Role of noscomial infection informatics surveillance system in the prevention and control of multidrug-resistant organisms infections

OBJECTIVE: To analyze the role of nosocomial infection informatics surveillance system in the prevention and control of multidrug-resistant organisms(MDROs) infections. METHODS: The First Affiliated Hospital of Guangdong Pharmaceutical University was selected as the study subjects, which had adopted the nosocomial infection informatics surveillance system since Jan.2020. The period of Jan.to Dec.2020 were regarded as the study period, and Jan.to Dec.2019 were regarded as the control period. The situation of nosocomial infection and MDROs infections in the two periods were retrospectively analyzed. RESULTS: The incidence of nosocomial infections and underreporting of nosocomial infection cases in this hospital during the study period were 2.52%(1 325/52 624) and 1.74%(23/1 325), respectively, and the incidences of ventilator associated pneumonia(VAP), catheter related bloodstream infection(CRBSI), catheter related urinary tract infection(CAUTI)were 4.10(31/7 568), 2.11(14/6 634), and 2.50(25/9 993) respectively, which were lower than those during the control period(P< 0.05). The positive rate of pathogenic examination in the hospital during the study period was 77.95%(1 269/1 628), which was higher than that during the control period(P<0.05), the overall detection rate of MDROs was 15.77%(206/1 306), the detection rates of MDROs in Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus epidermidis, Pseudomonas aeruginosa and Staphylococcus aureus were lower than those during the control period(P<0.05). CONCLUSION: The development and application of the informatics technology-based surveillance system of nosocomial infection could effectively reduce the incidence of nosocomial infections and device related infections, decrease the under-reporting of infection cases, and also reduce the detection rate of MDROs as well as the proportion of MDROs detected in common pathogenic species.

Managing infection prevention and control in the emergency care setting: an overview for emergency nurses.

The control and prevention of infection in emergency departments (EDs) remains challenging because of the complexity of the environment and the consistently high attendance in many EDs. Emergency nurses play an essential role in infection prevention and control in this clinical area. The COVID-19 pandemic has refocused the need for emergency nurses to have a good knowledge and understanding of infection control processes and the clinical skills to protect themselves and patients alike. This article provides an overview of UK epidemiological perspectives, the main pathogens associated with healthcare infections, the importance of reducing pathogen transmission and the emergency nurse's role in antibiotic stewardship.

Role of antiseptics in the prevention and treatment of infections in nursing homes.

Inadequate infection control, wound care, and oral hygiene protocols in nursing homes pose challenges to residents' quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine. Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can lead to resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in-vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity. Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.

CEFAZOLIN-INDUCED COAGULOPATHY

SESSION TITLE: Critical Thinking SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 09:15 am - 10:15 am INTRODUCTION: Cephalosporins have been known to cause hypo-prothrombinemia and prothrombin prolongation (1). The proposed mechanism of this coagulopathy is secondary to a N-methylthiotetrazole side chain interfering with vitamin-k metabolism (1). Current literature supporting the association between cefazolin and hypo-prothombinemia have only been reported through case reports. As cefazolin is a commonly used antibiotic, it is important that healthcare professionals are aware of its potential bleeding risk. We present a case of a 72 year old female with cefazolin-induced hypo-prothrombinemia. CASE PRESENTATION: A malnourished 72-year old female with a past medical history of recent methicillin-susceptible Staphyloccocus aureus (MSSA) bacteremia and COVID-19 pneumonia presented to the emergency department from a skilled nursing facility (SNF) due to shortness of breath. The patient was previously discharged to SNF to complete a 14 day course of IV cefazolin due to her MSSA bacteremia. On admission, vital signs were significant for a respiratory rate of 22 and a pulse oximetry reading of 78% on room air. Laboratory findings were significant for an elevated prothrombin time of >100 seconds, an INR >15, and a D-dimer of 42,344 ng/mlL. A computed tomography angiography (CTA) of the chest revealed a small segmental pulmonary embolus in the right lower lobe of the lung. The patient was started on a heparin drip, placed on a non-rebreather mask, and admitted to the ICU for closer monitoring. Infectious disease was consulted and cefazolin was discontinued. Due to the patient's risk of bleeding her heparin drip was stopped. It was decided not to reverse the patient's coagulopathy with vitamin K as there were no signs of an acute bleed in the setting of an acute pulmonary embolus. The patient was started on nafcillin in place of cefazolin. Four days after discontinuation of cefazolin, the patient's INR had trended down from >15 to 1.6 and she was started on Lovenox 1mg/kg for the treatment of her acute PE. DISCUSSION: Due to the timing of the discontinuation of cefazolin and the correction of the hypo-prothrombinemia, a clear association between the two can be made. It has been proposed that cefazolin's side chain, heterocyclic thiol, 2-methyl-1,3,4-thiadiazole-5-thiol (MTD), causes a similar reaction that other cephalosporins have on the metabolism of Vitamin K (2). This altered Vitamin K metabolism was also likely exacerbated due to the patient's malnourishment and likely depleted vitamin k reserves (2). CONCLUSIONS: Although rare, this case demonstrates the need for clinicians to be aware of the potential bleeding risk associated with cephalosporins and cefazolin in particular. In the future, routine monitoring of PT/INR levels may be recommended when initiating cephalosporins. Reference #1: Park GH, Kim S, Kim MS, Yu YM, Kim GH, Lee JS, Lee E. The Association Between Cephalosporin and Hypoprothrombinemia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2019 Oct 16;16(20):3937 Reference #2: Shearer, M. J., Bechtold, H., Andrassy, K., Koderisch, J., McCarthy, P. T., Trenk, D., Jähnchen, E., & Ritz, E. (1988). Mechanism of cephalosporin-induced hypoprothrombinemia: relation to cephalosporin side chain, vitamin K metabolism, and vitamin K status. Journal of clinical pharmacology, 28(1), 88–95 DISCLOSURES: no disclosure on file for John Abernathy;No relevant relationships by Ethan Goldberg No relevant relationships by Renee Miu No relevant relationships by Luis Osorio no disclosure on file for Satesh Saroop;no disclosure on file for Oliver Sevilla;no disclosure on file for Kristen Zubel;

Antimicrobial resistance patterns of bacterial and fungal isolates in COVID-19

Background: The pattern of bacterial infection in coronavirus disease 2019 (COVID-19) patients differ worldwide. Objectives: This study aimed to determine the patterns of bacterial infections and the antibiotic resistance profile by VITEK 2 (bioMerieux, France) in the culture of blood samples from hospitalized patients with COVID-19.

Bacterial, fungal and viral zoonoses of pets

Today, pets are the source of numerous infectious diseases that can be transmitted to humans, as a result of their increasingly frequent contact. The most important viruses with zoonotic potential include rabies and influenza viruses as well as rotaviruses and noroviruses. However, the importance of individual viruses varies depending on the climate and infectious disease control systems in certain countries. Dogs, cats, and other increasingly popular types of pets can transmit bacterial zoonotic agents to humans in various ways. In addition to known pathogens such as the bacteria causing leptospirosis, salmonellosis, campylobacteriosis, or brucellosis, the bacteria Pasteurella multocida and Bartonella henselae transmitted by bites or scratches are also significant in human pathology. There has been a significant increase in the prevalence of methicillin-resistant strains of Staphylococcus aureus in isolates originating from pets and the transmission of these strains between humans and animals requires special attention. Furthermore, fungi causing diseases such as sporotrichosis or dermatophytosis are linked to long-term and persistent infections in humans. The epidemiological situation caused by SARS-CoV-2, and the assumption of an interspecies jump of this virus from animals to humans, including its documented presence in domestic cats, dogs, tigers, and martens, have raised the question of the possibility of virus transmission from pets to humans. However, the current pandemic is caused exclusively by SARS-CoV-2 transmission in the human population, and these animals are not a source of infection for humans. A significant number of zoonoses originating from pets is a threat to public health, thus requiring the "One Health" approach through close cooperation between human and veterinary medicine to develop and implement effective health measures for both humans and animals. As part of responsible ownership, pet owners must be informed by veterinarians about measures to prevent infectious diseases and certain risks that are related to keeping certain species of animals.

