Common Source Of Infection Research Articles

Determination of regional relationships among Salmonella spp. isolated from retail pork circulating in the Chiang Mai municipality area using a WGS data approach

Salmonella is recognized as a significant zoonotic foodborne pathogen, and pork products are involved in one-fifth of infections. Whole genome sequencing data of Salmonella isolated from retail's pork circulating in the Chiang Mai Municipality area between April 2013 and September 2014, were used to focus on genetic diversity and proven in pig-human transmission based on Multilocus Sequence Typing (MLST). Additionally, WGS data were used to investigate virulence genes, to assess the hazard or pathogenic potential transferred into the food production chain. In this study, all 32 Salmonella strains were classified into 11 Sequence Types (STs). ST469 accounted for the majority (41%). The sequence types of two other strains, 6% of the total, could not be identified. All tested strains carried at least 15 virulence genes. The most frequent gene profile was “sfm-fim-sop-inv.-org-sip-spa-sif-fli-flg-hil-spr-ssa-sse-pag-bss” (47%). Salmonella circulating in the study area demonstrated competence in biofilm production, host cell adhesion, host cell invasion, and host cell survival. Based on the phenotypic and genotypic findings, as well as pathogen source, it appears possible that a common supply chain or common infection source might be presented in the retail pork system in the study area. In addition, an epidemiological comparison of the Salmonella genotypes from the current study with those from other areas such as People's Republic of China (PR China) and the Lao People's Democratic Republic (Lao PDR) was generated by Minimum spanning tree (MST). Identical strains originating from humans, animals and food were found. The findings indicate that contamination can be occured at all levels including pre-harvest, the farm-slaughterhouse-retail chain and consumers over different geographical areas. Acquiring information about infection sources and transmission routes will hopefully motivate all sectors to enforce strict sanitation controls at all production stages including the consumer level.

Risk Factors Associated with Retinal Lesions Resulting from Widespread Systemic Infection

To clarify the prevalence, microbiologic features, and risk factors of endogenous intraocular infections in patients with positive fungal or bacterial blood culture results. Retrospective case series. Inpatients (n = 433) with positive blood culture results who underwent an ophthalmology consultation between January 2006 and September 2012 in Japan. We retrospectively reviewed the ophthalmology consultations of 433 inpatients with positive blood culture results. Clinical features of patients with confirmed chorioretinitis or endophthalmitis were analyzed through descriptive statistical methods and univariate and multivariate models. Correlation of clinical features with retinal lesions of disseminated bacteremia or fungemia. Among 433 inpatients with positive blood culture results, 116 (26.8%) were unresponsive and 27 (6.2%) had subjective ocular symptoms. Eighty-four (19.4%) had candidemia, including 16 (3.7%) with retinal lesions. Additionally, 34 patients (7.8%) had chorioretinitis or endophthalmitis in 1 eye (17 patients [3.9%]) or both eyes (17 eyes [3.9%]; 51 eyes total). Of these 34 patients, 20 (58.8%) and 17 (50%) had systemic bacterial and fungal infections, respectively (both infections were noted in 3 patients [8.8%]). Staphylococcus aureus was the most common bacteria. Candida albicans was the most common fungus, followed by Candida glabrata. Catheter-related bloodstream infections were the most common source of infection among the 34 patients with chorioretinitis or endophthalmitis, followed by infective endocarditis, urinary tract infection, and soft-tissue and bone disease. Among the 114 bacteremic patients who underwent an ophthalmology consultation because of suspicion of infective endocarditis, only 16 (14%) had infective endocarditis, of whom only 1 (0.88%) had retinal lesions. Nineteen of 34 patients (55.9%) with retinal lesions survived sepsis. Among them, only 1 patient (5.3%) with bacteremia lost significant vision (no light perception), and the remaining 18 patients (94.7%) regained vision. No patient with candidemia had vision loss. Multivariate analysis revealed that candidemia, infective endocarditis, broad-spectrum antibiotic use, and eye symptoms were independent predictors of retinal lesions (all P < 0.05). An ophthalmology consultation may be useful for patients with candidemia, infective endocarditis, broad-spectrum antibiotic use, or ocular symptoms. However, routine ophthalmologic evaluation may be less efficient for bacteremic patients without definitive infective endocarditis lacking other risk factors.

