The recent outbreak of novel H1N1 influenza has underscored the importance of hospital preparedness in responding toepidemic and pandemic respiratory illness. Comprehensive planning for the emergence of novel respiratory pathogens shouldbe based on an all-hazards approach, with the input of key stakeholders. A staged, scalable model allows for a flexibleresponse, and the addition of a medical control chief and a situational assessment chief to the incident command systemprovides the clinical and epidemiologic expertise essential for effective implementation. Strategies for coordinated and efficientcommunication both within and outside the institution should be clearly outlined. Furthermore, the outbreak of novel H1N1influenza demonstrated the necessity of (1) additional support roles within the hospital, (2) development of employeedatabases, and (3) incorporation of disease severity into staged planning. Careful consideration of these issues will allowinstitutions to better meet the challenges of treating epidemic and pandemic respiratory illness, both now and in the future.
Further research is needed on appropriate respiratory protection for influenza. Mandatory vaccination programs should be considered in all healthcare settings. Pandemic preparedness plans should be revised, focusing on flexibility, communication, stockpiling of essential supplies, and staffing support for infection control.
Heartland virus is a suspected tickborne pathogen in the United States. We describe a case of hemophagocytic lymphohistiocytosis, then death, in an immunosuppressed elderly man in Missouri, USA, who was infected with Heartland virus.
Objective: To assess extent of a healthcare-associated outbreak of SARS-CoV-2 and evaluate effectiveness of infection control measures, including universal masking Design: Outbreak investigation including 4 large-scale point-prevalence surveys Setting: Integrated VA Health Care System with 2 facilities and 330 beds Participants: Index patient and 250 exposed patients and staff Methods: We identified exposed patients and staff and classified them as probable and confirmed cases based on symptoms and testing. We performed a field investigation and assessment of patient and staff interactions to develop probable transmission routes. Infection prevention interventions implemented included droplet and contact precautions, employee quarantine, and universal masking with medical and cloth facemasks. Four point-prevalence surveys of patient and staff subsets were conducted using real-time reverse-transcriptase polymerase chain reaction for SARS-CoV-2. Results: Among 250 potentially exposed patients and staff, 14 confirmed cases of Covid-19 were identified. Patient roommates and staff with prolonged patient contact were most likely to be infected. The last potential date of transmission from staff to patient was day 22, the day universal masking was implemented. Subsequent point-prevalence surveys in 126 patients and 234 staff identified 0 patient cases and 5 staff cases of Covid-19, without evidence of healthcare-associated transmission. Conclusions: Universal masking with medical facemasks was effective in preventing further spread of SARS-CoV-2 in our facility in conjunction with other traditional infection prevention measures.
OBJECTIVE To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria DESIGN Retrospective cohort study SETTING A 1,250-bed academic tertiary referral center PATIENTS Hospitalized adults METHODS This study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital's medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as "isolated." The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures. RESULTS During the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11-1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89-2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47-2.00; surgical ICU aOR, 1.82; 95% CI, 1.51-2.19), and obtaining the urine culture ≥1 calendar day after admission (1-7 days aOR, 1.91; 95% CI. 1.71-2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37-3.34). CONCLUSIONS Isolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections. Infect Control Hosp Epidemiol 2017;38:455-460.
A 53-year-old Thai man with a history of pemphigus vulgaris on chronic prednisolone (30 mg/day) presented to a hospital in Thailand with a 5-month history of lower back pain. He had initially been treated with tramadol, amitriptyline, and gabapentin without relief. Two months prior to presentation, he had developed weakness of the right leg, and he presented when weakness in his right foot made it difficult for him to keep his sandal on. He denied numbness, paresthesia, urinary retention, or bowel incontinence. On physical exam, he appeared well, with a temperature of 36.6°C, a blood pressure of 141/72 mm Hg, and a pulse of 74 beats per minute. Neurologic exam showed a knee flexion score of 4/5 and a foot dorsiflexion score of 3/5 on the right and a knee flexion score of 4/5 and foot dorsiflexion on the left. Sensation was intact bilaterally. Patellar reflexes were 1ϩ bilaterally, with downward plantar reflexes. Initial laboratory investigation showed a white blood cell count of 11,000 cells/mm 3 (normal, 4,000 to 11,000 cells/mm 3 ), with 81.1% neutrophils and 0.3% eosinophils (absolute eosinophil count, 33 cells/mm 3 ). Three serial stool specimens sent for microscopic ova and parasite identification were negative.Gadolinium-enhanced magnetic resonance imaging (MRI) of the lumbosacral spine was performed (Fig. 1A), demonstrating arachnoiditis with a nonenhancing, loculated cystic lesion attached to the left aspect of the cauda equina. Based on this appearance, a parasitic infection was suspected, and neurosurgical consultation was requested. The patient was taken to the operating room for removal of the structure. The cystic lesion was identified in the intradural space, and within was found a macroscopic white helminth (Fig. 1B). The exact length of the specimen could not be determined due to fragmentation during extraction but was greater than 3 cm. Gross pathology showed a helminth with pseudosegmentation evidenced by various circumferences, while microscopic specimens demonstrated a tegumental brush border, calcareous bodies, and a lack of organoid structures (Fig. 1C). With the combination of clinical presentation and pathological findings, a diagnosis of sparganosis was made. Subsequent MRI of the brain also showed evidence of cerebral and cerebellar involvement, with white matter enhancement and serpiginous tunneling (Fig. 1D). On further history, the patient acknowledged that he frequently consumed both raw frog and raw snake meat. He again denied any other neurologic symptoms apart from those mentioned previously, and there was no evidence of cerebellar or cerebral dysfunction on exam. DISCUSSIONSparganosis is a zoonotic infection caused by cestodes of the genera Spirometra and Sparganum, members of the Diphyllobothriidae family (1; DPDx, sparganosis [Centers
The impact of the revised Clinical and Laboratory Standards Institute interpretative criteria for cefepime in Enterobacteriaceae remains unclear. We applied the new breakpoint on 644 previously defined cefepime-susceptible Enterobacteriaceae isolates. We found no differences in mortality or microbiological failure, regardless of isolates being susceptible or cefepime-susceptible dose-dependent by current criteria.
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