LEUKOCYTOCLASTIC VASCULITIS IN MITRAL VALVE ENDOCARDITIS

Background: Vasculitis is a known, although not commonly observed, manifestation of bacterial endocarditis. It is imperative that diagnosis is made promptly and appropriately treated, as vasculitis can often be painful and uncomfortable for patients. Case: 75-year-old male is admitted to the hospital for Coronavirus Disease 2019 (COVID-19). Several weeks after recovering from his respiratory infection, patient developed a diffuse, purpuric rash that began on his forearms and gradually spread throughout his bilateral upper extremities to his hands and fingers, as well as to his shoulders and lateral chest. Skin biopsy was performed and revealed findings suggestive of leukocytoclastic vasculitis. Blood work revealed Methicillin Resistant Staph Aureus (MRSA) bacteremia, sensitive to Vancomycin. Transthoracic echocardiogram revealed native mitral valve endocarditis. Transesophageal echocardiogram was not performed due to patient's underlying comorbidities and high risk. Decision-making: Patient was diagnosed with leukocytoclastic vasculitis secondary to bacterial endocarditis. Rheumatologic workup, including antineutrophil cytoplasmic antibodies, antinuclear antibodies, serum complement levels, anti-smith antibodies and double stranded deoxyribonucleic acid, was negative. Patient was ultimately discharged on a prolonged course of Vancomycin and his diffuse rash resolved one month later. Conclusion: There are only a few case reports describing the direct association between leukocytoclastic vasculitis and infective endocarditis. It is important to consider the association of vasculitis and endocarditis in order to effectively treat because immunosuppression, particularly with steroids, is the gold standard treatment for vasculitis. Our patient experienced near complete resolution of the rash after completion of antibiotics and no other therapy was deemed necessary.

Air dispersal of meticillin-resistant Staphylococcus aureus in residential care homes for the elderly: implications for transmission during the COVID-19 pandemic.

BACKGROUND: Meticillin-resistant Staphylococcus aureus (MRSA) infections are rampant in hospitals and residential care homes for the elderly (RCHEs). AIM: To analyse the prevalence of MRSA colonization among residents and staff, and degree of environmental contamination and air dispersal of MRSA in RCHEs. METHODS: Epidemiological and genetic analysis by whole-genome sequencing (WGS) in 12 RCHEs in Hong Kong. FINDINGS: During the COVID-19 pandemic (from September to October 2021), 48.7% (380/781) of RCHE residents were found to harbour MRSA at any body site, and 8.5% (8/213) of staff were nasal MRSA carriers. Among 239 environmental samples, MRSA was found in 39.0% (16/41) of randomly selected resident rooms and 31.3% (62/198) of common areas. The common areas accessible by residents had significantly higher MRSA contamination rates than those that were not accessible by residents (37.2%, 46/121 vs. 22.1%, 17/177, P=0.028). Of 124 air samples, nine (7.3%) were MRSA-positive from four RCHEs. Air dispersal of MRSA was significantly associated with operating indoor fans in RCHEs (100%, 4/4 vs. 0%, 0/8, P=0.002). WGS of MRSA isolates collected from residents, staff and environmental and air samples showed that ST 1047 (CC1) lineage 1 constituted 43.1% (66/153) of all MRSA isolates. A distinctive predominant genetic lineage of MRSA in each RCHE was observed, suggestive of intra-RCHE transmission rather than clonal acquisition from the catchment hospital. CONCLUSION: MRSA control in RCHEs is no less important than in hospitals. Air dispersal of MRSA may be an important mechanism of dissemination in RCHEs with operating indoor fans.

Infection Prevention during Use of a Warm Zone Model in Cohort Patient Care Locations during the COVID-19 Pandemic

Background. The COVID-19 pandemic required hospitals to care for influxes of patients in cohort locations during critical shortages of personal protective equipment (PPE). Safety zones can be used to protect healthcare workers caring for patients with infectious pathogens. During the COVID-19 pandemic, our hospital developed a Warm Zone model (WZM) to streamline the care of patients with COVID. We established specific areas in our COVID cohort units where staff were permitted to bridge between rooms without doffing gowns, but still doffing gloves and performing hand hygiene between patients. We recognized that a WZM could inadvertently increase risk of nosocomial transmission of pathogens if gowns acted as fomites. For this reason, patients with known infectious pathogens were excluded from the WZM. To measure for unintended harmful consequences of the WZM, our Infection Prevention (IP) department performed surveillance for hospital onset (HO) Clostridioides difficile (CDI), Carbapenemresistant enterobacteriaceae (CRE) and Methicillin-resistant Staphyloccocus aureus (MRSA) bloodstream infections on units that implemented the WZM. Methods. Two intensive care units and 3 wards where COVID positive patients were cohorted were included in surveillance. The timeframe for this analysis was 7/1/2020 - 3/31/2021. An electronic surveillance system was used to measure HO infections. The National Healthcare Surveillance Network (NHSN) LabID definitions were used when determining HO CDI and MRSA bloodstream infections (BSI). Results. During the study period, there were no HO CRE, 1 HO CDI, and 2 HO MRSA BSI in cohort units. There was no evidence to suggest that the HO CDI or HO MRSA BSI were associated with use of a WZM. During this time period, there were 14 cases of community onset (CO) CDI, 2 cases of CO MRSA BSI, and one CO CRE. Conclusion. During use of a WZM in COVID cohort units, IP did not identify significant increase in HO CDI, CRE, or MRSA BSI compared to non-cohort units. We were limited in our ability to measure acquisition of pathogens because active surveillance screening for colonization was not performed. However, we were able to safely employ a WZM to streamline patient care in COVID cohort areas without evidence of causing nosocomial infections via patient-to-patient transmission.