Molecular Fingerprinting Studies Do Not Support Intrahospital Transmission of Candida albicans among Candidemia Patients in Kuwait.

Candida albicans, a constituent of normal microbial flora of human mucosal surfaces, is a major cause of candidemia in immunocompromised individuals and hospitalized patients with other debilitating diseases. Molecular fingerprinting studies have suggested nosocomial transmission of C. albicans based on the presence of clusters or endemic genotypes in some hospitals. However, intrahospital strain transmission or a common source of infection has not been firmly established. We performed multilocus sequence typing (MLST) on 102 C. albicans bloodstream isolates (representing 92% of all culture-confirmed candidemia patients over a 31-month period at seven major hospitals) to identify patient-to-patient transmission or infection from a common source in Kuwait, a small country in the Middle East where consanguineous marriages are common. Repeat bloodstream isolates from six patients and nine surveillance cultures from other anatomic sites from six patients were also analyzed. Fifty-five isolates belonged to unique genotypes. Forty-seven isolates from 47 patients formed 16 clusters, with each cluster containing 2–9 isolates. Multiple isolates from the same patient from bloodstream or other anatomical sites yielded identical genotypes. We identified four cases of potential patient-to-patient transmission or infection from a common source based on association analysis between patients' clinical/epidemiological data and the corresponding MLST genotypes of eight C. albicans isolates. However, further fingerprinting by whole genome-based amplified fragment length polymorphism (AFLP) analysis yielded 8 different genotypes, ruling out intrahospital transmission of infection. The findings suggest that related strains of C. albicans exist in the community and fingerprinting by MLST alone may complicate hospital infection control measures during outbreak investigations.

Characterization of Pseudomonas syringae pv. syringae, Causal Agent of Citrus Blast of Mandarin in Montenegro.

Citrus blast caused by bacterium Pseudomonas syringae is a very important disease of citrus occuring in many areas of the world, but with few data about genetic structure of the pathogen involved. Considering the above fact, this study reports genetic characterization of 43 P. syringae isolates obtained from plant tissue displaying citrus blast symptoms on mandarin (Citrus reticulata) in Montenegro, using multilocus sequence analysis of gyrB, rpoD, and gap1 gene sequences. Gene sequences from a collection of 54 reference pathotype strains of P. syringae from the Plant Associated and Environmental Microbes Database (PAMDB) was used to establish a genetic relationship with our isolates obtained from mandarin. Phylogenetic analyses of gyrB, rpoD, and gap1 gene sequences showed that P. syringae pv. syringae causes citrus blast in mandarin in Montenegro, and belongs to genomospecies 1. Genetic homogeneity of isolates suggested that the Montenegrian population might be clonal which indicates a possible common source of infection. These findings may assist in further epidemiological studies of this pathogen and for determining mandarin breeding strategies for P. syringae control.

HIV-AIDS patients with respiratory manifestation: study at tertiary care center

Background: HIV affects virtually all organ systems in the body. Pulmonary disease is one of the most frequent complications of HIV infection. It is found in mostly married, young and middle aged, urban poor with male preponderance and heterosexual and blood transfusion being the commonest source of infection. Prompt diagnosis and early management may hasten the clinical recovery and reduce the risk and severity of toxic drug effects. Moreover knowledge regarding the incidence and early manifestations may help in developing strategies regarding prophylactic therapy of various infections of respiratory system. Aim of this study was to find the Incidence, occurrence and pattern of respiratory infections in HIV infected patients, use of various drugs used and response of therapy in respiratory infections and to study impact of HAART in PLHA with respiratory infection. Methods: Fifty HIV infected patients showing clinical evidence of respiratory system involvement and admitted in our hospital from May 2014 to November 2015 were studied in present study. Clinical history was noted and detailed physical examination, laboratory evaluation and specialized tests were carried out in all patients looking especially for presence of associated opportunistic infections in other systems.Results: Cough and dyspnea were the prominent respiratory symptoms and commonest sign was consolidation (42%) and effusion (24%) or no respiratory signs (26%).Tuberculosis (66%) followed by bacterial pneumonia (24%) including recurrent bacterial pneumonia (6%), PCP (8%) and fungal infection (2%), were the commonest respiratory manifestations. Commonest organisms isolated in bacterial pneumonia were Streptococcus Pneumonia, Staph aureus and Klebsiella. Incidence of pulmonary TB was 66%. PCP was found in 8% of cases. HAART combination of lamivudine, stavudine and nevirapine were found efficacious, safe and well tolerated when combined with other antibiotics and/or AKT.Conclusions: Heterosexual exposure (70%) and blood borne infection (18%) were commonest route of infection. Fever and weight loss was commonest presenting constitutional symptoms and all patients either belonged to B or C category.

