.1. Her hospital stay was long and punctuated by many complications, including admission to the intensive care unit. At the beginning of April 2022, she started complaining of increased coughing, for which another SARS-CoV-2 RT-qPCR test was performed. The latter nasopharyngeal swab showed a strongly positive result. To support the theory of healthcare-associated reinfection, whole genome sequencing was performed and confirmed reinfection with Omicron BA.2. Since this patient was one of ten positive cases in this particular ward, a hospital outbreak investigation was performed. Whole genome sequencing data were available for five of these ten patients and showed a cluster of four patients with ≤2 small nucleotide polymorphisms difference.
Collapse
Affiliation(s)
- Kim Callebaut
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Anke Stoefs
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Dimitri Stylemans
- Department of Pulmonology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Oriane Soetens
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Florence Crombé
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ellen Vancutsem
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Hideo Imamura
- Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore) Platform, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ingrid Wybo
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Deborah De Geyter
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Denis Piérard
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Astrid Muyldermans
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Thomas Demuyser
- Department of Microbiology and Infection Control, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| |
Collapse
|
8
|
Fehér Á, Szarvas Z, Lehoczki A, Fekete M, Fazekas-Pongor V. Co-infections in COVID-19 patients and correlation with mortality rate. Minireview. Physiol Int 2022; 109:1-8. [PMID: 35218335 DOI: 10.1556/2060.2022.00015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 01/04/2022] [Accepted: 02/01/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The goal of our review was to gather information on the most important community-acquired and hospital-acquired co-infections among coronavirus disease 2019 (COVID-19) patients, and to examine not only the effect of these co-infections on disease outcomes but also to identify the possible risk factors that predispose COVID-19 patients to co-infections. METHODS Medline (PubMed) and Google Scholar were searched for relevant articles published between January 1st, 2020, and September 31st, 2021, on the topic of co-infections among COVID-19 patients. RESULTS Among community-acquired and hospital-acquired co-infections, bacterial and fungal co-infections are equally frequent, followed by viral co-infections that affected a relatively smaller portion of patients. Overall, co-infections were more frequent in the hospital than at the community level. Risk factors for acquiring co-infections include male gender, longer length of hospital stay, presence of supportive treatment, such as ventilation, the admission to intensive care units, the administration of medications, such as steroids or antibiotics, and certain blood parameters, such as high C-reactive protein or lymphopenia. The presence of co-infections could aggravate the COVID-19 disease severity, prolong the healing time of patients, and lead to worse disease outcomes overall. CONCLUSION Co-infections may increase the mortality of COVID-19 patients, especially in the hospital setting. Paying closer attention to hygiene, adhering to diagnostic and therapeutic protocols, implementing antimicrobial stewardship programs could decrease the occurrence of co-infections and lead to improved outcomes for COVID-19 patients.
Collapse
Affiliation(s)
- Ágnes Fehér
- 1 Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Zsófia Szarvas
- 1 Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Andrea Lehoczki
- 2 National Institute for Hematology and Infectious Diseases, Department of Hematology and Stem Cell Transplantation, South Pest Central Hospital, Budapest, Hungary
| | - Mónika Fekete
- 1 Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| | - Vince Fazekas-Pongor
- 1 Department of Public Health, Semmelweis University, Faculty of Medicine, Budapest, Hungary
| |
Collapse
|
9
|
Hanley S, Odeniyi F, Feemster K, Coffin SE, Sammons JS. Epidemiology and Risk Factors for Healthcare-Associated Viral Infections in Children. J Pediatric Infect Dis Soc 2021; 10:941-950. [PMID: 34313773 DOI: 10.1093/jpids/piab015] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Healthcare-associated viral infections (HA-VIs) are common in hospitalized children and are increasingly recognized as a cause of preventable harm; however, the epidemiology and modifiable risk factors for pediatric HA-VIs are poorly understood. METHODS We performed a retrospective case-control study to identify risk factors and outcomes associated with pediatric HA-VIs at a quaternary care children's hospital. HA-VI surveillance was performed hospital-wide using Centers for Disease Control and Prevention (CDC) definitions. We abstracted data from the electronic medical record and conducted semi-structured interviews with patient caregivers to identify potential exposures 4 days before the HA-VI onset. RESULTS During the 20-month study period, we identified 143 eligible patients with HA-VIs and enrolled 64 matched case-control pairs. In total, 79 viruses were identified among 64 case patients. During the exposure period, case, as compared with control, patients were more frequently exposed to a sick visitor (odds ratio = 5.19; P = .05). During the 7 days after the HA-VI onset, case, as compared with control, patients had a greater length of antibacterial therapy per patient-days (mean 411 vs 159) as well as greater days of antibacterial therapy per patient-days (mean 665 vs 247). CONCLUSIONS The results of this study show that exposure to a sick visitor is a potentially modifiable risk factor for pediatric HA-VIs. Hospitalized children with HA-VIs also have increased exposure to antibacterial agents when compared with matched controls. Our findings suggest that hospital policies may need to be revised, with emphasis on visitor screening and partnership with families, to reduce the incidence of pediatric HA-VIs during hospitalization.
Collapse
Affiliation(s)
- Samantha Hanley
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Folasade Odeniyi
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kristen Feemster
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Susan E Coffin
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Disease Control, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA.,Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Julia S Sammons
- Pediatric Infectious Diseases Epidemiology and Antimicrobial Stewardship (IDEAS) Research Program, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Infection Prevention and Control, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| |
Collapse
|
10
|
Park MG, Cho SY, Kwon SY, Choi H, Lee JW. Clinical and microbiological characteristics of men with nonobstructive acute pyelonephritis: A multicenter retrospective observational study. Medicine (Baltimore) 2021; 100:e27386. [PMID: 34622842 PMCID: PMC8500611 DOI: 10.1097/md.0000000000027386] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
To investigate the differences in clinical and microbiological features in men hospitalized with community-acquired (CA) and healthcare-associated (HA) nonobstructive acute pyelonephritis (APN), as well as the predictive factors associated with bacteremia.Men discharged from urological centers with nonobstructive APN were identified using an electronic medical records system. We compared the clinical and microbiological data between subjects with CA-APN and HA-APN.Of the 245 men with nonobstructive APN, 175 had CA-APN, and 70 had HA-APN. The HA group was significantly older, had a longer hospital stay, and had more underlying diseases, bacteremia, and intensive care unit admissions than the CA group. The most commonly cultured microorganism was Escherichia coli. The susceptibility of the cultured bacteria to fluoroquinolone was 68.7% in the CA group and 45.3% in the HA group (P = .005). The proportion of extended-spectrum beta-lactamase-producing bacteria was 22.7% for CA and 53.5% for HA (P < .001). The sensitivity to piperacillin/tazobactam was 94.9% for CA and 90.0% for HA, and the sensitivity to amikacin was more than 95% for both groups. The multivariate analysis revealed that an age ≥65 years and chronic liver disease were independent predictive factors for bacteremia.The incidence of antibiotic resistance and bacteremia was higher in the HA group than in the CA group. However, resistance to fluoroquinolone and the presence of extended-spectrum beta-lactamase-producing bacteria were high in both groups. Piperacillin/tazobactam and amikacin may be suitable treatment options in men with nonobstructive APN.
