Year: 2015

Man’s best friend fetching noro

Andreas Voss (@AVIPNL) Norovirus , ,

Schermafbeelding 2015-07-08 om 17.25.43

Caffy et al. identified man’s best friend, dogs (sorry for all those cat lovers), as a possible source of human norovirus.   The UK-based-researcher showed that different genotypes of human norovirus-like particles can bind to canine gastrointestinal tissue, suggesting that infection is (theoretically) possible.  In addition, some of the dogs mounted an immune response to human norovirus.

How much of a problem do we actually have? Time to let Bella & Buster go?

In my opinion this seems still to be unclear. Neither do we know whether dogs could shed human norovirus in quantities necessary to cause infections in humans, nor (and most importantly) did the researchers succeed to detected human norovirus in the canine feces samples. Thus, so far no reason to switch your best friend with a gold fish – which, by the way, might carry the risk of atypical mycobacteria!

Caddy Sl et al.  J Clin Microbiol. 2015 Jun;53(6):1873-83. doi: 10.1128/JCM.02778-14. Epub 2015 Apr 1
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CRE winging its way around the world

Jon Otter (@jonotter) CRE , , , ,

aeroplane

CRE are known to be adept at hitchhiking around the world, hence the focus on cross-border transmission in Europe. A startling example of this comes in a report from Poland result from the terrorist shootings in Tunisia. Two Polish nationals seriously injured in the shootings were repatriated following a 10-day stay in a hospital in Tunis, Tunisia. A grand total of four CREs were identified from the two patients!

Three of these were identified at the time of admission, so almost certainly originated in Tunisia. The fourth CRE was identified 10 days after repatriation to Poland. The authors suggest that the most likely explanation for this is poor sensitivity of admission screening. I venture, however, that it’s more likely due to in-hospital transmission in Poland, since the two patients were treated by the same staff.

Nonetheless, the most troublesome finding here is that at least three separate CREs were imported into Poland by just two patients. Can anybody find me a paper on the prevalence and epidemiology of CRE in Tunisia? No? Thought not. The implication here is that CRE is already far more established than feared in Tunisia and many other parts of the world!

Image: Aeroplane.

MRSA in Denmark

Andreas Voss (@AVIPNL) CA-MRSA, CC398, MRSA, ST398

MRSA

(from Statens Serum Institut, EPI-News, N023-2015)

‘The number of hospital­-acquired cases observed in 2014 increased to 95 from 52 cases in 2013, but still comprise only a limited share of the total number of cases (3%). The number of MRSA cases of the CC398 type, which is closely associated with pigs, increased substantially from 643 cases in 2013 to 1,276 cases in 2014 and comprised 43% of the total number of cases. Community­-acquired MRSA, i.e. in persons with no known contact to pigs, hospitals or nursing homes, comprised 946 cases in 2014, compared with 821 cases in 2013. In 478 of these cases (51%), there was known exposure to a person with MRSA, most frequently a member of the household (92%). In 56 cases, MRSA was isolated from blood, corresponding to 2.9% of all S. aureus bacteraemia cases, which is a substantial increase with respect to recent years, but the figure remains low compared with other European countries.’

And here I stop citing the report. For those interested in the complete report, please follow the link: MRSA Denmark.

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Biofilms make the hospital environment far from ‘inanimate’

Jon Otter (@jonotter) Biofilm, Contamination , , , ,

biofilm

Anybody doubting that biofilms really do exist on dry hospital surfaces needs to read this study: biofilms are there, they are complex, and they are common. A landmark study by the same Australian Vickery group published in 2012 first identified biofilms on a handful of dry hospital surfaces in an ICU. But this study is far more comprehensive and convincing.

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Fidaxomicin reduces C. difficile environmental contamination

Jon Otter (@jonotter) C. difficile, Environment , , ,

It is well-established that fidaxomicin reduces the recurrence rate of C. difficile infection (CDI), but this study from my old research group at GSTT / KCL is the first to evaluate the impact of treatment with fidaxomicin on environmental contamination. The bottom line is that patients treated with fidaxomicin had less C. difficile contamination than patients treated with vancomycin / metronidazole.