Declining trend of infections in renal transplant recipients in a tertiary care hospital from India

Introduction: Infections are an important cause of morbidity and mortality in renal transplant recipients. This retrospective study was done to study the infection profile in renal transplant recipients. Materials and Methods: Seventy-three patients who developed infections out of 144 renal transplant recipients at a tertiary care center in southern India between January 2010 and June 2014 were studied. Infections were analyzed in terms of incidence, time of onset after transplant, clinical presentation, diagnosis, graft dysfunction, and patient and graft survival. Results: A total of 145 infection episodes were documented in the 73 patients studied. Majority (79.5%) were males and females constituted 20.5%. Predominant age group involved was 21–30 years (38.4%). Most common donor was mother (30.1%). Induction therapy was given in 21 (28.8%) patients. Mean duration of follow-up was 21.3 months. Most common infections were those of urinary tract (34.5%), followed by viral (31.2%), sepsis (15.2%), mycobacterial (9.7%), and fungal (6.2%). Parasitic infections (giardiasis and Strongyloides hyperinfection syndrome) occurred in 2 (1.4%) patients. Cytomegalovirus accounted for 14.5% and BK virus for 5.5% of total infections. Majority (77.1%) of the infection episodes occurred in the first 6 months of transplantation. There were 11 (7.6%) episodes of graft dysfunction and three patients had graft failure. A total of nine deaths were recorded due to these infections. Conclusion: Urinary tract is the most common source of infection in renal transplant recipients, followed by viral infections. Understanding the chronologic pattern of these infectious episodes facilitates early diagnosis and management of patients.

Epidemiology of infection as a precipitating factor for diabetic ketoacidosis at Tanta University Hospital

Introduction Diabetic ketoacidosis (DKA) is one of the life-threatening sequels in diabetes mellitus. Nonadherence to treatment, infections, psychological troubles, and comorbid diseases were the main precipitating factors that trigger DKA. Aim Evaluate infection as a precipitating factor of DKA and its correction may contribute to improve outcome and decrease recurrence. Patients and methods This descriptive, cross-sectional study was conducted on 200 patients with DKA admitted to the Internal Medicine Department, Tanta University Hospital. All patients were subjected to history taking, clinical examination, routine investigations, glycosylated hemoglobin, and albumin–creatinine ratio. Results Our study included 86 men and 114 women. Of these, 113 patients were of type 2 diabetes, 83 patients were of type 1 diabetes, two patients were of secondary diabetes, and two patients were having gestational diabetes. Infection was the main precipitating factor of DKA (46.5%). The most common source of infections was urinary tract infections and respiratory tract infections (31.2, 26.8%, respectively). Infection was the precipitating cause in 38.5% of type 1 diabetes and 53.9% of type 2 diabetes with P value was 0.033. DKA was the first presentation of diabetes in 18.5% of patients. Stress, dietary errors, pregnancy, and nonidentified causes were 19%. Conclusion Infection is the main precipitating factor of DKA in patients of Tanta University Hospital.

