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1. Health care-associated measles outbreak in pediatric wards in a tertiary care hospital: Challenges and Swiss cheese model enforcement for patient safety.

Author

Maskari, Zaina AL, Tai, Amal AL, Kindi, Hanan AL, Busaidi, Aisha AL, Mammari, Khalsa AL, Shukri, Intisar AL, Hashami, Hilal AL, Maskari, Nawal AL, and Waili, Badria AL

Abstract

• Healthcare-associated Measles outbreaks can amplify outbreaks in countries achieved elimination. • Unvaccinated pediatric patients may acquire severe Measles in hospitals. • Molecular surveillance is a vital tool to confirm the measles outbreak. • Layers of infection control must be implemented to prevent Measles outbreaks. Measles is one of the most contagious of all infectious diseases, for example, up to 9 out of 10 susceptible people with close contact to a measles patient will develop measles. In countries where measles is rare, transmissions in health care facilities have been a key factor in amplifying outbreaks Describe the hospital transmission of measles among unvaccinated children in pediatric service, challenges faced and recommendations for health care settings by applying the Swiss cheese model. Between December 2019 and January 2020; multiple exposures to measles cases occurred. The incident and factors that led to the outbreak are described. The matrix and fusion genes, non-coding region sequence analysis was also conducted on the 3 strains isolated from the cases. The outbreak extended from December 2019 to January 2020, which resulted in 110 exposed individuals (85 health care workers and 25 patients). Eleven (44%) children exposed were vaccinated, 14 (56%) were not yet vaccinated, and the measles status of 10 (11.8%) HCWs was not known at the time of the outbreak. Two infants acquired measles in the hospital, and both required ICU care. Three infants and one HCW received immunoglobulin. The phylogenetic tree of the matrix and fusion genes, non-coding region sequencing confirmed that all three cases had 100% identical measles strain. In countries where measles elimination goals are achieved, a multifaceted approach to prevent measles transmission in health care is vital to maintain patient safety. [ABSTRACT FROM AUTHOR]

Published
2023
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2. Methodologic challenges and lessons learned through conducting a hospital-based Salmonella Javiana case-control study.

Author

Stancill, Lisa B., Ponder, Madison G., Kinlaw, Alan C., Teal, Lisa, Sickbert-Bennett, Emily E., Weber, David J., and DiBiase, Lauren M.

Abstract

• While sparse data limited inference, fruit cups were implicated in hospital outbreak of salmonellosis due to the attack rates at 2 different facilities. • Challenges encountered during the outbreak investigation included: control selection, small sample size, loss of data in food ordering database, and heterogeneity in operations between facilities. • Understanding and anticipating challenges is critical for conducting efficient and effective case-control studies in the hospital setting. • The key to intervening quickly and efficiently during hospital-based food-borne outbreaks is accurate, readily available food history, collaboration and using epidemiological tools that maximize the information. Determine the food(s) most likely contaminated by Salmonella Javiana associated with a salmonellosis outbreak involving 2 hospitals in North Carolina that were within 50 miles of each other in November 2021. A 2:1 matched case-control study was conducted. Food histories were obtained from hospital food orders and potential confounder covariates were collected from patient medical records. Attack rates and conditional logistic regression odds ratios (OR) were estimated at the 80% confidence interval (CI) for each food exposure and salmonellosis. There were 21 cases and 42 controls included. Fruit cups had the strongest association with salmonellosis (matched and adjusted OR = 7.9 80% CI: 2.7, 23.6). Hospital-specific ORs varied for several food items, but attack rates analyses provided additional evidence that fruit cups were a likely common source. Our analyses implicated fruit cups in an outbreak of salmonellosis in 2 hospitals. Other methodologic challenges included selection of controls among sick patients, heterogeneity of food exposures, reliance on food orders rather than foods consumed, and retention of food history records. Understanding and anticipating these challenges through changes to policies and operational procedures is critical for conducting efficient and effective case-control studies in the hospital setting. [ABSTRACT FROM AUTHOR]

Published
2023
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3. Healthcare-associated Clostridioides difficile infection during the COVID-19 pandemic in a tertiary care hospital in Romania

Author

Manea Eliza, Jipa Raluca, Milea Alexandru, Roman Antonia, Neagu Georgiana, and Hristea Adriana

Subjects
clostridioides difficile infection, covid-19, healthcare associated, risk factors, Internal medicine, RC31-1245
Abstract

Introduction. Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic.

Published
2021
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4. Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016

Author

Paige A. Armstrong, Sandra M. Rivera, Patricia Escandon, Diego H. Caceres, Nancy Chow, Matthew J. Stuckey, Jorge Díaz, Adriana Gomez, Norida Vélez, Andres Espinosa-Bode, Soraya Salcedo, Adriana Marin, Indira Berrio, Carmen Varón, Angel Guzman, Jairo E. Pérez-Franco, Julian D. Escobar, Nohora Villalobos, Juan M. Correa, Anastasia P. Litvintseva, Shawn R. Lockhart, Ryan Fagan, Tom M. Chiller, Brendan Jackson, and Oscar Pacheco

Subjects
fungi, candidemia, resistance, healthcare associated, Candida auris, antimicrobial resistance, Medicine, Infectious and parasitic diseases, RC109-216
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

Published
2019
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5. Rapid feedback on hospital onset SARS-CoV-2 infections combining epidemiological and sequencing data

Author

Oliver Stirrup, Joseph Hughes, Matthew Parker, David G Partridge, James G Shepherd, James Blackstone, Francesc Coll, Alexander Keeley, Benjamin B Lindsey, Aleksandra Marek, Christine Peters, Joshua B Singer, The COVID-19 Genomics UK (COG-UK) consortium, Asif Tamuri, Thushan I de Silva, Emma C Thomson, and Judith Breuer

Subjects
COVID-19, healthcare associated, nosocomial, SARS-CoV-2, whole genome sequencing, outbreak, Medicine, Science, Biology (General), QH301-705.5
Abstract

Background: Rapid identification and investigation of healthcare-associated infections (HCAIs) is important for suppression of SARS-CoV-2, but the infection source for hospital onset COVID-19 infections (HOCIs) cannot always be readily identified based only on epidemiological data. Viral sequencing data provides additional information regarding potential transmission clusters, but the low mutation rate of SARS-CoV-2 can make interpretation using standard phylogenetic methods difficult. Methods: We developed a novel statistical method and sequence reporting tool (SRT) that combines epidemiological and sequence data in order to provide a rapid assessment of the probability of HCAI among HOCI cases (defined as first positive test >48 hr following admission) and to identify infections that could plausibly constitute outbreak events. The method is designed for prospective use, but was validated using retrospective datasets from hospitals in Glasgow and Sheffield collected February–May 2020. Results: We analysed data from 326 HOCIs. Among HOCIs with time from admission ≥8 days, the SRT algorithm identified close sequence matches from the same ward for 160/244 (65.6%) and in the remainder 68/84 (81.0%) had at least one similar sequence elsewhere in the hospital, resulting in high estimated probabilities of within-ward and within-hospital transmission. For HOCIs with time from admission 3–7 days, the SRT probability of healthcare acquisition was >0.5 in 33/82 (40.2%). Conclusions: The methodology developed can provide rapid feedback on HOCIs that could be useful for infection prevention and control teams, and warrants further prospective evaluation. The integration of epidemiological and sequence data is important given the low mutation rate of SARS-CoV-2 and its variable incubation period. Funding: COG-UK HOCI funded by COG-UK consortium, supported by funding from UK Research and Innovation, National Institute of Health Research and Wellcome Sanger Institute.

Published
2021
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6. Case–Case Comparison of Candida auris Versus Other Candida Species Bloodstream Infections: Results of an Outbreak Investigation in Colombia.

Author

Caceres, Diego H., Rivera, Sandra M., Armstrong, Paige A., Escandon, Patricia, Chow, Nancy A., Ovalle, Maria Victoria, Díaz, Jorge, Derado, Gordana, Salcedo, Soraya, Berrio, Indira, Espinosa-Bode, Andres, Varón, Carmen, Stuckey, Matthew J., Mariño, Adriana, Villalobos, Nohora, Lockhart, Shawn R., Chiller, Tom M., Prieto, Franklin E., and Jackson, Brendan R.

Abstract

Background: Candida auris is an emerging multidrug-resistant yeast that causes outbreaks in healthcare settings around the world. In 2016, clinicians and public health officials identified patients with C. auris bloodstream infections (BSI) in Colombian healthcare facilities. To evaluate potential risk factors and outcomes for these infections, we investigated epidemiologic and clinical features of patients with C. auris and other Candida species BSI. Methods: We performed a retrospective case-case investigation in four Colombian acute care hospitals, defining a case as Candida spp. isolated from blood culture during January 2015–September 2016. C. auris BSI cases were compared to other Candida species BSI cases. Odds ratio (OR), estimated using logistic regression, was used to assess the association between risk factors and outcomes. Results: We analyzed 90 patients with BSI, including 40 with C. auris and 50 with other Candida species. All had been admitted to the intensive care unit (ICU). No significant demographic differences existed between the two groups. The following variables were independently associated with C. auris BSI: ≥ 15 days of pre-infection ICU stay (OR: 5.62, CI: 2.04–15.5), evidence of severe sepsis (OR: 3.70, CI 1.19–11.48), and diabetes mellitus (OR 5.69, CI 1.01–31.9). Conclusion: Patients with C. auris BSI had longer lengths of ICU stay than those with other candidemias, suggesting that infections are acquired during hospitalization. This is different from other Candida infections, which are usually thought to result from autoinfection with host flora. [ABSTRACT FROM AUTHOR]

Published
2020
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7. Healthcare-associated Clostridioides difficile infection during the COVID-19 pandemic in a tertiary care hospital in Romania

Author

Antonia Roman, Adriana Hristea, Raluca Jipa, Alexandru Milea, Georgiana Neagu, and Eliza Manea

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), genetic structures, medicine.drug_class, medicine.medical_treatment, Cephalosporin, Antibiotics, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Pandemic, medicine, risk factors, 030212 general & internal medicine, 0303 health sciences, healthcare associated, 030306 microbiology, business.industry, Incidence (epidemiology), Immunosuppression, Retrospective cohort study, clostridioides difficile infection, Antimicrobial, RC31-1245, covid-19, business
Abstract

Introduction Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic.Methods We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018.Results We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days).Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment - mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group.Conclusions The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.What is important: Information on healthcare-acquired C.difficile in COVID-19 patients is limited, but not only C.difficile infection remains a worrying issue, but is also an emerging topic. We found that antibiotic use seems to be the most important factor associated with CDI and our data emphasize the need for rational use of antibiotics and for ongoing attention regarding CDI in COVID-19 patients.

Published
2021

8. Racial Differences in Sepsis Mortality at U.S. Academic Medical Center-Affiliated Hospitals.

Author

Chaudhary, Ninad S., Donnelly, John P., and Wang, Henry E.

Subjects
*RACIAL differences, *SEPSIS, *MORTALITY, *HOSPITAL care, *INTENSIVE care units
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. [ABSTRACT FROM AUTHOR]

Published
2018
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9. Burden of Healthcare-Associated Viral Respiratory Infections in Children's Hospitals.

Author

Quach, Caroline, Shah, Rita, and Rubin, Lorry G.

Subjects
*CHILD health services, *CONFIDENCE intervals, *CROSS infection, *HOSPITAL wards, *INTENSIVE care units, *LONGITUDINAL method, *MATHEMATICAL statistics, *NEONATAL intensive care, *PARAMYXOVIRUSES, *PEDIATRICS, *PUBLIC health surveillance, *RESPIRATORY infections, *RESPIRATORY syncytial virus, *RNA viruses, *VIRUS diseases, *PARAMETERS (Statistics), *NEONATAL intensive care units, *DISEASE incidence, *RETROSPECTIVE studies
Abstract

Objective. Although healthcare-associated (HA) viral respiratory infections (VRIs) are common in pediatrics, no benchmark for comparison exists. We aimed to determine, compare, and assess determinants of unit-specific HA-VRI incidence rates in 2 children's hospitals. Methods. This study was a retrospective comparison of prospective cohorts. The Montreal Children's Hospital and the Cohen Children's Medical Center of New York perform prospective surveillance for HA-VRI using standardized definitions that require the presence of symptoms compatible with VRI and virus detection. Cases detected between April 1, 2010, and March 31, 2013, were identified using surveillance databases. Annual incidence rates were calculated, and a generalized estimating equation model was used to assess determinants of HA-VRI rates. Results. The overall HA-VRI rate during the 3-year study period was significantly higher at Montreal Children's Hospital than that at Cohen Children's Medical Center of New York (1.91 vs 0.80 per 1000 patient-days, respectively; P < .0001). Overall, the HA-VRI incidence rate was lowest in the neonatal intensive care unit. Rates in the pediatric intensive care, oncology, and medical/ surgical units were similar. The most common etiology of HA-VRI at both institutions was rhinovirus (49% of cases), followed by parainfluenza virus and respiratory syncytial virus. Hospitals with less than 50% single rooms had HA-VRI rates 1.33 (95% confidence interval, 1.29-1.37) times higher than hospitals with more than 50% single rooms for a given unit type. Conclusions. HA-VRI rates were substantial but different among 2 children's hospitals. Future studies should examine the effect of HA-VRI and evaluate best practices for preventing such infections. [ABSTRACT FROM AUTHOR]

Published
2018
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10. Changing ICU culture to reduce catheter-associated urinary tract infections.

Author

Maxwell, Marcia, Murphy, Kristy, and McGettigan, Maude

Subjects
CATHETER-associated urinary tract infections, AWARDS, COMPARATIVE studies, CORPORATE culture, HOSPITALS, INTENSIVE care units, LONGITUDINAL method, PERSONNEL management, QUALITY assurance, URINALYSIS, QUALITATIVE research, URINARY catheters, DESCRIPTIVE statistics, PREVENTION
Abstract

Background: The presence of an indwelling urinary catheter predisposes a patient to a Catheter Associated Urinary Tract Infection. Each day a catheter is left in place, the patient risk for a CAUTI increases 5%. Many characteristics of a Level II Trauma Center ICU/IMCU contribute to the routine insertion of, and reluctance to remove, indwelling urinary catheters. The aim of this project was to decrease the patient harm of CAUTI incidence by focusing on a cultural transformation around the use of indwelling urinary catheters. Methods: A core group of nursing staff, leadership, physicians and infection preventionists within the ICU/IMCU of a regional Level II Trauma Center in the state of Colorado led this quality improvement project. The goal of the project was to clarify appropriate indwelling urinary catheter indications for use, assess organizational and cultural influences and develop a support structure around CAUTI prevention using the Plan-Do-Study-Act model of Quality Improvement. The team also participated in the "On the CUSP: STOP CAUTI" initiative sponsored by the Colorado Hospital Association. Results: At year-end 2015, infection prevention data demonstrated an 87.5% decrease in CAUTI from 2014, as well as a decrease in utilization of 9%. A zero CAUTI rate was sustained for 394 consecutive days from May 2015-May 2016. During daily multidisciplinary rounds, nurses are now reporting the plan for urinary catheter removal before the question is asked. Conclusion: The deliberate layering of single interventions over an extended period of time allowed for the adoption of each intervention before moving on to the next. Nurses and other members of the healthcare team supported each other in adopting the interventions. Interventions included considering alternatives to indwelling urinary catheters, aseptically inserting catheters for appropriate criteria only, removing catheters as soon as possible, improved urine specimen collection practices and enhanced care and maintenance measures for critical care patients. [ABSTRACT FROM AUTHOR]

Published
2018

11. Incidence of healthcare-associated coronavirus disease 2019 (COVID-19) in the state of Geneva

Author

Delphine S. Courvoisier, Gaud Catho, Denis Mongin, Stéphan Juergen Harbarth, and Anne Iten

Subjects
Microbiology (medical), ddc:616, medicine.medical_specialty, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Epidemiology, business.industry, Incidence (epidemiology), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Concise Communication, Disease activity, Infectious Diseases, Healthcare associated, Emergency medicine, Pandemic, ddc:618.97, medicine, business, Healthcare system
Abstract

An examination of all coronavirus disease 2019 (COVID-19) cases and patient movements in Geneva indicated important disease activity within the healthcare system since the beginning of the pandemic. We estimate that 4.3% of all COVID-19 cases were likely acquired within the healthcare system, contributing to 62% of the COVID-19–related deaths.

