Comparison of methods for sampling and detection of carbapenemase-producing organisms in clinical hand wash basin drains in healthcare.

There are currently no standardised methods for the sampling and testing of clinical hand wash basin (HWB) samples for the detection of carbapenemase-producing organisms (CPO). Methods of sampling (drain aspirate versus swab from top of drain) and detection of CPO in clinical HWB drains in two different healthcare settings, one which was dealing with a hospital wide outbreak of CPO (hospital A) and another with no reported outbreaks (hospital B) were compared. Drain aspirates and swabs from HWB drains were tested using multiplex PCR together with culture-based methods. No significant difference in detection of CPO was found between drain aspirate or swab methods of sampling. Direct PCR on samples detected significantly more carbapenemase genes than culture on CARBA agar (p < 0.0001 and 0.0045 respectively). A higher percentage of HWB drains were positive in hospital A both by culture and direct PCR, and a significantly higher number of carbapenemase genes were detected in hospital A HWB drain aspirate both by PCR and culture (p = 0.014 and 0.0071 respectively). There was a high correlation between drain swab positivity by PCR and culture in hospital A (91%) compared to hospital B where it was only 33%. No difference could be found in drain contamination rates when HWB with rear drain was compared against those with drain directly below the tap. Colonisation of HWB at the top of the drain may be related to risk of cross transmission of CPO from healthcare environment to patients.

Recurrent Campylobacter jejuni Infection in an Immunodeficient Patient Treated with Repeated Faecal Microbiota Transplant (FMT)-A Case Report.

There is limited evidence to guide successful treatment of recurrent Campylobacter infection in patients with common variable immunodeficiency (CVID) already managed on regular immunoglobulin therapy. The role of faecal microbiota transplant (FMT) is uncertain. We report a case of recurrent Campylobacter jejuni infection in a patient with CVID treated with repeated FMT with 18 months of symptom resolution prior to relapse.

Clostridium difficile infection in pregnant and postpartum women in 2 hospitals and a review of literature.

BACKGROUND: Healthcare-associated Clostridium difficile infection (CDI) in pregnant/postpartum women is underreported, especially outside of North America. We report a cluster of cases in 2 neighboring secondary care hospitals in South-East England. The objective of this study was to identify the epidemiology and risk factors for infection. METHODS: An investigation into a cluster of cases of confirmed CDI in pregnant/postpartum women was performed over a 12-month period, from June 2016 to June 2017. RESULTS: Eleven cases, in 10 patients, were identified, including 1 patient who had a relapse. Eight of 10 patients developed symptoms after hospital discharge. All patients had received broad-spectrum antibiotics prior to CDI onset. Environmental vectors, such as labor room mattresses, that were found difficult to effectively decontaminate after heavy contamination with blood, feces, and other body fluids may have been possible reservoirs. An infection control care bundle was successful in preventing further cases. CONCLUSIONS: Antibiotic use and exposure to the organism in a contaminated labor room environment are likely risk factors for healthcare-associated CDI in postpartum women. Active surveillance is necessary to prevent these infections, as these cases often present after hospital discharge.

What are the critical steps in processing blood cultures? A prospective audit evaluating current practice of reporting blood cultures in a centralised laboratory serving secondary care hospitals.

AIMS: To assess current procedures of processing positive blood cultures against national standards with an aim to evaluate its clinical impact and to determine the utility of currently available rapid identification and susceptibility tests in processing of blood cultures. METHODS: Blood cultures from three secondary care hospitals, processed at a centralised laboratory, were prospectively audited. Data regarding processing times, communication with prescribers, changes to patient management and mortality within 30 days of a significant blood culture were collected in a preplanned pro forma for a 4-week period. RESULTS: Of 2206 blood cultures, 211 positive blood cultures flagged positive. Sixty-nine (3.1%) of all cultures were considered to be contaminated. Fifty per cent of blood cultures that flagged positive had a Gram stain reported within 2 hours. Two (0.99%) patients with a significant bacteraemia had escalation of antimicrobial treatment at the point of reporting the Gram stain that was subsequently deemed necessary once sensitivity results were known. Most common intervention was de-escalation of therapy for Gram-positive organisms at the point of availability of pathogen identification (25.6% in Gram positive vs 10% in Gram negative; p=0.012). For Gram-negative organisms, the most common intervention was de-escalation of therapy at the point of availability of sensitivity results (43% in Gram negatives vs 17.9% in Gram positive; p=0.0097). Overall mortality within 30 days of a positive blood culture was 10.9% (23/211). Antibiotic resistance may have contributed to mortality in four of these patients (three Gram negative and one Gram positive). CONCLUSION: Gram stain result had the least impact on antibiotic treatment interventions (escalation or de-escalation). Tests that improve identification time for Gram-positive pathogens and sensitivity time for Gram-negative pathogens had the greatest impact in making significant changes to antimicrobial treatment.

Herpetic neonatal pustular rash.

Pustular rash in a neonate is very common and is usually associated with staphylococcal infection. The present report describes the case of a 12-day-old neonate with a pustular rash, secondary to herpes simplex infection. A high index of suspicion is necessary in neonates presenting with suggestive signs, especially with negative bacterial cultures. Prompt initiation of aciclovir treatment after obtaining diagnostic samples may be life-saving.