Impact of Multiplex Polymerase Chain Reaction Technology with Antimicrobial Stewardship Interventions in the Management of Patients with Positive Blood Cultures

BackgroundTraditional blood culture identification methods often lead to delayed time to optimal antimicrobial agents. This delay may increase morbidity and mortality. Rapid diagnostic tests decrease time to organism identification. The BioFire FilmArray®, a multiplex Polymerase Chain Reaction (mPCR) technology, was implemented at CHI Memorial in October 2016. We aimed to evaluate the tool’s blood culture identification panel in conjunction with antimicrobial stewardship (AS) on improving the management of patients with blood stream infections.MethodsDuring the post-mPCR period, the AS team received real-time notifications of blood culture results via a pager system, reviewed available patient data, and made recommendations to the primary service as necessary. A retrospective chart review was conducted in adult inpatients with positive blood cultures from November 1, 2015 to December 31, 2015 (pre-mPCR period) and November 1, 2016 to January 31, 2017 (post-mPCR period). The primary endpoint was the time to effective and de-escalated antimicrobial therapy in the pre- and post-mPCR periods. Secondary endpoints included differences in pre- and post-mPCR periods in the time to pathogen identification, adverse drug reactions, Clostridium difficile infections, length of stay, in-hospital mortality, 30-day readmission and antimicrobial costs.ResultsA total of 149 patients were included; 77 in the pre-mPCR and 72 in the post-mPCR period. The median age was 70 years, 30% of patients were admitted to ICU, most common source of infection was urinary tract and most common organisms were Escherichia coli and Staphylococcus aureus. There were more patients with sepsis in the post-mPCR group. Time to pathogen identification was significantly reduced from 68.7 to 34.1 hours (P < 0.01). Median times to effective and de-escalated therapy were also significantly reduced from 5.8 to 3.8 hours (P = 0.04) and 73.6 to 36.3 hours (P < 0.01), respectively. No significant differences in secondary outcomes were noted between groups.ConclusionmPCR blood culture identification tool combined with antimicrobial stewardship leads to faster time to effective and de-escalated antimicrobial therapy.Disclosures All authors: No reported disclosures.

Polymicrobial Bloodstream Infections due to Intra-Abdominal Infections: A Retrospective Analysis of 158 Cases at a Tertiary Care Hospital in Japan

Polymicrobial bloodstream infections (PBSIs) are associated with a high mortality rate and the intra-abdominal infections are one of the most common sources of PBSIs. However, scant information exists regarding etiology of PBSIs caused by intra-abdominal infections. The aim of this study is to investigate clinical and microbiological characteristics and risk factors contributing to the mortality of PBSIs due to intra-abdominal infections. This is a retrospective cohort study conducted from July 2003 to December 2015 at a tertiary care teaching hospital in Japan. The medical records of adult patients with PBSIs caused by intra-abdominal infections were reviewed. Demographic, clinical, microbiological and outcome data were collected and analyzed to evaluate risk factors associated with the crude 30-day mortality. A total of 158 patients with PBSIs due to intra-abdominal infections were identified. The mean age of the patients was 74.6 (SD: 11.7) years and the crude 30-day mortality was 16.5% (26/158). Cholangitis was the most common source of infections (51.2%), followed by gastrointestinal perforations (37.8%). Based on univariate analysis, gastrointestinal cancers (P = 0.002), solid tumors (P = 0.005) and blood culture isolates including Enterococcus spp. (P = 0.048) were significantly related to mortality. Multivariate analysis using logistic regression model demonstrated that gastrointestinal cancers (odds ratio [OR] =4.05, 95% confidence interval [CI]: 0.49–11.0, P = 0.006) and blood culture isolates including Enterococcus spp. (OR=2.91, 95% CI: 1.02–8.32, P = 0.04) were independently associated with 30-day mortality. Gastrointestinal cancers and blood culture isolates including Enterococcus spp. were associated with the crude 30-day mortality in patients with PBSIs due to intra-abdominal infections. The role of Enterococcus spp. in polymicrobial infections should be further studied. Multivariate analysis of factors associated with 30-day mortality Multivariate analysis of factors associated with 30-day mortality All authors: No reported disclosures.

