Seasonal respiratory virus circulation was diminished during the COVID-19 pandemic.

BACKGROUND: Measures introduced during the COVID-19 pandemic intended to address the spread of SARS-CoV-2 may also influence the incidence of other common seasonal respiratory viruses (SRV). This evaluation reports laboratory-confirmed cases of common SRV in a well-defined region of central Canada to address this issue. METHODS: Surveillance data for common non-SARS-CoV-2 SRV in Ottawa, Canada, was provided by the Eastern Ontario Regional Laboratory Association (EORLA) reference virology lab. Weekly reports of the number of positive tests and the proportion that yielded positive results were analyzed from August 26, 2018, to January 2, 2022. RESULTS: A drastic reduction in influenza and other common SRV was observed during the 2020-2021 influenza season in the Ottawa region. Influenza was virtually undetected post-SARS-CoV-2 emergence. Rhinoviruses and enteroviruses were the only viruses that remained relatively unaffected during this period. CONCLUSIONS: We speculated that the introduction of nonpharmaceutical measures including masking to prevent SARS-CoV-2 transmission contributed to the near absence of SRV in the Ottawa region. These measures should remain a key component in addressing spikes in SRV activity and future pandemics.

Robinsoniella peoriensis: An emerging pathogen and rare cause of wound infection in children.

BACKGROUND: Robinsoniella peoriensis is an anaerobic gram-positive bacilli first isolated from swine manure in 2003 but has since been associated with human infections. METHODS: We describe a pediatric case of R. peoriensis infection following a below-knee amputation for a limb injury and its treatment. Methods of identifying R. peoriensis and reported in vitro antimicrobial minimum inhibitory concentrations from the literature are reviewed. RESULTS: R. peoriensis is readily identifiable via 16S rRNA gene sequencing and Matrix-Assisted Laser Desorption Ionization-Time of Flight. There is variability in the antibiotic susceptibility profiles reported in the literature, but antibiotics with low in vitro minimum inhibitor concentrations against R. peoriensis include beta-lactam/beta-lactamase inhibitors, carbapenems, vancomycin, and metronidazole. CONCLUSION: This is the first reported case of R. peoriensis infection following a traumatic injury in Canada to our knowledge and highlights the importance of recognizing this organism and other anaerobes in settings where wounds are grossly contaminated with soil.

HISTORIQUE: Le Robinsoniella peoriensis est un bacille anaérobie à Gram positif d'abord isolé en 2003 dans le lisier de porc, mais qui a été associé à des infections humaines depuis. MÉTHODOLOGIE: Les auteurs décrivent un cas pédiatrique d'infection à R. peoriensis après une amputation au-dessous du genou à cause de la lésion d'un membre et de son traitement. Les chercheurs ont examiné les méthodes pour identifier le R. peoriensis et les concentrations minimales inhibitrices antimicrobiennes in vitro tirées des publications. RÉSULTATS: Le R. peoriensis est facile à identifier au moyen du séquençage du gène d'ARNr 16S et du spectromètre de masse à temps de vol pour la désorption-ionisation laser assistée par matrice. La description des profils de susceptibilité des antibiotiques est variable selon les publications, mais les antibiotiques aux concentrations minimales inhibitrices contre le R. peoriensis sont les bêta-lactamines et les inhibiteurs de bêta-lactamase, les carbapénems, la vancomycine et le métronidazole. CONCLUSION: À la connaissance des auteurs, il s'agit du premier cas déclaré d'infection à R. peoriensis après une lésion traumatique au Canada, ce qui fait ressortir l'importance de tenir compte de cet organisme et d'autres anaérobies lorsque les plaies sont grandement contaminées par de la terre.

Prevalence of Hypogammaglobulinemia in Adult Invasive Pneumococcal Disease.

