Pub Date : 2025-01-17DOI: 10.1016/j.jhin.2025.01.004
P. Bortolozzi-Mendes , M. Rennó de Campos , H. de Oliveira Couto , M.C. Vieira de Almeida , J.G.C. Gonçalves de Oliveira , F. Bellissimo-Rodrigues , C.H. Miranda , A. Pazin-Filho
Background
Tuberculosis (TB) remains a significant public health concern, particularly in low-to-middle-income countries. Healthcare workers (HCWs) are at a higher risk due to prolonged exposure. The World Health Organization (WHO) has proposed guidelines focusing on administrative interventions, structural interventions, and personal protective equipment (PPE) usage to mitigate this risk.
Aim
To evaluate the effectiveness of the WHO-recommended measures regarding the risk of developing TB among the HCWs.
Methods
This was a retrospective analysis of TB incidence among patients admitted to a tertiary public emergency department (ED) compared with HCWs from 2000 to 2023. TB notifications were extracted among HCWs and the general population of Ribeirão Preto from a public database.
Findings
From 2000 to 2023, the ED handled an average of 148,496 patients per quadrennium, with 202 TB patients per quadrennium. The prevalence ratio of TB per 100,000 patients increased from 80 to 170 (P = 0.035) and the incidence rates rose from 39 to 157 per 100,000 patients (P = 0.046). The incidence rate of TB among HCWs started at 412.0 (85.0; 1201.0) and decreased to 179.0 (20.0; 619.0). In total, 11 HCWs were diagnosed with TB. The relative risk of having TB between HCWs and the general population was significantly higher before the programme implementation and became equivalent after it.
Conclusion
Implementing WHO-recommended TB control measures was demonstrated to be effective in reducing the incidence rate ratios between HCWs and the general population in a high-burden tertiary hospital in Brazil.
{"title":"Impact of WHO-recommended tuberculosis control measures on occupational tuberculosis risk among healthcare workers in a high-burden tertiary hospital in Brazil: a 24-year retrospective analysis","authors":"P. Bortolozzi-Mendes , M. Rennó de Campos , H. de Oliveira Couto , M.C. Vieira de Almeida , J.G.C. Gonçalves de Oliveira , F. Bellissimo-Rodrigues , C.H. Miranda , A. Pazin-Filho","doi":"10.1016/j.jhin.2025.01.004","DOIUrl":"10.1016/j.jhin.2025.01.004","url":null,"abstract":"<div><h3>Background</h3><div>Tuberculosis (TB) remains a significant public health concern, particularly in low-to-middle-income countries. Healthcare workers (HCWs) are at a higher risk due to prolonged exposure. The World Health Organization (WHO) has proposed guidelines focusing on administrative interventions, structural interventions, and personal protective equipment (PPE) usage to mitigate this risk.</div></div><div><h3>Aim</h3><div>To evaluate the effectiveness of the WHO-recommended measures regarding the risk of developing TB among the HCWs.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of TB incidence among patients admitted to a tertiary public emergency department (ED) compared with HCWs from 2000 to 2023. TB notifications were extracted among HCWs and the general population of Ribeirão Preto from a public database.</div></div><div><h3>Findings</h3><div>From 2000 to 2023, the ED handled an average of 148,496 patients per quadrennium, with 202 TB patients per quadrennium. The prevalence ratio of TB per 100,000 patients increased from 80 to 170 (<em>P</em> = 0.035) and the incidence rates rose from 39 to 157 per 100,000 patients (<em>P</em> = 0.046). The incidence rate of TB among HCWs started at 412.0 (85.0; 1201.0) and decreased to 179.0 (20.0; 619.0). In total, 11 HCWs were diagnosed with TB. The relative risk of having TB between HCWs and the general population was significantly higher before the programme implementation and became equivalent after it.</div></div><div><h3>Conclusion</h3><div>Implementing WHO-recommended TB control measures was demonstrated to be effective in reducing the incidence rate ratios between HCWs and the general population in a high-burden tertiary hospital in Brazil.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"157 ","pages":"Pages 75-82"},"PeriodicalIF":3.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-17DOI: 10.1016/j.jhin.2025.01.003
C Dupin, A Cissé, V Lemoine, A Turban, V Marie, N Mazille, S Soive, C Piau-Couapel, B Youenou, P Martins-Simoes, V Cattoir, A Tristan, P Y Donnio, G Ménard
Purpose: Since 2021, several reports of Staphylococcus haemolyticus outbreaks in neonatal intensive care units (NICUs) have been reported in France. The aim of this study was to understand how it became established in the NICUs of two facilities, which share the care of newborns.