Published
2021

12. Quality of life of HIV-negative, previously healthy individuals following cryptococcal meningoencephalitis

Author

Joseph Snow, Lillian Ham, Owen Dean, Sally Hunsberger, John H. Powers, Seher Anjum, Peter R. Williamson, Kieren A. Marr, Katherine Traino, Jing Wang, and Terri L. Scott

Subjects
Adult, Male, Fungal infection, Quality of life, Pediatrics, medicine.medical_specialty, Health Status, Science, Human immunodeficiency virus (HIV), HIV Infections, Meningitis, Cryptococcal, medicine.disease_cause, Article, Cohort Studies, Medical research, Healthcare associated, medicine, Humans, Cognitive impairment, Sleep disorder, Multidisciplinary, business.industry, HIV, Cryptococcal meningoencephalitis, Middle Aged, medicine.disease, Healthy individuals, Cohort, Cryptococcus neoformans, Medicine, Female, business
Abstract

The morbidity and mortality of cryptococcal meningoencephalitis (CM) in previously healthy, HIV-negative individuals is increasingly recognized. We administered a healthcare associated quality of life (QOL) survey to the largest longitudinally followed cohort of these patients in the United States. We identified moderate or severe self-reported impairment in at least one QOL domain in 61% of subjects at least one year following diagnosis. Self-reported cognitive impairment was noted in 52% and sleep disturbance was noted in 55%. This is the first comprehensive study of cross-sectional long-term QOL in previously healthy patients following cryptococcal infection.

Published
2021

13. Quantitative microbial risk assessment of human norovirus infection in environmental service workers due to healthcare-associated fomites

Author

Keeve E. Nachman, K.N. Overbey, K.J. Schwab, Ghassan B. Hamra, and C. Rock

Subjects
Microbiology (medical), viruses, medicine.disease_cause, Risk Assessment, Article, fluids and secretions, Healthcare associated, Microbial risk, Environmental health, medicine, Infection control, Humans, Personal protective equipment, Caliciviridae Infections, business.industry, Transmission (medicine), Norovirus, virus diseases, General Medicine, Service worker, Infectious Diseases, Fomites, Risk assessment, business, Delivery of Health Care
Abstract

Summary Background Healthcare-associated norovirus outbreaks place a large burden on healthcare staff. Environmental service workers (ESWs), however, remain understudied despite high contact with potentially contaminated surfaces. Understanding the magnitude of the risk of norovirus infection in healthcare ESWs can protect workers and improve infection control. Aim This study simulated the risk of norovirus infection for unprotected ESWs after a single fomite contact, assuming no disinfection or protective equipment, in norovirus-positive patient rooms. In addition, the risk of secondary surface transmission from norovirus-exposed ESWs was simulated. Methods A quantitative microbial risk assessment employing two-dimensional Monte Carlo simulation with parameters extracted from the literature was used to estimate norovirus infection from multiple fomite contact scenarios defined by: norovirus source (patient vomit/diarrhoea), location (bathroom/patient room) and target outcome (ESW/secondary illness). Findings Unprotected ESWs have a maximum estimated risk of norovirus infection of 33% (1:3) for a single fomite contact in a room where a norovirus-positive patient had a diarrhoeal event. Patient vomit events lead to fomite contact risk estimates that are four orders of magnitude lower than those for diarrhoeal events. The estimated risk of secondary illness from touching a common surface is as high as 25% (1:4) after single fomite exposure following a diarrhoeal event. Conclusions A single fomite contact may lead to sizable risk of norovirus infection in ESWs if personal protective equipment and disinfection are not used appropriately. ESWs can also transfer virus to secondary surfaces, initiating further infections. Interventions are needed to reduce fomite transfer of norovirus, and protect patients and staff from nosocomial infections.

Published
2021

14. Healthcare-associated COVID-19 in England: a national data linkage study

Author

Julie V. Robotham, Olisaeloka Nsonwu, Simon Thelwall, Russell Hope, Sarah Gerver, Simon M Collin, Mark H. Wilcox, James Stimson, Alex Bhattacharya, and Susan Hopkins

Subjects
Microbiology (medical), Linkage (software), Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), community-onset infection, business.industry, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Aftercare, Information Storage and Retrieval, Outbreak, COVID-19, Patient Discharge, Article, Infectious Diseases, Healthcare associated, healthcare-associated infection, Pandemic, medicine, Humans, Positive test, business, Delivery of Health Care, National data
Abstract

Objectives : Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. Methods : Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test

Published
2021

15. Healthcare-associated COVID-19: The experience of an academic medical center

Author

Rachel Pryor, Oliva Hess, Michael P. Stevens, Michelle Doll, Emily Godbout, Gonzalo Bearman, and Kaila Cooper

Subjects
Microbiology (medical), 2019-20 coronavirus outbreak, Academic Medical Centers, Coronavirus disease 2019 (COVID-19), business.industry, Epidemiology, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, COVID-19, medicine.disease, Infectious Diseases, Healthcare associated, medicine, Humans, Center (algebra and category theory), Medical emergency, Health Facilities, business, Letter to the Editor, Delivery of Health Care
Published
2020

16. Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016

Author

Carmen Varón, Nancy A. Chow, Soraya Salcedo, Adriana Marin, Julian D Escobar, Jairo E Pérez-Franco, Paige A. Armstrong, Indira Berrio, Diego H. Cáceres, Anastasia P. Litvintseva, Shawn R. Lockhart, Oscar Pacheco, Andres Espinosa-Bode, Patricia Escandón, Norida Vélez, Juan M Correa, Angel Guzman, Matthew J. Stuckey, Nohora Villalobos, Adriana Gomez, Ryan Fagan, Jorge Díaz, Tom Chiller, Brendan R Jackson, and Sandra Rivera

Subjects
Male, Antifungal Agents, Epidemiology, lcsh:Medicine, Communicable Diseases, Emerging, Disease Outbreaks, 0302 clinical medicine, Infection control, Colonization, Public Health Surveillance, 030212 general & internal medicine, Child, Candida, Aged, 80 and over, Cross Infection, Transmission (medicine), Medical record, Mortality rate, Candidiasis, Middle Aged, Candida auris, Infectious Diseases, Child, Preschool, Female, Seasons, Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016, Microbiology (medical), Adult, medicine.medical_specialty, Adolescent, 030231 tropical medicine, Microbial Sensitivity Tests, Colombia, healthcare-associated, History, 21st Century, lcsh:Infectious and parasitic diseases, resistance, 03 medical and health sciences, Young Adult, Drug Resistance, Fungal, Internal medicine, medicine, nosocomial infections, Humans, lcsh:RC109-216, antimicrobial resistance, Mortality, Aged, healthcare associated, business.industry, Research, candidemia, lcsh:R, Outbreak, Infant, Patient Outcome Assessment, fungi, business
Abstract

Adherence to infection control recommendations is critical to prevent spread of this novel yeast., 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

Published
2019

17. Nurses' knowledge, practices and perceptions regarding Clostridioides difficile: Survey results.

Author

Finnimore K, Smyth W, Carrucan J, and Nagle C

Subjects
Humans, Clostridioides, Cross-Sectional Studies, Clinical Competence, Surveys and Questionnaires, Clostridioides difficile, Cross Infection, Clostridium Infections prevention & control, Clostridium Infections microbiology
Abstract

Background: Clostridioides difficile infection (CDI) can cause patients debilitating symptoms, places additional demands on nurses' and midwives' and is increasingly prevalent. Understanding the knowledge base of nurses caring for patients with CDI may contribute to improving care practices., Methods: A cross-sectional anonymous survey across our Hospital and Health Services was conducted. Descriptive statistics and thematic analysis techniques were used to analyse, summarise, and report data., Results: A total of 198 completed surveys by nurses were included in the analysis. Most respondents (73.2%) could not recall having any recent CDI education. Nearly all agreed that CDI is an important infection control issue (80. 8%), and that CDI education was important (94.9%). Knowledge of the potentially fatal outcome of CDI was not well known with only 53% responding correctly to this question. Respondents were confident in fundamental infection control precautions of patient placement (93.4%) and environmental cleaning (86.4%). Knowledge of the microbiological aspects of CDI were less well known. The impact to workload and the additional burden of caring for patients with CDI was evident in the overwhelming response (83%) to the two open-ended questions about what makes it "easy" and what make it "hard" to implement infection control strategies for CDI patients., Conclusion: Respondents identified many factors that could contribute to less-than optimal care and management of inpatients with CDI, and identified some solutions that would facilitate the provision of best practice. An educational intervention, with emphasis on the areas of greatest knowledge deficits, has been developed., (Copyright © 2022 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)

Published
2023
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18. The complex epidemiology of extended-spectrum β-lactamase-producing Enterobacteriaceae.

Author

Tal Jasper, Ruthy, Coyle, Joseph R, Katz, David E, and Marchaim, Dror

Abstract

Antimicrobial resistance is a growing worldwide iatrogenic complication of modern medical care. Extended-spectrum β-lactamases have emerged as one of the most successful resistance mechanisms, limiting our therapeutic options to treat various human infections. The dissemination of these enzymes to the community probably signifies an irreversible step. This paper will review the evolution of human infections associated with extended-spectrum β-lactamase-producing organisms in the past 20 years, and will present and discuss the current challenges, controversies, debates and knowledge gaps in this research field. [ABSTRACT FROM AUTHOR]

Published
2015
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19. Missed diagnosis of Clostridium difficile infection; a prospective evaluation of unselected stool samples.

Author

Reigadas, E., Alcalá, L., Marín, M., Burillo, A., Muñoz, P., and Bouza, E.

Abstract

Summary Background Clostridium difficile infection (CDI) is the leading cause of hospital-acquired diarrhoea in developed countries, however a high proportion of CDI episodes go undiagnosed, either because physicians do not request identification of toxigenic C. difficile or microbiologists do not perform the appropriate tests. Objective To investigate the clinical characteristics of patients with CDI within a non-selected population and to determine risk factors for clinical underdiagnosis. Methods We conducted a prospective study in which systematic testing for toxigenic C. difficile on all diarrhoeic stool samples was performed regardless of the clinician's request. Patients aged >2 years positive for toxigenic C. difficile and diarrhoea were enrolled (Jan–June 2013) and monitored at least 2 months after their last episode. Results We identified 204 cases of CDI, of which three-quarters were healthcare-associated. Most cases were mild to moderate (83.8%), the recurrence rate was 16.2%, and CDI-related mortality was low (2.5%). A significant proportion (12.7%) of CDI cases would have been missed owing to lack of clinical suspicion. Community-acquired cases and young age were risk factors for clinical underdiagnosis. Conclusion Our data support the introduction of a systematic search for toxigenic C. difficile in all diarrhoeic stools from inpatients and outpatients older than 2 years. [ABSTRACT FROM AUTHOR]

Published
2015
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20. Containment of COVID-19 and reduction in healthcare-associated respiratory viral infections through a multi-tiered infection control strategy

Author

Thuan Tong Tan, Wan Qi Ho, Limin Wijaya, Liang En Wee, Chong Yu Edwin Sng, Xiang Ying Jean Sim, Grace Teck Cheng Kwek, Jie Yi Ong, Wee Hoe Gan, Kenneth Boon Kiat Tan, Indumathi Venkatachalam, Ying Ying Chua, Ruan Wen, Juat Lan Chiang, Edwin Philip Conceicao, Chee Kian Tham, Xin Hui Jorin Ng, Moi Lin Ling, and Kwan Ki Karrie Ko

Subjects
medicine.medical_specialty, Isolation (health care), Health Personnel, education, Subspecialty, Masking (Electronic Health Record), Pandemic, medicine, Humans, Infection control, Respiratory Tract Infections, General Nursing, Cross Infection, Respiratory tract infections, healthcare associated, SARS-CoV-2, Transmission (medicine), business.industry, Public Health, Environmental and Occupational Health, transmission, Outbreak, COVID-19, Containment, Infectious Diseases, Emergency medicine, surveillance, business, Research Paper
Abstract

Background During the ongoing COVID-19 pandemic, healthcare-associated transmission of respiratory viral infections (RVI) is a concern. To reduce the impact of SARS-CoV-2 and other respiratory viruses on patients and healthcare workers (HCWs) we devised and evaluated a multi-tiered infection control strategy with the goal of preventing nosocomial transmission of SARS-CoV2 and other RVIs across a large healthcare campus. Methodology From January-June 2020, a multi-tiered infection control strategy was implemented across a healthcare campus in Singapore, comprising the largest acute tertiary hospital as well as four other subspecialty centres, with more than 10,000 HCWs. Drawing on our institution’s experience with an outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003, this strategy included improved patient segregation and distancing, and heightened infection prevention and control (IPC) measures including universal masking. All symptomatic patients were tested for COVID-19 and common RVIs. Results A total of 16,162 admissions campus-wide were screened; 7.% (1155/16162) tested positive for COVID-19. Less than 5% of COVID-19 cases (39/1155) were initially detected outside of isolation wards in multi-bedded cohorted wards. Improved distancing and enhanced IPC measures successfully mitigated onward spread even amongst COVID-19 cases detected outside of isolation. COVID-19 rates amongst HCWs were kept low (0.13%, 17/13066) and reflected community acquisition rather than nosocomial spread. Rates of healthcare-associated-RVI amongst inpatients fell to zero and this decrease was sustained even after the lifting of visitor restrictions. Conclusion This multi-tiered infection control strategies can be implemented at-scale to successfully mitigate healthcare-associated transmission of respiratory viral pathogens., Highlights • A multi-tiered infection control strategy successfully contained both COVID-19 and common respiratory viral infections throughout a large healthcare system over six months of surveillance. • Despite caring for >1500 COVID-19 cases, no patient-staff transmission occurred. • Rates of healthcare-associated respiratory viral infections fell to zero over a six-month period. • Key components of the strategy included improved patient segregation and distancing, and universal masking.

Published
2020

21. Viral infections in pregnancy: advice for healthcare workers.

Author

Chin, T.L., MacGowan, A.P., Jacobson, S.K., and Donati, M.

