A fatal case associated with enterovirus D68 (EV-D68) infection affecting a 10-year-old boy was reported in Hong Kong in 2014. To examine if a new strain has emerged in Hong Kong, we sequenced the partial genome of the EV-D68 strain identified from the fatal case and the complete VP1, and partial 5′UTR and 2C sequences of nine additional EV-D68 strains isolated from patients in Hong Kong. Sequence analysis indicated that a cluster of strains including the previously recognized A2 strains should belong to a separate clade, clade D, which is further divided into subclades D1 and D2. Among the 10 EV-D68 strains, 7 (including the fatal case) belonged to the previously described, newly emerged subclade B3, 2 belonged to subclade B1, and 1 belonged to subclade D1. Three EV-D68 strains, each from subclades B1, B3, and D1, were selected for complete genome sequencing and recombination analysis. While no evidence of recombination was noted among local strains, interclade recombination was identified in subclade D2 strains detected in mainland China in 2008 with VP2 acquired from clade A. This study supports the reclassification of subclade A2 into clade D1, and demonstrates interclade recombination between clades A and D2 in EV-D68 strains from China.
MRSA carriage at admission to acute medical units was prevalent in Hong Kong. Our results suggest that targeted screening is a pragmatic approach to increase the detection of the MRSA reservoir. Molecular typing suggests that old age homes are epicenters in amplifying the MRSA burden in acute hospitals. Enhancement of infection control measures in old age homes is important for the control of MRSA in hospitals.
Background: Global dissemination of SARS-CoV-2 Variants of Concern (VOCs) remains a concern. The aim of this study is to describe how mass testing and phylogenetic analysis successfully prevented local transmission of SARS-CoV-2 VOC in a densely populated city with low herd immunity for COVID-19. Methods: In this descriptive study, we conducted contact tracing, quarantine, and mass testing of the potentially exposed contacts with the index case. Epidemiological investigation and phylogeographic analysis were performed. Findings: Among 11,818 laboratory confirmed cases of COVID-19 diagnosed till 13 th May 2021 in Hong Kong, SARS-CoV-2 VOCs were found in 271 (2.3%) cases. Except for 10 locally acquired secondary cases, all SARS-CoV-2 VOCs were imported or acquired in quarantine hotels. The index case of this SARS-CoV-2 VOC B.1.351 epidemic, an inbound traveler with asymptomatic infection, was diagnosed 9 days after completing 21 days of quarantine. Contact tracing of 163 contacts in household, hotel, and residential building only revealed 1 (0.6%) secondary case. A symptomatic foreign domestic helper (FDH) without apparent epidemiological link but infected by virus with identical genome sequence was subsequently confirmed. Mass testing of 0.34 million FDHs identified two more cases which were phylogenetically linked. A total of 10 secondary cases were identified that were related to two household gatherings. The clinical attack rate of household close contact was significantly higher than non-household exposure during quarantine (7/25, 28% vs 0/2051, 0%; p < 0.001). Interpretation: The rising epidemic of SARS-CoV-2 VOC transmission could be successfully controlled by contact tracing, quarantine, and rapid genome sequencing complemented by mass testing. Funding: Health and Medical Research Fund Commissioned Research on Control of Infectious Disease (see acknowledgments for full list).
ObjectiveTo determine the efficacy of 2 types of antimicrobial privacy curtains in clinical settings and the costs involved in replacing standard curtains with antimicrobial curtains.DesignA prospective, open-labeled, multicenter study with a follow-up duration of 6 months.SettingThis study included 12 rooms of patients with multidrug-resistant organisms (MDROs) (668 patient bed days) and 10 cubicles (8,839 patient bed days) in the medical, surgical, neurosurgical, orthopedics, and rehabilitation units of 10 hospitals.MethodCulture samples were collected from curtain surfaces twice a week for 2 weeks, followed by weekly intervals.ResultsWith a median hanging time of 173 days, antimicrobial curtain B (quaternary ammonium chlorides [QAC] plus polyorganosiloxane) was highly effective in reducing the bioburden (colony-forming units/100 cm2, 1 vs 57; P < .001) compared with the standard curtain. The percentages of MDRO contamination were also significantly lower on antimicrobial curtain B than the standard curtain: methicillin-resistant Staphylococcus aureus, 0.5% vs 24% (P < .001); carbapenem-resistant Acinetobacter spp, 0.2% vs 22.1% (P < .001); multidrug-resistant Acinetobacter spp, 0% vs 13.2% (P < .001). Notably, the median time to first contamination by MDROs was 27.6 times longer for antimicrobial curtain B than for the standard curtain (138 days vs 5 days; P = .001).ConclusionsAntimicrobial curtain B (QAC plus polyorganosiloxane) but not antimicrobial curtain A (built-in silver) effectively reduced the microbial burden and MDRO contamination compared with the standard curtain, even after extended use in an active clinical setting. The antimicrobial curtain provided an opportunity to avert indirect costs related to curtain changing and laundering in addition to improving patient safety.
We evaluated the performance and the cost of toxigenic culture using a commercial chromogenic medium (CDIF) for 538 stool specimens. Compared with real-time PCR, this method was found to detect an additional 9% of positive specimens and result in 61% reduction in material costs, with a trade-off increase in turnaround time of 1 day.A ccurate and reliable laboratory diagnosis of Clostridium difficile infection (CDI) remains a challenge to microbiologists 35 years after its discovery (1). While toxin enzyme immunoassays (EIA) have unacceptably low sensitivities (2), the cytotoxin neutralization assay (CTN) is too time-consuming and labor-intensive to perform. The performance of more recently developed PCR tests for toxin gene detection is promising, with mean sensitivity ranging from 90% to 100% and specificity ranging from 96% to 99% (3, 4). The hand-on time of some commercial assays can be minimal, since extraction and PCR are all carried out in a self-contained cartridge (4). However, PCR has not been widely utilized in clinical laboratories, presumably due to budgetary issues (5). Alternatively, C. difficile isolates can be recovered on selective media. When combined with a sensitive and specific toxin detection method, such as CTN or PCR, toxigenic culture is regarded as one of the gold standards of CDI diagnosis (6). The prototype selective culture medium cycloserine-cefoxitin-fructose-egg yolk agar (CCFA) requires 48 h of incubation and alcohol treatment (7). As a result, toxigenic culture is advocated as part of a diagnostic algorithm to increase the yield, after initial screening by glutamate dehydrogenase (GDH) EIA (8-11). With the availability of a commercial chromogenic selective medium, ChromID C. difficile agar (CDIF) (bioMérieux, France), that allows direct recovery of C. difficile within 24 h of incubation (12, 13), coupled with rapid identification by matrix-assisted laser desorption ionization time-of-fight (MALDI-TOF) mass spectrometry and inference of toxigenicity by PCR for the toxin gene (9), toxigenic culture as a routine diagnostic test is no longer impractical. The aim of the present study was to compare the performance and the cost of toxigenic culture against those of real-time PCR performed on stool specimens.Briefly, 538 soft or liquid stool samples were plated directly onto CDIF medium, which was then incubated in an anaerobic chamber for 48 h according to standard laboratory methods. Suspected flat and irregular colonies were confirmed to be C. difficile by MALDI-TOF mass spectrometry (Biotyper 3.0; Bruker Dal-
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