Most COVID-19 outbreaks in nursing homes are explained by transmission of SARS-CoV-2 from nurses or visitors.
We describe an outbreak with 64 of the 67 residents identified as COVID-19 cases within ...two weeks (34 in nursing block 1, 30 in nursing block 2), at least 32 of them had relevant symptoms of COVID-19. Thirteen of the residents’ deaths were associated with COVID-19. In addition, 27 of approximately 60 staff members were identified as COVID-19 cases, 23 of them had relevant symptoms. In none of the samples from residents or staff was a mutation of SARS-CoV-2 detected. Quarantine of the residents was already in force at the beginning of the outbreak. A common source among the staff was considered to be unlikely because the two nursing home blocks had no staff rotation and the staff had to wear FFP2 masks during contact with residents. Three months after the outbreak the RNA of SARS-CoV-2 was detected on 14 of 39 sampled indoor surfaces of the air ventilation system with Ct values between 34.9 and 41.9, but only at the air supply in the corridor (11 of 24 samples) and the air overflow in the door between the corridor and the residents’ rooms (three of 11 samples) but not at the air exhaust in the residents’ bathrooms.
The air ventilation system and an inversion weather situation three days before the first confirmed case may have enhanced viral spread inside the nursing home assuming that a common source with a high viral load had existed at the time of outbreak.
During the period from April 2012 to May 2013, 13 newborns (1 to 4 weeks of age) and 1 child in a pediatric hospital ward in Germany were colonized with
producing an extended-spectrum beta-lactamase ...(ESBL) (CTX-M-15). A microbiological source-tracking analysis with human and environmental samples was carried out to identify the source and transmission pathways of the
clone. In addition, different hygienic intervention methods were evaluated.
isolates were detected in the detergent drawer and on the rubber door seal of a domestic washer-extractor machine that was used in the same ward to wash laundry for the newborns, as well as in two sinks. These strains were typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. The environmental findings were compared with those for the human strains and the isolates detected on clothing. The results from both techniques showed that the strains were identical (sequence type 201 and PFGE type 00531, a clone specific to this hospital and not previously isolated in Germany), emphasizing the washing machine as a reservoir and fomite for the transmission of these multidrug-resistant bacteria. After the washing machine was taken out of use, no further colonizations were detected during the subsequent 4-year period.
Washing machines should be further investigated as possible sites for horizontal gene transfer (ESBL genes) and cross-contamination with clinically important Gram-negative strains. Particularly in the health care sector, the knowledge of possible (re-)contamination of laundry (patients' clothes and staff uniforms) with multidrug-resistant Gram-negative bacteria could help to prevent and to control nosocomial infections. This report describes an outbreak with a single strain of a multidrug-resistant bacterium (
sequence type 201) in a neonatal intensive care unit that was terminated only when the washing machine was removed. In addition, the study implies that changes in washing machine design and processing are required to prevent accumulation of residual water where microbial growth can occur and contaminate clothes.
Zusammenfassung
Hintergrund
Rezidivierende mukokutane Infektionen durch PVL‐positive
Staphylococcus (S.) aureus
‐Stämme stellen in Deutschland ein zunehmendes Problem dar. In den letzten Jahren ...wurden Ausbrüche in Kindertagesstätten und Kommunen beschrieben. Dennoch liegen zurzeit keine diagnostischen Algorithmen oder Therapieempfehlungen für die entsprechenden Infektionen in Deutschland vor.
Methode
Eine Literaturrecherche in der Datenbank PubMed/MEDLINE erfolgte mit dem Ziel, einen diagnostischen und therapeutischen Algorithmus zu erarbeiten. Zudem wurden nationale und internationale Empfehlungen berücksichtigt.
Ergebnisse
Panton‐Valentine Leukozidin (PVL) ist ein porenbildendes Protein, das von bestimmten
S. aureus‐
Stämmen produziert wird. Sowohl Methicillin‐sensible (MSSA) als auch Methicillin‐resistente
S. aureus
(MRSA)‐Stämme können das für die PVL‐Produktion verantwortliche Gen
lukS‐lukF
besitzen. Das klinische Bild der durch einen PVL‐positiven
S. aureus
verursachten Infektionen erstreckt sich von einzelnen rezidivierenden Abszessen bis hin zu einer ausgedehnten Furunkulose. Bei etwa 40 % der Patienten kommt es zu Rezidiven der Beschwerden trotz einer konsequenten Behandlung der Erstinfektion. Die Therapie variiert je nach klinischem Bild der jeweiligen Infektion. Zudem wird in der Literatur eine Screeninguntersuchung der Patienten und ihrer engen Kontaktpersonen sowie eine bakterielle Dekolonisation der Betroffenen empfohlen.
Schlussfolgerungen
Diese Arbeit fokussiert auf die Pathogenese und Risikofaktoren der rezidivierenden mukokutanen Infektionen durch PVL‐positive
S. aureus‐
Stämme und versucht einen diagnostischen und therapeutischen Algorithmus zur optimalen Patientenversorgung vorzuschlagen.
Summary
Background
Recurrent mucocutaneous infections caused by PVL‐positive Staphylococcus (S.) aureus strains represent an increasing problem in Germany. Although there have been several outbreaks ...at day care centers and in urban communities in recent years, there are currently no diagnostic algorithms or treatment recommendations for these particular infections in Germany.
