Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital.

OBJECTIVE: We investigated concurrent outbreaks of Pseudomonas aeruginosa carrying blaVIM (VIM-CRPA) and Enterobacterales carrying blaKPC (KPC-CRE) at a long-term acute-care hospital (LTACH A). METHODS: We defined an incident case as the first detection of blaKPC or blaVIM from a patient's clinical cultures or colonization screening test. We reviewed medical records and performed infection control assessments, colonization screening, environmental sampling, and molecular characterization of carbapenemase-producing organisms from clinical and environmental sources by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. RESULTS: From July 2017 to December 2018, 76 incident cases were identified from 69 case patients: 51 had blaKPC, 11 had blaVIM, and 7 had blaVIM and blaKPC. Also, blaKPC were identified from 7 Enterobacterales, and all blaVIM were P. aeruginosa. We observed gaps in hand hygiene, and we recovered KPC-CRE and VIM-CRPA from drains and toilets. We identified 4 KPC alleles and 2 VIM alleles; 2 KPC alleles were located on plasmids that were identified across multiple Enterobacterales and in both clinical and environmental isolates. CONCLUSIONS: Our response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent CPO outbreaks at LTACH A. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.

The burden of childhood injuries and evidence based strategies developed using the injury surveillance system in Pasto, Colombia.

OBJECTIVE: This article characterises the burden of childhood injuries and provides examples of evidence-based injury prevention strategies developed using a citywide injury surveillance system in Pasto, Colombia. METHODS: Fatal (2003-2007) and non-fatal (2006-2007) childhood injury data were analysed by age, sex, cause, intent, place of occurrence, and disposition. RESULTS: Boys accounted for 71.5% of fatal and 64.9% of non-fatal injuries. The overall fatality rate for all injuries was 170.8 per 100,000 and the non-fatal injury rate was 4,053 per 100,000. Unintentional injuries were the leading causes of fatal injuries for all age groups, except for those 15-19 years whose top four leading causes were violence-related. Among non-fatal injuries, falls was the leading mechanism in the group 0-14 years. Interpersonal violence with a sharp object was the most important cause for boys aged 15-19 years. Home was the most frequent place of occurrence for both fatal and non-fatal injuries for young children 0-4 years old. Home, school and public places became an important place for injuries for boys in the age group 5-15 years. The highest case-fatality rate was for self-inflicted injuries (8.9%). CONCLUSIONS: Although some interventions have been implemented in Pasto to reduce injuries, it is necessary to further explore risk factors to better focus prevention strategies and their evaluation. We discuss three evidence-based strategies developed to prevent firework-related injuries during festival, self-inflicted injuries, and road traffic-related injuries, designed and implemented based on the injury surveillance data.

Occurrence of ß-Lactamase-Producing Gram-Negative Bacterial Isolates in Water Sources in Cali City, Colombia.

INTRODUCTION: Pollution by domestic, industrial, and hospital wastes of the artificial and natural waters of the city of Cali led us to investigate the presence of Gram-negative bacteria resistant to antibiotics in these aquatic ecosystems. MATERIAL AND METHODS: We used culture-dependent methods and molecular techniques to investigate the prevalence and dynamics of ß-lactamase producing Gram-negative bacteria in five areas located in channels and rivers that cross the city of Cali in January (dry season) and May (wet season). The association between the variables was determined by the chi-square test, using the statistical package SPSS vs 23.0. RESULTS: The main species being Escherichia coli and Pseudomonas spp. with associated resistance to both cefoxitin and cefotaxime were observed in 73.3% isolates during the dry season. Most of the isolates belonged to antibiotype 3 (with resistance to 6 antibiotics), 51.2% in the dry season and 48.9% in the wet season, and they were found especially in the artificial waters of "Intersector Canal (CVC) Sur". CONCLUSION: These results indicate that ß-lactamase-producing Gram-negative bacteria are widespread in the environment in the aquatic ecosystem of Cali city. The artificial and natural waters that cross the city are finally discharged into the Rio Cauca; this river can then be considered as a medium for the spread of bacterial antibiotic resistance genes.

Isolation of Candida dubliniensis for the first time in Cali, Colombia, and its identification with phenotyping methods.

Candida dubliniensis is an emerging pathogenic yeast isolated mainly from the oral cavity of HIV-infected patients. The close phenotypic and genotypic relationship between C. albicans and C. dubliniensis has led to incorrectly identifying isolates of C. dubliniensis as C. albicans. The oral cavities of 107 diabetic patients were studied in Cali, Colombia, and 72 colonies of Candida, with shades of green on CHROMagar Candida culture media, were obtained. Various phenotypic tests were carried out, which included germ tube formation and production of chlamydospores on corn meal Agar. Additionally, growth studies were carried out at 42 degrees C and 45 degrees C and on Sabouraud agar with 6.5%, sodium chloride. Identification of C. dubliniensis with these tests was confirmed with API 20C Aux. We identified 65 and 7 colonies of C. albicans and C. dubliniensis, respectively. This is the first time that C. dubliniensis is identified with phenotypic methods in Colombia.

Medically important fungi found in hallux nails of university students from Cali, Colombia.

The presence of medically important fungi was studied in hallux nails scrapings obtained from 504 students (204 males, 300 females) of three universities in Cali. Specimens were examined by direct microscopic examination and fungal culture. Medically important fungi were found in 49 (9.7%) students, 24 (4.8%) had onychomycosis while the rest did not have nail lesions. Trichophyton rubrum was the most commonly isolated fungi in students with lesions, where as T. mentagrophytes predominated in healthy nails. Most of the students with fungi were males. The prevalence of fungi was higher in individuals between 26 and 35 years. No association was observed between fungi and practicing sports or undergoing pedicures. These results suggest that dermatophytes can be found in healthy hallux nails, which can be reservoirs of pathogenic fungi.

Dermatofitos en perros de Cali, Colombia / Dermatophytes in dogs from Cali, Colombia

En Cali se realizó un estudio de perros con el fin de determinar la frecuencia de dermatofitos. La toma de muestra se hizo en hocico, cabeza, dorso, vientre y zonas laterales por la técnica del tapete y para cada sitio y perro muestreado se utilizó una alfombra diferente. Las muestras se sembraron en agar selectivo para hongos patógenos. Se examinaron 251 perros, 86 callejeros y 165 caseros, entre los cuales se encontraron 34 (13,5 por ciento) positivos para dermatofitos; de éstos, 23 correspondieron a perros caseros y 11 a callejeros. No se establecieron diferencias significativas entre estas dos categorías. Tampoco se encontró asociación con la edad, el sexo, la raza o la longitud del pelo, pero sí hubo relación entre la presencia de lesiones en la piel y el aislamiento de hongos (P<,0,05). El dermatofito más aislado fue el Microsporum gypseum (55,9 por ciento), seguido por Microsporum canis y Trichophyton mentagrophytes var mentagrophytes, cada uno con el 14,7 por ciento y Trichophyton rubrum con 2,9 por ciento de los aislamientos. Estos dos últimos hongos sólo se hallaron en los perros caseros