Infection control and hospital epidemiology, Jan 5, 2016
OBJECTIVE To concomitantly determine the differential degrees of air and environmental contaminat... more OBJECTIVE To concomitantly determine the differential degrees of air and environmental contamination by Acinetobacter baumannii based on anatomic source of colonization and type of ICU layout (single-occupancy vs open layout). DESIGN Longitudinal prospective surveillance study of air and environmental surfaces in patient rooms. SETTING A 1,500-bed public teaching hospital in Miami, Florida. PATIENTS Consecutive A. baumannii-colonized patients admitted to our ICUs between October 2013 and February 2014. METHODS Air and environmental surfaces of the rooms of A. baumannii-colonized patients were sampled daily for up to 10 days. Pulsed-field gel electrophoresis (PFGE) was used to type and match the matching air, environmental, and clinical A. baumannii isolates. RESULTS A total of 25 A. baumannii-colonized patients were identified during the study period; 17 were colonized in the respiratory tract and 8 were colonized in the rectum. In rooms with rectally colonized patients, 38.3% of ai...
Members of the herpesvirus family, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes si... more Members of the herpesvirus family, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV), have been recognized as causal agents of chorioretinal inflammatory diseases. We investigated the use of the polymerase chain reaction for the detection of CMV, HSV, and EBV genomes in aqueous, subretinal fluid, and vitreous specimens in patients with clinically diagnosed CMV retinitis. Cytomegalovirus but not HSV or EBV genomic sequences were detected in all of these clinical specimens. We also investigated 18 normal aqueous and eight normal vitreous specimens obtained from patients undergoing cataract or vitrectomy surgery. Cytomegalovirus, HSV, and EBV DNA were not detected in any of the normal aqueous specimens. There was one weakly positive CMV normal vitreous, but none was HSV or EBV positive by the polymerase chain reaction. These results indicate that the polymerase chain reaction may be useful as a rapid and sensitive diagnostic technique to aid in the confirmation of clinical observations.
Background: Klebsiella pneumoniae carbapenemases (KPC) are enzymes that confer resistance against... more Background: Klebsiella pneumoniae carbapenemases (KPC) are enzymes that confer resistance against most beta-lactams. Despite having been identified worldwide, studies describing successful control of KPC outbreaks are few. Objective: Characterization of the epidemiology and infection control measures of a KPC-producing K. pneumoniae outbreak. Methods: The intervention was conducted at a 1,500 bed public, urban, teaching hospital in the Miami metro area. Using the Microbiology database, all ertapenem resistant K. pneumoniae obtained from clinical specimens from January 1, 2009 to November 1, 2009 were identified. Additionally, 2 point prevalence surveys (using rectal cultures) were performed. Environmental cultures were also obtained. Ertapenem-resistant enteric Gram negative rods identified by Vitek II underwent a modified Hodge test, KPC PCR and PFGE. Colistin susceptibilities were done by broth microdilution. Because all infections were identified in the SICU, a bundle interventio...
Cerebral phaeohyphomycosis is a rare disease caused by dematiaceous (darkly pigmented) fungi. Cla... more Cerebral phaeohyphomycosis is a rare disease caused by dematiaceous (darkly pigmented) fungi. Cladophialophora species are highly neurotropic, and Cladophialophora bantiana (synonym=Xylohypha bantiana or C. trichoides) is the most commonly identified agent. Most reported cases of cerebral phaeohyphomycosis have occurred in immunocompetent patients; however, some case reports and experimental data have suggested that cellular immune deficiency is a risk factor. We report a case of pulmonary and cerebral phaeohyphomycosis in a cardiac transplant patient due to a newly identified species of Cladophialophora. Optimal management includes both antifungal therapy and surgery.
Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinet... more Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinetobacter baumannii despite a bundle of interventions. We aim to describe the effect of the subsequent implementation of electronic dissemination of the weekly findings of a bundle of interventions. This was a quasiexperimental study performed at a 1,500-bed, public, teaching hospital. From January 2011 to March 2012, weekly electronic communications were sent to the hospital leadership and intensive care units (ICUs). These communications aimed to describe, interpret, and package the findings of the previous week's active surveillance cultures, environmental cultures, environmental disinfection, and hand cultures. Additionally, action plans based on these findings were shared with recipients. During 42 months and 1,103,900 patient-days, we detected 438 new acquisitions of carbapenem-resistant A baumannii. Hospital wide, the rate of acquisition decreased from 5.13 ± 0.39 to 1.93 ± 0.23 per 10,000 patient-days, during the baseline and postintervention periods, respectively (P < .0001). This effect was also observed in the medical and trauma ICUs, with decreased rates from 67.15 ± 10.56 to 17.4 ± 4.6 (P < .0001) and from 55.9 ± 8.95 to 14.71 ± 4.45 (P = .0004), respectively. Weekly and systematic dissemination of the findings of a bundle of interventions was successful in decreasing the rates of carbapenem-resistant A baumannii across a large public hospital.
