Successful control of Serratia marcescens outbreak in a neonatal unit of a tertiary-care hospital in Spain

ObjectiveSerratia marcescens is a Gram-negative bacterium that is found in hospital environments and commonly associated with outbreaks in neonatal units. One S. marcescens isolate was detected from a bloodstream culture from a neonate in our hospital that was followed by an outbreak. The aim of this study was to describe the molecular epidemiology of a S. marcescens outbreak in the neonatal unit.MethodsIn order to investigate the outbreak, weekly surveillance rectal swabs were submitted for culture from all patients admitted in this unit from August to September 2018. Environmental samples were obtained from potential sources in September 2018. Typing of isolates was performed by pulsed field gel electrophoresis (PFGE). In addition, we studied the in vitro activity of chlorhexidine against S. marcescens.ResultsDuring this period, 146 infants were hospitalised in our neonatal unit, of which 16 patients had a S. marcescens-positive sample. A total of 36 environmental surveillance samples were collected, and one sample from a stethoscope from an incubator of a colonized baby was positive for S. marcescens. All the 18 isolates, including the isolate from the stethoscope, belonged to a single PFGE cluster. We found that very low concentrations of chlorhexidine, even with application times close to 0 achieved significant reductions in the amount of S. marcescens.ConclusionA unique clone of S. marcescens caused this outbreak, including isolates from patients and from one stethoscope. The outbreak was controlled with the early implementation of specific control measures.     

Successful control of a norovirus outbreak among attendees of a hospital teaching conference

We report an outbreak of norovirus gastroenteritis after a hospital teaching conference, and describe the specific measures instituted by the infection control team. No secondary cases of norovirus infection were identified among hospital staff or patients. In a case-control study, we identified multiple food source contamination as the source of the outbreak. Our report highlights the potential success of a multifaceted infection control strategy in preventing the transmission of norovirus in health care settings.     

婴幼儿法洛四联症一期根治术后ICU滞留的危险因素

目的 探讨婴幼儿法洛四联症(tetralogy of Fallot, TOF)一期根治术后重症监护室(ICU)滞留的危险因素。方法 回顾性分析武汉亚洲心脏病医院2015年1月至2019年12月收治的215例法洛四联症行一期根治术患儿的临床资料,根据术后ICU时间分为滞留组46例(ICU时间≥7d)和对照组169例(ICU时间＜7d),比较两组患儿围术期相关资料。多因素logistic回归分析TOF一期根治术后ICU滞留的危险因素。结果 单因素分析显示,两组患儿在年龄（P=0.003）、体重（P=0.002）、左心室舒张末期容积指数(LVEDVI,P=0.001)、McGoon比值（P<0.001）、Nakata指数（P=0.042）、升主动脉与主肺动脉直径比值（AO/PA,P=0.012）、跨瓣环补片（P=0.022）、体外循环时间（P<0.001）、主动脉阻断时间（P<0.001）、机械通气时间（P<0.001）及术后并发症（P<0.001）方面均存在统计学差异,logistic回归分析结果提示,体外循环时间大于120 min[P<0.05,OR=3.445（1.241~9.561）]、体重低于8kg[P<0.05,OR=2.802（1.103~7.120）]及术后并发症[p<0.01,OR=7.660（3.464~16.941）]是TOF患儿一期根治术后ICU滞留的危险因素。结论 体外循环时间延长、低体重及术后出现并发症是TOF患儿一期根治术后ICU滞留的危险因素。     

Outbreak of Burkholderia cepacia complex among ventilated pediatric patients linked to hospital sinks

We investigated a cluster of Burkholderia cepacia complex colonization in ventilated pediatric patients. Isolates from 15 patients, 2 sink drains, and several ventilator components were found to belong to a single B cenocepacia clone. Hospital tap water used during oral and tracheostomy care was identified as the most likely mechanism for transmission.     

Successful control of vancomycin-resistant Enterococcus faecium nosocomial outbreak in a teaching hospital in China

In 2008, a vancomycin-resistant enterococci outbreak occurred across 2 intensive care units in our hospital. This outbreak prompted us to implement intensified control measures. We describe the molecular epidemiology of the outbreak, as well as the intervention strategies that resulted in successful control of the outbreak.     

Outbreaks of Serratia marcescens bacteriuria in a neurosurgical intensive care unit of a tertiary care teaching hospital: a clinical, epidemiologic, and laboratory perspective

BACKGROUND: Serratia marcescens is an aerobic gram-negative bacillus belonging to the family Enterobacteriacea. Infections caused by S marcescens may be difficult to treat because of their resistance to a variety of antibiotics, including beta-lactams and aminoglycosides. METHODS: This study aimed to (1) identify the risk factors associated with the development of Serratia marcescens bacteriuria in neurosurgical intensive care units (NSICU); (2) genotype the pathogens to determine the source of infection; (3) compare these results with antibiograms; and (4) determine and implement appropriate control measures. A retrospective case-control study of the epidemiologic data, the surveillance of environmental cultures, and the genotyping of strains using arbitrarily primed polymerase chain reaction (AP-PCR) were performed at a 750-bed, tertiary care teaching hospital. Seventy-four bacteriuria patients were compared with 74 age/sex-matched control patients in the NSICU between March 2002 and March 2004. The factors assessed were patient demographics; duration of hospital stay; duration of indwelling catheter use before and during stay in the NSICU; chronic underlying illnesses (diabetes mellitus, cardiovascular disease, malignancy); other sites of infection; history of trauma; exposure to a nasogastric tube; mechanical ventilation; urinary catheterization; central venous catheterization; surgical drainage; tracheostomy; brain or spine surgery; and receipt of total parenteral nutrition (TPN), antimicrobials (beta-lactams, aminoglycosides, quinolones, carbapenems, vancomycins), or steroids. RESULTS: Patients with S marcescens bacteriuria were more likely to have a longer NSICU stay and other sites of infection. Environmental surveillance showed the handling of urine jugs to be the point source of contamination. Genotyping and antibiograms of 14 patients were the same except for those of 2 patients. CONCLUSION: The patient-related risk factors were identified, and a rapid identification of the organism was made. Heightened surveillance, infection control measures, and empiric therapy led to improved methods for handling urine jugs, which terminated the outbreak.     

Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital

ObjectiveCardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital.Aims of the auditTo assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit.MethodsThis is a retrospective observational audit of the case records of all the adult patients who were resuscitated from ‘code blue’. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations.ResultsTwenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute.ConclusionA overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval.