Background Hospital outbreaks of epidemiologically important pathogens are usually caused by lapses in infection control measures and result in increased morbidity, mortality, and cost. However, ...there is no benchmark to compare the occurrence of hospital outbreaks across hospitals. Methods We implemented proactive infection control measures with an emphasis on timely education of health care workers and hospitalized patients at Queen Mary Hospital, a teaching hospital. Our benchmarked performance (outbreak episodes per 1 million patient discharges and 1 million patient-days) was compared with those of other regional public hospitals without these additional proactive measures in place between 2010 and 2014. Results During the study period, Queen Mary Hospital had 1 hospital outbreak resulting in 1.48 and 0.45 outbreak episodes per 1 million patient discharges and patient-days, respectively, values significantly lower than the corresponding overall rates in the 7 acute regional hospitals (24.26 and 6.70 outbreak episodes per 1 million patient discharges and patient-days, respectively; P < .001) and that of all 42 public hospitals in Hong Kong (41.62 and 8.65 outbreak episodes per 1 million patient discharges and patient-days, respectively; P < .001). Conclusions The results of this large study on benchmarked rate of hospital outbreaks per patient discharges or patient-days suggests that proactive infection control interventions may minimize the risk of hospital outbreaks.
Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs ...yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization. Infect Control Hosp Epidemiol 2016;37:983-986.
Nitrogen pollution increases the susceptibility of corals to heat-induced bleaching. However, different forms of nitrogen (nitrate vs. ammonium/urea) may have different impacts on thermal tolerance ...of corals. We used an 18-month field experiment on the oligotrophic fore reef of Moorea, French Polynesia, to test how different forms of nitrogen (nitrate vs. urea) impacted coral bleaching. The experiment spanned two moderate thermal stress events in 2016 and 2017. Nitrate increased bleaching prevalence in Acropora by up to 100% and in Pocillopora by up to 60% compared to control corals. Urea exposure often had intermediate effects on bleaching (not different from either control or nitrate-exposed corals) in both taxa. Importantly, nitrate prolonged bleaching in both Acropora and Pocillopora as nitrate-exposed corals remained bleached even after thermal stress ended, while control and urea-exposed corals had mostly recovered. Nitrate exposure also increased the prevalence of partial mortality in Pocillopora colonies and more than tripled the number of colonies that completely died. Our data are the first to show contrasting effects of different forms of nitrogen on coral bleaching and mortality in a natural reef environment, linking previous patterns from large-scale correlative studies with results from more mechanistic laboratory experiments. Most importantly, we showed that corals exposed to nitrate exhibited more frequent bleaching, bleached for longer duration, and were more likely to die than corals in low nitrogen conditions. Exposure to excess nitrogen, particularly anthropogenic nitrogen, may lower the temperature threshold at which corals bleach, triggering bleaching events on polluted reefs even when typical thermal stress thresholds have not been crossed.
OBJECTIVE To study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs). METHODS We analyzed 31,526 patients ...with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction. RESULTS Of 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 95% CI, 1.15-3.18, P=.013), presence of wound or drain (3.12 1.70-5.71, P<.001), and use of cephalosporins (3.06 1.42-6.59, P=.004), carbapenems (2.21 1.10-4.48, P=.027), and PPIs (2.84 1.72-4.71, P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3-411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 95% CI, 0.17-0.73, P=.005). CONCLUSIONS Concomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE. Infect Control Hosp Epidemiol 2016;1418-1425.
To identify potential biomarkers for improving diagnosis of melioidosis, we compared plasma metabolome profiles of melioidosis patients compared to patients with other bacteremia and controls without ...active infection, using ultra-high-performance liquid chromatography-electrospray ionization-quadruple time-of-flight mass spectrometry. Principal component analysis (PCA) showed that the metabolomic profiles of melioidosis patients are distinguishable from bacteremia patients and controls. Using multivariate and univariate analysis, 12 significant metabolites from four lipid classes, acylcarnitine (n = 6), lysophosphatidylethanolamine (LysoPE) (n = 3), sphingomyelins (SM) (n = 2) and phosphatidylcholine (PC) (n = 1), with significantly higher levels in melioidosis patients than bacteremia patients and controls, were identified. Ten of the 12 metabolites showed area-under-receiver operating characteristic curve (AUC) >0.80 when compared both between melioidosis and bacteremia patients, and between melioidosis patients and controls. SM(d18:2/16:0) possessed the largest AUC when compared, both between melioidosis and bacteremia patients (AUC 0.998, sensitivity 100% and specificity 91.7%), and between melioidosis patients and controls (AUC 1.000, sensitivity 96.7% and specificity 100%). Our results indicate that metabolome profiling might serve as a promising approach for diagnosis of melioidosis using patient plasma, with SM(d18:2/16:0) representing a potential biomarker. Since the 12 metabolites were related to various pathways for energy and lipid metabolism, further studies may reveal their possible role in the pathogenesis and host response in melioidosis.
Abstract The clinical workflow of using chromogenic agar and matrix-assisted laser desorption ionization time-of-fight mass spectrometry (MALDI-TOF MS) for Clostridium difficile identification was ...evaluated. The addition of MALDI-TOF MS identification after the chromID C. difficile chromogenic agar culture could significantly improve the diagnostic accuracy of C. difficile.
Talaromyces marneffei
, previously known as
Penicillium marneffei
, is the most important pathogenic thermally dimorphic fungus causing systemic mycosis in Southeast Asia. Traditionally,
T. marneffei
...infection in human was mainly associated with acquired immunodeficiency syndrome caused by HIV infection. In recent years, there has been an increasing number of
T. marneffei
infections reported in non-HIV-infected patients with other immunocompromised conditions, including autoantibodies against interferon-gamma, systemic lupus erythematosis, solid organ transplantation, Job’s syndrome, hematological malignancies, and use of novel targeted therapies. In this article, we describe the first case of fatal
T. marneffei
infection in a patient with underlying autoimmune hepatitis, presented as fever without localizing features. The diagnosis of talaromycosis was confirmed with the identification of the fungi isolated from the blood culture specimen by conventional methods and using matrix-assisted laser desorption–ionization time-of-flight mass spectrometer. This case shows the importance of a high index of suspicion, particularly for such a highly fatal but potentially treatable fungal infection.
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