Collapse
Affiliation(s)
- Min Gu Park
- Department of Urology, Inje University Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Se Yun Kwon
- Department of Urology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea
| | - Hoon Choi
- Department of Urology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jeong Woo Lee
- Department of Urology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Korea
| |
Collapse
|
11
|
Åttman E, Syrjänen J, Lyytikäinen O, Ollgren J, Sinisalo M, Vuento R, Mattila E, Huttunen R. Healthcare-associated blood stream infections in hematological patients in Finland during the years 2006-2016. Eur J Haematol 2021; 107:311-317. [PMID: 33987847 DOI: 10.1111/ejh.13663] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim was to identify the clinical characteristics, outcome, and antimicrobial susceptibility of healthcare-associated bloodstream infections (BSIs) in hematological patients. METHODS This retrospectively collected laboratory-based surveillance data include 3404 healthcare-associated BSIs in 2296 patients with a hematological malignancy in hospitals participating in the Finnish Hospital Infection Program from January 1, 2006, to December 31, 2016. RESULTS The most common underlying diseases were acute myelogenous leukemia (35%) and non-Hodgkin lymphoma (22%). Gram-positive organisms accounted for 60%-46% and gram-negative organisms for 24%-36% of BSIs in 2006-2016. The most common causative organism was coagulase-negative staphylococci (CoNS) (n = 731). The 7- and 28-day case fatality rates were 5.2% and 11.4%, respectively, and was highest in BSIs caused by Candida species (10.8% and 30.8%). The median age of patients increased from 59 years in 2006-2008 to 62 years in 2015-2016 (P < .01). Five percent of S aureus isolates were resistant to methicillin and five percent of Pseudomonas aeruginosa isolates were multidrug-resistant. Four percent of Klebsiella and seven percent of E coli isolates were resistant to ceftazidime. CONCLUSIONS The proportion of gram-positive bacteria decreased and gram-negative bacteria increased over time. The case fatality rate was low and the median age of patients increased during the study.
Collapse
Affiliation(s)
- Emilia Åttman
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Jaana Syrjänen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Outi Lyytikäinen
- Department of Infectious Disease Epidemiology, National Institute for Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- Department of Infectious Disease Epidemiology, National Institute for Health and Welfare, Helsinki, Finland
| | - Marjatta Sinisalo
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | | | - Erja Mattila
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
12
|
Seagle EE, Jackson BR, Lockhart SR, Georgacopoulos O, Nunnally NS, Roland J, Barter DM, Johnston HL, Czaja CA, Kayalioglu H, Clogher P, Revis A, Farley MM, Harrison LH, Davis SS, Phipps EC, Tesini BL, Schaffner W, Markus TM, Lyman MM. The landscape of candidemia during the COVID-19 pandemic. Clin Infect Dis 2021; 74:802-811. [PMID: 34145450 DOI: 10.1093/cid/ciab562] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [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: 03/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has resulted in unprecedented healthcare challenges, and COVID-19 has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. However, studies of candidemia and COVID-19 co-infection have been limited in sample size and geographic scope. We assessed differences in patients with candidemia with and without a COVID-19 diagnosis. METHODS We conducted a case-level analysis using population-based candidemia surveillance data collected through the Centers for Disease Control and Prevention's Emerging Infections Program during April-August 2020 to compare characteristics of candidemia patients with and without a positive test for COVID-19 in the 30 days before their Candida culture using chi-square or Fisher exact tests. RESULTS Of the 251 candidemia patients included, 64 (25.5%) were positive for SARS-CoV-2. Liver disease, solid organ malignancies, and prior surgeries were each >3 times more common in patients without COVID-19 co-infection, whereas intensive care unit-level care, mechanical ventilation, having a central venous catheter, and receipt of corticosteroids and immunosuppressants were each >1.3 times more common in patients with COVID-19. All cause in-hospital fatality was two times higher among those with COVID-19 (62.5%) than without (32.1%). CONCLUSIONS One quarter of candidemia patients had COVID-19. These patients were less likely to have certain underlying conditions and recent surgery commonly associated with candidemia and more likely to have acute risk factors linked to COVID-19 care, including immunosuppressive medications. Given the high mortality, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19.