Background: Patients with humoral immune deficiency are susceptible to invasive pneumococcal disease (IPD). This study estimates the prevalence of underlying hypogammaglobulinemia in admitted IPD cases and examines whether IPD cases had received preventative treatment. Methods: All adult IPD cases (Streptococcus pneumoniae in blood or cerebrospinal fluid) admitted to The Ottawa Hospital (TOH) from January 2013 to December 2015 were identified through the Eastern Ontario Regional Laboratory. Documented clinical demographics, S. pneumoniae serotype, serum immunoglobulins measured previously or in convalescence, and vaccination status of the cases were collected retrospectively for descriptive analyses. Results: There were 134 IPD in 133 patients (47.4% male; mean age 63, standard deviation [SD] = 15.6 years) during a 3-year observation period. All-cause mortality rate was 22.6% over a mean follow-up time of 362, SD = 345 days. Fifty-seven patients (42.9%) had serum immunoglobulin levels measured. Eighteen were either found to have hypogammaglobulinemia in convalescence (8/18) or previously known to have hypogammaglobulinemia (10/18). None of the known hypogammaglobulinemic patients had received antibiotic prophylaxis and/or immunoglobulin replacement therapy within 4 months prior to IPD. The high and low estimates of prevalence of hypogammaglobulinemia were 31.6% (of all measured) and 13.5% (of all cases). Among 18 patients with hematological malignancies in our cohort, 13 had hypogammaglobulinemia. Many isolates were vaccine serotypes; however, only 8 had documented previous pneumococcal vaccination. Conclusions: IPD has high mortality, and hypogammaglobulinemia was present in at least 13.5% of IPD cases. Secondary hypogammaglobulinemia is especially common in cases with hematological malignancy and IPD.

Cost Analysis of Universal Screening vs. Risk Factor-Based Screening for Methicillin-Resistant Staphylococcus aureus (MRSA).

BACKGROUND: The literature remains conflicted regarding the most effective way to screen for MRSA. This study was designed to assess costs associated with universal versus risk factor-based screening for the reduction of nosocomial MRSA transmission. METHODS: The study was conducted at The Ottawa Hospital, a large multi-centre tertiary care facility with approximately 47,000 admissions annually. From January 2006-December 2007, patients underwent risk factor-based screening for MRSA on admission. From January 2008 to August 2009 universal MRSA screening was implemented. A comparison of costs incurred during risk factor-based screening and universal screening was conducted. The model incorporated probabilities relating to the likelihood of being tested and the results of polymerase chain reaction (PCR) testing with associated effects in terms of MRSA bacteremia and true positive and negative test results. Inputted costs included laboratory testing, contact precautions and infection control, private room costs, housekeeping, and length of hospital stay. Deterministic sensitivity analyses were conducted. RESULTS: The risk factor-based MRSA screening program screened approximately 30% of admitted patients and cost the hospital over $780 000 annually. The universal screening program screened approximately 83% of admitted patients and cost over $1.94 million dollars, representing an excess cost of $1.16 million per year. The estimated additional cost per patient screened was $17.76. CONCLUSION: This analysis demonstrated that a universal MRSA screening program was costly from a hospital perspective and was previously known to not be clinically effective at reducing MRSA transmission. These results may be useful to inform future model-based economic analyses of MRSA interventions.

Skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA): an affliction of the underclass.

OBJECTIVE: The objective of this study was to determine whether skin and soft tissue infections (SSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) in patients presenting to The Ottawa Hospital emergency departments (TOHEDs) differed from SSTIs caused by methicillin-susceptible Staphylococcus aureus (MSSA) with regard to risk factors, management, and outcomes. METHODS: All patients seen at TOHEDs in 2006 and 2007 with SSTIs who yielded MRSA or MSSA in cultures from the site of infection were eligible for inclusion. We excluded patients with decubitus ulcers and infections related to diabetes or peripheral vascular disease. We used an unmatched case-control design. Cases were defined as patients with MRSA isolated from the infection site, and controls were defined as patients with MSSA isolated from the infection site. Data were collected retrospectively from health records and laboratory and hospital information systems. RESULTS: A total of 153 patients were included in the study (81 cases and 72 controls). The mean age of cases was 37 years, compared to 47 years for the controls (p < 0.001). Cases were more likely to have transient residence (31% v. 3% [OR 15.6, 95% CI 3.9-61.8, p < 0.001]), present with abscesses (64% v. 15% [OR 9.9, 95% CI 4.3-23.7, p < .001]), have a documented history of hepatitis C infection (28% v. 3% [OR 13.9, 95% CI 3.9-55.0, p < 0.001]), and have a history of substance abuse (53% v. 10% [OR 10.5, 95% CI 4.4-25.1, p < 0.001]). Cases most commonly used crack cocaine and injection drugs. CONCLUSION: SSTIs caused by MRSA at TOHEDs mainly occur in a population that is young and transient with comorbidities such as hepatitis C and substance abuse.