ABSTRACT
OBJECTIVE: We investigated concurrent outbreaks of Pseudomonas aeruginosa carrying blaVIM (VIM-CRPA) and Enterobacterales carrying blaKPC (KPC-CRE) at a long-term acute-care hospital (LTACH A). METHODS: We defined an incident case as the first detection of blaKPC or blaVIM from a patient's clinical cultures or colonization screening test. We reviewed medical records and performed infection control assessments, colonization screening, environmental sampling, and molecular characterization of carbapenemase-producing organisms from clinical and environmental sources by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. RESULTS: From July 2017 to December 2018, 76 incident cases were identified from 69 case patients: 51 had blaKPC, 11 had blaVIM, and 7 had blaVIM and blaKPC. Also, blaKPC were identified from 7 Enterobacterales, and all blaVIM were P. aeruginosa. We observed gaps in hand hygiene, and we recovered KPC-CRE and VIM-CRPA from drains and toilets. We identified 4 KPC alleles and 2 VIM alleles; 2 KPC alleles were located on plasmids that were identified across multiple Enterobacterales and in both clinical and environmental isolates. CONCLUSIONS: Our response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent CPO outbreaks at LTACH A. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.
Subject(s)
Bacterial Proteins , beta-Lactamases , Humans , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacterial Proteins/genetics , beta-Lactamases/genetics , Hospitals , Klebsiella pneumoniae , Microbial Sensitivity Tests , PlasmidsABSTRACT
In July 2020, the Florida Department of Health was alerted to three Candida auris bloodstream infections and one urinary tract infection in four patients with coronavirus disease 2019 (COVID-19) who received care in the same dedicated COVID-19 unit of an acute care hospital (hospital A). C. auris is a multidrug-resistant yeast that can cause invasive infection. Its ability to colonize patients asymptomatically and persist on surfaces has contributed to previous C. auris outbreaks in health care settings (1-7). Since the first C. auris case was identified in Florida in 2017, aggressive measures have been implemented to limit spread, including contact tracing and screening upon detection of a new case. Before the COVID-19 pandemic, hospital A conducted admission screening for C. auris and admitted colonized patients to a separate dedicated ward.
Subject(s)
COVID-19/therapy , Candida/isolation & purification , Candidiasis/epidemiology , Disease Outbreaks , Hospital Units , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Florida/epidemiology , Humans , Male , Middle AgedABSTRACT
Pregnant Sprague-Dawley rats received 50, 250, and 500 mg/kg/day diisononyl phthalate (DiNP) from GD 12 to 19 via corn oil gavage to study the dose response for effects on fetal male rat sexual development as well as metabolite disposition in the dam and fetus. Monoisononyl phthalate (MiNP), mono(carboxy-isooctyl) phthalate (MCiOP), mono(hydroxyl-isononyl) phthalate (MHiNP), mono(oxo-isononyl) phthalate (MOiNP), and monoisononyl phthalate glucuronide (MiNP-G) were found in all measured tissues. MCiOP was the major metabolite, followed in decreasing order by MiNP, MHiNP, MOiNP, and MiNP-G. Percentage of dose absorbed decreased at 750 mg/kg/day. Testosterone concentration in the fetal testes was reduced at 250 and 750 mg/kg/day. Multinucleated germ cells were increased in the testes of rats at 250 and 750 mg/kg/day. The no observed effect level (NOEL) for this study was 50 mg/kg/day based on increased MNGs and reduced testes testosterone concentration in the fetal rat.
Subject(s)
Endocrine Disruptors/toxicity , Phthalic Acids/toxicity , Sexual Development/drug effects , Testis/drug effects , Testosterone/metabolism , Amniotic Fluid/metabolism , Animals , Endocrine Disruptors/blood , Endocrine Disruptors/pharmacokinetics , Female , Fetus/drug effects , Fetus/physiology , Liver/metabolism , Male , No-Observed-Adverse-Effect Level , Phthalic Acids/blood , Phthalic Acids/pharmacokinetics , Placenta/metabolism , Pregnancy , Rats , Rats, Sprague-Dawley , Testis/metabolism , Testis/pathology , Tissue DistributionABSTRACT
The objective of this study was to compare alcohol urge, drinking behaviour and mood across two beverage conditions (alcohol/soft drink), over multiple drinks. Forty-five (22 men) participants completed two conditions (alcohol/soft-drink). Baseline alcohol urge and mood was measured before an initial drink consumed (0.2 g/kg alcohol or lemonade). Four drinking phases, which provided alcohol and lemonade, followed. Alcohol urge, mood and liking/enjoyment of beverages were measured. Participants' typical drinking habits were recorded, allowing comparisons across drinking factors. Alcohol urge was greater in the alcohol condition (P<0.03), which positively correlated with liking and drinking enjoyment of the alcohol beverage (P<0.04). Binge drinking and weekly alcohol consumption positively related to alcohol urge during the first half of the alcohol condition (P<0.02). Feeling stimulated was positively related to alcohol urge (P<0.01). Sip latency was quickest for alcohol in the alcohol condition (P<0.001) and did not increase over time as in the soft-drink condition (P<0.001). This study presents a paradigm in which alcohol motivation can be assessed within more typical drinking occasion parameters. Urge related to alcohol's positive reinforcing effects. As more alcohol was consumed, a disassociation of liking and wanting alcohol occurred, indicating that different processes may underlie behaviour during different periods of a drinking occasion.