In total, the rooms of 38 / 66 (57.6%) patients treated with metronidazole / vancomycin had one or more positive environmental cultures compared with 25 / 68 (36.8%) patients treated with fidaxomicin (P = 0.02). Similarly, when considering all of the sampled environmental sites (four per room), 68 / 264 (25.8%) were positive in patients treated with metronidazole / vancomycin compared with 47 / 272 (17.3%) in patients treated with fidaxomicin (P = 0.02) (see Figure below).

Fidax CDI

Figure: Environmental contamination with C. difficile in the rooms of patients treated with fidaxomicin vs. vancomycin / metronidazole.

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What’s lurking in the hospital environment? The importance of cleaning and disinfection in infection prevention and control

Jon Otter (@jonotter) Environment , , ,

image

I was asked to speak to a group of link nurses at Southampton Hospital earlier in the week, and thought I’d share my slides, here.

I am passionate about the importance of surface contamination in transmission: I still think it’s really under-rated. I am pretty sure that most healthcare workers would have no idea that your chances of acquiring C. difficile infection (and others) is influenced by who used the room or bed space before you. And who would believe that VRE could survive on a dry surface for 4 years? Or that touching a surface is as important as touching the patient in terms of acquiring contamination on your hands?

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Tubular Bells

Martin Kiernan (@emrsa15) CAUTI, Infection Prevention and Control , ,
7193961732_4be9677267_q
Picture courtesy of Justin Cellini

Bells have a certain resonance for me. When they toll, people listen as they are normally of significance. I have just heard one. I have been waiting from this paper to come out since I heard the authors speak about progress at last year’s Infection Prevention Society meeting in Glasgow. Decision-making prior to passing a urinary catheter is something close to my heart, since we need to know why people do things if we are to modify practice. For me, telling people that a list of specific indications for an intervention exists merely makes the decision-maker pick which one on the list fits their desire or perceived need to catheterise most.

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ICPIC 2015

Andreas Voss (@AVIPNL) Meetings , ,

all-in-oneSorry, this was the attempt of a mobile upload straight from the meeting. Here a cleaned version, actually including  the picture. I promise, I will not continue (for now) to promote ICPIC via this blog. I do so via Twitter (@avipnl), but someone just presented a nice slide expressing the fact that you want a lot (too much) from one thing – in this case disinfection wipes.
“Wipes are like an egg-laying, milk-giving, wolly pig!”

Just passing through

Martin Kiernan (@emrsa15) Antibiotic resistance, Epidemiology, MDR-GNR , ,
Picture courtesy of Shanna Trim
Picture courtesy of Shanna Trim

Travel is easy, cheap (well, depending on your desire for luxury) and you get to meet some interesting characters on your way. Unfortunately, as this recent study from France just published in Clinical Infectious Diseases shows, some of the species that you interact with may have escaped your attention (unless you’re carrying agar plates or some fancy molecular kit with you).

The authors studied travellers attending five vaccination clinics in France prior to and post-travel looking for acquisition of MDR Enterobacteriaeceae. Over 50% came home with more than they bargained for, smuggling MDROs into France in their colons.

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CRE – too weak to spread!?

Andreas Voss (@AVIPNL) CRE , , ,

superbug

(Photo: thinkprogress.org)

In the May issue of ICHE, Weber et al. published their findings of a study looking at the environmental contamination of rooms occupied  by patients colonized or infected with CRE. In addition to their observations they actively inoculated test surfaces with 102 CRE (which I find rather low). They found that the contamination in the patients’ room was infrequent (8.4%) and at low levels (5.1 CFU/120cm2). With the single exception of K. pneumoniae on formica, alle CRE had a less than 15% survival at 24 hours and a 0% survival after 72 hours.

Should we just conclude that the chance of CRE transmission from the environment is very low?

I believe that this conclusion would be too early and probably wrong. The survival of micro-organisms in the environment is clearly strain dependent and while the authors used clinical isolates they did not mention if they included a strain that has proven its ability to spread (eg. outbreak isolates). In general multi-resistant bacteria may loose some of their fitness – including the ability to survive in the environment – but survival studies like those of Kramer et al. show survival of multiple weeks for E. coli and Klebsiella spp.

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