Impact of an Antimicrobial Stewardship Bloodstream Surveillance Program (BSP) in Hospitalized Patients

BackgroundBloodstream infections (BSI) in hospitalized patients represent sentinel events characterized by increased mortality. These infections represent an attractive stewardship opportunity because they warrant rapid initiation of empiric antimicrobial therapy, deft transition to directed (gram stain guided) and definitive (susceptibility guided) therapy.MethodsUnder a retrospective pre-post study design, a review of patient charts 18 months before and 18 months after initiation of a hospital BSP was carried out. Pre-intervention, the hospital ward and attending physician were notified of all positive blood cultures (standard of care). Post-intervention an infectious disease pharmacist collaborating with an infectious disease consultant was notified in addition to standard notifications.Results226 patients with BSI were identified pre-intervention and 195 patients post-intervention. The two cohorts were similar in baseline characteristics: the most common source of infection was urinary tract (Figure 1); the most common blood stream isolates were E. coli, S. aureus, β-hemolytic streptococci and K. pneumoniae (Figure 2); 71.7% of infections were community acquired; 11.4% were polymicrobial. Empiric therapy was given in 82.6% of patients (16.3% non-susceptible). Directed therapy was given in 54.9% of patients (3.5% non-susceptible). The post-intervention cohort received directed therapy on average 4.36 hours earlier (P = .003), were more likely to receive adequate definitive therapy (99.0% post vs. 79.1% pre, P < .001), and were stepped down to oral therapy earlier (6 days vs. 8 days). Prescription of second generation cephalosporins (0.0% vs. 4.3%, P = .05), quinolones (16.7% vs. 32.7%, P = .005), clindamycin (2.6% vs. 10.3%, P = .03) and aminoglycosides (6.1% vs. 14.6%, P = .05) were decreased for directed therapy post-intervention.ConclusionA hospital BSP can improve time to first dose of parenteral antimicrobial directed therapy and adequacy of definitive therapy, shorten time from IV to oral step-down and reduce prescription of targeted antimicrobial classes. A BSP can be an effective stewardship strategy in hospitalized patients.Disclosures All authors: No reported disclosures.

A Retrospective Study on the Compliance with Surviving Sepsis Campaign Guideline in Patients with Sepsis Admitted to Intensive Care Unit in Hong Kong

The global incidence of sepsis is increasing due to earlier recognition, but mortality from sepsis still remains high. Local data on the management according to the Surviving Sepsis Campaign Care Bundle is still lacking. Hence, this study looks at the epidemiology, patient characteristics and management of septic patients admitted to intensive care unit (ICU) in a regional hospital in Hong Kong. Clinical records of all patients admitted to ICU of Tseung Kwan O Hospital from 1st January to 30th June, 2014 were screened. There were 108 patients who fulfilled the inclusion criteria, corresponding to incidence of 32%. There were 62% males with a mean age of 63.6 years. Most patients (34.3%) were diagnosed in emergency department and the majority (46%) were transferred to ICU within 3 h of diagnosis, whereas 44% were transferred >6 h after diagnosis and 10% were transferred between 3-6 h. Most common source of infection was respiratory (26%), followed by blood (15.7%) and urinary tract (7%). Three-hour bundle compliance: measurement of lactate (0%), blood culture before antibiotics (56%), administration of antibiotics (100%) and administration of intravenous fluids volume to 30 ml/kg (21%). Six-hour bundle compliance: Vasopressor use (89%), central venous pressure monitoring (68%), central venous oxygen saturation measurement (0%). The hospital mortality rate was 26.8%. In conclusion, mortality of sepsis is high. Relentless effort is needed to boost the adherence to Sepsis Care Bundle, especially the measurement of serum lactate. Protocols, checklists, education and simulation training are possible means to improve the quality of care and clinical outcome of septic patients.

Outcome of burr-hole aspiration of brain abscess.

Objective:To determine the clinical outcome of burr-hole aspiration of brain abscess.Methods:We analyzed 100 cases of intracranial abscess, treated surgically from January 2015 and October 2016 at Jinnah Postgraduate Medical Centre (JPMC). All patients were treated with burr hole aspiration. Medical records were analyzed for demographics, clinical presentation, predisposing factors, abscess location on imaging and clinical outcomes were charted.Results:The study included 100 patients with 73 (73%) males and 27 (27%) females with a mean age of 36.69±10.96 years. Mean duration of signs and symptoms was 8.50±4.2 days. The most common presenting complaint was altered sensorium in 70 (70%) patients and commonest source of infection was otitis media seen in 27 patients (27%). The GCS on presentation was 13 in 57 (57%) cases. The parietal region was the most common site in 43 patients (43%), followed by frontal region in 33 patients (33%). Complete resolution of abscess with recovery of preoperative neuro-deficit was seen in 77 (77%) patients and recovery with major neuro-deficit was observed in 10 (10%) cases while 13 (13%) patients expired.Conclusion:Early diagnosis, optimum follow-up and timely burr-hole aspiration are the keys in the proper management of brain abscess.