Collapse
Affiliation(s)
- Emma E Seagle
- ASRT, Inc; Atlanta, Georgia, USA.,Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Brendan R Jackson
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Shawn R Lockhart
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Ourania Georgacopoulos
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Natalie S Nunnally
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| | - Jeremy Roland
- California Emerging Infections Program; Oakland, California, USA
| | - Devra M Barter
- Colorado Department of Public Health and Environment; Denver, Colorado, USA
| | - Helen L Johnston
- Colorado Department of Public Health and Environment; Denver, Colorado, USA
| | | | - Hazal Kayalioglu
- Connecticut Emerging Infections Program, Yale School of Public Health; New Haven, Connecticut, USA
| | - Paula Clogher
- Connecticut Emerging Infections Program, Yale School of Public Health; New Haven, Connecticut, USA
| | - Andrew Revis
- Atlanta VA Medical Center; Atlanta, Georgia, USA.,Foundation for Atlanta Veterans Education and Research; Atlanta, Georgia, USA.,Georgia Emerging Infections Program; Atlanta, Georgia, USA
| | - Monica M Farley
- Atlanta VA Medical Center; Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine; Atlanta, Georgia, USA
| | - Lee H Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health; Baltimore, Maryland, USA
| | - Sarah Shrum Davis
- New Mexico Emerging Infections Program, University of New Mexico; Albuquerque, New Mexico, USA
| | - Erin C Phipps
- New Mexico Emerging Infections Program, University of New Mexico; Albuquerque, New Mexico, USA
| | - Brenda L Tesini
- University of Rochester School of Medicine; Rochester, New York, USA
| | | | | | - Meghan M Lyman
- Mycotic Disease Branch, Centers for Disease Control and Prevention; Atlanta, Georgia, USA
| |
Collapse
|
13
|
Abstract
Healthcare-associated Legionnaires’ disease (HCA LD) can cause nosocomial outbreaks with high death rates. We compared community-acquired LD cases with HCA LD cases in Europe during 2008−2017 using data from The European Surveillance System. A total of 29 countries reported 40,411 community-acquired and 4,315 HCA LD cases. Of the HCA LD cases, 2,937 (68.1%) were hospital-acquired and 1,378 (31.9%) were linked to other healthcare facilities. The odds of having HCA LD were higher for women, children and persons <20 years of age, and persons >60 years of age. Out of the cases caused by Legionella pneumophila with a known serotype, community-acquired LD was more likely to be caused by L. pneumophila serogroup 1 (92.3%) than was HCA LD (85.1%). HCA LD patients were more likely to die. HCA LD is associated with specific patient demographics, causative strains, and outcomes. Healthcare facilities should consider these characteristics when designing HCA LD prevention strategies.
Collapse
|
14
|
Ellingford JM, George R, McDermott JH, Ahmad S, Edgerley JJ, Gokhale D, Newman WG, Ball S, Machin N, Black GC. Genomic and healthcare dynamics of nosocomial SARS-CoV-2 transmission. eLife 2021; 10:65453. [PMID: 33729154 PMCID: PMC8009659 DOI: 10.7554/elife.65453] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [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: 12/04/2020] [Accepted: 03/16/2021] [Indexed: 01/17/2023] Open
Abstract
Understanding the effectiveness of infection control methods in reducing and preventing SARS-CoV-2 transmission in healthcare settings is of high importance. We sequenced SARS-CoV-2 genomes for patients and healthcare workers (HCWs) across multiple geographically distinct UK hospitals, obtaining 173 high-quality SARS-CoV-2 genomes. We integrated patient movement and staff location data into the analysis of viral genome data to understand spatial and temporal dynamics of SARS-CoV-2 transmission. We identified eight patient contact clusters (PCC) with significantly increased similarity in genomic variants compared to non-clustered samples. Incorporation of HCW location further increased the number of individuals within PCCs and identified additional links in SARS-CoV-2 transmission pathways. Patients within PCCs carried viruses more genetically identical to HCWs in the same ward location. SARS-CoV-2 genome sequencing integrated with patient and HCW movement data increases identification of outbreak clusters. This dynamic approach can support infection control management strategies within the healthcare setting.
Collapse
Affiliation(s)
- Jamie M Ellingford
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Ryan George
- Department of Infection Prevention & Control, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - John H McDermott
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Shazaad Ahmad
- Department of Virology, Manchester Medical Microbiology Partnership, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Jonathan J Edgerley
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - David Gokhale
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - William G Newman
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Stephen Ball
- Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, University of Manchester, Manchester, United Kingdom.,Department of Clinical Endocrinology, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Nicholas Machin
- Department of Virology, Manchester Medical Microbiology Partnership, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.,Manchester Medical Microbiology Partnership, Public Health England and Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Graeme Cm Black
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom.,Division of Evolution and Genomic Sciences, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
15
|
Ambrose M, Roselle GA, Kralovic SM, Gamage SD. Healthcare-Associated Legionella Disease: A Multi-Year Assessment of Exposure Settings in a National Healthcare System in the United States. Microorganisms 2021; 9:264. [PMID: 33525457 PMCID: PMC7911807 DOI: 10.3390/microorganisms9020264] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 01/08/2023] Open
Abstract
Healthcare facilities are high-risk environments for Legionella disease (LD), including Legionnaires' disease, but transmission in these settings is often overlooked. We used the LD database at the U.S. Department of Veterans Affairs (VA) national healthcare system to assess the type of healthcare exposure for LD cases. Cases were extracted from the database for 1 September 2012 through 31 July 2019, focusing on cases with an overnight stay at a VA facility during the 10-day exposure window prior to symptom onset. Patient medical charts were reviewed for demographics and types of healthcare setting exposure(s). There were 99 LD cases in the cohort: 31.3% were classified as having definite VA exposure, 37.4% were classified as possible VA with inpatient exposure, and 31.3% were classified as possible VA with both inpatient and outpatient exposure. For definite VA LD cases, 67.7% had some type of exposure in the long-term care setting. While 63% of the 99 cases had exposure in the acute care setting only, both the long-term care and acute care settings contributed substantially to the total number of exposure days. A review of patient movement during the exposure period showed the variable and sometimes extensive use of the VA system, and it provides insights useful for epidemiologic investigations and potential preventive actions.
Collapse
Affiliation(s)
- Meredith Ambrose
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, Department of Veterans Affairs, Washington, DC 20420, USA; (M.A.); (G.A.R.); (S.M.K.)
| | - Gary A. Roselle
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, Department of Veterans Affairs, Washington, DC 20420, USA; (M.A.); (G.A.R.); (S.M.K.)
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Medical Service, Cincinnati VA Medical Center, Cincinnati, OH 45220, USA
| | - Stephen M. Kralovic
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, Department of Veterans Affairs, Washington, DC 20420, USA; (M.A.); (G.A.R.); (S.M.K.)
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
- Medical Service, Cincinnati VA Medical Center, Cincinnati, OH 45220, USA
| | - Shantini D. Gamage
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, Department of Veterans Affairs, Washington, DC 20420, USA; (M.A.); (G.A.R.); (S.M.K.)