Methods: All positive S. haemolyticus clinical samples isolated from 2020 until 2023 and medical records were analysed. Phenotypic analyses consisted of typing method using the quantitative antibiogram (QA) method, and microbiological investigations using whole genome sequencing (WGS). Environmental samples and hands of healthcare workers were collected, with the same analyses realized if S. haemolyticus was identified. Observational studies of Healthcare workers (HCWs) hygiene practices were also performed.
Results: One hundred and sixteen neonates were positive for S. haemolyticus, of whom 44 (38%) were infected. ST29 strains were highly predominant, and distinct clonal populations were identified. Transfers of newborns between the two centres, followed by cross-transmissions, could explain the dissemination of one population. Twenty-one environmental samples revealed the presence of the clones involved in neonates. One clonal population was also found on the hands of 15% of the healthcare workers sampled. Misconceptions about alcohol-based hand rub were observed, and daily disinfection of NICU equipment was not optimal.
Conclusion: Preliminary reports point to cross-transmission within and between NICUs, either directly by healthcare worker hands or indirectly via contaminated environments, especially incubators. The ST29 lineage is identified in most NICUs with a capacity to adapt locally and to cause outbreaks.
{"title":"Emergence and establishment of Staphylococcus haemolyticus ST29 in two Western France neonatal intensive care units.","authors":"C Dupin, A Cissé, V Lemoine, A Turban, V Marie, N Mazille, S Soive, C Piau-Couapel, B Youenou, P Martins-Simoes, V Cattoir, A Tristan, P Y Donnio, G Ménard","doi":"10.1016/j.jhin.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.01.003","url":null,"abstract":"<p><strong>Purpose: </strong>Since 2021, several reports of Staphylococcus haemolyticus outbreaks in neonatal intensive care units (NICUs) have been reported in France. The aim of this study was to understand how it became established in the NICUs of two facilities, which share the care of newborns.</p><p><strong>Methods: </strong>All positive S. haemolyticus clinical samples isolated from 2020 until 2023 and medical records were analysed. Phenotypic analyses consisted of typing method using the quantitative antibiogram (QA) method, and microbiological investigations using whole genome sequencing (WGS). Environmental samples and hands of healthcare workers were collected, with the same analyses realized if S. haemolyticus was identified. Observational studies of Healthcare workers (HCWs) hygiene practices were also performed.</p><p><strong>Results: </strong>One hundred and sixteen neonates were positive for S. haemolyticus, of whom 44 (38%) were infected. ST29 strains were highly predominant, and distinct clonal populations were identified. Transfers of newborns between the two centres, followed by cross-transmissions, could explain the dissemination of one population. Twenty-one environmental samples revealed the presence of the clones involved in neonates. One clonal population was also found on the hands of 15% of the healthcare workers sampled. Misconceptions about alcohol-based hand rub were observed, and daily disinfection of NICU equipment was not optimal.</p><p><strong>Conclusion: </strong>Preliminary reports point to cross-transmission within and between NICUs, either directly by healthcare worker hands or indirectly via contaminated environments, especially incubators. The ST29 lineage is identified in most NICUs with a capacity to adapt locally and to cause outbreaks.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1016/j.jhin.2025.01.001
H Humphreys, A D K Hill
{"title":"Surgery and sustainability: time for multi-disciplinary collaboration to reduce the carbon footprint while not compromising infection prevention.","authors":"H Humphreys, A D K Hill","doi":"10.1016/j.jhin.2025.01.001","DOIUrl":"10.1016/j.jhin.2025.01.001","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-07DOI: 10.1016/j.jhin.2024.12.011
K E Horváthné, Z Balogh
{"title":"Evaluating the accuracy of point prevalence surveys: a comparative analysis with Hungarian National Nosocomial Surveillance (NNSR) data.","authors":"K E Horváthné, Z Balogh","doi":"10.1016/j.jhin.2024.12.011","DOIUrl":"10.1016/j.jhin.2024.12.011","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-07DOI: 10.1016/j.jhin.2024.12.010
S. Göpel , J. Guther , B.P. Gladstone , N. Conzelmann , S. Bunk , T. Terzer , T.D. Verschuuren , D. Martak , E. Salamanca Rivera , I.B. Autenrieth , S. Peter , J.A.J.W. Kluytmans , D. Hocquet , J. Rodriguez-Baño , E. Tacconelli , MODERN WP1 Study Group
Background
Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-PE) are highly prevalent in long-term care (LTCF) settings. In order to estimate the acquisition rate of ESBL-producing Escherichia coli and Klebsiella pneumoniae in LTCF settings, and identify clinical and environmental risk factors, a multi-centre, prospective cohort study was conducted in six LTCFs in Germany, France, Spain and the Netherlands.