Lacrimal sac infections and microbial analysis

Lacrimal sac infection is one of the common pathologies in a routine ophthalmic practice. Dacryocystitis often present as epiphora with or without discharge. Regurgitation of mucopurulent discharge from punctum is a specific indicator of sac infection. In this article, we have reviewed the literature on the microbial spectrum in lacrimal duct obstruction with sac infection. The common microbial organism and the antibiotic sensitivity status of the same have also been reviewed. More than 90% culture positivity is noted in all the studies as noted in the literature. Gram-positive organism is the commonest source of infection. Staphylococcal species, namely, Staphylococcus aureus have been noted to be the most common among the Gram-positive organisms. The other Gram-positive organisms include Streptococcus pneumonia and Staphylococcus epidermidis. The Gram-negative organisms predominantly seen are Pseudomonas aeruginosa, Hemophilus influenza, and Klebsiella. Very rarely anaerobic organism such as Propionibacterium, fungi like Candida, other Gram-negative microbes such as Enterobacter, and occasionally, Mycobacterium are also cultured. Gram-positive organisms are sensitive to Vancomycin, Ofloxacin, Gatifloxacin, and Chloramphenicol. Gram-negative organisms showed sensitivity to Tobramycin. Resistant to topical quinolones has also been reported in some studies. The overall antibiotic sensitivity has been good and encouraging in the management of lacrimal sac infections.

BIOLOGICAL PROPERTIES AND MOLECULAR-GENETIC CHARACTERISTICS OF BACILLUS ANTHRACIS STRAINS, ISOLATED DURING THE OUTBREAK OF ANTHRAX IN THE YAMALO-NENETS AUTONOMOUS DISTRICT IN 2016

Objective of the study was to identify phenotypic properties and genetic peculiarities of Bacillus anthracis strains, isolated during the outbreak of anthrax in the territory of Yamal in 2016. Materials and methods . Investigated were the strains of anthrax agent, applying basic and subsequent identification tests and canSNP-, MLVA-genotyping methods and whole genome sequencing. Results and conclusions . The results showed the identity of the phenotypic properties, canSNPand MLVA25-genotypes, and profiles of whole genome-sequencing, regardless of the source of the strains isolation. Confirmed was a common source of human infection. Defined were phylogenetic interrelations of the tested strains and their position in global B. anthracis population. For the first time ever explored was variability of the gene pattern, associated with pathogenicity, and demonstrated – the efficiency of the proposed algorithm for genetic typing.

A Cluster of Fluconazole-Resistant Malassezia pachydermatis in a Neonatal Intensive Care Unit — California, 2015–2016