... Marylou Ingram, Timothy J. Cleary, Brandon J. Price, Relf L. Price 111, Albert Castro Institu... more ... Marylou Ingram, Timothy J. Cleary, Brandon J. Price, Relf L. Price 111, Albert Castro Institute for Cell Analysis, Departments of Medicine ... Suspensions of each organism (formalin killed) were adjusted to a density of a 0.5 McFarland barium sulfate turbidity standard (4) in ...
Acinetobacter baumannii is a pathogen of importance worldwide. From January 2011 until January 20... more Acinetobacter baumannii is a pathogen of importance worldwide. From January 2011 until January 2012, environmental and surveillance cultures were collected from patients admitted to our intensive care units (ICUs). Surveillance cultures were obtained on admission to the ICU and weekly thereafter. Environmental cultures of high-touch surfaces were performed on an alternating basis every week. A room was designated as contaminated if at least 1 object was positive for carbapenem-resistant A baumannii. We only evaluated the rooms belonging to patients who tested positive for Acinetobacter infection. Five hundred eighty-six rooms were cultured across the 5 ICUs surveyed, of which 134 (22.9%) had patients who tested positive for infection with Acinetobacter. Among patients colonized in the rectum, the odds of having bed rails contaminated with A baumannii were 2.55 times the odds of those with only respiratory colonization (P = .03). The odds of having intravenous pumps contaminated with A baumannii among patients with only respiratory colonization were 2.72 times the odds of contamination among patients colonized in the rectum (P = .03). There was a significant difference in the degree of contamination of bedrails and intravenous pumps based on the occupant's anatomic source of A baumannii infection.
TUBERCULOSIS is a major health problem among Haitians who have recently entered southern Florida.... more TUBERCULOSIS is a major health problem among Haitians who have recently entered southern Florida. Among those medically screened on arrival, we found that the prevalence of tuberculosis was 650 cases per 100,000 population. A high proportion of patients with ...
We aimed to determine the association between environmental exposure to carbapenem-resistant Acin... more We aimed to determine the association between environmental exposure to carbapenem-resistant Acinetobacter baumannii and the subsequent risk of acquiring this organism. Patients exposed to a contaminated hospital environment had 2.77 times the risk of acquiring carbapenem-resistant A. baumannii than did unexposed patients (relative risk, 2.77 [95% confidence interval, 1.50-5.13]; P = .002).
Infection control and hospital epidemiology, Jan 5, 2016
OBJECTIVE To concomitantly determine the differential degrees of air and environmental contaminat... more OBJECTIVE To concomitantly determine the differential degrees of air and environmental contamination by Acinetobacter baumannii based on anatomic source of colonization and type of ICU layout (single-occupancy vs open layout). DESIGN Longitudinal prospective surveillance study of air and environmental surfaces in patient rooms. SETTING A 1,500-bed public teaching hospital in Miami, Florida. PATIENTS Consecutive A. baumannii-colonized patients admitted to our ICUs between October 2013 and February 2014. METHODS Air and environmental surfaces of the rooms of A. baumannii-colonized patients were sampled daily for up to 10 days. Pulsed-field gel electrophoresis (PFGE) was used to type and match the matching air, environmental, and clinical A. baumannii isolates. RESULTS A total of 25 A. baumannii-colonized patients were identified during the study period; 17 were colonized in the respiratory tract and 8 were colonized in the rectum. In rooms with rectally colonized patients, 38.3% of ai...
Members of the herpesvirus family, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes si... more Members of the herpesvirus family, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV), have been recognized as causal agents of chorioretinal inflammatory diseases. We investigated the use of the polymerase chain reaction for the detection of CMV, HSV, and EBV genomes in aqueous, subretinal fluid, and vitreous specimens in patients with clinically diagnosed CMV retinitis. Cytomegalovirus but not HSV or EBV genomic sequences were detected in all of these clinical specimens. We also investigated 18 normal aqueous and eight normal vitreous specimens obtained from patients undergoing cataract or vitrectomy surgery. Cytomegalovirus, HSV, and EBV DNA were not detected in any of the normal aqueous specimens. There was one weakly positive CMV normal vitreous, but none was HSV or EBV positive by the polymerase chain reaction. These results indicate that the polymerase chain reaction may be useful as a rapid and sensitive diagnostic technique to aid in the confirmation of clinical observations.
Background: Klebsiella pneumoniae carbapenemases (KPC) are enzymes that confer resistance against... more Background: Klebsiella pneumoniae carbapenemases (KPC) are enzymes that confer resistance against most beta-lactams. Despite having been identified worldwide, studies describing successful control of KPC outbreaks are few. Objective: Characterization of the epidemiology and infection control measures of a KPC-producing K. pneumoniae outbreak. Methods: The intervention was conducted at a 1,500 bed public, urban, teaching hospital in the Miami metro area. Using the Microbiology database, all ertapenem resistant K. pneumoniae obtained from clinical specimens from January 1, 2009 to November 1, 2009 were identified. Additionally, 2 point prevalence surveys (using rectal cultures) were performed. Environmental cultures were also obtained. Ertapenem-resistant enteric Gram negative rods identified by Vitek II underwent a modified Hodge test, KPC PCR and PFGE. Colistin susceptibilities were done by broth microdilution. Because all infections were identified in the SICU, a bundle interventio...