Methods
Longitudinal screening of residents was performed over 32 weeks, collecting epidemiological and clinical data and environmental samples. The primary outcome was the rate of new acquisition of ESBL-PE among LTCF residents. Molecular epidemiology was studied using whole genome sequencing, and risk factor analysis was undertaken using logistic and Poisson regression models.
Results
In total, 299 residents provided 1958 samples during follow-up. The prevalence of ESBL-PE colonization at baseline was 16.4%, and the incidence of acquisition was 0.79 per 1000 resident-days, both with high variability between LTCFs. Age ≥80 years, vascular disease and antibiotic consumption within the preceding year were risk factors for baseline colonization. Lack of hand sanitizers and a low nurse:resident ratio were associated with colonization. The presence of medical devices was associated with risk of acquisition. Vascular disease, hemiplegia, antibiotic consumption, and non-availability of private bathrooms were associated with carriage of multiple sequence types (STs). The prevalence of ESBL-PE among environmental samples was 2%, exclusively in LTCFs with high prevalence among residents. Genetic analysis showed a high prevalence of ST10 E. coli and ST405 K. pneumoniae at two study sites.
Conclusion
Infection prevention interventions, including availability of hand sanitizers, the number of nurses per resident, and antimicrobial stewardship, constitute important measures to control ESBL-PE in LTCFs. Genome-based surveillance could guide targeted interventions.
{"title":"Drivers of extended-spectrum β-lactamase (ESBL)- producing Enterobacterales colonization among residents of long-term care facilities: a European multicentre prospective cohort study","authors":"S. Göpel , J. Guther , B.P. Gladstone , N. Conzelmann , S. Bunk , T. Terzer , T.D. Verschuuren , D. Martak , E. Salamanca Rivera , I.B. Autenrieth , S. Peter , J.A.J.W. Kluytmans , D. Hocquet , J. Rodriguez-Baño , E. Tacconelli , MODERN WP1 Study Group","doi":"10.1016/j.jhin.2024.12.010","DOIUrl":"10.1016/j.jhin.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-PE) are highly prevalent in long-term care (LTCF) settings. In order to estimate the acquisition rate of ESBL-producing <em>Escherichia coli</em> and <em>Klebsiella pneumoniae</em> in LTCF settings, and identify clinical and environmental risk factors, a multi-centre, prospective cohort study was conducted in six LTCFs in Germany, France, Spain and the Netherlands.</div></div><div><h3>Methods</h3><div>Longitudinal screening of residents was performed over 32 weeks, collecting epidemiological and clinical data and environmental samples. The primary outcome was the rate of new acquisition of ESBL-PE among LTCF residents. Molecular epidemiology was studied using whole genome sequencing, and risk factor analysis was undertaken using logistic and Poisson regression models.</div></div><div><h3>Results</h3><div>In total, 299 residents provided 1958 samples during follow-up. The prevalence of ESBL-PE colonization at baseline was 16.4%, and the incidence of acquisition was 0.79 per 1000 resident-days, both with high variability between LTCFs. Age ≥80 years, vascular disease and antibiotic consumption within the preceding year were risk factors for baseline colonization. Lack of hand sanitizers and a low nurse:resident ratio were associated with colonization. The presence of medical devices was associated with risk of acquisition. Vascular disease, hemiplegia, antibiotic consumption, and non-availability of private bathrooms were associated with carriage of multiple sequence types (STs). The prevalence of ESBL-PE among environmental samples was 2%, exclusively in LTCFs with high prevalence among residents. Genetic analysis showed a high prevalence of ST10 <em>E. coli</em> and ST405 <em>K. pneumoniae</em> at two study sites.