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| |
Collapse
|
16
|
Wee LE, Conceicao EP, Tan JY, Venkatachalam I, Ling ML. Zero healthcare-associated respiratory viral infections amongst haematology inpatients: unexpected consequence of heightened infection control during COVID-19 outbreak. J Hosp Infect 2020; 107:S0195-6701(20)30492-8. [PMID: 34756843 PMCID: PMC7580702 DOI: 10.1016/j.jhin.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/15/2020] [Accepted: 10/18/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Jing Yuan Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore; Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| |
Collapse
|
17
|
Wee LE, Sim XYJ, Conceicao EP, Aung MK, Wong HM, Teh YE, Tan KY, Wijaya L, Tan TBH, Ling ML, Venkatachalam I. Early Recognition of Coronavirus 2019 Disease (COVID-19) Infection in Surgical Inpatients: The Importance of a Risk-Stratified Approach for Early Testing and Isolation. Surg Infect (Larchmt) 2020; 21:760-765. [PMID: 32716758 DOI: 10.1089/sur.2020.184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: In the ongoing coronavirus disease 2019 (COVID-19) pandemic, resuming provision of surgical services poses a challenge given that patients may have acute surgical pathologies with concurrent COVID-19 infection. We utilized a risk-stratified approach to allow for early recognition and isolation of potential COVID-19 infection in surgical patients, ensuring continuity of surgical services during a COVID-19 outbreak. Patients and Methods: Over a four-month period from January to April 2020, surgical patients admitted with concurrent respiratory symptom, infiltrates on chest imaging, or suspicious travel/epidemiologic history were placed in a dedicated ward in which they were tested for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). If emergency operations were necessary prior to the exclusion of COVID-19, patients were managed as per suspected cases of COVID-19, with appropriate precautions and full personal protective equipment (PPE). Results: From January through April 2020, a total of 8,437 patients were admitted to our surgical department; 5.9% (498/8437) required peri-operative testing for SARS-CoV-2. Because testing was in-house with turnaround within 24 hours, only a small number of emergency operations (n = 10) were conducted for suspected COVID-19 cases prior to results; none tested positive. The testing yield was lower in surgical inpatients compared with medical inpatients (odds ratio [OR] = 0.20, 95% confidence interval [CI], 0.12-0.32, p < 0.001). Three operations were conducted in known COVID-19 cases; all healthcare workers (HCWs) used full PPE. A risk-stratified testing strategy picked up previously unsuspected COVID-19 in six cases; 66.7% (4/6) were asymptomatic at presentation. Although 48 HCWs were exposed to these six cases, delayed diagnosis was averted and no evidence of spread to patients or HCWs was detected. Conclusion: A risk-stratified approach allowed for early recognition, testing, and isolation of potential COVID-19 infection in surgical patients, ensuring continuity of surgical services.
Collapse
Affiliation(s)
- Liang En Wee
- Singhealth Infectious Diseases Residency, Singapore.,Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Xiang Ying Jean Sim
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Edwin Philip Conceicao
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - May Kyawt Aung
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Hei Man Wong
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Yii Ean Teh
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Kwee Yuen Tan
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Limin Wijaya
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Tan Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Moi Lin Ling
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - Indumathi Venkatachalam
- Department of Infectious Diseases, Singapore General Hospital, Singapore.,Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| |
Collapse
|
18
|
Jung J, Kim MJ, Kim JY, Lee JY, Kwak SH, Hong MJ, Chong YP, Lee SO, Choi SH, Kim YS, Woo JH, Kang WS, Chung JW, Kim MN, Kim SH. Candida auris colonization or infection of the ear: A single-center study in South Korea from 2016 to 2018. Med Mycol 2020; 58:124-127. [PMID: 30874806 DOI: 10.1093/mmy/myz020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/28/2018] [Revised: 01/27/2019] [Accepted: 02/12/2019] [Indexed: 11/12/2022] Open
Abstract
Candida auris was first identified in Japan from specimens obtained from the ear, but most reports since have reported invasive infections or non-ear based cases. We reviewed all the microbiology records from a single center in South Korea from February 2016 to July 2018. One hundred eleven isolates were positive for C. auris from 79 patients. All 79 patients positive for C. auris had positive ear discharge samples. All but one of the patients with C. auris had been to the otorhinolaryngology clinic. Symptom-driven ear culture was done for all but one patient, whose culture was performed for surveillance. Ear discharges were mostly purulent (60%) or serous (34%). We performed the environmental cultures at the otorhinolaryngology outpatient clinic to evaluate the environmental contamination of C. auris, but C. auris was not isolated from medical equipment and environmental surfaces.
Collapse
Affiliation(s)
- Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ja Young Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Jeong-Young Lee
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Sun Hee Kwak
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Min Jee Hong
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Yong Pil Chong
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yang Soo Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun Hee Woo
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Seok Kang
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong Woo Chung
- Department of Otorhinolaryngology-Head & Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| |
Collapse
|
19
|
Dantes RB, Jones TT, Neujahr DC. Delayed Recognition of Community Transmission of COVID-19 Resulting in Healthcare Worker Infections. Infect Control Hosp Epidemiol 2020;:1-6. [PMID: 32517835 DOI: 10.1017/ice.2020.285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
20
|
Armstrong PA, Rivera SM, Escandon P, Caceres DH, Chow N, Stuckey MJ, Díaz J, Gomez A, Vélez N, Espinosa-Bode A, Salcedo S, Marin A, Berrio I, Varón C, Guzman A, Pérez-Franco JE, Escobar JD, Villalobos N, Correa JM, Litvintseva AP, Lockhart SR, Fagan R, Chiller TM, Jackson B, Pacheco O. Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016. Emerg Infect Dis 2019; 25. [PMID: 31211679 PMCID: PMC6590770 DOI: 10.3201/eid2507.180491] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Candida auris is an emerging multidrug-resistant fungus that causes hospital-associated outbreaks of invasive infections with high death rates. During 2015-2016, health authorities in Colombia detected an outbreak of C. auris. We conducted an investigation to characterize the epidemiology, transmission mechanisms, and reservoirs of this organism. We investigated 4 hospitals with confirmed cases of C. auris candidemia in 3 cities in Colombia. We abstracted medical records and collected swabs from contemporaneously hospitalized patients to assess for skin colonization. We identified 40 cases; median patient age was 23 years (IQR 4 months-56 years). Twelve (30%) patients were <1 year of age, and 24 (60%) were male. The 30-day mortality was 43%. Cases clustered in time and location; axilla and groin were the most commonly colonized sites. Temporal and spatial clustering of cases and skin colonization suggest person-to-person transmission of C. auris. These cases highlight the importance of adherence to infection control recommendations.