Methods
We performed a literature search in the PubMed/MEDLINE database with the goal of developing an algorithm for diagnosis and treatment of these infections. National and international recommendations were also considered.
Results
Panton‐Valentine leukocidin (PVL) is a pore‐forming protein produced by certain S. aureus strains. Both methicillin‐susceptible (MSSA) and methicillin‐resistant S. aureus (MRSA) strains may carry the lukS‐lukF gene responsible for PVL production. The clinical presentation of infections caused by PVL‐positive S. aureus ranges from isolated recurrent abscesses to extensive furunculosis. Despite adequate treatment of primary infections, approximately 40 % of patients develop recurrent disease. The choice of treatment regimen is guided by the clinical presentation of the infection. In addition, some scientific literature recommends bacteriological screening of patients and their contacts, followed by decolonization of affected individuals.
Conclusions
The present article focuses on the pathogenesis and risk factors of recurrent mucocutaneous infections caused by PVL‐positive S. aureus strains and proposes a diagnostic and therapeutic algorithm for optimal patient care.
Zusammenfassung
Hintergrund
Rezidivierende mukokutane Infektionen durch PVL‐positive Staphylococcus (S.) aureus‐Stämme stellen in Deutschland ein zunehmendes Problem dar. In den letzten Jahren wurden ...Ausbrüche in Kindertagesstätten und Kommunen beschrieben. Dennoch liegen zurzeit keine diagnostischen Algorithmen oder Therapieempfehlungen für die entsprechenden Infektionen in Deutschland vor.
Methode
Eine Literaturrecherche in der Datenbank PubMed/MEDLINE erfolgte mit dem Ziel, einen diagnostischen und therapeutischen Algorithmus zu erarbeiten. Zudem wurden nationale und internationale Empfehlungen berücksichtigt.
Ergebnisse
Panton‐Valentine Leukozidin (PVL) ist ein porenbildendes Protein, das von bestimmten S. aureus‐Stämmen produziert wird. Sowohl Methicillin‐sensible (MSSA) als auch Methicillin‐resistente S. aureus (MRSA)‐Stämme können das für die PVL‐Produktion verantwortliche Gen lukS‐lukF besitzen. Das klinische Bild der durch einen PVL‐positiven S. aureus verursachten Infektionen erstreckt sich von einzelnen rezidivierenden Abszessen bis hin zu einer ausgedehnten Furunkulose. Bei etwa 40 % der Patienten kommt es zu Rezidiven der Beschwerden trotz einer konsequenten Behandlung der Erstinfektion. Die Therapie variiert je nach klinischem Bild der jeweiligen Infektion. Zudem wird in der Literatur eine Screeninguntersuchung der Patienten und ihrer engen Kontaktpersonen sowie eine bakterielle Dekolonisation der Betroffenen empfohlen.
Schlussfolgerungen
Diese Arbeit fokussiert auf die Pathogenese und Risikofaktoren der rezidivierenden mukokutanen Infektionen durch PVL‐positive S. aureus‐Stämme und versucht einen diagnostischen und therapeutischen Algorithmus zur optimalen Patientenversorgung vorzuschlagen.
Backround: Due to extensive surgical intervention for macroscopic complete cytoreduction in epithelial ovarian cancer (EOC) patients, severe complications in the postoperative course are possible.
A ...total of 345 EOC patients who underwent cytoreductive surgery were retrospectively evaluated regarding risk factors for an unfavorable postoperative course. Possible pre-, intra- and postoperative risk factors were statistically analyzed performing multivariate ordinal logistic regression.
A total of 345 EOC patients underwent cytoreductive surgery. There were no complications in 114 patients, mild complications in 114 patients and severe complications in 117 patients. The risk factor evaluation identified age (p=0.049), smoking (p=0.032) and duration of surgery (p<0.0001) as significant factors for severe postoperative morbidity.
In EOC patients age, smoking and the duration of surgery have significant impact on the postoperative course. Only the duration of surgery can be positively influenced by a well-trained EOC team.
Nosocomial infections caused by antibiotic-resistant pathogens demonstrate the continued need for preventive hygiene management strategies. Information and training of patients in their personal ...hygiene is a current requirement of the German Society for Hospital Hygiene, and is recommended by the Commission for Hospital Hygiene and Infection Prevention (
, KRINKO) at the Robert Koch Institute.
The aim of this study was to evaluate patients' existing knowledge of hygiene and their motivation to actively participate in preventive hygiene measures.
This study included 445 inpatients at the Polyclinic for Surgery of University Hospital Bonn. Subjects were interviewed over a 6-month period using a questionnaire comprising 21 questions on the topic of hygiene.
The majority of patients rated their subjective level of knowledge as intermediate (41%), 25% as poor and 35% as high. The respondents rated the active inclusion of patients in hygiene practices as highly relevant, and were willing to actively contribute to infection prevention, whereby the patients considered hand washing and hand disinfection in particular as important starting points. 78% of the respondents wanted more information on hygiene, particularly on wound and food hygiene. Targeted hygiene education provided by hospital staff had a positive effect on the patients' subjective level of information, as well as on their confidence in physicians and nursing staff. Previous information via television or radio had a negative impact on the patients' subjective information level and on their confidence in hospital staff.
Most surgically treated patients are motivated to actively contribute to preventive hygiene measures. This represents an additional and important option for applying hospital hygiene more effectively and, above all, closer to the patient. Information and education should preferably be performed by healthcare professionals.
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