Abstract

Summary: Background: Healthcare workers (HCWs) have the potential for increased exposure to infectious disease resulting from the provision of patient care. Pregnancy can confer specific problems in some infections for the mother and her unborn child. Aims: To discuss the viral infections encountered in the UK that constitute a particular risk to the pregnant HCW: human immunodeficiency virus, hepatitis B virus, hepatitis C virus, varicella-zoster virus, herpes simplex virus, human parvovirus B19, cytomegalovirus, rubella, measles, enteroviruses, mumps and influenza. Evidence for nosocomial transmission, clinical aspects specific to pregnancy, and recommendations to protect the pregnant HCW at work are included. Methods: Medline, EMBASE and Pubmed were searched using a list of keywords specific to each viral infection, including ‘nosocomial’, ‘occupational’ and ‘healthcare workers’. References from the bibliographies of articles identified were reviewed for relevant material. Findings: The evidence for increased risk in the healthcare setting for many of these infections, outside of outbreaks, is weak, possibly because of the application of standard protective infection control measures or because risk of community exposure is greater. The pregnant HCW should be advised on protective behaviour in both settings. Potential interventions include vaccination and reducing the likelihood of exposure through universal precautions, infection control and redeployment. Conclusion: Protection of the pregnant HCW is the responsibility of the individual, antenatal care provider and employer, and is made possible through awareness of the risks and potential interventions both before and after exposure. If exposure occurs or if the HCW develops an infective illness, urgent specialist advice is required. [Copyright &y& Elsevier]

Published
2014
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22. Bacterial Infections in Cirrhosis: Prevention and Treatment.

Author

Prado, Verónica, Acevedo, Juan, and Fernández, Javier

Abstract

Bacterial infection is a frequent complication in patients with advanced cirrhosis. Incidence ranges between 25 and 30 %. Most common infections are spontaneous bacterial peritonitis and urinary infections followed by pneumonia, skin/soft tissue infections and bacteremia. Cirrhosis increases the risk to develop sepsis, severe sepsis and death. Therefore, early diagnosis and adequate treatment of infection is essential in the management of these patients. Recent data show that currently recommended empirical antibiotic strategies (ß-lactams) fail frequently in nosocomial and healthcare associated infections in cirrhosis, a feature that is related to the higher prevalence of multidrug resistant bacteria in infections acquired in the healthcare environment. Empirical antibiotic treatment should therefore be selected according not only to the type and severity of infection but also to the site of acquisition of infection. Antibiotic guidelines should be tailored according to the local epidemiological pattern of multiresistance. [ABSTRACT FROM AUTHOR]

Published
2014
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23. Healthcare-associated outbreak of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in a rural hospital in Missouri, March 2020

Author

Steven J. Lawrence, Amy Pierce, Brittany K. Smith, George Turabelidze, Betty C. Faulconer, and Daved H. Fremont

Subjects
Microbiology (medical), 2019-20 coronavirus outbreak, Missouri, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, Epidemiology, Hospitals, Rural, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID-19, Outbreak, medicine.disease_cause, Virology, Virus, Disease Outbreaks, Rural hospital, Infectious Diseases, Healthcare associated, Humans, Medicine, business, Letter to the Editor, Delivery of Health Care, Coronavirus
Published
2020
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24. Systematic review of healthcare-associated Burkholderia cepacia complex outbreaks: presentation, causes and outbreak control

Author

Andrew Atkinson, Jonas Marschall, and Emmanuel Häfliger

Subjects
biology, business.industry, Nocosomial, lcsh:Public aspects of medicine, Outbreak, Context (language use), lcsh:RA1-1270, 610 Medicine & health, Burkholderia cepacia, biology.organism_classification, lcsh:Infectious and parasitic diseases, Burkholderia cepacia complex, Healthcare associated, Intrinsic, Disinfectant, Environmental health, Medicine, lcsh:RC109-216, Original Research Article, Outbreak control, business
Abstract

Background Over the past decades, the Burkholderia cepacia complex (BCC) has been linked to multiple healthcare-associated outbreaks. No systematic analysis of these outbreaks has been carried out to date. The aim of this study was to conduct a systematic review of reports on nosocomial BCC outbreaks. Methods Published studies from 1971 until 9/12/2019 presenting nosocomial BCC outbreaks were identified using Embase, Pubmed and abstracts from professional meetings. Results We identified a total of 111 outbreak reports. Thirty-two percent of the affected institutions were academic hospitals and 43.8% community hospitals. The average outbreak duration was 198.6 ± 604.4 days. A total of 240 deaths (10% of the 2’390 case patients) were reported but only 28 (1.2% of the 2’390 case patients and 11.7% of the 240 deaths) were directly attributable to BCC. The source could be identified in 73.9% of the outbreaks; 53.2% were caused by contaminated medical solutions and medications, 12% were due to a contaminated disinfectant. In 28.2% of the outbreaks intrinsic product contamination was reported. Multidrug resistance was noted in 26.1% of the BCC strains. PFGE was the most frequently used typing method (43.2%) in the context of outbreak work-up. Conclusion Medical products are the most frequent source of BCC outbreaks, representing over half of the identified sources, with 12% of the outbreaks caused by disinfectant products. Intrinsic product contamination was detected frequently, suggesting a need for stricter regulation. While BCC-related mortality was low, our systematic review revealed significant heterogeneity in both investigations and reporting of BCC outbreaks.

Published
2020
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25. Investigation of Various Virulence Factors and SCCmec Types in the Healthcare-associated and Community-associated Methicillin Resistance Staphylococcus aureus Strains

Author

Abdurrahman Aygül, Selçuk Kaya, Sureyya Gul Yurtsever, Şafak Ermertcan, Ismail Ozturk, Salih Atakan Nemli, and Ege Üniversitesi

Subjects
Healthcare associated, Staphylococcus aureus, SCCmec, medicine, Virulence, Biology, medicine.disease_cause, Methicillin resistance, 0-Belirlenecek, Community associated, Microbiology
Abstract

Objective: the objective of this study was to investigate some virulence genes and SCCmec types of methicillin-resistant Staphylococcus aureus (MRSA) isolates and to determine their relationship with virulence factors. Methods: A total of 100 MRSA strains, 64 from healthcare-associated and 36 from community-associated infections, were included in the study. the presence of mecA gene was investigated by PCR. SCCmec types and efb, clfB, agrA gene were detected by multiplex PCR and their relationship with virulence factors has been analyzed. Results: All of the isolates contain the mecA gene. At the same time, in 66 strains (66%) agrA gene, in 58 strains (58%) clfB gene, and in 47 strains (47%) efb gene were positive. in terms of SCCmec types, the distribution of these types among the 64 HA-SA strains was 53% similar-to-type-III, 16% type IV, 2% type I and 30% unclassified. the distribution of the types among the 36 CA-SA strains was 19% similar-to-type-III, 25% type IV, 8% type I and 47% unclassified, respectively. When SCCmec types were evaluated according to clinical sample type, similar-to-type-III isolates were found to be dominant in wound samples. Efb (78%), clfB (85%), agrA (88%) were the dominant genes in similar-to-type-III strains, whereas clfB (74%), agrA (100%) were the main genes detected in the type IV strains. Conclusions: It is of clinical and epidemiological importance to know the origin of MRSA strains because this affects the empirical treatment choice.

Published
2020

26. Healthcare-Associated Viral Infections: Considerations for Nosocomial Transmission and Infection Control

Author

Demmler-Harrison, Gail J.

Subjects
Pediatric, Viral infections, Healthcare associated, Nosocomial, Article, Virus
Abstract

Nosocomial and healthcare-associated viral infections are major contributors to patient morbidity and mortality, prolonged hospitalization, and increased healthcare costs in all pediatric age groups. Healthcare workers are also at risk of acquiring nosocomial viral infections, affecting their own health, as well as facilitating spread of the infection to other patients, their family, and the community. Healthcare-associated viral infections may occur in a variety of healthcare settings, including clinics, emergency centers, urgent care centers, procedure suites, operating rooms, hospital wards, nurseries, and intensive care units. In addition, non-patient care areas, such as the cafeteria, waiting areas, and playrooms may also be a source of viral infections that can spread in the healthcare setting. These infections may be device-related or transmitted via blood products or organ donation and respiratory droplets, through food including human milk, person to person, or via air ducts, fomites, and surfaces. They most commonly involve the respiratory and gastrointestinal tracts; however, all organ systems may potentially be involved. Both DNA and RNA viruses, either common or exotic, may contribute to healthcare-associated viral infections. Advances in molecular viral diagnostics have enabled rapid detection and routine surveillance for viral infections and now allow early identification of viruses. Prompt identification allows timely containment measures to minimize transmission to other patients or healthcare workers and avoids hospital, community, and global outbreaks.

Published
2018

27. Risk factors for healthcare-associated urinary tract infection and their applications in surveillance using hospital administrative data: a systematic review.

Author

King, C., Garcia Alvarez, L., Holmes, A., Moore, L., Galletly, T., and Aylin, P.

Abstract

Summary: Background: Healthcare-associated urinary tract infections (HCA UTI) account for a large proportion of hospital infections, with recently launched surveillance in the UK focusing on reducing catheter-associated urinary tract infections. However, a wealth of administrative information already collected routinely by hospitals is currently not used to its maximum potential for surveillance. Aim: To quantify the evidence base of HCA UTI risk factors and to determine their potential for shaping and informing innovative surveillance tools using local hospital data. Methods: A systematic literature review was undertaken to find established risks for HCA UTI. Population-attributable risk percentages (PAR%) were calculated for these risk factors, generating a hierarchy of risks. Administrative hospital data were subsequently interrogated for these quantified risks. Findings: Over 30% of the risk factors identified from the systematic literature review were independent predictors of infection. The highest PAR% was associated with urinary catheterization, with the calculation that 79.3% of UTI would be prevented if catheterization was not performed. PAR% calculations were performed for 60% of the independent predictors for HCA UTI. Sixty-five percent of the identified independent risk factors were found to be coded within the administrative hospital dataset, including urinary catheterization. Conclusion: This work has quantified established HCA UTI risks and demonstrates that there is potential for more effective use of administrative hospital data for risk monitoring and surveillance of HCA UTI. [ABSTRACT FROM AUTHOR]

Published
2012
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28. Clinical characteristics of healthcare-associated pneumonia in a public hospital in a metropolitan area of Japan.

Author

Sugisaki, Midori, Enomoto, Tatsuji, Shibuya, Yasuhiro, Matsumoto, Aki, Saitoh, Hitoshi, Shingu, Akiko, Narato, Ritsuko, and Nomura, Koichiro

Subjects
*COMMUNITY-acquired pneumonia, *COMMUNITY-acquired infections, *PNEUMONIA, *PUBLIC hospitals, *MORTALITY, *NUTRITION
Abstract

Healthcare-associated pneumonia (HCAP) is a new category that is essential in the present aging society. Knowing the different characteristics and outcomes between patients with HCAP and community-acquired pneumonia (CAP) would help physicians manage and treat HCAP patients. Although HCAP is thought to be heterogeneous in regions, there are no reports from a metropolitan area in Japan. We retrospectively reviewed the clinical findings of all consecutive pneumonia patients who required hospitalized care in our hospital between April 2006 and March 2010. There were 184 (35.0%) patients with HCAP and 342 (65.0%) patients with CAP. Previous hospitalization within 90 days of the infection was the most common criterion for HCAP (63.0%). HCAP patients were significantly older than CAP patients (82.5 vs. 70.0 years, P < 0.001). The percentage of patients with poor functional status was higher in HCAP than CAP (64.0% vs. 26.6%, P < 0.001). Hospital mortality was significantly higher in HCAP patients than in CAP patients (15.8% vs. 5.0%, P < 0.001). Low levels of serum albumin (odds ratio, 0.126; 95% CI, 0.025-0.640; P = 0.012) and high scores in the ADROP (age, dehydration, respiratory failure, orientation, and blood pressure) system (odds ratio, 2.846; 95% CI, 1.449-5.587; P = 0.002) were the risk factors for HCAP mortality. In conclusion, patients with HCAP have different epidemiological characteristics compared with those with CAP in a metropolitan area of Japan. Outcomes and risk factors for mortality of patients with HCAP included poor nutritional status and high severity scores on the pneumonia severity scoring system. [ABSTRACT FROM AUTHOR]

Published
2012
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29. Trends in sources of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia: data from the national mandatory surveillance of MRSA bacteraemia in England, 2006–2009.

Author

Wilson, J., Guy, R., Elgohari, S., Sheridan, E., Davies, J., Lamagni, T., and Pearson, A.

Abstract

Summary: The national mandatory surveillance system for reporting meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia in England has captured data on the source of reported bacteraemias since 2006. This study analysed episodes of MRSA bacteraemia (N =4404) where a probable source of infection was reported between 2006 and 2009. In 2009, this information was available for one-third of reported episodes of MRSA bacteraemia. Of these, 20% were attributed to intravascular devices and 28% were attributed to skin and soft tissue infection. Sixty-four percent of the patients were male, and urinary tract infection was a significantly more common source of MRSA bacteraemia in males compared with females (12% vs 3%). Detection of bacteraemia within two days of hospital admission does not reliably discriminate between community- and hospital-associated MRSA bacteraemia as community cases are frequently associated with an invasive procedure/device. Between 2006 and 2009, there was a significant decline in the proportion of episodes of MRSA bacteraemia associated with central vascular catheters [incidence rate ratio (IRR) 0.42, 95% confidence interval (CI) 0.29–0.61; P <0.001], peripheral vascular catheters (IRR 0.69, 95% CI 0.48–0.99; P =0.042) and surgical site infection (IRR 0.42, 95% CI 0.25–0.72; P =0.001), and a significant increase in the proportion of episodes of MRSA bacteraemia associated with skin and soft tissue infection (IRR 1.33, 95% CI 1.05–1.69; P =0.017) and attributed to contamination of the specimen (IRR 1.96, 95% CI 1.25–3.06; P =0.003). Since data were not available for all cases, the generalizability of these trends depends on the assumption that records with source data reflect a reasonably random sample of cases in each year. These changes have occurred in the context of a general decline in the rate of MRSA bacteraemia in England since 2006. [ABSTRACT FROM AUTHOR]

Published
2011
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30. Bacterial diversity among four healthcare-associated institutes in Taiwan

Author

Chang-Hua Chen, Kuan-Hsueh Chen, Han-Yueh Kuo, Chuan Yi Tang, Zhao-Feng Chen, Hsueh-Fen Hung, Wen-Pei Chen, Ming-Li Liou, and Yaw-Ling Lin

Subjects
0301 basic medicine, media_common.quotation_subject, Science, 030106 microbiology, Taiwan, Biodiversity, Biology, Article, 03 medical and health sciences, Human health, Healthcare associated, Microbial ecology, RNA, Ribosomal, 16S, Environmental Microbiology, Humans, Microbiome, Phylogeny, Built environment, media_common, Cross Infection, Multidisciplinary, Bacteria, Ecology, Microbiota, High-Throughput Nucleotide Sequencing, 030104 developmental biology, Amplicon sequencing, Medicine, Health Facilities, Metagenomics, Diversity (politics)
Abstract

Indoor microbial communities have important implications for human health, especially in health-care institutes (HCIs). The factors that determine the diversity and composition of microbiomes in a built environment remain unclear. Herein, we used 16S rRNA amplicon sequencing to investigate the relationships between building attributes and surface bacterial communities among four HCIs located in three buildings. We examined the surface bacterial communities and environmental parameters in the buildings supplied with different ventilation types and compared the results using a Dirichlet multinomial mixture (DMM)-based approach. A total of 203 samples from the four HCIs were analyzed. Four bacterial communities were grouped using the DMM-based approach, which were highly similar to those in the 4 HCIs. The α-diversity and β-diversity in the naturally ventilated building were different from the conditioner-ventilated building. The bacterial source composition varied across each building. Nine genera were found as the core microbiota shared by all the areas, of which Acinetobacter, Enterobacter, Pseudomonas, and Staphylococcus are regarded as healthcare-associated pathogens (HAPs). The observed relationship between environmental parameters such as core microbiota and surface bacterial diversity suggests that we might manage indoor environments by creating new sanitation protocols, adjusting the ventilation design, and further understanding the transmission routes of HAPs.

