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• 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]

• 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]

Group B Streptococcus late-onset disease, occurring from 7 through 89 days of life, remains an important cause of sepsis and meningitis in infants. The pathogenesis and mode of transmission associated with group B Streptococcus late-onset disease remain unclear. Neonate's digestive tract mucosa colonization may be acquired perinatally or postpartum, from maternal or non-maternal sources. Although maternal sources appear predominant, group B Streptococcus late-onset disease is not influenced by intrapartum antibiotic prophylaxis. Among non-maternal sources of transmission, horizontal nosocomial transmission is possible and may be underestimated in the neonate intensive care unit setting, accounting for about 10% of cases. The origin of transmission may be another patient, a caregiver or the intensive care unit environment. Awaiting for better understanding of transmissions routes and efficient strategies of prevention, clinicians facing such a case in a hospitalized neonate should maintain a high index of suspicion for a nosocomial origin and a potential cluster, ensure routine submission of isolate to a reference laboratory and reinforce infection control precautions. [ABSTRACT FROM AUTHOR]

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.

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

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.

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

Introducción. Candida auris se considera una amenaza para la salud por su multirresistencia, por causar infecciones y por asociarse con brotes. En el 2016, se generó una alerta nacional para la vigilancia de este microorganismo. Objetivo. Describir el comportamiento de la circulación de C. auris en Colombia, entre 2016 y julio de 2019. Materiales y métodos. Es un estudio descriptivo. Los datos se recolectaron mediante la vigilancia por laboratorio, según los criterios de envío de aislamientos establecido en la Circular 025 de 2012. La confirmación de C. auris se hizo por PCR o mediante el método de ionización por desorción láser asistida por matriz - espectrometría de masas de tiempo de vuelo (MS MALDITOF). Las pruebas de sensibilidad a los antimicóticos se practicaron en 109 aislamientos, utilizando microdilución en caldo para anfotericina B, fluconazol, voriconazol y anidulofungina. Para las variables cualitativas, se calcularon las proporciones, y para las numéricas, las medidas de tendencia central. Resultados. Se reportaron 680 casos de C. auris en 140 instituciones de 19 entidades territoriales. En Bogotá, D.C., Cartagena y Barranquilla, se concentraron más del 60 % de los casos. El 62,2 % eran hombres. La mediana de la edad fue de 41 años (0-97). Los niños de 0 a 18 años representaron el 45,3 %. En su mayoría, los aislamientos se recuperaron de sangre (74,3 %) y orina (21 %). El 51 % de los aislamientos fueron sensibles a los cuatro antifúngicos. Conclusión. Candida auris ha tenido una rápida dispersión en Colombia, lo que hace necesario el fortalecimiento de las medidas de control, así como estudios adicionales que profundicen en la descripción de este microorganismo emergente. [ABSTRACT FROM AUTHOR]

Healthcare-related transmission of Crimean-Congo haemorrhagic fever (CCHF) is a well-recognized hazard. We report a multicentre retrospective cross-sectional study undertaken in Turkey in 2014 in nine hospitals, regional reference centres for CCHF, covering the years 2002 to 2014 inclusive. Data were systematically extracted from charts of all personnel with a reported health care injury/accident related to CCHF. Blood samples were tested for CCHF IgM/IgG by enzyme-linked immunosorbent assay and/or viral nucleic acid detection by PCR after the injury. Fifty-one healthcare-related exposures were identified. Twenty-five (49%) of 51 resulted in laboratory-confirmed infection, with a 16% (4/25) overall mortality. The main route of exposure was needlestick injury in 32/51 (62.7%). A potential benefit of post-exposure prophylaxis with ribavirin was identified. [ABSTRACT FROM AUTHOR]