Collapse
|
21
|
Al-Rawahi GN, Al-Najjar A, McDonald R, Deyell RJ, Golding GR, Brant R, Tilley P, Thomas E, Rassekh SR, O'Gorman A, Wong P, Turnham L, Dobson S. Pediatric oncology and stem cell transplant patients with healthcare-associated Clostridium difficile infection were already colonized on admission. Pediatr Blood Cancer 2019; 66:e27604. [PMID: 30666782 DOI: 10.1002/pbc.27604] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/22/2018] [Accepted: 12/14/2018] [Indexed: 01/02/2023]
Abstract
UNLABELLED Clostridium difficile is the leading cause of healthcare-associated infections worldwide. The diagnosis of C. difficile infection (CDI) in pediatric oncology patients is complex as diarrhea is common, and there is a high rate of colonization in infants and young children. This study was conducted to assess the accuracy of the surveillance definitions of healthcare-associated CDI (HA-CDI) and to determine the prevalence of toxigenic C. difficile colonization among pediatric oncology and stem cell transplant patients. METHODS A prospective cohort study was conducted over a three-year period in an inpatient pediatric oncology and stem cell transplant setting. Baseline stool samples were collected within three days of admission and were genotypically compared with clinically indicated samples submitted after three days of admission. RESULTS A total of 175 patients were recruited with a total of 536 admissions. The adjusted prevalence of baseline toxigenic C. difficile colonization among admissions was 32.8%. Seventy-eight percent of positive admissions did not have history of CDI. Colonization with a toxigenic strain on admission was predictive of CDI (OR = 28.6; 95% CI, 6.58-124.39; P < 0.001). Nearly all clinical isolates (8/9) shared identical pulsed-field gel electrophoresis patterns with baseline isolates or were closely related (1/9). Only one of the 11 cases that were considered HA-CDI was potentially nosocomially acquired. CONCLUSION The prevalence of colonization with toxigenic C. difficile in our cohort is high. Unfortunately, the current CDI surveillance definitions overestimate the incidence of HA-CDI in pediatric oncology and stem cell transplantation settings.
Collapse
Affiliation(s)
- Ghada N Al-Rawahi
- Department of Pathology and Laboratory Medicine, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Abeer Al-Najjar
- Pediatric Infectious Diseases, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Rachel McDonald
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca J Deyell
- Division of Pediatric Hematology/Oncology/BMT, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - George R Golding
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Rollin Brant
- Department of Statistics, University of British Columbia, British Columbia Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Peter Tilley
- Department of Pathology and Laboratory Medicine, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Eva Thomas
- Department of Pathology, Sidra Medicine and Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Shahrad R Rassekh
- Division of Pediatric Hematology/Oncology/BMT, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Aisling O'Gorman
- Division of Pediatric Hematology/Oncology/BMT, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Peggy Wong
- Division of Pediatric Hematology/Oncology/BMT, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Lucy Turnham
- Division of Pediatric Hematology/Oncology/BMT, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Simon Dobson
- Department of Pathology, Sidra Medicine and Weill Cornell Medical College in Qatar, Doha, Qatar
| |
Collapse
|
22
|
Rogers T, Sok K, Erickson T, Aguilera E, Wootton SH, Murray KO, Hasbun R. Impact of Antibiotic Therapy in the Microbiological Yield of Healthcare-Associated Ventriculitis and Meningitis. Open Forum Infect Dis 2019; 6:ofz050. [PMID: 30899767 PMCID: PMC6422431 DOI: 10.1093/ofid/ofz050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/30/2019] [Indexed: 11/13/2022] Open
Abstract
The impact of antibiotic therapy on the diagnosis of healthcare-associated ventriculitis and meningitis (HCAVM) is unknown. Antibiotics were administered before obtaining cerebrospinal fluid (CSF) in 217 out of 326 (66%) patients with HCAVM, and they impacted the sensitivity of the cerebrospinal fluid Gram stain and culture (P ≤ .004).
Collapse
Affiliation(s)
- Thomas Rogers
- Infectious Disease Division, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center in Houston, Houston, Texas
| | - Kevin Sok
- Infectious Disease Division, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center in Houston, Houston, Texas
| | - Timothy Erickson
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Elizabeth Aguilera
- Infectious Disease Division, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Susan H Wootton
- Infectious Disease Division, Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas
| | - Kristy O Murray
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Rodrigo Hasbun
- Infectious Disease Division, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center in Houston, Houston, Texas
| |
Collapse
|
23
|
Abstract
Delftia tsuruhatensis, which was first isolated in environmental samples, was rarely associated with human infections. We report on pneumonia caused by D. tsuruhatensis in an infant who underwent cardiac surgery. Retrospective analyses detected 9 other isolates from 8 patients. D. tsuruhatensis is an emergent pathogen, at least for immunocompromised patients.
Collapse
|
24
|
Alten JA, Rahman AKMF, Zaccagni HJ, Shin A, Cooper DS, Blinder JJ, Retzloff L, Aban IB, Graham EM, Zampi J, Domnina Y, Gaies MG. The Epidemiology of Healthcare-associated Infections in Pediatric Cardiac Intensive Care Units. Pediatr Infect Dis J 2018; 37:768-72. [PMID: 29280785 DOI: 10.1097/INF.0000000000001884] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) represent serious complications for patients within pediatric cardiac intensive care units (CICU). HAIs are associated with increased morbidity, mortality and resource utilization. There are few studies describing the epidemiology of HAIs across the entire spectrum of patients (surgical and nonsurgical) receiving care in dedicated pediatric CICUs. METHODS Retrospective analyses of 22,839 CICU encounters from October 2013 to September 2016 across 22 North American CICUs contributing data to the Pediatric Cardiac Critical Care Consortium clinical registry. RESULTS HAIs occurred in 2.4% of CICU encounters at a rate of 3.3 HAIs/1000 CICU days, with 73% of HAIs occurring in children <1 year. Eighty encounters (14%) had ≥2 HAIs. Aggregate rates for the 4 primary HAIs are as follows: central line-associated blood stream infection, 1.1/1000 line days; catheter-associated urinary tract infections, 1.5/1000 catheter days; ventilator-associated pneumonia, 1.9/1000 ventilator days; surgical site infections, 0.81/100 operations. Surgical and nonsurgical patients had similar HAIs rates/1000 CICU days. Incidence was twice as high in surgical encounters and increased with surgical complexity; postoperative infection occurred in 2.8% of encounters. Prematurity, younger age, presence of congenital anomaly, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT) 4-5 surgery, admission with an active medical condition, open sternum and extracorporeal membrane oxygenation were independently associated with HAIs. In univariable analysis, HAI was associated with longer hospital length of stay and durations of urinary catheter, central venous catheter and ventilation. Mortality was 24.4% in patients with HAIs versus 3.4% in those without, P < 0.0001. CONCLUSIONS We provide comprehensive multicenter benchmark data regarding rates of HAIs within dedicated pediatric CICUs. We confirm that although rare, HAIs of all types are associated with significant resource utilization and mortality.