Published
2017

31. Comparative Analysis of Eleven Healthcare-Associated Outbreaks of Middle East Respiratory Syndrome Coronavirus (Mers-Cov) from 2015 to 2017

Author

Sibylle Bernard-Stoecklin, Mamunur Rahman Malik, Abdullah M. Assiri, Birgit Nikolay, Maria D. Van Kerkhove, Hassan El Bushra, Moran Ki, Simon Cauchemez, Abdul Aziz Bin Saeed, Arnaud Fontanet, Peter Ben Embarek, Center for Global Health Research and Education - Centre pour la Recherche et la Formation en Santé Mondiale (CGH), Institut Pasteur [Paris]-Réseau International des Instituts Pasteur (RIIP), Modélisation mathématique des maladies infectieuses - Mathematical modelling of Infectious Diseases, Institut Pasteur [Paris]-Centre National de la Recherche Scientifique (CNRS), Ministry of Health [Riyadh], Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), National Cancer Center Korea, Regional Office for the Eastern Mediterranean [Cairo] (EMRO), Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology, Pasteur-Cnam Risques infectieux et émergents (PACRI), Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Institut Pasteur [Paris]-Conservatoire National des Arts et Métiers [CNAM] (CNAM), Conservatoire National des Arts et Métiers [CNAM] (CNAM), B.N. and S.C. acknowledge financial support from the Investissement d’Avenir program, the Laboratoire d’Excellence Integrative Biology of Emerging Infectious Diseases program (Grant ANR-10-LABX-62-IBEID), the Models of Infectious Disease Agent Study of the National Institute of General Medical Sciences, the AXA Research Fund and the INCEPTION project (PIA/ANR-16-CONV-0005)., ANR-10-LABX-0062,IBEID,Integrative Biology of Emerging Infectious Diseases(2010), ANR-16-CONV-0005,INCEPTION,Institut Convergences pour l'étude de l'Emergence des Pathologies au Travers des Individus et des populatiONs(2016), Institut Pasteur [Paris] (IP)-Réseau International des Instituts Pasteur (RIIP), Institut Pasteur [Paris] (IP)-Centre National de la Recherche Scientifique (CNRS), WHO - Regional Office for the Eastern Mediterranean [Cairo, Egypt] (EMRO), Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Institut Pasteur [Paris] (IP)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM), and HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)

Subjects
0301 basic medicine, Male, Multivariate analysis, MESH: Coronavirus Infections, lcsh:Medicine, MESH: Infectious Disease Transmission, Professional-to-Patient, MESH: Comorbidity, Comorbidity, medicine.disease_cause, Disease Outbreaks, Infectious Disease Transmission, Professional-to-Patient, 0302 clinical medicine, Healthcare associated, MESH: Risk Factors, [MATH.MATH-ST]Mathematics [math]/Statistics [math.ST], Health care, Epidemiology, MESH: Disease Outbreaks, lcsh:Science, MESH: Aged, Cross Infection, Multidisciplinary, MESH: Middle Aged, Transmission (medicine), Age Factors, Middle Aged, MESH: Hospitals, Hospitals, 3. Good health, Middle East Respiratory Syndrome Coronavirus, Infectious diseases, Female, Coronavirus Infections, MESH: History, 21st Century, Adult, MESH: Republic of Korea, medicine.medical_specialty, Infectious Disease Transmission, Patient-to-Professional, Middle East respiratory syndrome coronavirus, Health Personnel, Saudi Arabia, History, 21st Century, World health, Article, 03 medical and health sciences, Environmental health, MESH: Infectious Disease Transmission, Patient-to-Professional, Republic of Korea, medicine, Humans, Aged, MESH: Age Factors, MESH: Humans, business.industry, lcsh:R, MESH: Middle East Respiratory Syndrome Coronavirus, Outbreak, MESH: Cross Infection, MESH: Adult, MESH: Male, MESH: Saudi Arabia, 030104 developmental biology, Risk factors, MESH: Health Personnel, lcsh:Q, business, MESH: Female, 030217 neurology & neurosurgery
Abstract

Since its emergence in 2012, 2,260 cases and 803 deaths due to Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization. Most cases were due to transmission in healthcare settings, sometimes causing large outbreaks. We analyzed epidemiologic and clinical data of laboratory-confirmed MERS-CoV cases from eleven healthcare-associated outbreaks in the Kingdom of Saudi Arabia and the Republic of Korea between 2015–2017. We quantified key epidemiological differences between outbreaks. Twenty-five percent (n = 105/422) of MERS cases who acquired infection in a hospital setting were healthcare personnel. In multivariate analyses, age ≥65 (OR 4.8, 95%CI: 2.6–8.7) and the presence of underlying comorbidities (OR: 2.7, 95% CI: 1.3–5.7) were associated with increased mortality whereas working as healthcare personnel was protective (OR 0.07, 95% CI: 0.01–0.34). At the start of these outbreaks, the reproduction number ranged from 1.0 to 5.7; it dropped below 1 within 2 to 6 weeks. This study provides a comprehensive characterization of MERS HCA-outbreaks. Our results highlight heterogeneities in the epidemiological profile of healthcare-associated outbreaks. The limitations of our study stress the urgent need for standardized data collection for high-threat respiratory pathogens, such as MERS-CoV.

Published
2019
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32. Association Between Children’s Hospital Visitor Restrictions and Healthcare-Associated Viral Respiratory Infections: A Quasi-Experimental Study

Author

Maria Bovee, Angela Rupp, Stanford T. Shulman, Xiaotian Zheng, Larry K. Kociolek, Elizabeth Gray, Sameer Patel, and Hawa Forkpa

Subjects
medicine.medical_specialty, health care facilities, manpower, and services, education, Transmission index, 03 medical and health sciences, 0302 clinical medicine, Healthcare associated, Hospital Administration, healthcare-associated infection, health services administration, Quasi experimental study, Medicine, Humans, 030212 general & internal medicine, Respiratory system, Viral respiratory infection, Child, Respiratory Tract Infections, health care economics and organizations, Retrospective Studies, Chicago, 0303 health sciences, Cross Infection, Inpatients, 030306 microbiology, business.industry, Transmission (medicine), enterovirus, Visitor pattern, Brief Report, Incidence, General Medicine, Visitors to Patients, visitors, Hospitals, Pediatric, Organizational Policy, respiratory virus, Infectious Diseases, rhinovirus, Pediatrics, Perinatology and Child Health, Emergency medicine, Respiratory virus, Seasons, business
Abstract

We investigated the effect of annual winter visitor restrictions on hospital respiratory virus transmission. The healthcare-associated (HA) viral respiratory infection (VRI) transmission index (number of HA VRIs per 100 inpatient community-associated VRIs) was 59% lower during the months in which visitor restrictions were implemented. These data prompt consideration for instituting year-round visitor restrictions.

Published
2019

33. Automated data mining of the electronic health record for investigation of healthcare-associated outbreaks

Author

Lee H. Harrison, Graham M. Snyder, Marissa P Pacey, Melissa Saul, Jieshi Chen, Jane W. Marsh, Alexander J. Sundermann, Ashley M Ayres, Mustapha M. Mustapha, Kathleen A. Shutt, Artur Dubrawski, James K. Miller, and A. William Pasculle

Subjects
Male, Microbiology (medical), Epidemiology, Hospitalized patients, Article, Disease Outbreaks, law.invention, Automated data, 03 medical and health sciences, 0302 clinical medicine, Healthcare associated, Electronic health record, law, medicine, Data Mining, Electronic Health Records, Humans, 030212 general & internal medicine, Retrospective Studies, Cross Infection, 0303 health sciences, 030306 microbiology, business.industry, Outbreak, medicine.disease, Hospitals, Infectious Diseases, Transmission (mechanics), Female, Medical emergency, business
Abstract

Background:Identifying routes of transmission among hospitalized patients during a healthcare-associated outbreak can be tedious, particularly among patients with complex hospital stays and multiple exposures. Data mining of the electronic health record (EHR) has the potential to rapidly identify common exposures among patients suspected of being part of an outbreak.Methods:We retrospectively analyzed 9 hospital outbreaks that occurred during 2011–2016 and that had previously been characterized both according to transmission route and by molecular characterization of the bacterial isolates. We determined (1) the ability of data mining of the EHR to identify the correct route of transmission, (2) how early the correct route was identified during the timeline of the outbreak, and (3) how many cases in the outbreaks could have been prevented had the system been running in real time.Results:Correct routes were identified for all outbreaks at the second patient, except for one outbreak involving >1 transmission route that was detected at the eighth patient. Up to 40 or 34 infections (78% or 66% of possible preventable infections, respectively) could have been prevented if data mining had been implemented in real time, assuming the initiation of an effective intervention within 7 or 14 days of identification of the transmission route, respectively.Conclusions:Data mining of the EHR was accurate for identifying routes of transmission among patients who were part of the outbreak. Prospective validation of this approach using routine whole-genome sequencing and data mining of the EHR for both outbreak detection and route attribution is ongoing.

Published
2019

34. 302. Peripheral IV catheters, a common source of healthcare-associated Staphylococcus aureus bacteremia

Author

Deborah Aragon, Cory Hussain, Timothy C. Jenkins, Heather Young, and Bryan Knepper

Subjects
medicine.medical_specialty, Infectious Diseases, AcademicSubjects/MED00290, Oncology, Healthcare associated, business.industry, Internal medicine, Poster Abstracts, Medicine, Staphylococcus aureus bacteremia, business, Peripheral
Abstract

Background Healthcare-associated S. aureus bacteremia (HA-SAB) has traditionally been attributed to surgical site infections (SSI) or central line-associated bloodstream infections. However, peripheral IV catheters (pIV) are increasingly recognized as cause of HA-SAB. This study evaluates risk factors for HA-SAB due to pIV. Methods This is a retrospective, case-control study of adult patients hospitalized at Denver Health Medical Center with HA-SAB (SAB presenting with hospital-onset [≥3 days after hospitalization] or community-onset attributed to recent hospitalization [discharge ≤7 days prior]). The time period ranged from Jan 1, 2016 to Nov 30, 2019. Cases were reviewed by an infectious diseases physician to determine the source of SAB. PIV-related SAB was defined as phlebitis, cellulitis, and/or drainage at the site of a previous pIV AND no other source or another less likely source based on progress notes and microbiology results. Three controls were matched to each pIV-related SAB case based on the age of the patient (±5 years) and the date the pIV was placed (±3 days). Patients who were admitted for elective procedures, to psychiatry, to obstetrics, and those who died within 2 days of pIV placement were excluded. Results There were 376 episodes of SAB during the study period; 313 were community-onset while 63 were HA-SAB (50 hospital-onset and 13 community-onset attributed to hospitalization). PIV was the most common cause of HA-SAB (n=20, 29.4%); other common causes were SSI (n=10, 15.9%), source present at admission (n=8, 12.7%), and pneumonia (n=7, 11.1%). The median age of patients with pIV-related SAB was 53 years (SD 15.6), and 85% were male. The median duration of pIV was 5 days (SD 2.8). Twenty percent was MRSA. As compared to controls, pIV in immunocompromised individuals and those placed by emergency medical services (EMS) were more likely to develop SAB (OR 11.8, 95% CI 2.5–56.5 and OR 6.9, 95% CI 6.9–24.0, respectively). Age, gender, pIV location, and duration of pIV were not associated with development of SAB. Conclusion PIV placed by EMS are more likely to cause SAB than those placed in the hospital. Facilities should consider changing these pIV promptly upon admission to the hospital and work with EMS to improve pIV placement technique. Disclosures All Authors: No reported disclosures

Published
2020

35. 868. Investigations of Healthcare-Associated Elizabethkingia Infections – United States, 2013-2019

Author

Maroya Spalding Walters, Matthew B. Crist, Heather Moulton-Meissner, Kiran M. Perkins, Elizabeth Soda, Ainsley C. Nicholson, and John R. McQuiston

Subjects
Healthcare associated infections, medicine.medical_specialty, food.ingredient, business.industry, Elizabethkingia, Inflammatory perforation, Pathogenicity, Pathogenic organism, Infectious disease prevention / control, Infectious Diseases, food, AcademicSubjects/MED00290, Oncology, Healthcare associated, Poster Abstracts, Medicine, Skilled Nursing Facility, business, Intensive care medicine
Abstract

Background Elizabethkingia (EK) are non-motile gram-negative rods found in soil and water and are an emerging cause of healthcare-associated infections (HAIs). We describe Centers for Disease Control and Prevention (CDC) consultations for healthcare-associated EK infections and outbreaks. Methods CDC maintains records of consultations with state or local health departments related to HAI outbreaks and infection control breaches. We reviewed consultations involving EK species as the primary pathogen of concern January 1, 2013 to December 31, 2019 and summarized data on healthcare settings, infection types, laboratory analysis, and control measures. Results We identified 9 consultations among 8 states involving 73 patient infections. Long-term acute-care hospitals (LTACHs) accounted for 4 consultations and 32 (43%) infections, and skilled nursing facilities with ventilated patients (VSNFs) accounted for 2 consultations and 31 (42%) infections. Other settings included an acute care hospital, an assisted living facility, and an outpatient ear, nose, and throat clinic. Culture sites included the respiratory tract (n=7 consultations), blood (n=4), and sinus tract (n=1), and E. anophelis was the most commonly identified species. Six consultations utilized whole genome sequencing (WGS); 4 identified closely related isolates from different patients and 2 also identified closely related environmental and patient isolates. Mitigation measures included efforts to reduce EK in facility water systems, such as the development of water management plans, consulting water management specialists, flushing water outlets, and monitoring water quality, as well as efforts to minimize patient exposure such as cleaning of shower facilities and equipment, storage of respiratory therapy supplies away from water sources, and use of splash guards on sinks. Conclusion EK is an important emerging pathogen that causes HAI outbreaks, particularly among chronically ventilated patients. LTACHs and VSNFs accounted for the majority of EK consultations and patient infections. Robust water management plans and infection control practices to minimize patient exposure to contaminated water in these settings are important measures to reduce infection risk among vulnerable patients. Disclosures All Authors: No reported disclosures

Published
2020

36. Clinical Characteristics of Nursing- and Healthcare-Associated Tuberculosis

Author

Yohei Shirakami, Tatsuo Kato, K. Sano, Shigeo Yasuda, Ryoko Ohnishi, Toshitaka Suzuki, Nobuo Murakami, and Masahito Shimizu

Subjects
community-acquired tuberculosis, Tuberculosis, business.industry, Mortality rate, elderly tuberculosis patients, lcsh:R, lcsh:Medicine, Disease, medicine.disease, Single Center, Article, 03 medical and health sciences, Malnutrition, Nursing care, 0302 clinical medicine, 030228 respiratory system, Healthcare associated, Nursing, NHCAP, Health care, medicine, 030212 general & internal medicine, business
Abstract

Tuberculosis remains a serious health problem worldwide. Patients with tuberculosis who also require nursing care due to aging and underlying diseases are considered to have a high mortality rate, however, there are few studies describing detailed examinations of such disease conditions. Objective: The present study was conducted to investigate differences in clinical features of elderly tuberculosis patients according to the levels of nursing and healthcare required. Design: The study participants included 146 elderly (&ge, 65 years) patients diagnosed with active tuberculosis among patients hospitalized with tuberculosis at a single center. The patients were classified into two groups: a nursing- and healthcare-associated tuberculosis group (n = 71) and a community-acquired tuberculosis group (n = 75). Results: The nursing- and healthcare-associated tuberculosis patients were older and had a higher frequency of comorbidities compared with the community-acquired tuberculosis group. Patients in the nursing- and healthcare-associated tuberculosis group had markedly lower levels of serum albumin and hemoglobin, and higher levels of C-reactive protein. The rate of in-hospital death was significantly higher in the nursing- and healthcare-associated tuberculosis group. This was attributed to malnutrition and comorbid conditions rather than the severity of tuberculosis. Conclusion: The prognosis was poor in elderly tuberculosis patients receiving nursing and healthcare.

