Increase in Community Acquired S. aureus Bloodstream Infection Associated with the Sars-Cov-2 Public Health Emergency.

Aim In March 2020, a public health emergency related to COVID-19 was declared in Ireland, resulting in certain healthcare restrictions. We hypothesised, in the microbiology laboratory in Galway University Hospital (GUH), that the national lockdown would impact results from our blood culture service. Methods A surveillance review of all blood cultures received in the microbiology laboratory in GUH for the six-month period March-August 2020 was performed and compared to the same time-period for the preceding four years. Patient demographics and blood culture isolates were collected and reviewed. Results From March to August 2020, 5,753 blood culture sets were tested, of which 6.1% (n=351) were positive; a lower positivity rate than in previous years. In 2020, 46 S. aureus isolates were detected in blood cultures (representing 13.1% of all 351 positive blood cultures), which was significantly higher than 2016-2019. Conclusion The higher number of reported S. aureus bloodstream infections in the SARS-CoV-2-era was unexpected.

Successful termination of sustained transmission of resident MRSA following extensive NICU refurbishment: an intervention study.

BACKGROUND: Neonatal sepsis is a leading cause of morbidity and mortality in neonatal units worldwide. Meticillin-resistant Staphylococcus aureus (MRSA) has become a leading causative pathogen. Many neonatal units experience endemic colonization and infection of their infants, which is often very challenging to successfully eradicate. AIM: To assess the impact of neonatal unit refurbishment and redesign on endemic MRSA colonization and infection. METHODS: A retrospective review was carried out over an eight-year period in a 14-cot, level 2-3 neonatal unit in University Hospital Galway, a large university teaching hospital in the West of Ireland. Surveillance, colonization, and infection data for a four-year period pre and four-year period post neonatal unit refurbishment are described. Clinical and microbiological data were collected on all MRSA-colonized and -infected infants between 2008 and 2015. Molecular typing data are available for MRSA isolates. An interrupted time-series design was used, with unit refurbishment as the intervention. FINDINGS: Our neonatal unit had a pattern of sustained transmission of endemic resident MRSA strains which we could not eradicate despite repeated standard infection control interventions. Complete unit refurbishment led to successful termination of sustained transmission of these strains. Colonization decreased and no infants were actively infected post refurbishment of the unit. CONCLUSION: We report successful termination of sustained transmission of endemic strains of MRSA from our neonatal unit following complete unit redesign and refurbishment.

Geographic distribution and incidence of Lyme borreliosis in the west of Ireland.

BACKGROUND: Lyme borreliosis is caused by Borrelia burgdorferi and is the most common tick-transmitted infection in temperate regions. Infection often presents with erythema migrans and/or other clinical features in early infection. METHODS: Blood samples are submitted for testing for antibodies to Borrelia burgdorferi by enzyme immunoassay and positive samples are confirmed by a reference laboratory by IgG and IgM line immune assay. A retrospective extraction of all laboratory requests and results for Lyme borreliosis from 2011 to 2014 was performed. Patient addresses were mapped to local electoral area (LEA). RESULTS: The total number of requests was 5049 and 242 (5%) were positive over 5 years. The number of positive and tested samples were 40/748, 45/905, 41/947, 73/1126 and 43/1323 from 2011 to 2014. Even though the number of requests increased over the years, there was no significant increase in the number of positives. Incidences per 100,000 population for requests and positives were calculated at LEA level and showed considerable variation. The highest incidence was shown in one LEA (Connemara) with nearly 500 requests and 43 positives per 100,000 population per year. CONCLUSIONS: Increased awareness may explain the increase in requests. There is no indication of an increase in incidence. As many GPs treat suspected Lyme borreliosis empirically without testing and as antibody may be undetectable early in the course of illness, the true incidence of infection is likely to exceed the number of laboratory-confirmed cases.

Antifungal susceptibility testing and candidaemia at a tertiary referral hospital.

Candidaemia is associated with a high mortality. We have reviewed cases of candidaemia over a 2-year period at a tertiary referral hospital in association with the introduction of routine antifungal susceptibility testing. The aim of the study was two fold; firstly to establish the typical profile of a patient who might experience a Candida bloodstream infection and secondly, to evaluate methods of antifungal susceptibility testing. In 2008-2009, 31 patients with candidaemia were retrospectively identified using the Laboratory Information Systems (Apex). Clinical data were obtained by chart review. Antifungal susceptibility testing to fluconazole and voriconazole was carried out on 20 of the clinical isolates using three different methods. These isolates were also sent to the mycology reference laboratory at Bristol and results were compared. The male-to-female ratio was 2.1:1 with an age range from 6 weeks to 89 years. Candida albicans was the predominant species (n= 17). Patients were predominantly general surgical (39%), oncology (16%) and urology (13%). Identified risk factors included treatment with broad-spectrum antimicrobial agents (89%), central venous catheters (CVCs) (89%), and surgery during the current admission (54%). The crude mortality rate (death prior to discharge) was 42%. Only 1 of the 20 isolates tested, a Candida glabrata, tested resistant to fluconazole. Of 3 antifungal susceptibility test systems evaluated (VITEK 2, TREK Sensititre YeastOne and CLSI disk diffusion); the VITEK 2 system was considered most appropriate for routine use in our laboratory. Retrospective review of therapy identified 7 patients treated with echinocandins in whom susceptibility testing indicated that fluconazole could have been used with significant reduction in cost of therapy.

Comparison of BACTEC MGIT 960 and BACTEC 460 for culture of Mycobacteria.

We have compared the BACTEC 460 system with the BACTEC MGIT 960 system for culture of mycobacteria from 1800 routine clinical specimens. Rate of isolation of M. tuberculosis and time to detection of positive culture was comparable for both systems (BACTEC 460, 35 isolates, BACTEC MGIT 960, 34 isolates). Contamination of cultures was more common with the BACTEC MGIT 960 system. With intensification of the decontamination process an acceptable contamination rate was achieved in the BACTEC MGIT 960 system but time to detection of positive culture was increased by 1 to 2 days.