Collapse
|
25
|
Abstract
OBJECTIVES To determine the racial disparities in severe sepsis hospitalizations and outcomes in U.S. academic medical center-affiliated hospitals. DESIGN Retrospective analysis of sepsis hospitalizations. SETTINGS U.S. academic medical center-affiliated hospitals participating in Vizient Consortium from 2012 to 2014. PATIENTS Sepsis hospitalizations using International Classification of Diseases, Ninth revision, discharge diagnoses codes defined by the Angus method. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We compared rates of sepsis hospitalization, ICU admission, organ dysfunction, and hospital mortality between blacks and whites. We repeated the analyses stratified by community-acquired, healthcare-associated, and hospital-acquired sepsis subtypes. Of 10,244,780 hospitalizations in our cohort, 1,114,386 (10.9%) had sepsis. Sepsis subtypes included community-acquired sepsis (61.8%), healthcare-associated sepsis (23.8%), and hospital-acquired sepsis (14.4%). Although the proportion of discharges with sepsis was lower for blacks than whites (106.72 vs 109.43 per 1,000 hospitalizations; p < 0.001), the proportion of black sepsis hospitalizations was higher for individuals greater than 30 years old. Blacks exhibited lower adjusted sepsis hospital mortality than whites (odds ratio, 0.85; 95% CI, 0.84-0.86). The adjusted odds of hospital mortality following community-acquired, healthcare-associated, and hospital-acquired sepsis were lower for blacks than whites. CONCLUSIONS In this current series of hospital discharges at U.S. academic medical center-affiliated hospitals, blacks exhibited lower adjusted rates of sepsis hospitalizations and mortality than whites.
Collapse
Affiliation(s)
- Ninad S. Chaudhary
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - John P. Donnelly
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Henry E. Wang
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama
- Department of Emergency Medicine, University of Texas Health Science Center at Houston, TX
| |
Collapse
|
26
|
Abstract
Aim To describe definitions of healthcare‐associated influenza (HAI) in recent literature and in hospitals participating in a survey of Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN) members. Method A review with PubMed search was undertaken to retrieve articles published between 2008 and 2016, focusing on the subject headings “influenza, human” and “cross infection.” Definitions of clinical influenza‐like illness (ILI) and HAI were identified. An invitation to participate in the survey was sent to 218 SRN members via email. Results Of 75 articles on HAI included in the review, 30 presented a standardized definition of clinical ILI based on fever (100%), cough (80%), and sore throat (70%). Forty studies (53%) contained a standardized HAI definition, grounded on threshold delay from admission in 29 of them, this delay ranging from 48 to 196 hour (median: 72 hour). Fifty‐five SRN members responded to the survey, with a standardized definition of HAI adopted by 76% of them. This definition was based on clinical features for 24%, virological features for 31%, and both for 45%. Fever (mean threshold: 38.0°C) was part of the definition for 82%. The features required most frequently in the clinical definition were cough (46%) and sore throat (26%). Median threshold delay between admission and symptoms onset adopted for HAI definition was 48 hour (range: 24‐96 hour). Conclusion This work underlined the heterogeneity of HAI definitions in different countries. A standardized definition would be helpful to evaluate HAI spread, outcomes in patients and healthcare systems, and the impact of prevention measures, including vaccination.
Collapse
Affiliation(s)
- Elodie Munier-Marion
- Infection Control and Epidemiology Unit, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France
| | - Thomas Bénet
- Infection Control and Epidemiology Unit, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Emerging Pathogens Laboratory - Fondation Mérieux, INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Centre International de Recherche en Infectiologie, Lyon, France.,INSERM, F-CRIN, I-REIVAC, Lyon Collaborative Center, Lyon, France
| | - Philippe Vanhems
- Infection Control and Epidemiology Unit, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.,Emerging Pathogens Laboratory - Fondation Mérieux, INSERM U1111, CNRS, UMR5308, ENS de Lyon, UCBL1, Centre International de Recherche en Infectiologie, Lyon, France.,INSERM, F-CRIN, I-REIVAC, Lyon Collaborative Center, Lyon, France
| |
Collapse
|
27
|
Yi J, Sederdahl BK, Wahl K, Jerris RR, Kraft CS, McCracken C, Gillespie S, Kirby AE, Shane AL, Moe CL, Anderson EJ. Rotavirus and Norovirus in Pediatric Healthcare-Associated Gastroenteritis. Open Forum Infect Dis 2016; 3:ofw181. [PMID: 27807589 PMCID: PMC5088695 DOI: 10.1093/ofid/ofw181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/23/2016] [Indexed: 12/30/2022] Open
Abstract
Rotavirus and norovirus are important etiologies of gastroenteritis among hospitalized children. During 2012–2013, we tested 207 residual stool specimens from children with healthcare-associated vomiting and/or diarrhea for rotavirus and norovirus. Twenty (10%) were rotavirus positive, and 3 (3%) were norovirus positive, stressing the importance of these pathogens in hospitalized children.