Background Malassezia pachydermatis, a common veterinary yeast, rarely causes outbreaks in neonatal intensive care units (NICUs). One outbreak was associated with healthcare worker (HCW) colonization with strains shared by pet dogs. Prevention relies on good hand hygiene, but data HCW pet ownership and interaction are lacking. We report a cluster of 5 cases of M. pachydermatis infection or colonization during December 2015–September 2016 in a Level 3, 84-bed NICU and results of a HCW survey on hand and pet-related hygiene.Methods A case was defined as a culture yielding M. pachydermatis from sterile sites or skin of a NICU patient. We used whole-genome sequencing (WGS) to examine genetic relatedness among the 5 M. pachydermatis isolates compared with 9 isolates in CDC’s historical collection. As part of a series of NICU hand hygiene improvement campaigns, we administered a web-based survey of hand hygiene practice, pet ownership, and pet health to 290 NICU HCWs employed while case-patients were admitted.ResultsWe identified 5 cases (3 fungemias, 1 infected urinoma, 1 colonization) during the 9-month period (Figure 1), and a hospital lookback revealed no M. pachydermatis infections before the first case. All patients had low birth weight, central venous or peripheral arterial catheters, prior broad-spectrum antibiotics, and antifungal prophylaxis. All isolates were resistant to fluconazole and were highly related by WGS (<14 single-nucleotide polymorphisms [SNPs]) but unrelated to historical isolates (>40,000 SNPs). Survey respondents (N = 151[52%]; Figure 2) reported perceived peer HCW hand hygiene lower than their own, and 69% reported daily contact with dogs or cats. Survey results did not differ among staff who did (n = 15) and did not (n = 136) care for all case patients. No cases were reported in the 7 months following the fifth case.Conclusion We report a NICU cluster of fluconazole-resistant M. pachydermatis cases nearly identical by WGS, suggesting a common source of infection, possibly related to HCW carriage following contact with household pets. A hygiene improvement campaign may have mitigated further transmission. M. pachydermatis is a potential cause of fungemia among neonates on fluconazole prophylaxis.Disclosures All authors: No reported disclosures.

Clinical profile and outcome of patients with severe sepsis treated in an intensive care unit in India

Sepsis is the leading cause of intensive care unit (ICU) admissions and is associated with high mortality. To identify the incidence, risk factors and outcome of patients with severe sepsis and septic shock. A prospective observational study was done in a multidisciplinary ICU over a period of 18 months. We included all adult patients admitted to ICU with features of severe sepsis and septic shock as per SCCM/ACCP guidelines. Data related to demography, co-existing illnesses, parameters to assess Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, other relevant laboratory data, source of infection, organ failures and supportive measures given were recorded. Primary outcome data on mortality was collected and secondary outcome data on ventilator days, ICU length of stay (ALOS) and ventilator free days were recorded. A total of 1162 patients were screened and 356 patients had severe sepsis. Incidence of severe sepsis was 30.6% and mortality rate was 51.6%. APACHEII (23.37 ± 9.47) and SOFA (7.58 ± 4.05) scores at admission were high. Most common source of infection was from the respiratory tract (37.2%) followed by urinary tract (10.3%) and intra-abdominal (9.5%) infections. About 63% of patients required ventilator support, 25.5% of patients required vasopressor support despite adequate fluid resuscitation and one third of patients required renal replacement therapy (35.7%). Haematocrit, total leucocyte count, serum bilirubin and SOFA scores were significantly higher among non-survivors. Incidence of severe sepsis was high and was associated with a poor patient outcome in an ICU in India.

Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study.

The prognostic significance of serum albumin levels in patients with sepsis has previously been reported; however, these studies have not excluded the potential confounding effect of exogenous albumin administration. In this study, we investigate the predictive value of serum albumin for the prognosis of severe sepsis without the interference of exogenous albumin administration. A prospective cohort study was conducted from April to November 2014 in the internal and surgical intensive care units of a tertiary care hospital. During the study period, due to a supply shortage, patients were not treated with human albumin. Serum albumin levels were measured, and laboratory and clinical data were collected at the onset of severe sepsis. Prognostic factors were analyzed using receiver operating characteristic curve and multivariate Cox proportional hazard regression analysis. Survival was assessed by Kaplan-Meier method. One hundred sixteen patients were included in the study. The overall 28-day mortality was 26.7%. The most common infection sources were lower respiratory tract, abdomen/pelvis, and bloodstream. Compared to patients who survived, those who died had lower serum albumin levels and higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores. Receiver operating characteristic curves demonstrate that albumin level is a strong predictor of 28-day mortality, and the optimal cutoff value maximizing sensitivity and specificity is 29.2 g/L. Through multivariate Cox regression analysis, low serum albumin levels (<29.2 g/L) and APACHE II scores are identified as independent risk factors for mortality. Patients with lower serum albumin levels more often had abdominal/pelvic sources of infection, acute kidney or liver injury, septic shock, and higher APACHE II and SOFA scores. The 28-day survival rate was lower for patients with serum albumin below 29.2 g/L than for patients with serum albumin at or above this level. Having excluded potential confounding effect of exogenous albumin administration, low serum albumin levels are associated with an increased risk of death in patients with severe sepsis.