Published
2018

37. Pneumonies associées aux soins de réanimation

Author

Antoine Roquilly, Olivier Brissaud, Eric Kipnis, Philippe Montravers, Sami Hraiech, Gerald Chanques, Rémi Bruyère, Jean-Ralph Zahar, Jérôme Pugin, Djamel Mokart, Marc Leone, Fabrice Michel, Lila Bouadma, Stéphane Dauger, Sébastien Gibot, Charles-Edouard Luyt, Dimitri Margetis, Saad Nseir, Antoine Monsel, Belaid Bouhemad, Lionel Velly, Yoann Launey, Boris Jung, Microbes évolution phylogénie et infections (MEPHI), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Hôpital Bichat - Claude Bernard, Service d'anesthésie - réanimation chirurgicale [CHU de Dijon], Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Lipides - Nutrition - Cancer [Dijon - U1231] (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement, Pôle de réanimation pédiatrique (CHU de Bordeaux), CHU de Bordeaux Pellegrin [Bordeaux], Neuroprotection du Cerveau en Développement / Promoting Research Oriented Towards Early Cns Therapies (PROTECT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Réanimation Médicale [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] (DRIS), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital Nord [CHU - APHM], Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Département Anesthésie-Réanimation, Hôpital Roger Salengro, CHRU de Lille, Hôpital Roger Salengro, CHRU de Lille, Lille, France, Recherche translationelle relations hôte-pathogènes, Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service d'Anesthésie Réanimation [Rennes], CHU Pontchaillou [Rennes], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Saint-Antoine [AP-HP], Assistance Publique - Hôpitaux de Marseille (APHM), Institut Paoli-Calmettes, Fédération nationale des Centres de lutte contre le Cancer (FNCLCC), Département d'Anesthésie Réanimation, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Immunologie - Immunopathologie - Immunothérapie (I3), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service des Soins Intensifs [Genève], Université de Genève = University of Geneva (UNIGE)-Hôpitaux Universitaires de Genève (HUG), Hôpital Universitaire de Genève = University Hospitals of Geneva (HUG), Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital Avicenne [AP-HP], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de réanimation - soins continus (Centre hospitalier de Bourg-en-Bresse), Centre Hospitalier de Bourg-en-Bresse, Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université de Genève (UNIGE)-Hôpitaux Universitaires de Genève (HUG), and Hôpital Universitaire de Genève

Subjects
Gynecology, medicine.medical_specialty, Intensive care units, business.industry, 030208 emergency & critical care medicine, 3. Good health, Healthcare-associated pneumonia, 03 medical and health sciences, 0302 clinical medicine, Anesthesiology and Pain Medicine, Healthcare associated, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, 030212 general & internal medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract

Resume La Societe francaise d’anesthesie et de reanimation et la Societe de reanimation de langue francaise ont publie des recommandations se concentrant sur les pneumonies associees aux soins de reanimation. Le but de ces seize experts francophones etait de produire un cadre permettant une meilleure prise de decision pour les medecins reanimateurs. Ces recommandations sont liees a trois sujets precis (la prevention, le diagnostique et le traitement) chez quatre types de patients (BPCO, neutropenie, postoperation et pediatrique). L’analyse litteraire et la formulation des recommandations ont ete conduites selon le systeme GRADE. Une recherche litteraire extensive a ete conduite sur 10 ans sur les publications indexees sur les bases de donnees Cochrane et Pubmed. Les pneumonies associees aux soins doivent etre evitees grâce a une approche multimodale standardisee et en utilisant la decontamination digestive la ou la prevalence des bacteries multi resistantes aux medicaments etait inferieure a 20 %. Le diagnostique se base sur l’evaluation clinique et les analyses microbiologiques. En l’absence de facteurs de risques pour les bacteries multi resistantes, de bacille a gram-negatif non-fermentant et/ou d’une mortalite accrue (choc sceptique, defaillance organique), la monotherapie est fortement recommandee. Apres documentation microbiologique, il est recommande de reduire le spectre et de preferer la monotherapie pour l’antibiotherapie des pneumonies associees aux soins de reanimation, y compris les bacilles a gram-negatif non-fermentant.

Published
2018
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38. Preventing Healthcare-Associated Legionellosis: Results after 3 Years of Continuous Disinfection of Hot Water with Monochloramine and an Effective Water Safety Plan

Author

Mohamed Yassin, Maria Anna Coniglio, and Margherita Ferrante

Subjects
Legionella, Health, Toxicology and Mutagenesis, lcsh:Medicine, 030501 epidemiology, Article, Legionella pneumophila, 03 medical and health sciences, Water Safety Plan, 0302 clinical medicine, Healthcare associated, Water Supply, Environmental health, Medicine, Infection control, Water Pollutants, 030212 general & internal medicine, water distribution system, Cross Infection, Legionellosis, biology, business.industry, monochloramine, risk assessment, Chloramines, lcsh:R, Public Health, Environmental and Occupational Health, Waterborne diseases, medicine.disease, biology.organism_classification, Hospitals, respiratory tract diseases, Disinfection, Italy, Water safety plan, Critical control point, Legionnaires' disease, Water Microbiology, 0305 other medical science, Risk assessment, business, Disinfectants, Environmental Monitoring
Abstract

The purpose of this study is to report the experience of the implementation and application of a 3-year Water Safety Plan (WSP) together with the secondary disinfection of water by monochloramine to control and prevent healthcare-associated legionellosis in an Italian hospital strongly colonized by Legionella. Risk assessment was carried out by the WSP team. The main critical control points focused on in developing the WSP for the control of Legionella was the water distribution system. A sampling plan for the detection of Legionella was implemented. A widespread contamination of the hot water distribution system by L. pneumophila sg5 was found. Results after 3 years of the continuous disinfection of hot water with monochloramine indicate the eradication of Legionella. The implementation and application of a WSP in a hospital, together with the disinfection of the water distribution system with monochloramine, can be effective in controlling the growth of Legionella and in preventing nosocomial legionellosis.

Published
2018

39. Delftia tsuruhatensis, an Emergent Opportunistic Healthcare-Associated Pathogen

Author

Grégory Dubourg, Alexandre Ranc, Pierre-Edouard Fournier, Didier Raoult, Florence Fenollar, Microbes évolution phylogénie et infections (MEPHI), Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Vecteurs - Infections tropicales et méditerranéennes (VITROME), Institut de Recherche Biomédicale des Armées (IRBA)-Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées (IRBA), and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA)

Subjects
0301 basic medicine, Microbiology (medical), Epidemiology, 030106 microbiology, lcsh:Medicine, healthcare-associated, Microbiology, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Healthcare associated, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, medicine, Research Letter, emergence, pneumonia, Delftia tsuruhatensis, lcsh:RC109-216, bacteremia, bacteria, Pathogen, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, biology, Gram-negative bacterial infections, business.industry, lcsh:R, Delftia tsuruhatensis, an Emergent Opportunistic Healthcare-Associated Pathogen, medicine.disease, biology.organism_classification, 3. Good health, Pneumonia, 030104 developmental biology, Infectious Diseases, Delftia, Bacteremia, France, business, Bacteria, pathogen
Abstract

International audience; 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.

Published
2018
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40. INVESTIGATION OF HAND HYGIENE KNOWLEDGE LEVEL OF PHYSIOTHERAPY AND

Author

Ilgin, D, Karaali, HK, Ozcan, O, Arslan, S, Arslan, T, Gunduz, T, and Limoncu, ME

Subjects
education, infections, hygiene guidelines, healthcare students, healthcare associated
Abstract

Introduction: Increasing health care students' awareness about the hand hygiene (HH) during the pre-graduation period becomes an important requirement for providing both patient's safety and the healthcare student's safety by preventing healthcare associated infections (HCAIs). Although it has been emphasized that rehabilitation clinics are important places to be taken into consideration in the transmission of HCAIs, the number of studies about the students from department of physiotherapy and rehabilitation (DPR) are limited. Thus, our research was done to examine the HH knowledge level of students of DPR. Materials and methods: This cross-sectional study was done by 191 volunteers from a total of 209 first and second-year students. We recorded the sociodemographic characteristics. Based on the suggestions commented in the Center for Disease Control and Prevention Guideline for HH in Health Care Settings, HH knowledge levels were assessed using face to face interview technique. Results: The average correct answer rate to the questions about the HH knowledge level was 69.49%. The level of knowledge about the importance of HH was good, but the correct response rates for terminology and alcohol-based handrub were less than 50%. Conclusions: Since DPR students form an important ring in the therapy chain, so in the development of educational programs for the students of DPR, it is very important to improve their knowledge level especially about terminology and alcohol-based handrub techniques.

Published
2018

41. Clusters of Healthcare-Associated Legionnaires’ Disease in Two Hospitals of Central Greece

Author

Varvara A. Mouchtouri, Vasileios Nakoulas, Anna Katsiafliaka, F Kolokythopoulou, Elias Plakokefalos, George Rachiotis, Maria Kyritsi, and Christos Hadjichristodoulou

Subjects
0301 basic medicine, medicine.medical_specialty, business.industry, 030106 microbiology, Case Report, General Medicine, Disease, medicine.disease, lcsh:Infectious and parasitic diseases, Aerosol therapy, Distribution system, 03 medical and health sciences, 0302 clinical medicine, Healthcare associated, Emergency medicine, medicine, Infection control, Legionnaires' disease, Disease prevention, lcsh:RC109-216, 030212 general & internal medicine, Legionella pneumophila Serogroup 1, business
Abstract

Healthcare-associated Legionnaires’ disease often leads to fatal respiratory tract infection among hospitalized patients. In this report, three cases of Legionnaires’ disease among patients in two different hospitals (Hospital A and Hospital B) were investigated. After conducting an epidemiologic and environmental investigation, the water distribution systems (WDSs) were identified as the possible source of infection, as Legionella pneumophila serogroup 1 (Lp1) was isolated from both clinical and environmental samples. Patients received aerosol therapy with nebulizers during their hospitalization. Based on the results of the investigation, the hospitals’ infection control committees reviewed their policies for Legionnaires’ disease prevention and implemented control measures focusing on using sterile fluids for aerosol treatments.

Published
2018

42. 2476. External and Internal Validation of the Healthcare-associated Infection Data in the Korean National Healthcare-associated Infectious Surveillance System (KONIS)

Author

Sang-Oh Lee, Pyoeng Gyun Choe, Hong Bin Kim, Tae Hyong Kim, Je Eun Song, Mi Suk Lee, So-Yeon Yoo, Yee Gyung Kwak, Sung Ran Kim, Sun Hee Park, Jun Yong Choi, Young Hwa Choi, Hyeon Mi Yoo, Young Keun Kim, Myoung Jin Shin, Ji Youn Choi, and Su Ha Han

Subjects
Healthcare associated infections, business.industry, Medical record, medicine.disease, Intensive care unit, law.invention, Pneumonia, Abstracts, Infectious Diseases, Oncology, Healthcare associated, law, Poster Abstracts, medicine, Medical emergency, Internal validation, business, Reference standards
Abstract

Background National surveillance data should be validated to identify data quality issues. This study tested the validity of healthcare-associated infection (HAI) data in the Korean National Healthcare-associated Infections Surveillance System (KONIS), intensive care unit (ICU) module. Methods The validation process consisted of external (EV) and internal (IV) validation phases. For the 10 hospitals that were selected based on the HAI rate, among the 193 participating hospitals between July 2016 and June 2017, both EV and IV were performed. For the EV, the validation team reviewed 295 medical records of 60 patients with reported HAIs, including 20 urinary tract infections (UTIs), 27 bloodstream infections (BSIs), and 13 cases of pneumonia (PNEU), and 235 patients with no reported HAI during 1-day visits conducted in November and December 2017. The reviewer’s diagnosis of HAI was regarded as the reference standard. IV was conducted by the staff of each hospital and evaluated whether UTI or BSI were present. Primary IV was performed for 279 patients who were subject to EV. Secondary IV was performed on 203 patients in another 11 selected participating hospitals that did not report HAIs to KONIS during the 1-year study period. Results In the EV, the diagnosis of UTI in the participating hospitals had a sensitivity of 72.0% and specificity of 99.3%. The sensitivity of BSI and PNEU was 63.2% and 70.6%, respectively, and specificity was 98.8% and 99.6%. The agreement (kappa) between the EV and primary IV was significant, with κ = 0.754 for UTI and κ = 0.674 for BSI. The results of the secondary IV showed that the hospitals that had no reports of HAI had few hospital beds and performed few blood or urine culture tests. In the secondary IV, eight UTIs and three BSIs were newly diagnosed in three hospitals, respectively. The reasons for not reporting the HAIs were presumed to be a lack of understanding of the surveillance standards and fear of the disadvantages of disclosing the HAI. Conclusion This study shows the need for ongoing validation and continuous training of surveillance personnel to maintain the accuracy of surveillance data. We also confirmed that IV can be used as an alternative monitoring method to examine validity and accuracy. Disclosures All authors: No reported disclosures.