Cerebral phaeohyphomycosis is a rare disease caused by dematiaceous (darkly pigmented) fungi. Cla... more Cerebral phaeohyphomycosis is a rare disease caused by dematiaceous (darkly pigmented) fungi. Cladophialophora species are highly neurotropic, and Cladophialophora bantiana (synonym=Xylohypha bantiana or C. trichoides) is the most commonly identified agent. Most reported cases of cerebral phaeohyphomycosis have occurred in immunocompetent patients; however, some case reports and experimental data have suggested that cellular immune deficiency is a risk factor. We report a case of pulmonary and cerebral phaeohyphomycosis in a cardiac transplant patient due to a newly identified species of Cladophialophora. Optimal management includes both antifungal therapy and surgery.
Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinet... more Our institution continued to experience a hyperendemic situation with carbapenem-resistant Acinetobacter baumannii despite a bundle of interventions. We aim to describe the effect of the subsequent implementation of electronic dissemination of the weekly findings of a bundle of interventions. This was a quasiexperimental study performed at a 1,500-bed, public, teaching hospital. From January 2011 to March 2012, weekly electronic communications were sent to the hospital leadership and intensive care units (ICUs). These communications aimed to describe, interpret, and package the findings of the previous week's active surveillance cultures, environmental cultures, environmental disinfection, and hand cultures. Additionally, action plans based on these findings were shared with recipients. During 42 months and 1,103,900 patient-days, we detected 438 new acquisitions of carbapenem-resistant A baumannii. Hospital wide, the rate of acquisition decreased from 5.13 ± 0.39 to 1.93 ± 0.23 per 10,000 patient-days, during the baseline and postintervention periods, respectively (P < .0001). This effect was also observed in the medical and trauma ICUs, with decreased rates from 67.15 ± 10.56 to 17.4 ± 4.6 (P < .0001) and from 55.9 ± 8.95 to 14.71 ± 4.45 (P = .0004), respectively. Weekly and systematic dissemination of the findings of a bundle of interventions was successful in decreasing the rates of carbapenem-resistant A baumannii across a large public hospital.
... Marylou Ingram, Timothy J. Cleary, Brandon J. Price, Relf L. Price 111, Albert Castro Institu... more ... Marylou Ingram, Timothy J. Cleary, Brandon J. Price, Relf L. Price 111, Albert Castro Institute for Cell Analysis, Departments of Medicine ... Suspensions of each organism (formalin killed) were adjusted to a density of a 0.5 McFarland barium sulfate turbidity standard (4) in ...
Acinetobacter baumannii is a pathogen of importance worldwide. From January 2011 until January 20... more Acinetobacter baumannii is a pathogen of importance worldwide. From January 2011 until January 2012, environmental and surveillance cultures were collected from patients admitted to our intensive care units (ICUs). Surveillance cultures were obtained on admission to the ICU and weekly thereafter. Environmental cultures of high-touch surfaces were performed on an alternating basis every week. A room was designated as contaminated if at least 1 object was positive for carbapenem-resistant A baumannii. We only evaluated the rooms belonging to patients who tested positive for Acinetobacter infection. Five hundred eighty-six rooms were cultured across the 5 ICUs surveyed, of which 134 (22.9%) had patients who tested positive for infection with Acinetobacter. Among patients colonized in the rectum, the odds of having bed rails contaminated with A baumannii were 2.55 times the odds of those with only respiratory colonization (P = .03). The odds of having intravenous pumps contaminated with A baumannii among patients with only respiratory colonization were 2.72 times the odds of contamination among patients colonized in the rectum (P = .03). There was a significant difference in the degree of contamination of bedrails and intravenous pumps based on the occupant's anatomic source of A baumannii infection.
TUBERCULOSIS is a major health problem among Haitians who have recently entered southern Florida.... more TUBERCULOSIS is a major health problem among Haitians who have recently entered southern Florida. Among those medically screened on arrival, we found that the prevalence of tuberculosis was 650 cases per 100,000 population. A high proportion of patients with ...
We aimed to determine the association between environmental exposure to carbapenem-resistant Acin... more We aimed to determine the association between environmental exposure to carbapenem-resistant Acinetobacter baumannii and the subsequent risk of acquiring this organism. Patients exposed to a contaminated hospital environment had 2.77 times the risk of acquiring carbapenem-resistant A. baumannii than did unexposed patients (relative risk, 2.77 [95% confidence interval, 1.50-5.13]; P = .002).
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