Outbreak of G2P[4] rotavirus gastroenteritis in a retirement community, Brazil, 2015: An important public health risk?

The present study described a group A rotavirus (RVA) outbreak in an age-care facility in Brazil, using epidemiologic and molecular diagnostic methods. A descriptive clinical, epidemiological and environmental investigation was conducted. Stool samples were collected and screened for RVA, Norovirus (NoV), Enteric Adenovirus 40/41 (AdV 40/41) and Astrovirus (AstV) using ELISA, RT-PCR, qRT-PCR, electron microscopy and sequencing methods. Outbreak occurred during 26th–29th October, 2015; 28 individuals affected (22 residents; 6 staff). The attack rate was 25.9% and 8.5% among residents (median-age: 85.5 years) and staff (median-age: 28 years), respectively. Female staff was identified as the index case. RVA G2P[4] genotype was detected in 87.5% (7/8). Genetic analysis demonstrated that the outbreak involved one single strain, suggesting a common-source infection. RVA should be considered during outbreaks investigations in residential facilities, and raise the question if the current licensed RVA vaccines for children could also be helpful for the elderly.

Successful control of a large outbreak of HIV infection associated with injection of cathinone derivatives in Tel Aviv, Israel

ObjectivesOutbreaks of HIV infection have been linked to injectable drug abuse, but specific triggers often remain obscure. We report on an outbreak of primary HIV infection among people who inject drugs (PWID) in Tel Aviv, associated with a local shift in drug-use practices. MethodsA cluster of primary HIV infection cases in PWID was detected in May 2012. Retrospective and prospective multi-hospital case finding was initiated. PWID were interviewed and risk factors for primary HIV infection were identified. Starting in December 2012, a multifaceted intervention was implemented, including educational activities, increasing syringe exchange supplies, active screening, early initiation of antiretroviral therapy, and referral to drug withdrawal programmes. ResultsForty-two PWID with primary HIV infection were detected between May 2012 and April 2013. Compared with the corresponding pre-outbreak period, the annual incidence of primary HIV infection in PWID increased from 0 to 20 cases/1000 population (p <0.0001). Sixty-nine per cent were hospitalized because of concomitant bacterial infections and sepsis. Phylogenetic analysis of HIV isolates from case patients showed tight clustering suggesting a single common source of infection. The outbreak was temporally related to a widespread shift from heroin to injectable cathinone-derivatives and buprenorphine, which entailed high-risk injection practices. Targeted intervention resulted in a dramatic and sustained reduction in HIV infection in the PWID population. ConclusionsInjectable amphetamines are gaining momentum among PWID worldwide. Tracing of this outbreak to cathinone use and implementing a targeted intervention programme effectively terminated the outbreak.

English

Pseudomonas aeruginosa (P. aeruginosa) is an opportunistic pathogen and a leading cause of hospital- acquired infections. Characterization of the isolates from different infection sites might help to control infections caused by the pathogen. The aim of the present work is to characterize P. aeruginosa isolates recovered from different clinical specimens at two hospitals in Cairo with regard to their antibiogram, genotypes and virulence factors. The highest antimicrobial resistance pattern was exhibited by isolates from sputum. Resistance rate recorded for sputum samples to different in- use antibiotics was 80, 80-100, 36, 54 and 54% for Penicillins, Cephems, Carbapenems, Aminoglycosides and Fluoroquinolones, respectively. Phenotypic detection of virulence factors in P. aeruginosa isolates included detection of protease, lecithinase, DNase, hemolysin and pyocyanin revealed that, each isolate had at least one virulence factor. Protease and lecithinase were the most commonly detected, where 68 and 66% of the isolates showed positive protease and lecithinase activities respectively. Random amplified polymorphic DNA (RAPD) genotyping using 2 random primers revealed 22 and 14 different genetic profiles. Phylogenetic trees based on genetic distances showed 3 clusters with obvious similarity between some isolates, indicating common sources of infection. No association could be found between clustering pattern of the isolates, their antibiogram and virulence. &nbsp; Key words: Pseudomonas aeruginosa, antibiogram, genotypes, random amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR). &nbsp