Impact of discontinuing isolation in a private room for patients infected or colonized with vancomycin-resistant enterococci (VRE) on the incidence of healthcare-associated VRE bacteraemia in a hospital with a predominantly shared-room setting

BACKGROUND

Isolating patients infected or colonized with vancomycin-resistant enterococci (VRE) in a private room or cohort room to prevent hospital transmission is controversial.

AIM

To evaluate the effect of a relaxed isolation policy for VRE-infected or colonized patients on healthcare-associated (HA) VRE bacteraemia in an acute care hospital with a predominantly shared-room setting.

METHODS

The incidence of HA VRE bacteraemia was compared during a private isolation era (October 2014-September 2017), a cohort isolation era (October 2017-June 2020), and a no isolation era (July 2020-June 2022). Using Poisson regression modelling, an interrupted time-series analysis was conducted to analyse level changes and trends in incidences of HA VRE bacteraemia for each era.

FINDINGS

The proportion of VRE-infected or -colonized patients staying in shared rooms increased from 18.3% in the private isolation era to 82.6% in the no isolation era (P < 0.001). There was no significant difference in the incidences of HA VRE bacteraemia between the private isolation era and the cohort isolation era (relative risk: 1.01; 95% confidence interval: 0.52-1.98; P = 0.977) or between the cohort isolation era and the no isolation era (0.99; 0.77-1.26; P = 0.903). In addition, there was no significant slope increase in the incidence of HA VRE bacteraemia between any of the eras.

CONCLUSION

In a hospital with predominantly shared rooms, the relaxation of isolation policy did not result in increased HA VRE bacteraemia, when other infection control measures were maintained.

DNA Methylation and gene expression patterns are widely altered in fetal growth restriction and associated with FGR development

Fetal growth restriction (FGR) is the failure of the fetus toachieve its genetically determined growth potential, which increasesrisks for a variety of genetic diseases, such as type 2 diabetes mellitus, coronary artery disease, and stroke, during the lifetime. The dysregulation of DNA methylationis known to interact with environmental fluctuations, affect gene expressions comprehensively, and be fatal to fetus development in specific cases. Therefore, we set out to find out epigenetic and transcriptomic alterations associated with FGR development. We found a set of differentially expressed genes associated with differentially methylated regions in placentae and cord blood samples. Using dimensional reduction analysis, the expression and methylation variables of the epigenetically altered genes classified the FGR samples from the controls. These genes were also enriched in the biological pathways such as metabolism and developmental processes related to FGR. Furthermore, three genes of INS, MEG3, and ZFP36L2 are implicated in epigenetic imprinting, which has been associated with FGR. These results strongly suggest that DNA methylation is highly dysregulated during FGR development, and abnormal DNA methylation patterns are likely to alter gene expression.

Muscle fatigue measured with evoked muscle vibrations

Skeletal muscle vibrates laterally during voluntary and evoked muscle contractions. We hypothesized that the vibration amplitude from evoked muscle twitches is directly related to evoked twitch force from fatiguing muscle. To test the hypothesis, vibrations produced by evoked muscle twitches were recorded during short (5-second) rest periods as the muscle was intermittently exercised with voluntary contractions. Trials were performed at 30%, 50%, and 70% of maximal voluntary contraction. Evoked muscle twitches eliminated the problems of motivation and tremor that complicate sound and vibration measurements during voluntary contractions. Results from the first dorsal interosseus hand muscle in 11 normal adult volunteers revealed that the vibration amplitude is highly correlated (r2 = 0.93, at 70% MVC, r2 = 0.97, at 50% MVC; r2 = 0.85, at 30% MVC) with force. Both potentiation and reduction of force with exercise were accompanied by parallel changes in vibration amplitude, as measured with an accelerometer. Compound muscle action potentials did not increase with exercise-induced twitch potentiation, and did not correlate as highly with force during fatigue.