Published
2019

43. 2465. Healthcare-Associated Pediatric Cutaneous Mucormycosis at Texas Children’s Hospital, 2012–2019

Author

Paula A. Revell, Catherine E. Foster, Judith R. Campbell, and Lucila Marquez

Subjects
Mycology culture, Pediatrics, medicine.medical_specialty, Cutaneous mucormycosis, business.industry, Mucormycosis, medicine.disease, Institutional review board, Infectious disease prevention / control, Abstracts, Infectious Diseases, Oncology, Healthcare associated, Poster Abstracts, medicine, business, Skin lesion, Genotype determination
Abstract

Background Cutaneous mucormycosis in children is a rare fungal infection which primarily occurs in patients with underlying medical conditions and is associated with significant morbidity. We describe characteristics of pediatric patients with healthcare-associated (HCA) cutaneous mucormycosis at Texas Children’s Hospital (TCH) and results of an outbreak investigation. Methods Patients at TCH were identified retrospectively through review of the TCH Microbiology Laboratory mycology culture reports from 1/1/2012–2/18/2019. Pediatric patients Results We identified 12 patients with HCA cutaneous mucormycosis. The characteristics of these patients are detailed in the table. Six cases of Rhizopus infection occurred over a narrow 7 month period from March through September of 2017 prompting an outbreak investigation. Genotyping results revealed 4 molecular types from 5 available isolates suggesting that the isolates were not clonally related. Adhesive products were suspected as a potential source. Infection Control activities included site visits to the hospital supply warehouse and linen facility. Tape practices throughout the hospital were assessed through a nursing survey. Samples of adhesive products were cultured at an environmental microbiology laboratory and no Rhizopus spp. were isolated. A source was not identified. Conclusion Mucormycosis is a life-threatening infection in children. Providers should have a low threshold of suspicion for cutaneous mucormycosis in patients with underlying medical conditions (malignancies and extreme prematurity) that develop skin lesions near medical device dressings or securement sites. Disclosures All authors: No reported disclosures.

Published
2019

44. The effect of hospital biocide sodium dichloroisocyanurate on the viability and properties of Clostridium difficile spores

Author

Jennifer S. Hawkins, Les Baillie, Lovleen Tina Joshi, and Angelina Welsch

Subjects
0301 basic medicine, Biocide, Surface Properties, 030106 microbiology, Biology, Applied Microbiology and Biotechnology, Sodium dichloroisocyanurate, Microbiology, RS, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Healthcare associated, Humans, 030212 general & internal medicine, Pathogen, Enterocolitis, Pseudomembranous, Log10 reduction, Spores, Bacterial, Cross Infection, Microbial Viability, Clostridioides difficile, Triazines, fungi, Exosporium, Clostridium difficile, Hospitals, Spore, chemistry, Hydrophobic and Hydrophilic Interactions, Disinfectants
Abstract

Clostridium difficile is the primary cause of healthcare associated diarrhoea globally and produces spores which are resistant to commonly used biocides and are able persist on contaminated surfaces for months. This study examined the effect of sublethal concentrations of the biocide sodium dichloroisocyanurate (NaDCC) on the viability of spores produced by 21 clinical isolates of C. difficile representing a range of PCR ribotypes. Spores exposed to 500 ppm NaDCC for 10 minutes exhibited between a 4 – 6 log10 reduction in viability which was independent of spore PCR ribotype. The effect of sublethal concentrations of biocide on the surface properties of exosporium positive and negative clinical isolates was determined using a spore adhesion to hydrocarbon assay. These isolates differed markedly in their responses suggesting that exposure to biocide can have a profound effect on hydrophobicity and thus the ability of spores to adhere to surfaces. This raises the intriguing possibility that sublethal exposure to NaDCC could inadvertently promote the spread of the pathogen in healthcare facilities.

Published
2017

45. Association between Pseudomonas aeruginosa positive water samples and healthcare-associated cases: nine-year study at one university hospital

Author

Bouxom, Hélène, Fournier, Damien, Bouiller, Kévin, Hocquet, Didier, Bertrand, Xavier, Muggeo, Anaëlle, Guillard, Thomas, Klein, Frédéric, Reffuveille, Fany, François, Caroline, Babosan, Anamaria, Bajolet, Odile, De Champs, Christophe, Laborde, Caroline, Aho, Serge Ludwig, Pechinot, André, Le Moing, Vincent, Piroth, Lionel, Chirouze, Catherine, Treepong, Panisa, Kos, V.N., Guyeux, Christophe, Blanc, D., Valot, Benoit, Gbaguidi-Haore, Houssein, Varin, Amélie, Cholley, Pascal, Thouverez, Michelle, Muller, Allison, Rogues, Anne-Marie, Péfau, Muriel, Alfandari, Serge, Gauzit, Rémy, Dumartin, Catherine, El Garch, Farid, de Jong, Anno, Sauget, Marlène, Lefebvre, A., Quantin, Cécile, Vanhems, Philippe, Lucet, Jean-Christophe, Nuemi, G., Astruc, Karine, Chavanet, Pascal, Aho-Glélé, Ludwig-Serge, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service de Réanimation Médicale (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire de Bactériologie–Virologie-Hygiène Hospitalière, Université de Reims Champagne-Ardenne (URCA)-Centre Hospitalier Universitaire de Reims (CHU Reims), Laboratoire Départemental de l'Orne, Laboratoire de Microbiologie de l’Environnement (LME), Institut National de la Recherche Agronomique (INRA)-Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU), Université de Reims Champagne-Ardenne (URCA), Laboratoire de Virologie Médicale et Moléculaire - EA 4684 (CardioVir), Université de Reims Champagne-Ardenne (URCA)-SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Centre Hospitalier Universitaire de Reims (CHU Reims), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Laboratoire de Microbiologie Médicale et Moléculaire, Université de Bourgogne (UB), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Département d'infectiologie (CHU de Dijon), Franche-Comté Électronique Mécanique, Thermique et Optique - Sciences et Technologies (UMR 6174) (FEMTO-ST), Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC), Laboratoire Hubert Curien [Saint Etienne] (LHC), Institut d'Optique Graduate School (IOGS)-Université Jean Monnet [Saint-Étienne] (UJM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Pellegrin, CHU de Bordeaux, CHU Bordeaux [Bordeaux], Service des maladies infectieuses, Service d'anesthésie-réanimation [Hôtel-Dieu], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel-Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Vétoquinol, Interactions et dynamique des environnements de surface (IDES), Université Paris-Sud - Paris 11 (UP11)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Université Paris Diderot - Paris 7 (UPD7), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Recherche Agronomique (INRA), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Adaptive Distributed Applications and Middleware (ADAM), Laboratoire d'Informatique Fondamentale de Lille (LIFL), Université de Lille, Sciences et Technologies-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lille, Sciences Humaines et Sociales-Centre National de la Recherche Scientifique (CNRS)-Université de Lille, Sciences et Technologies-Institut National de Recherche en Informatique et en Automatique (Inria)-Université de Lille, Sciences Humaines et Sociales-Centre National de la Recherche Scientifique (CNRS)-Inria Lille - Nord Europe, Institut National de Recherche en Informatique et en Automatique (Inria), Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Université de Reims Champagne-Ardenne (URCA)-Centre Hospitalier Universitaire de Reims (CHU Reims)-SFR CAP Santé (Champagne-Ardenne Picardie Santé), Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV)-Université de Reims Champagne-Ardenne (URCA)-Université de Picardie Jules Verne (UPJV), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), Université de Franche-Comté (UFC)-Centre National de la Recherche Scientifique (CNRS)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Université de Technologie de Belfort-Montbeliard (UTBM), Hôpital Jean Minjoz, Hôpital Hôtel-Dieu [Paris]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Laboratoire Chrono-environnement (UMR 6249) (LCE), Université de Reims Champagne-Ardenne (URCA)-Université de Reims Champagne-Ardenne (URCA), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Université de Technologie de Belfort-Montbeliard (UTBM)-Ecole Nationale Supérieure de Mécanique et des Microtechniques (ENSMM)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Laboratoire Hubert Curien (LHC), Institut d'Optique Graduate School (IOGS)-Université Jean Monnet - Saint-Étienne (UJM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), Service Biostatistiques et Informatique Médicale (CHU de Dijon) (DIM), Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Hôpital Bichat - Claude Bernard, Service des Maladies Infectieuses et Tropicales, Hôpital du Bocage, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon)-Pôle des Pathologies Lourdes, Service d'épidémiologie et d'hygiène hospitalières (CHU de Dijon), Laboratoire d'Ecologie végétale et de Biogéochimie, Université libre de Bruxelles (ULB), UMR5116, Centre Émile Durkheim (CED), Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS)-Université de Bordeaux (UB)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Service Biostatistiques et Informatique Médicale (CHU de Dijon) ( DIM ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Hospices Civils de Lyon ( HCL ), Université Paris Diderot - Paris 7 ( UPD7 ), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ) -Pôle des Pathologies Lourdes, Université Libre de Bruxelles [Bruxelles] ( ULB ), Groupe d'étude des proliférations lymphoïdes ( GPL ), Université de Rouen Normandie ( UNIROUEN ), Normandie Université ( NU ) -Normandie Université ( NU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre Émile Durkheim ( CED ), and Université de Bordeaux ( UB ) -Sciences Po-Centre National de la Recherche Scientifique ( CNRS ) -Université de Bordeaux ( UB ) -Sciences Po-Centre National de la Recherche Scientifique ( CNRS )

Subjects
Male, Microbiology (medical), Healthcare associated infections, medicine.medical_specialty, [SDV]Life Sciences [q-bio], Healthcare-associated infections, 030501 epidemiology, medicine.disease_cause, Hospitals, University, 03 medical and health sciences, 0302 clinical medicine, Healthcare associated, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Internal medicine, Intensive care, medicine, Humans, Pseudomonas Infections, 030212 general & internal medicine, Intensive care medicine, Generalized estimating equation, ComputingMilieux_MISCELLANEOUS, Aged, Cross Infection, business.industry, Pseudomonas aeruginosa, Incidence (epidemiology), Water, General Medicine, University hospital, 3. Good health, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Infectious Diseases, Female, France, Water Microbiology, 0305 other medical science, business, Case analysis
Abstract

Summary Objective To study the association between the results of water samples and Pseudomonas aeruginosa healthcare-associated cases in a French university hospital. Methods Generalized Estimating Equations were used on complete case and imputed datasets. The spatial unit was the building and the time unit was the quarter. Results For the period 2004–2013, 2932 water samples were studied; 17% were positive for P. aeruginosa. A higher incidence of P. aeruginosa cases was associated with a higher proportion of positive water samples ( P =0.056 in complete case analysis and P =0.031 with the imputed dataset). The association was no longer observed when haematology and intensive care units were excluded, but was significant in analyses of data concerning intensive care units alone ( P Conclusion This study suggests that water outlet contamination in hospitals can lead to an increase in healthcare-associated P. aeruginosa cases in wards dealing with susceptible patients, but does not play a significant role in other wards.

Published
2017
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46. Aerosolised antibiotics for the management of healthcare‐associated pneumonia (HCAP) and ventilator‐associated pneumonia (VAP)

Author

Hill A Enuh, Collins U Enuh, Jay Nfonoyim, Ifeanyi R Ezedunukwe, and Keith Diaz

Subjects
Medicine General & Introductory Medical Sciences, medicine.medical_specialty, medicine.drug_class, business.industry, Antibiotics, Ventilator-associated pneumonia, medicine.disease, 03 medical and health sciences, Pneumonia, 0302 clinical medicine, 030228 respiratory system, Healthcare associated, medicine, Pharmacology (medical), 030212 general & internal medicine, Intensive care medicine, business
Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the benefits and harms of aerosolised antibiotics, comparing aerosolised versus systemic antibiotics, aerosolised antibiotics versus placebo and the addition of aerosolised to systemic antibiotics versus systemic antibiotics alone.

Published
2017

47. Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae

Author

Jean-Ralph Zahar, Philippe Lesprit, Stephane Ruckly, Aurelia Eden, Hitoto Hikombo, Louis Bernard, Stephan Harbarth, Jean-François Timsit, Christian Brun-Buisson, Nejla Aissa, Alain Losniewski, Sandrine Henard, Christian Rabaud, Cécile Janssen, Léonardo Pagani, Stéphane Bland, Jacques Gaillat, Jean Pierre Bru, Pierre Bonnin, Gaelle Clavère, Virginie Vitrat, Laurence Maulin, Luc Quarsaet, Helene Roger, Jean-Baptiste Euzen, Eric Denes, Elodie Couve-Daecon, Catherine Lechiche, Jean-Philippe Lavigne, Véronique Mondain, Celine Pulcini, Veronique Garnier, Dorothée Lambert, Maxime Hentzien, Yohan Nguyen, Jean Paul Talarmin, Pascaline Rameau, Françoise Geffroy, Arnaud Salmon-Rousseau, Vincent Cattoir, Antoine Froissart, Said Aberrane, Laurence Legout, France Roblot, Guillaume Beraud, Patricia Pavese, Olivier Belmonte, Nicolas Traversier, Laurent Bellec, Marie Lagrange-Xelot, Marie-Pierre Moiton, Barbara Kuli, Pascal Longuet, Agnes Scanvic, Lea Colombain, Milagros Ferreyra, Maxime Jean, Etienne Laurens, Matthieu Saada, Hugues Aumaitre, Martine Malet, Frederique Roustant, Vincent LeMoing, Jean-Pierre Helene, Jonathan Theodore, Caroline Garandeau, Jocelyne Caillon, Benjamin Olivero, David Boutoille, Didier Lepelletier, Lucia Grandière-Perez, Aurélie Beaudron, Céline Ramanantsoa, Catherine Varache, Nicolas Varache, Nicolas Crochette, Hikombo Hitoto, Sophie Blanchi, Pascale Penn, Bernard Louis, Dominique Vanjak, Marie-Christine Escande, René-Gilles Patrigeon, Stéphanie Honoré, Audrey Barrelet, Marlène Amara, Jean-Marc Galempoix, Jean-Claude Réveil, Patricia Bucchiotty, Carine Couzigou, Alban LeMonnier, Emilie Boidin, Stephane Sire, Nelly Luizy, Caroline Bronstain, Carolina Fankhauser, Caroline Brossier, Elodie von Dach, Colette Sauve, Marie-Noelle Adam, Laurent Hocqueloux, Laurent Bret, Marie-Hélène André, Régine Barruet, Marion Challier, Andre Cabié, Benoit Roze, Patrick Plesiat, Katy Jeanot, Isabelle Patry, Joséphine Moreau, Catherine Chirouze, Aaron Laurent, Marie-Nadège Bachelier, Guillaume Kac, Nicolas Farthouat, Nicolas Feuillebois, Thomas Guimard, Sandra Bourdon, Sophie Nguyen, Serge Alfandari, Houcine Bentayeb, Mari-Thérèse Albertini, Bruno Marchou, Noémie Gaudré, Damien Dubois, Christelle Guillet-Caruba, Florence Doucet Populaire, Nicolas Fortineau, Leila Escaut, Vincent Fihman, Rémy Gauzit, Josette Raymond, Solene Kerneis, Veronique Leflon-Guibout, Agnes Lefort, Aurelien Dinh, Anne-Laure Roux, Sophie Abgrall, Françoise Jauréguy, Jean-Christophe Lucet, Nathalie Soismier, Amanda Lopes, Emmanuelle Cambau, Veronique Manceron, Guilène Barnaud, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Hôpital Foch [Suresnes], Outcomerea, Centre Hospitalier Saint Jean de Perpignan, Centre Hospitalier Le Mans (CH Le Mans), Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS), Faculté de médecine [Genève], Prévention et contrôle des infections (PCI ), Hôpitaux Universitaires de Genève (HUG), Services de Maladies Infectieuses et Tropicales [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de réanimation médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)

Subjects
Male, 0301 basic medicine, Pediatrics, Bacteremia, Community-Acquired Infections/epidemiology/microbiology, Antibiotic appropriateness, Klebsiella spp, 0302 clinical medicine, Healthcare associated, Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Prevalence, Risk of mortality, Medicine, Pharmacology (medical), Prospective Studies, 030212 general & internal medicine, beta-Lactamases/secretion, Community onset, ddc:616, Aged, 80 and over, Cross Infection, education.field_of_study, biology, Enterobacteriaceae Infections, General Medicine, Middle Aged, Enterobacteriaceae, 3. Good health, Community-Acquired Infections, Treatment Outcome, Infectious Diseases, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Cross Infection/microbiology, Female, Bacteremia/epidemiology/microbiology, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, Population, beta-Lactamases, 03 medical and health sciences, Extended-spectrum β-lactamase, Antibiotic therapy, Enterobacteriaceae/classification/enzymology/isolation & purification, Humans, Risk factor, education, Aged, Enterobacteriaceae Infections/epidemiology/microbiology, business.industry, biochemical phenomena, metabolism, and nutrition, biology.organism_classification, bacterial infections and mycoses, Survival Analysis, Risk factors, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Bacteraemia, business
Abstract

International audience; Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.