</div></div><div><h3>Conclusion</h3><div>Infection prevention interventions, including availability of hand sanitizers, the number of nurses per resident, and antimicrobial stewardship, constitute important measures to control ESBL-PE in LTCFs. Genome-based surveillance could guide targeted interventions.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"157 ","pages":"Pages 67-74"},"PeriodicalIF":3.9,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jhin.2024.09.010
C. Love , A. Street , E. Riddell , R.J.B. Goudie , R.C. Brock , R. Thaxter , T. Gouliouris , A. Conway Morris , C.B. Beggs , C. Peters , M.J. Butler , D.J. Gould , V.L. Keevil
{"title":"Acceptability of air cleaning units on inpatient wards: help for infection control or hindrance for ward occupants?","authors":"C. Love , A. Street , E. Riddell , R.J.B. Goudie , R.C. Brock , R. Thaxter , T. Gouliouris , A. Conway Morris , C.B. Beggs , C. Peters , M.J. Butler , D.J. Gould , V.L. Keevil","doi":"10.1016/j.jhin.2024.09.010","DOIUrl":"10.1016/j.jhin.2024.09.010","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 254-256"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jhin.2024.11.001
H. Humphreys , S. Daniels
{"title":"Cold atmospheric plasma as an alternative decontaminant to control healthcare-associated infections and antimicrobial resistance – significant potential that can be realized globally","authors":"H. Humphreys , S. Daniels","doi":"10.1016/j.jhin.2024.11.001","DOIUrl":"10.1016/j.jhin.2024.11.001","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 231-233"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jhin.2024.09.024
T. Kremer , N.J. Rowan , G. McDonnell
Background
The cleaning of reusable medical devices involves inherent challenges that can impact on the effectiveness of the cleaning process; consequently, the subsequent safety of patients. Fluid dynamics play a critical role in determining the flow and distribution of cleaning agents where the design of the device can either facilitate or hinder this important process. Complex geometries, narrow channels, or irregular surfaces can impede effective flushing of contaminants leading to incomplete cleaning that creates a greater likelihood for patient contamination risks.
Methods
Device features (N = 23) were exposed to the most challenging cleaning conditions to find the point of failure in both fluid dynamics and soil retention. Experimental results obtained from the aforementioned along with associated compound risks were used to assign a risk value. Using the ‘hardest to clean’ device feature approach as the base risk value, the total quantitative risk score was calculated for different reusable medical devices from numerical values obtained from addressing 14 questions focusing on variability in geometry, material use, types of cleaning, and intended patient use. Patient risk values for devices with different features were calculated from using Kremer’s cleaning categories based on position within value ranges.
Findings
Occurrences less than 18 correspond to minimal risk devices while a total risk score between the values of 18 and 39 are moderate and ≥40 scores corresponds to the maximal category.
Conclusion
Application of this quantitative assessment approach will facilitate appropriate mitigation of risk for cleaning reusable medical devices by informing use of targeted effective interventions. Future use of this Kremer cleaning classification will complement and augment disinfection and sterilization modalities.