Collapse
Affiliation(s)
- Jumi Yi
- Department of Pediatrics , Emory University School of Medicine
| | - Bethany K Sederdahl
- Department of Pediatrics, Emory University School of Medicine; Rollins School of Public Health, Emory University
| | - Kelly Wahl
- Rollins School of Public Health , Emory University
| | - Robert R Jerris
- Children's Healthcare of Atlanta; Department of Pathology and Laboratory Medicine
| | - Colleen S Kraft
- Department of Pathology and Laboratory Medicine; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | | | - Scott Gillespie
- Department of Pediatrics , Emory University School of Medicine
| | - Amy E Kirby
- Rollins School of Public Health , Emory University
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine; Rollins School of Public Health, Emory University; Children's Healthcare of Atlanta
| | | | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine; Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
28
|
Abstract
A notable portion of deaths in bloodstream infections (BSI) have previously been shown to occur within 2 days after taking the first positive blood culture specimen. The aim of this study was to analyse patients' characteristics and causative pathogens of BSIs, leading to early deaths in order to explore possibilities for prevention. Patients with BSI in Helsinki and Uusimaa region (population = 1.5 million) in 2007 were identified from the National Infectious Disease Register (n = 2181) and their deaths within 2 days after the first positive blood culture from the Population Information System (n = 76). Of the early fatal BSIs, 42 (55%) were community-acquired (CA-BSI) and 34 (45%) healthcare-associated (HA-BSI). Charlson comorbidity index was moderate-to-high (index ≥ 3) in 71% of HA-BSIs and 60% of CA-BSIs. The most common pathogens in CA-BSIs were Streptococcus pneumoniae (29%) and Escherichia coli (24%) and in HA-BSIs Pseudomonas aeruginosa (24%) and Staphylococcus aureus (18%). The respiratory tract (50%) was the most common focus of infection. Empiric antimicrobial treatment was more often appropriate in CA-BSIs vs HA-BSIs (81% vs 41%, p < 0.001), but treatment delays were longer in CA-BSIs. The majority of the BSI patients who died early had severe comorbidities. S. pneumoniae accounted for one third of CA-BSIs, highlighting the potential role of pneumococcal vaccines in prevention. Early recognition of BSI and its origin (CA-BSI vs HA-BSI) is crucial. Continuous surveillance data on causative microbes and resistance trends in hospitals is needed to propose guidelines for empiric antimicrobial therapy of BSIs.
Collapse
Affiliation(s)
- Keiju S K Kontula
- a Division of Infectious Diseases , HUH Inflammation Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Kirsi Skogberg
- a Division of Infectious Diseases , HUH Inflammation Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Jukka Ollgren
- b Department of Infectious Disease , National Institute for Health and Welfare , Helsinki , Finland
| | - Asko Järvinen
- a Division of Infectious Diseases , HUH Inflammation Center, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Outi Lyytikäinen
- b Department of Infectious Disease , National Institute for Health and Welfare , Helsinki , Finland
| |
Collapse
|
29
|
Abstract
OBJECTIVES Severe sepsis poses a major burden on the U.S. healthcare system. Previous epidemiologic studies have not differentiated community-acquired severe sepsis from healthcare-associated severe sepsis or hospital-acquired severe sepsis hospitalizations. We sought to compare and contrast community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis hospitalizations in a national hospital sample. DESIGN Retrospective analysis of severe sepsis discharges from University HealthSystem Consortium hospitals in 2012. SETTING United States. PATIENTS We used the criteria from Angus et al (discharge diagnoses for both a serious infection and organ dysfunction) to identify severe sepsis hospitalizations. We defined healthcare-associated severe sepsis as severe sepsis hospitalizations with an infection present at admission, where the patient was a nursing home resident, was on hemodialysis, or was readmitted within 30 days of a prior hospitalization. We defined community-acquired severe sepsis as all other severe sepsis patients with an infection present at admission. We defined hospital-acquired severe sepsis as severe sepsis patients where the documented infection was not present at admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Prevalence of community-acquired severe sepsis, healthcare-associated severe sepsis, and hospital-acquired severe sepsis, adjusted hospital mortality, length of hospitalization, length of stay in an ICU, and hospital costs. Among 3,355,753 hospital discharges, there were 307,491 with severe sepsis, including 193,081 (62.8%) community-acquired severe sepsis, 79,581 (25.9%) healthcare-associated severe sepsis, and 34,829 (11.3%) hospital-acquired severe sepsis. Hospital-acquired severe sepsis and healthcare-associated severe sepsis exhibited higher in-hospital mortality than community-acquired severe sepsis (hospital acquired [19.2%] vs healthcare associated [12.8%] vs community acquired [8.6%]). Hospital-acquired severe sepsis had greater resource utilization than both healthcare-associated severe sepsis and community-acquired severe sepsis, with higher median length of hospital stay (hospital acquired [17 d] vs healthcare associated [7 d] vs community acquired [6 d]), median length of ICU stay (hospital acquired [8 d] vs healthcare associated [3 d] vs community acquired [3 d]), and median hospital costs (hospital acquired [$38,369] vs healthcare associated [$8,796] vs community acquired [$7,024]). CONCLUSIONS In this series, severe sepsis hospitalizations included community-acquired severe sepsis (62.8%), healthcare-associated severe sepsis (25.9%), and hospital-acquired severe sepsis (11.3%) cases. Hospital-acquired severe sepsis was associated with both higher mortality and resource utilization than community-acquired severe sepsis and healthcare-associated severe sepsis.
Collapse
Affiliation(s)
- David B Page
- 1Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL. 2Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. 3Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | | | | |
Collapse
|
30
|
Abstract
Not only is Asia the most populous region in the world, but inappropriate therapy, including self-medication with over-the-counter antimicrobial agents, is a common response to infectious diseases. The high antibiotic selective pressure among the overcrowded inhabitants creates an environment that is suitable for the rapid development and efficient spread of numerous multidrug-resistant pathogens. Indeed, Asia is among the regions with the highest prevalence rates of healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) and community-associated methicillin-resistant S. aureus (CA-MRSA) in the world. Most hospitals in Asia are endemic for multidrug-resistant methicillin-resistant S. aureus (MRSA), with an estimated proportion from 28% (in Hong Kong and Indonesia) to >70% (in Korea) among all clinical S. aureus isolates in the early 2010s. Isolates with reduced susceptibility or a high level of resistance to glycopeptides have also been increasingly identified in the past few years. In contrast, the proportion of MRSA among community-associated S. aureus infections in Asian countries varies markedly, from <5% to >35%. Two pandemic HA-MRSA clones, namely multilocus sequence type (ST) 239 and ST5, are disseminated internationally in Asia, whereas the molecular epidemiology of CA-MRSA in Asia is characterized by clonal heterogeneity, similar to that in Europe. In this review, the epidemiology of S. aureus in both healthcare facilities and communities in Asia is addressed, with an emphasis on the prevalence, clonal structure and antibiotic resistant profiles of the MRSA strains. The novel MRSA strains from livestock animals have been considered to constitute a public health threat in western countries. The emerging livestock-associated MRSA strains in Asia are also included in this review.