Published
2017
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48. Erratum to 'Predominance of healthcare-associated cases among episodes of community-onset bacteraemia due to extended-spectrum β-lactamase-producing Enterobacteriaceae' [International Journal of Antimicrobial Agents 49/1 67-73]

Author

Jean-Ralph Zahar, Philippe Lesprit, Stephane Ruckly, Aurelia Eden, Hitoto Hikombo, Louis Bernard, Stephan Harbarth, Jean-Francois Timsit, Christian Brun-Buisson, Jean Carlet, Pierre Dellamonica, Remy Gauzit, Christian Rabaud, Serge Alfandari, Robert Cohen, Bruno Coignard, Celine Pulcini, Jerome Robert, Nejla Aissa, Alain Losniewski, Sandrine Henard, Cecile Janssen, Leonardo Pagani, Stephane Bland, Jacques Gaillat, Jean Pierre Bru, Pierre Bonnin, Gaelle Clavere, Virginie Vitrat, Laurence Maulin, Luc Quarsaet, Helene Roger, Jean-Baptiste Euzen, Eric Denes, Elodie Couve-Daecon, Catherine Lechiche, Jean-Philippe Lavigne, Veronique Mondain, Veronique Garnier, Dorothee Lambert, Maxime Hentzien, Yohan Nguyen, Jean Paul Talarmin, Pascaline Rameau, Francoise Geffroy, Arnaud Salmon-Rousseau, Vincent Cattoir, Antoine Froissart, Said Aberrane, Laurence Legout, France Roblot, Guillaume Beraud, Patricia Pavese, Olivier Belmonte, Nicolas Traversier, Laurent Bellec, Marie Lagrange-Xelot, Marie-Pierre Moiton, Barbara Kuli, Pascal Longuet, Agnes Scanvic, Lea Colombain, Milagros Ferreyra, Maxime Jean, Etienne Laurens, Matthieu Saada, Hugues Aumaitre, Martine Malet, Frederique Roustant, Vincent LeMoing, Jean-Pierre Helene, Jonathan Theodore, Caroline Garandeau, Jocelyne Caillon, Benjamin Olivero, David Boutoille, Didier Lepelletier, Lucia Grandiere-Perez, Aurelie Beaudron, Celine Ramanantsoa, Catherine Varache, Nicolas Varache, Nicolas Crochette, Hikombo Hitoto, Sophie Blanchi, Pascale Penn, Bernard Louis, Dominique Vanjak, Marie-Christine Escande, Rene-Gilles Patrigeon, Stephanie Honore, Audrey Barrelet, Marlene Amara, Jean-Marc Galempoix, Jean-Claude Reveil, Patricia Bucchiotty, Carine Couzigou, Alban LeMonnier, Emilie Boidin, Stephane Sire, Nelly Luizy, Caroline Bronstain, Carolina Fankhauser, Caroline Brossier, Elodie von Dach, Colette Sauve, Marie-Noelle Adam, Laurent Hocqueloux, Laurent Bret, Marie-Helene Andre, Regine Barruet, Marion Challier, Andre Cabie, Benoit Roze, Patrick Plesiat, Katy Jeanot, Isabelle Patry, Josephine Moreau, Catherine Chirouze, Aaron Laurent, Marie-Nadege Bachelier, Guillaume Kac, Nicolas Farthouat, Nicolas Feuillebois, Thomas Guimard, Sandra Bourdon, Sophie Nguyen, Houcine Bentayeb, Mari-Therese Albertini, Bruno Marchou, Noemie Gaudre, Damien Dubois, Christelle Guillet-Caruba, Florence Doucet Populaire, Nicolas Fortineau, Leila Escaut, Vincent Fihman, Josette Raymond, Solene Kerneis, Veronique Leflon-Guibout, Agnes Lefort, Aurelien Dinh, Anne-Laure Roux, Sophie Abgrall, Francoise Jaureguy, Jean-Christophe Lucet, Nathalie Soismier, Amanda Lopes, Emmanuelle Cambau, Veronique Manceron, Guilene Barnaud, Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Hôpital Foch [Suresnes], Centre Hospitalier Saint Jean de Perpignan, Service d'Infectiologie et des maladies infectieuses et tropicales [CH Le Mans] | Infectious and tropical disease department [Le Mans hospital], Centre Hospitalier Le Mans (CH Le Mans), Hôpital Bretonneau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Prévention et contrôle des infections (PCI ), Hôpitaux Universitaires de Genève (HUG), Services de Maladies Infectieuses et Tropicales [CHU Bichat], AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Service des maladies infectieuses, Centre Hospitalier Universitaire de Nice (CHU Nice)-University Hospital, Hôpital Cochin [AP-HP], Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Réseau Antibiolor, Stress, Immunité, Pathogènes (SIMPA), Université de Lorraine (UL), Centre Hospitalier Tourcoing, Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM - U912 INSERM - Aix Marseille Univ - IRD), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Institut de minéralogie, de physique des matériaux et de cosmochimie (IMPMC), Muséum national d'Histoire naturelle (MNHN)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de recherche pour le développement [IRD] : UR206-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Bactériologie [CHU Nancy], Institute for Computational Modeling in Civil Engineering, Technische Universität Braunschweig = Technical University of Braunschweig [Braunschweig], Imperial College London, Service des Maladies Infectieuses, Centre Hospitalier de la Région d'Annecy (Pringy), Service des Maladies infectieuses et tropicales [CHU Limoges], CHU Limoges, Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA), Centre Hospitalier Universitaire de Reims (CHU Reims), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CH Cornouaille, Plateforme imagerie et cytométrie (PFIC), Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse (AMMICa), Université Paris-Sud - Paris 11 (UP11)-Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Sud - Paris 11 (UP11)-Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service NEUROSPIN (NEUROSPIN), Université Paris-Saclay-Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Institute of New Imaging Technologies (INIT), Universitat Jaume I, Centre Hospitalier Universitaire de La Réunion (CHU La Réunion), Unité des maladies infectieuses, Hôpital Bichat - Claude Bernard, CHU Pontchaillou [Rennes], Laboratoire Cliniques Pathologique et Interculturelle (LCPI), Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT), SAD Paysage (SAD Paysage), Institut National de la Recherche Agronomique (INRA)-AGROCAMPUS OUEST, Service des maladies infectieuses CHU Perpignan, Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques et émergentes (TransVIHMI), Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Département de Chimie Moléculaire (DCM), Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Thérapeutiques cliniques et expérimentales des infections (EA 3826) (EA 3826), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Centre de Recherche en Ingénierie financière et finance Publique (CRIFP), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA), Service des maladies infectieuses et tropicales [CHU Nantes], Centre hospitalier universitaire de Nantes (CHU Nantes), Service de bactériologie et hygiène hospitalière [Nantes], Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes), Hôpital de la Timone [CHU - APHM] (TIMONE), Centre de Recherches en Oncologie biologique et Oncopharmacologie (CRO2), Aix Marseille Université (AMU)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier de Charleville-Mezières, Université de Bordeaux (UB), Institut de Recherche Dupuy de Lôme (IRDL), École Nationale d'Ingénieurs de Brest (ENIB)-Université de Bretagne Sud (UBS)-Université de Brest (UBO)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Centre National de la Recherche Scientifique (CNRS), Department of Cell Biology, Sciences III, Université de Genève = University of Geneva (UNIGE), Université Laval [Québec] (ULaval), Service de Maladies Infectieuses et Tropicales [Fort-de-France, Martinique], CHU de la Martinique [Fort de France]-Hôpital Pierre Zobda-Quitman [CHU de la Martinique], CHU de la Martinique [Fort de France]-Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], CHU Fort de France-CHU de la Martinique [Fort de France]-Hôpital Pierre Zobda-Quitman [CHU de la Martinique], CHU de la Martinique [Fort de France], Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Institut de l'élevage (IDELE), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Service des maladies infectieuses et tropicales, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques, Laboratoire d'Informatique de l'Université du Mans (LIUM), Le Mans Université (UM), Physiopathologie de l'Endothelium, Vascular research center of Marseille (VRCM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], Université de Sherbrooke (UdeS), Centre hospitalier universitaire de Tourcoing, Homéostasie Cellulaire et Pathologies (HCP), Université de Limoges (UNILIM)-CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Laboratoire Montpelliérain d'Économie Théorique et Appliquée (LAMETA), Université Montpellier 1 (UM1)-Université Paul-Valéry - Montpellier 3 (UPVM)-Institut National de la Recherche Agronomique (INRA)-Centre international d'études supérieures en sciences agronomiques (Montpellier SupAgro)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Faculty of Mathematics, Informatics, and Mechanics [Warsaw] (MIMUW), University of Warsaw (UW), Service de Microbiologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon [AP-HP], Services des maladies infectieuses, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Raymond Poincaré [AP-HP], Institut de Planétologie et d'Astrophysique de Grenoble (IPAG), Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Observatoire des Sciences de l'Univers de Grenoble (OSUG ), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national des sciences de l'Univers (INSU - CNRS)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Université Paris Diderot - Paris 7 (UPD7), Département de Médecine interne [Lariboisière], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Emergence de la résistance bactérienne in vivo (EA3964), AP-HP Groupe Hospitalier Lariboisière, Laboratoire d'ethnologie et de sociologie comparative (LESC), Université Paris Nanterre (UPN)-Centre National de la Recherche Scientifique (CNRS), Muséum national d'Histoire naturelle (MNHN), Equipe mobile d'infectiologie, CHU Necker - Enfants Malades [AP-HP], Service Microbiologie-Hygiène Hospitalière, Institut franco-allemand de recherche de Saint-Louis, Centre Hospitalier Universitaire [Grenoble] (CHU), Unité d’Otologie, implants auditifs et chirurgie de la base du crâne [CHU Pitié-Salpêtrière], Service d'Oto-Rhino-Laryngologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Recherches Translationnelles sur le VIH et les maladies infectieuses endémiques er émergentes (TransVIHMI), CHU Toulouse [Toulouse], Institut de recherche en astrophysique et planétologie (IRAP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut national des sciences de l'Univers (INSU - CNRS)-Observatoire Midi-Pyrénées (OMP), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Institut de Recherche pour le Développement (IRD)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Météo-France -Centre National de la Recherche Scientifique (CNRS), Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Epidémiologie pronostique des cancers et affections graves, Université Joseph Fourier - Grenoble 1 (UJF)-Institut National de la Santé et de la Recherche Médicale (INSERM), Infection Control Programme and WHO Collaborating Centre on Patient Safety, CHU Cochin [AP-HP], Université Nice Sophia Antipolis (... - 2019) (UNS), Université Côte d'Azur (UCA), Institut de recherche pour le développement [IRD] : UR206-Centre National de la Recherche Scientifique (CNRS)-Muséum national d'Histoire naturelle (MNHN)-Université Pierre et Marie Curie - Paris 6 (UPMC), Technische Universität Braunschweig [Braunschweig], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Observatoire Midi-Pyrénées (OMP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Laboratoire de Génie Informatique et Ingénierie de Production (LGI2P), IMT - MINES ALES (IMT - MINES ALES), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT), Service d'Otologie, Implants auditifs et Chirurgie de la base du crâne [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Santé publique : épidémiologie et qualité des soins-EA 2694 (CERIM), Recherches Translationnelles sur le VIH et les maladies infectieuses (TransVIHMI), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Recherche pour le Développement (IRD)-Université Montpellier 1 (UM1)-Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Universtié Yaoundé 1 [Cameroun]-Université de Montpellier (UM), Université Joseph Fourier - Grenoble 1 (UJF)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA), Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA), Université de Bretagne Sud (UBS)-Université de Brest (UBO)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Centre National de la Recherche Scientifique (CNRS), University of Geneva [Switzerland], Université Laval, Fonctionnement et conduite des systèmes de culture tropicaux et méditerranéens (UMR SYSTEM), Centre de Coopération Internationale en Recherche Agronomique pour le Développement (Cirad)-Institut National de la Recherche Agronomique (INRA)-Centre international d'études supérieures en sciences agronomiques (Montpellier SupAgro)-Centre International de Hautes Etudes Agronomiques Méditerranéennes - Institut Agronomique Méditerranéen de Montpellier (CIHEAM-IAMM), Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Centre International de Hautes Études Agronomiques Méditerranéennes (CIHEAM)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Wageningen University and Research Centre [Wageningen] (WUR), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon), Institut de l'Elevage, Laboratoire Chrono-environnement - UFC (UMR 6249) (LCE), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Centre Hospitalier Régional Universitaire [Besançon] (CHRU Besançon)-Hôpital Saint-Jacques, Service des maladies infectieuses et réanimation médicale, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou, Université de Sherbrooke [Sherbrooke], Hôpital Purpan [Toulouse], Université Montpellier 1 (UM1)-Université Paul-Valéry - Montpellier 3 (UM3)-Institut National de la Recherche Agronomique (INRA)-Centre international d'études supérieures en sciences agronomiques (Montpellier SupAgro)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut national d’études supérieures agronomiques de Montpellier (Montpellier SupAgro), Faculty of Mathematics, Informatics, and Mechanics [Warsaw], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Diderot - Paris 7 (UPD7)-Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP Hôpital Raymond Poincaré [Garches], Observatoire des Sciences de l'Univers de Grenoble (OSUG), Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP)-Institut national de recherche en sciences et technologies pour l'environnement et l'agriculture (IRSTEA)-Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes (UGA)-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS), Hôpital Avicenne-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris 13 (UP13), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris 13 (UP13)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC), Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Institut de Recherche pour le Développement (IRD)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de recherche pour le développement [IRD] : UR206-Muséum national d'Histoire naturelle (MNHN)-Centre National de la Recherche Scientifique (CNRS), Institut national des sciences de l'Univers (INSU - CNRS)-Université Toulouse III - Paul Sabatier (UT3), Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université, Direction de Recherche Fondamentale (CEA) (DRF (CEA)), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro)-Institut national d'enseignement supérieur pour l'agriculture, l'alimentation et l'environnement (Institut Agro), Université Cheikh Anta Diop [Dakar, Sénégal] (UCAD)-Institut de Recherche pour le Développement (IRD)-Université de Yaoundé I-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Université Montpellier 1 (UM1), Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015 - 2019) (COMUE UCA), Institut National de la Santé et de la Recherche Médicale (INSERM)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Aix Marseille Université (AMU), Centre National de la Recherche Scientifique (CNRS)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Université de Brest (UBO)-Université de Bretagne Sud (UBS), Wageningen University and Research [Wageningen] (WUR), CHU Fort de France-Hôpital Pierre Zobda-Quitman [CHU de la Martinique], CHU de la Martinique [Fort de France]-CHU de la Martinique [Fort de France], Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Institut National de la Santé et de la Recherche Médicale (INSERM)-Aix Marseille Université (AMU), Service des maladies infectieuses et réanimation médicale [Rennes], Hôpital Beaujon [AP-HP], Cholley, Pascal, Institut de Recherche pour le Développement (IRD)-Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Météo France-Centre National d'Études Spatiales [Toulouse] (CNES)-Centre National de la Recherche Scientifique (CNRS)-Centre National de la Recherche Scientifique (CNRS), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre National de la Recherche Scientifique (CNRS)-Université Paris-Sud - Paris 11 (UP11)-Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris-Sud - Paris 11 (UP11)-Institut Gustave Roussy (IGR)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Brest (UBO)-Centre National de la Recherche Scientifique (CNRS)-École Nationale Supérieure de Techniques Avancées Bretagne (ENSTA Bretagne)-Université de Bretagne Sud (UBS), Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), CHU Nice-University Hospital, Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Laboratoire de Physiologie des Invertébrés ( LPI ), Institut Français de Recherche pour l'Exploitation de la Mer ( IFREMER ), Laboratoire des Sciences de l'Environnement Marin (LEMAR) ( LEMAR ), Institut de Recherche pour le Développement ( IRD ) -Institut Français de Recherche pour l'Exploitation de la Mer ( IFREMER ) -Université de Brest ( UBO ) -Institut Universitaire Européen de la Mer ( IUEM ), Institut de Recherche pour le Développement ( IRD ) -Université de Brest ( UBO ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université de Brest ( UBO ) -Centre National de la Recherche Scientifique ( CNRS ) -Centre National de la Recherche Scientifique ( CNRS ), Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale ( SESSTIM ), Institut de Recherche pour le Développement ( IRD ) -Aix Marseille Université ( AMU ) -ORS PACA-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Nice Sophia Antipolis ( UNS ), Université Côte d'Azur ( UCA ), Institut de minéralogie, de physique des matériaux et de cosmochimie ( IMPMC ), Muséum National d'Histoire Naturelle ( MNHN ) -Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut de recherche pour le développement [IRD] : UR206-Centre National de la Recherche Scientifique ( CNRS ), Institut de recherche en astrophysique et planétologie ( IRAP ), Université Paul Sabatier - Toulouse 3 ( UPS ) -Observatoire Midi-Pyrénées ( OMP ) -Centre National de la Recherche Scientifique ( CNRS ), Equipe Poitevine de Recherche et d'Encadrement Doctoral en sciences criminelles de Poitiers ( EPRED ), Université de Poitiers, Laboratoire de Génie Informatique et Ingénierie de Production ( LGI2P ), IMT - Mines Alès Ecole Mines - Télécom ( IMT - MINES ALES ), Institut National des Sciences Appliquées de Lyon ( INSA Lyon ), Université de Lyon-Institut National des Sciences Appliquées ( INSA ), Laboratoire de Physique Corpusculaire - Clermont-Ferrand ( LPC ), Université Blaise Pascal - Clermont-Ferrand 2 ( UBP ) -Institut National de Physique Nucléaire et de Physique des Particules du CNRS ( IN2P3 ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Universitaire de Reims ( CHU de Reims ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Plateforme imagerie et cytométrie ( PFIC ), Analyse moléculaire, modélisation et imagerie de la maladie cancéreuse ( AMMICa ), Université Paris-Sud - Paris 11 ( UP11 ) -Institut Gustave Roussy ( IGR ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Paris-Sud - Paris 11 ( UP11 ) -Institut Gustave Roussy ( IGR ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Service NEUROSPIN ( NEUROSPIN ), Direction de Recherche Fondamentale (CEA) ( DRF (CEA) ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris-Saclay-Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris-Saclay, CHU de Poitiers, Santé publique : épidémiologie et qualité des soins-EA 2694 ( CERIM ), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Institute of New Imaging Technologies ( INIT ), Centre Hospitalier Universitaire de La Réunion ( CHU La Réunion ), Laboratoire Cliniques Pathologique et Interculturelle ( LCPI ), Université Toulouse - Jean Jaurès ( UT2J ), SAD Paysage ( SAD Paysage ), Institut National de la Recherche Agronomique ( INRA ) -AGROCAMPUS OUEST, VIH/SIDA et maladies associées, Université Montpellier 1 ( UM1 ), Département de Chimie Moléculaire ( DCM ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), Thérapeutiques Cliniques et Expérimentales des Infections, Université de Nantes ( UN ), Centre de Recherche en Ingénierie financière et finance Publique ( CRIFP ), Université Côte d'Azur ( UCA ) -Université Côte d'Azur ( UCA ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), Université de Nantes ( UN ) -Centre hospitalier universitaire de Nantes ( CHU Nantes ), Hôpital de la Timone [CHU - APHM] ( TIMONE ), Centre de Recherches en Oncologie biologique et Oncopharmacologie ( CRO2 ), Aix Marseille Université ( AMU ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université de Bordeaux ( UB ), Laboratoire Environnement Géomécanique et Ouvrages ( LAEGO ), Institut National Polytechnique de Lorraine ( INPL ), Institut de Recherche Dupuy de Lôme ( IRDL ), Centre National de la Recherche Scientifique ( CNRS ) -ENSTA Bretagne-Université de Brest ( UBO ) -Université de Bretagne Sud ( UBS ), Fonctionnement et conduite des systèmes de culture tropicaux et méditerranéens ( SYSTEM ), Centre de Coopération Internationale en Recherche Agronomique pour le Développement ( CIRAD ) -Institut National de la Recherche Agronomique ( INRA ) -Centre international d'études supérieures en sciences agronomiques ( Montpellier SupAgro ) -Institut national d’études supérieures agronomiques de Montpellier ( Montpellier SupAgro ), Wageningen University and Research Centre [Wageningen] ( WUR ), CHU de la Martinique-Hôpital Pierre Zobda-Quitman [CHU de la Martinique], CHU de la Martinique-Centre Hospitalier Universitaire de Martinique [Fort-de-France, Martinique], CHU Fort de France-CHU de la Martinique-Hôpital Pierre Zobda-Quitman [CHU de la Martinique], CHU de la Martinique, Agents pathogènes et inflammation - UFC (EA 4266) ( API ), Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Laboratoire d'Informatique de l'Université du Mans ( LIUM ), Le Mans Université ( UM ), Vascular research center of Marseille ( VRCM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Aix Marseille Université ( AMU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Aix Marseille Université ( AMU ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Aix Marseille Université ( AMU ), Université de Rennes 1 ( UR1 ), Université de Rennes ( UNIV-RENNES ) -Université de Rennes ( UNIV-RENNES ) -Hôpital Pontchaillou, Homéostasie Cellulaire et Pathologies ( HCP ), Université de Limoges ( UNILIM ) -CHU Limoges-Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST FR CNRS 3503 ), Hôpital Purpan - Centre Hospitalier Universitaire (CHU) de Toulouse, Laboratoire Montpelliérain d'Économie Théorique et Appliquée ( LAMETA ), Université Montpellier 1 ( UM1 ) -Université Paul-Valéry - Montpellier 3 ( UM3 ) -Centre international d'études supérieures en sciences agronomiques ( Montpellier SupAgro ) -Institut national de la recherche agronomique [Montpellier] ( INRA Montpellier ) -Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut national d’études supérieures agronomiques de Montpellier ( Montpellier SupAgro ), University of Warsaw ( UW ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Beaujon, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP Hôpital Raymond Poincaré [Garches], Institut de Planétologie et d'Astrophysique de Grenoble ( IPAG ), Observatoire des Sciences de l'Univers de Grenoble ( OSUG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Avicenne-Université Paris 13 ( UP13 ), Infection, Antimicrobiens, Modélisation, Evolution ( IAME ), Université Paris 13 ( UP13 ) -Université Paris Diderot - Paris 7 ( UPD7 ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Paris Diderot - Paris 7 ( UPD7 ), Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Lariboisière, Emergence de la résistance bactérienne in vivo ( EA3964 ), Laboratoire d'ethnologie et de sociologie comparative ( LESC ), Université Paris Nanterre ( UPN ) -Centre National de la Recherche Scientifique ( CNRS ), Muséum National d'Histoire Naturelle ( MNHN ), Hopital Necker-Enfants Malades, Centre Hospitalier Universitaire [Grenoble] ( CHU ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Université de Limoges (UNILIM)-Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST FR CNRS 3503)-CHU Limoges, and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13)

Subjects
Microbiology (medical), 0303 health sciences, medicine.medical_specialty, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, biology, 030306 microbiology, business.industry, General Medicine, biology.organism_classification, Antimicrobial, Enterobacteriaceae, 3. Good health, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Healthcare associated, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, medicine, Pharmacology (medical), 030212 general & internal medicine, Intensive care medicine, business, ComputingMilieux_MISCELLANEOUS, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Community onset
Abstract

International audience

Published
2017
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49. 398. Review of Mucormycosis Cases at the University of Colorado Hospital From 2012 to 2018 and Evaluation of Risk Factors and Appropriateness of Antifungal Prophylaxis

Author

Jessica Lum and Michelle A. Barron

Subjects
Antifungal, medicine.medical_specialty, business.industry, medicine.drug_class, Medical record, Mucormycosis, Hematologic Neoplasms, medicine.disease, Therapeutic immunosuppression, Abstracts, Infectious Diseases, Oncology, Healthcare associated, B. Poster Abstracts, Emergency medicine, Medicine, Weather patterns, business, Risk assessment
Abstract

Background Healthcare associated outbreaks of mucormycosis have been described in the literature. In 2017, the University of Colorado Hospital (UCH) had an increased number of cases of mucormycosis. The objective of this study was to evaluate possible risk factors and weather patterns associated with cases of mucormycosis diagnosed at UCH from 2012 to 2018 in order determine whether the current antifungal prophylaxis used at UCH should be modified. Methods A retrospective cohort was conducted involving patients >18 years old who were admitted to UCH between 2012 and 2018 and were diagnosed with proven or probable mucormycosis as defined by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) criteria. Medical records were reviewed, and data were collected on risk factors, antifungal prophylaxis, and mortality outcome. Weather data were collected from the National Centers for Environmental Information (NCEI). Results Twenty-five cases of proven or probable mucormycosis were identified. On average patients had at least two risk factors associated with mucormycosis. The most common risk factors included diabetes mellitus (DM) (13 patients), hematologic malignancy or hematopoietic stem cell transplant (HSCT) (11 patients), use of immunosuppressing medications (11 patients), and invasive procedures. (9 patients). At the time of diagnosis, only six patients were on an antifungal with mold activity. Eight patients died during hospitalization. The distribution of cases over time was compared with weather data for Colorado. A cluster of cases occurred in 2013 (6 cases) and in 2017 (8 cases). A majority of cases were diagnosed during the summer and fall months with July being the month with the most number of cases. There were higher levels of precipitation that occurred prior to or during the cluster of cases. Conclusion Cases of mucormycosis at UCH were associated with DM, hematologic malignancy/HSCT, use of immunosuppressive therapy, and invasive procedures. The increase of cases seen 2013 and 2017 occurred in the summer and fall months after higher levels of precipitation were observed in Colorado. Providers at UCH may consider modifying antifungal prophylaxis to include mold coverage in patients with >2 risk factors for mucormycosis who are admitted during the summer and fall. Disclosures M. Barron, Astellas Pharma: Investigator, Research support.

Published
2018

50. 559. Two Different Beasts: Comparing Epidemiology of Healthcare-Associated vs. Community-Acquired Methicillin-Resistant Staphylococcus aureus Bacteremia

Author

Luke McLaughlin and Stephanie Smith

Subjects
medicine.medical_specialty, Geographic area, MRSA colonization, business.industry, Clindamycin, biochemical phenomena, metabolism, and nutrition, medicine.disease_cause, medicine.disease, bacterial infections and mycoses, Methicillin-resistant Staphylococcus aureus, Intensive care unit, law.invention, Abstracts, Infectious Diseases, Oncology, Healthcare associated, law, Bacteremia, Internal medicine, Epidemiology, Poster Abstracts, medicine, business, medicine.drug
Abstract

Background Methicillin-resistant staphylococcus aureus (MRSA) bloodstream infection (BSI) is associated with significant morbidity and mortality. Healthcare-associated (HCA) MRSA infection (occurring >48 hours after hospitalization or in those with prior healthcare exposure) has traditionally been associated with severe invasive disease, while community-associated (CA) MRSA infection (occurring within 48 hours of hospitalization and without prior healthcare exposure) has been observed in otherwise healthy individuals. We characterized the epidemiology, resistance patterns, and clinical outcomes associated with MRSA BSI over a 5 year period comparing patients with community-onset bacteremia to those with hospital onset bacteremia. Methods We performed a retrospective chart review of 151 MRSA bloodstream infections from 2013–2018 at the University of Alberta Hospital (Edmonton, Canada). We assessed each BSI by: classification (CA vs. HCA), presence of MRSA risk factors, source of infection, MRSA resistance, rate of ICU admission, and 30-day mortality. Results The median age of all patients with MRSA BSI was 53 years (range 23–94). MRSA BSI occurred more commonly in males for both CA and HCA infection (53% and 62%). HCA-MRSA infections had a higher rate of previous MRSA colonization (64.8%) compared with CA-MRSA patients (41.7%). Injection drug use was higher in CA-MRSA infections (47% vs. 11%). The most common source of CA-BSI was bone/joint (30%) while line-associated infections were the most common in HCA-BSI. Clindamycin resistance was common (46–53% susceptible) while resistance to tetracyclines (91–97% susceptible) and trimethoprim/sulfamethoxazole (98–100% susceptible) was uncommon. HCA-MRSA BSI was associated with a higher rate of ICU admission (44% vs. 33%) and 30-day mortality (18.7% vs. 11.7%). Conclusion Invasive MRSA infection continues to be associated with significant morbidity and mortality. We found that healthcare-associated MRSA BSI was associated with a high rate of prior MRSA colonization as well as a higher rate of ICU admission and 30-day mortality. There are significant differences in the demographics of patients with CA BSI compared with HCA BSI. Interventions to prevent these infections need to be targeted to the geographic location of acquisition. Disclosures All authors: No reported disclosures.

Published
2019

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