{"title":"A new quantitative method for determining patient risk for reusable medical device categorization based on using and interpreting Kremer's cleaning classification system","authors":"T. Kremer , N.J. Rowan , G. McDonnell","doi":"10.1016/j.jhin.2024.09.024","DOIUrl":"10.1016/j.jhin.2024.09.024","url":null,"abstract":"<div><h3>Background</h3><div>The cleaning of reusable medical devices involves inherent challenges that can impact on the effectiveness of the cleaning process; consequently, the subsequent safety of patients. Fluid dynamics play a critical role in determining the flow and distribution of cleaning agents where the design of the device can either facilitate or hinder this important process. Complex geometries, narrow channels, or irregular surfaces can impede effective flushing of contaminants leading to incomplete cleaning that creates a greater likelihood for patient contamination risks.</div></div><div><h3>Methods</h3><div>Device features (<em>N</em> = 23) were exposed to the most challenging cleaning conditions to find the point of failure in both fluid dynamics and soil retention. Experimental results obtained from the aforementioned along with associated compound risks were used to assign a risk value. Using the ‘hardest to clean’ device feature approach as the base risk value, the total quantitative risk score was calculated for different reusable medical devices from numerical values obtained from addressing 14 questions focusing on variability in geometry, material use, types of cleaning, and intended patient use. Patient risk values for devices with different features were calculated from using Kremer’s cleaning categories based on position within value ranges.</div></div><div><h3>Findings</h3><div>Occurrences less than 18 correspond to minimal risk devices while a total risk score between the values of 18 and 39 are moderate and ≥40 scores corresponds to the maximal category.</div></div><div><h3>Conclusion</h3><div>Application of this quantitative assessment approach will facilitate appropriate mitigation of risk for cleaning reusable medical devices by informing use of targeted effective interventions. Future use of this Kremer cleaning classification will complement and augment disinfection and sterilization modalities.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 234-247"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The study institute was challenged with an outbreak of different vancomycin-resistant Enterococcus faecium (VREfm), including vanA- and/or vanB-containing isolates. Remarkably, screening overnight enriched specimens using a vanA and vanB real-time polymerase chain reaction (PCR) gave positive results for vanB with very low cycle threshold values, whereas VREfm-specific enrichment cultures remained negative. This paper describes the analysis of the diagnostic results leading to adaptation of the diagnostic algorithm.
Methods
The results of vanA and vanB screening PCR and VREfm-specific culture (Brilliance VRE) were collected and combined with genotyping data of the identified VREfm isolates. During the outbreak, a second VREfm-specific culture medium (CHROMagar VRE) was introduced, and the results were compared with the results obtained with Brilliance VRE agar.
Results
Thirty-five patients were identified as VREfm carriers, in which four different strains were identified: vanA (STnew-CT7088) and/or vanB (ST80-CT1065, ST117-CT7117 and ST117-CT7118). Complementing the PCR results, culture and genotyping revealed that culture with Brilliance VRE agar was inadequate for detection of the vanB ST117 isolates identified, irrespective of the minimum inhibitory concentration of vancomycin. In contrast, CHROMagar VRE was able to detect the vanB ST117 isolates and other tested isolates correctly.
Conclusions
The vanB ST117 isolates were detected inadequately by the VREfm-specific culture media, possibly contributing to unnoticed spread of VREfm. For this reason, CHROMagar VRE was evaluated during the outbreak and subsequently implemented in routine diagnostics, replacing Brilliance VRE agar.
{"title":"Analysis of a persistent outbreak with vancomycin-resistant Enterococcus faecium revealed the need for an adapted diagnostic algorithm","authors":"R.H.T. Nijhuis , A.J.L. Weersink , F. Stegeman-Heining , A.E. Smilde , D.C. Melles","doi":"10.1016/j.jhin.2024.10.013","DOIUrl":"10.1016/j.jhin.2024.10.013","url":null,"abstract":"<div><h3>Objectives</h3><div>The study institute was challenged with an outbreak of different vancomycin-resistant <em>Enterococcus faecium</em> (VREfm), including <em>vanA-</em> and/or <em>vanB</em>-containing isolates. Remarkably, screening overnight enriched specimens using a <em>vanA</em> and <em>vanB</em> real-time polymerase chain reaction (PCR) gave positive results for <em>vanB</em> with very low cycle threshold values, whereas VREfm-specific enrichment cultures remained negative. This paper describes the analysis of the diagnostic results leading to adaptation of the diagnostic algorithm.</div></div><div><h3>Methods</h3><div>The results of <em>vanA</em> and <em>vanB</em> screening PCR and VREfm-specific culture (Brilliance VRE) were collected and combined with genotyping data of the identified VREfm isolates. During the outbreak, a second VREfm-specific culture medium (CHROMagar VRE) was introduced, and the results were compared with the results obtained with Brilliance VRE agar.</div></div><div><h3>Results</h3><div>Thirty-five patients were identified as VREfm carriers, in which four different strains were identified: <em>vanA</em> (STnew-CT7088) and/or <em>vanB</em> (ST80-CT1065, ST117-CT7117 and ST117-CT7118). Complementing the PCR results, culture and genotyping revealed that culture with Brilliance VRE agar was inadequate for detection of the <em>vanB</em> ST117 isolates identified, irrespective of the minimum inhibitory concentration of vancomycin. In contrast, CHROMagar VRE was able to detect the <em>vanB</em> ST117 isolates and other tested isolates correctly.</div></div><div><h3>Conclusions</h3><div>The <em>vanB</em> ST117 isolates were detected inadequately by the VREfm-specific culture media, possibly contributing to unnoticed spread of VREfm. For this reason, CHROMagar VRE was evaluated during the outbreak and subsequently implemented in routine diagnostics, replacing Brilliance VRE agar.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 192-197"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.jhin.2024.11.006
D.J. Noel , C.W. Keevil , S.A. Wilks
Background
Disinfectants are a critical infection control measure that are relied upon globally in a range of settings including healthcare, food production, and domestic environments. However, bacteria have been shown to survive disinfectant treatments when harboured in dry surface biofilms or when disinfectants are used ineffectively. This provides an opportunity for organisms to develop low-level tolerance to various disinfectants. The capability of bacteria to develop adaptations to non-antibiotic antimicrobial agents is often overlooked.
Aim
To report on the capability and readiness of clinically relevant K. pneumoniae to adapt to common disinfectants that are relied upon every day across the world, delivering much-needed insights into an often-overlooked aspect of antimicrobial resistance.
Methods
This study investigated the ability of Klebsiella pneumoniae NDM-1 strain NCTC 13443 to adapt to a range of common chemical disinfectants (benzalkonium chloride, didecyldimethylammonium chloride, polyhexamethylene biguanide, chlorocresol and bronopol) via serial passage exposure method.
Findings
After long-term adaptation, K. pneumoniae developed tolerance to all tested disinfectants, exhibiting a minimum inhibitory concentration increase of between 30 and 413% compared with the untreated parent samples. Characterization of disinfectant cross-tolerance showed that while cross-tolerance can occur, most adapted samples became more susceptible to the second disinfectant treatment, probably because of the fitness cost of adaptation. Observed cross–tolerance/collateral sensitivity was not always reciprocated between disinfectant-tolerant samples.
Conclusions
Results suggest the order of disinfectant exposure is important during tolerance development. This has significant implications for disinfectant cleaning routines, and is probably due to variations in the underpinning tolerance mechanisms, even when the disinfectants display similar mechanisms of action.
{"title":"Development of disinfectant tolerance in Klebsiella pneumoniae","authors":"D.J. Noel , C.W. Keevil , S.A. Wilks","doi":"10.1016/j.jhin.2024.11.006","DOIUrl":"10.1016/j.jhin.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Disinfectants are a critical infection control measure that are relied upon globally in a range of settings including healthcare, food production, and domestic environments. However, bacteria have been shown to survive disinfectant treatments when harboured in dry surface biofilms or when disinfectants are used ineffectively. This provides an opportunity for organisms to develop low-level tolerance to various disinfectants. The capability of bacteria to develop adaptations to non-antibiotic antimicrobial agents is often overlooked.</div></div><div><h3>Aim</h3><div>To report on the capability and readiness of clinically relevant <em>K. pneumoniae</em> to adapt to common disinfectants that are relied upon every day across the world, delivering much-needed insights into an often-overlooked aspect of antimicrobial resistance.</div></div><div><h3>Methods</h3><div>This study investigated the ability of <em>Klebsiella pneumoniae</em> NDM-1 strain NCTC 13443 to adapt to a range of common chemical disinfectants (benzalkonium chloride, didecyldimethylammonium chloride, polyhexamethylene biguanide, chlorocresol and bronopol) via serial passage exposure method.</div></div><div><h3>Findings</h3><div>After long-term adaptation, <em>K. pneumoniae</em> developed tolerance to all tested disinfectants, exhibiting a minimum inhibitory concentration increase of between 30 and 413% compared with the untreated parent samples. Characterization of disinfectant cross-tolerance showed that while cross-tolerance can occur, most adapted samples became more susceptible to the second disinfectant treatment, probably because of the fitness cost of adaptation. Observed cross–tolerance/collateral sensitivity was not always reciprocated between disinfectant-tolerant samples.</div></div><div><h3>Conclusions</h3><div>Results suggest the order of disinfectant exposure is important during tolerance development. This has significant implications for disinfectant cleaning routines, and is probably due to variations in the underpinning tolerance mechanisms, even when the disinfectants display similar mechanisms of action.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 248-253"},"PeriodicalIF":3.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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