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BackgroundThe impact of healthcare personnel hand contamination in multidrug-resistant organism (MDRO) transmission is important and well studied; however, the role of patient hand contamination needs to be characterized further.MethodsPatients from 2 hospitals in southeast Michigan were recruited within 24 hours of arrival to their room and followed prospectively using microbial surveillance of nares, dominant hand, and 6 high-touch environmental surfaces. Sampling was performed on admission, days 3 and 7, and weekly until discharge. Paired samples of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the patients’ hand and room surfaces were evaluated for relatedness using pulsed-field gel electrophoresis and staphylococcal cassette chromosome mec, and Panton-Valentine leukocidin typing.ResultsA total of 399 patients (mean age, 60.8 years; 49% male) were enrolled and followed for 710 visits. Fourteen percent (n = 56/399) of patients were colonized with an MDRO at baseline; 10% (40/399) had an MDRO on their hands. Twenty-nine percent of rooms harbored an MDRO. Six percent (14/225 patients with at least 2 visits) newly acquired an MDRO on their hands during their stay. New MDRO acquisition in patients occurred at a rate of 24.6/1000 patient-days, and in rooms at a rate of 58.6/1000 patient-days. Typing demonstrated a high correlation between MRSA on patient hands and room surfaces.ConclusionsOur data suggest that patient hand contamination with MDROs is common and correlates with contamination on high-touch room surfaces. Patient hand hygiene protocols should be considered to reduce transmission of pathogens and healthcare-associated infections.

Tumor lysis syndrome (TLS) is an oncologic emergency that is caused by massive tumor cell lysis. It is commonly associated with hematological cancers like leukemia and lymphoma and uncommonly with solid nonhematologic tumors as well. However, spontaneous tumor lysis syndrome (STLS) without any cytotoxic chemotherapy rarely occurs in solid tumors. We describe a case of STLS in a metastatic adenocarcinoma of unknown primary and review the literature of STLS in solid non-hematologic tumors to identify various risk factors for pathogenesis of this entity.

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We report a case of Moraxella lacunata bacteremia and sepsis associated with ecthyma gangrenosum in a patient with a hematologic malignancy and successful treatment with antimicrobial therapy. Ecthyma gangrenosum, although classically associated with Pseudomonas aeruginosa, can occur with any bacterial, viral, or fungal infection. In this case report, we review the literature on Moraxella lacunata infections and conclude that it should be considered as a viable contender as a cause of ecthyma gangrenosum in any immunocompromised patient who presents with skin lesions and gram-negative rod bacteremia.

BackgroundMethicillin-resistant S. aureus (MRSA) and Vancomycin-resistant enterococci (VRE) are endemic in post-acute care (PAC) settings. We characterize their transmission between patients and environment in 6 PAC facilities in SE Michigan.MethodsIn a multicenter prospective observational cohort study we collected surveillance cultures of nares, oropharynx, groin, perianal area, wounds, device site(s) and 10 environmental sites collected at enrollment, day 14, and every 30 days thereafter from 651 newly admitted patients. Pulsed-field gel electrophoresis (PFGE) and PCR for SCCmec, agr, and Panton–Valentine leukocidin (pvl) were performed for MRSA. PFGE, and vanA/vanB genotyping were performed for VRE.Results386/651 (59%) participants were not colonized with MRSA at baseline, had more than 1 follow-up visit and were observed for 15,683 patient-days, over which 5,558 patient and 11,108 environmental swabs were collected. Of these 386 patients, 47 (12%) newly acquired MRSA and had complete strain typing available. 42% of strains were USA 100 HA-MRSA, and 31% were USA 300 CA-MRSA. 14% of strains were non USA 100–1100 strains. For 11/47 (23%), a related MRSA strain was isolated from the environment during the previous visit (Figure 1). 24/47 had a subsequent follow-up visit. In 13/24 (54%) a related MRSA strain was found in the environment on the next visit, suggesting transmission from the patient to the environment (Figure 1).For VRE, PFGE profiles showed high heterogeneity. Among 76 of 296 patients (followed for 11,580 days) who newly acquired VRE, a related VRE was found in the previous visit in 12% of patients, no VRE was found in the previous visit for 42 (55%), and an unrelated strain was present for 33%. In 37 patients for whom a follow-up visit was available, 22% had a related VRE strain in the environment on the subsequent visit and 27% had a new VRE strain.ConclusionNew acquisition of VRE was more common than MRSA in this PAC population. Using molecular epidemiologic methods in this large prospective cohort, we show active, frequent and immediate bi-directional transmission between patients and environment. Diminishing environmental contamination has the potential to reduce MDRO transmission to patients in a setting where MRSA and VRE are endemic.Disclosures M. Cassone, National Institute on Aging: Grant Investigator, Research grant; Centers for Disease Control and Prevention: Investigator, Research support; C. Armbruster, Centers for Disease Control and Prevention: Investigator, Research support; E. S. Snitkin, Centers for Disease Control and Prevention: Investigator, Research support; K. Gibson, National Institute on Aging: Investigator, Research grant; Centers for Disease Control and Prevention: Investigator, Research support J. Mantey, National Institute on Aging: Investigator, Research grant; Centers for Disease Control and Prevention: Investigator, Research support; K. C. Reyes, Centers for Disease Control and Prevention: Investigator, Research support S. Altamimi, Centers for Disease Contro...

Phishing is still a major security threat in cyberspace. In phishing, attackers steal critical information from victims by presenting a spoofing/fake site that appears to be a visual clone of a legitimate site. Several Unicode characters are visually identical to ASCII characters. This similarity in characters is generally known as homoglyphs. Malicious adversaries utilize homoglyphs in URLs and DNS domains to target organizations. To reduce the risks caused by phishing attacks, effective ways of detecting phishing websites are urgently required. This paper proposes a homoglyph attack detection model that combines a hash function and machine learning. There are two phases to the model approach. The machine was being trained during the development phase. The deployment phase involved deploying the model with a Java interface and testing the outcomes through actual user interaction. The results are more accurate when the URL is hashed, as any little changes to the URL can be recognized. The homoglyph detector can be developed as a stand-alone software that is used as the initial step in requesting a webpage as it enhances browser security and protects websites from phishing attempts. To verify the effectiveness, we compared the proposed model on several criteria to existing phishing detection methods. By using the hash function, the proposed security features increase the overall security of the homoglyph attack detection in terms of accuracy, integrity, and availability. The experiment results showed that the model can detect phishing sites with an accuracy of 99.8% using Random Forest, and the hash function improves the accuracy of homoglyph attack detection.