Nasal MRSA screen performance after intranasal povidone iodine decolonization

INTRODUCTION: The nasal methicillin resistant Staphyloccocus aureus (MRSA) polymerase chain reaction (PCR) screen has important antimicrobial stewardship implications for respiratory infections. The MRSA PCR test has a high negative predictive value for MRSA pulmonary infections. Universal decolonization with mupirocin prior to the assay may reduce the reliability of the screen. Intranasal povidone iodine is an alternative agent used for universal decolonization in the ICU. The impact of the nasal MRSA PCR screen's negative predictive value after the use of intranasal povidone iodine has not been evaluated, so our objective was to evaluate the performance of the nasal MRSA screening test after administration of povidone iodine. METHODS: We conducted a single-center, retrospective study that evaluated the performance of a nasal MRSA screen in critically ill, adult patients undergoing intranasal povidone iodine suppression from January 1st, 2020 to June 1st, 2021. Patients were included if they received intravenous vancomycin for a suspected pulmonary infection and had blood and/or respiratory cultures available. Exclusion criteria were as follows: coinfection from a presumed nonpulmonary source, known MRSA infection in the 30 days prior to the MRSA nasal screen, more than one dose of an anti-MRSA agent (other than vancomycin) prior to the PCR assay, MRSA screen more than 14 days before suspected infection, pregnancy, incarceration, and active severe acute respiratory syndrome coronavirus 2 infection. The primary outcome was the negative predictive value of the nasal MRSA screen. RESULTS: A total of 201 patients were screened for eligibility. 150 patients were excluded leaving 51 patients eligible for analysis. 32 patients received povidone iodine before the MRSA screen, and 19 patients received povidone iodine after the MRSA screen. Notably, none of the included patients had a positive MRSA culture. The negative predictive value of the nasal MRSA screen was 100% in both groups. Furthermore, specificity of the screen was 90.6% and 94.7% in the before and after groups, respectively. CONCLUSIONS: Preliminary data from this project suggests that the MRSA PCR screen may retain its reliability even if conducted after the administration of povidone iodine. Further prospective studies are needed to validate these results.

Antibiotic use and antibiotic resistance in French healthcare facilities in 2020: data from the national Spares network

The nationwide surveillance network coordinated by the project for Surveillance and Prevention of Antibiotic Resistance in hospitals (SPARES) collected information on antibiotic use and antibiotic resistance from 1,752 and 1,066 hospitals, respectively, in 2020. Antibiotic consumption for inpatients was 286 defined daily doses (DDD) per 1,000 patient-days (PD) and ranged from 38 DDD/1,000 PD in psychiatric wards to 1,145 in intensive care units (ICUs). The proportion of broad-spectrum antibiotics, according to the ECDC indicator for hospitals, was 35%. In a cohort of hospitals, antibiotic use was higher than the preceding year with a higher proportion of broad-spectrum antibiotics. Among Enterobacteriaceae strains, 8.3% produced extended spectrum beta-lactamase (ESBL) and 0.2% a carbapenemase. Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 14% of S. aureus. Proportions of ESBL-Enterobacteriaceae and of MRSA were lower than in 2019, consistent with previous trends. However, the higher incidence of ESBL-Enterobacteriaceae, in a context of specific hospital activity due to the Covid-19 crisis in 2020, will be further explored. Despite the ongoing health crisis, hospitals were able to monitor their situation regarding antimicrobial resistance;this underscores the usefulness of the SPARES network for providing information that can steer policies to control antimicrobial resistance.