Collapse
Affiliation(s)
- C-J Chen
- Division of Paediatric Infectious Diseases, Chang Gung Memorial Hospital and Children's Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | |
Collapse
|
31
|
Ahmetagic S, Salkic N, Ahmetagic A, Custovic A, Tihic N, Smajlovic J, Porobic-Jahic H. Clostridium difficile infection in hospitalized patients at university clinical center tuzla, bosnia and herzegovina: a 4 year experience. Mater Sociomed 2013; 25:153-7. [PMID: 24167425 PMCID: PMC3804390 DOI: 10.5455/msm.2013.25.153-157] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 07/25/2013] [Indexed: 11/08/2022] Open
Abstract
Introduction: Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina. Goal: We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012. Methods: We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay). Results: From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%). Conclusion: Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI.
Collapse
Affiliation(s)
- Sead Ahmetagic
- Infectious Diseases Department, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | | | | | | | | | | | | |
Collapse
|
32
|
Horcajada JP, Shaw E, Padilla B, Pintado V, Calbo E, Benito N, Gamallo R, Gozalo M, Rodríguez-Baño J. Healthcare-associated, community-acquired and hospital-acquired bacteraemic urinary tract infections in hospitalized patients: a prospective multicentre cohort study in the era of antimicrobial resistance. Clin Microbiol Infect 2013; 19:962-8. [PMID: 23279375 DOI: 10.1111/1469-0691.12089] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [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: 07/26/2012] [Revised: 10/25/2012] [Accepted: 10/25/2012] [Indexed: 02/05/2023]
Abstract
The clinical and microbiological characteristics of community-onset healthcare-associated (HCA) bacteraemia of urinary source are not well defined. We conducted a prospective cohort study at eight tertiary-care hospitals in Spain, from October 2010 to June 2011. All consecutive adult patients hospitalized with bacteraemic urinary tract infection (BUTI) were included. HCA-BUTI episodes were compared with community-acquired (CA) and hospital-acquired (HA) BUTI. A logistic regression analysis was performed to identify 30-day mortality risk factors. We included 667 episodes of BUTI (246 HCA, 279 CA and 142 HA). Differences between HCA-BUTI and CA-BUTI were female gender (40% vs 69%, p <0.001), McCabe score II-III (48% vs 14%, p <0.001), Pitt score ≥2 (40% vs 31%, p 0.03), isolation of extended spectrum β-lactamase-producing Enterobacteriaciae (13% vs 5%, p <0.001), median hospital stay (9 vs 7 days, p 0.03), inappropriate empirical antimicrobial therapy (21% vs 13%, p 0.02) and mortality (11.4% vs 3.9%, p 0.001). Pseudomonas aeruginosa was more frequently isolated in HA-BUTI (16%) than in HCA-BUTI (4%, p <0.001). Independent factors for mortality were age (OR 1.04; 95% CI 1.01-1.07), McCabe score II-III (OR 3.2; 95% CI 1.8-5.5), Pitt score ≥2 (OR 3.2 (1.8-5.5) and HA-BUTI OR 3.4 (1.2-9.0)). Patients with HCA-BUTI are a specific group with significant clinical and microbiological differences from patients with CA-BUTI, and some similarities with patients with HA-BUTI. Mortality was associated with patient condition, the severity of infection and hospital acquisition.
Collapse
Affiliation(s)
- J P Horcajada
- Hospital Universitari del Mar, Barcelona, Spain; Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Shorr AF, Zilberberg MD, Reichley R, Kan J, Hoban A, Hoffman J, Micek ST, Kollef MH. Readmission following hospitalization for pneumonia: the impact of pneumonia type and its implication for hospitals. Clin Infect Dis 2013; 57:362-7. [PMID: 23677872 DOI: 10.1093/cid/cit254] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Readmission rates following discharge after pneumonia are thought to represent the quality of care. Factors associated with readmission, however, remain poorly described. It is unclear if readmission rates vary based on pneumonia type. METHODS We retrospectively identified adults admitted to an index hospital with non-nosocomial pneumonia (January through December 2010) and who survived to discharge. We only included patients with bacterial evidence of infection. Readmission in the 30 days following discharge to any of 9 hospitals comprising the index hospital's healthcare system served as the primary end point. We recorded demographics, severity of illness, comorbidities, and infection-related factors. We noted whether the patient had healthcare-associated pneumonia (HCAP) versus community-acquired pneumonia. We utilized logistic regression analysis to determine factors independently associated with readmission. RESULTS The cohort included 977 subjects; 78.9% survived to discharge. The readmission rate equaled 20%. Neither disease severity nor the rate of initially inappropriate antibiotic therapy correlated with readmission. Subjects with HCAP were 7.5 (95% confidence interval [CI], 3.6-15.7) times more likely to be readmitted. Four HCAP criteria were independently associated with readmission: admission from long-term care (adjusted odds ratio [AOR], 2.2 [95% CI, 1.4-3.4]); immunosuppression (AOR, 1.9 [95% CI, 1.3-2.9]); prior antibiotics (AOR, 1.7 [95% CI, 1.2-2.6]); and prior hospitalization (AOR, 1.7 [95% CI, 1.1-2.5]). CONCLUSIONS Readmission for pneumonia is common but varies based on pneumonia type. The variables associated with readmission do not reflect factors that hospitals directly control. Use of one rule to guide payment that fails to account for HCAP and the HCAP criteria on readmission seems inappropriate.
Collapse
Affiliation(s)
- Andrew F Shorr
- Pulmonary and Critical Care Medicine, Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA.
| | | | | | | | | | | | | | | |
Collapse
|