Seroprevalence of SARS-CoV2 among Healthcare Workers: A Prospective Study.

BACKGROUND: Healthcare workers (HCWs) have close interaction with confirmed or suspected coronavirus disease 2019 (COVID-19) patients. Infection rates reported among HCWs is between 3% and 17%, and asymptomatic HCWs are a potential source of nosocomial transmission to vulnerable patients and colleagues. Universal mask use and good supply of personal protective equipment was implemented early at our institution. OBJECTIVES: To determine the rate of infection by the serologic status of HCWs during first three COVID-19 waves, based on occupation and risk of exposure, compared to Israeli general population. METHODS: We conducted a prospective cohort study at Emek Medical Center from April 2020 to April 2021. A total of 101 HCWs volunteered to be followed at six time points by a serology test and a questionnaire. RESULTS: A total of 101 HCWs completed six serologic tests. All participants were seronegative at the four initial tests. The cumulative seropositivity rate for COVID-19 in HCWs was 9.9% (10/101). Only three seropositive HCWs (2.97%) were hospital-acquired. CONCLUSIONS: Seroprevalence and seroconversion dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in 101 HCWs during COVID-19 outbreaks at Emek Medical Center were similar to the epidemiological curve of positive polymerase chain reaction results of the Israeli population, as published by the Israeli Ministry of Health, at each time point. Universal mask use and infection control measures may have contributed to a low hospital infection rate.

Bloodstream Infections Caused by Contaminants: Epidemiology and Risk Factors: A 10-Year Surveillance.

BACKGROUND: Skin colonization of microorganisms in blood cultures (BCs) are generally considered clinically non-significant and can be the source of a true infection, particularly in immunosuppressed patients. OBJECTIVES: To study the epidemiology and risk factors for bacteremia caused by contaminants. METHODS: This retrospective, descriptive study is based on adult BCs collected (2004-2013) and categorized as positive (True bacteremia [TrueB] or contamination) or negative. Clinical, demographic, and laboratory characteristics of BCs positive for the six most common potential contaminant pathogens (PCPs) that can cause TrueB and contamination (Coagulase-negative Staphylococcus [CoNS], Streptococcus viridans, Propionibacterium acnes, Corynebacterium spp., Bacillus spp., Clostridium spp.) were assessed. Ninety-two TrueB were identified vs. 196 contaminations (1:2 ratio). RESULTS: From 74,014 BCs, PCPs were found in 3735 samples, of which 3643 (97.5%) were contaminations and 92 (2.5%) were TrueB. The overall rate of BC contamination decreased during the study period from 6.7% to 3.8%. CoNS was the most common PCP. Bacillus spp. were only contaminants. Clostridium spp. and Streptococcus viridans were more often TrueB. In a multivariate model, predictors of TrueB included high creatinine levels, Streptococcus viridans in BC, and multiple positive BCs. A single culture of CoNS was strongly predictive of contamination. CONCLUSIONS: Ten years of data on BCs, focusing on six PCPs, demonstrates a significant, yet insufficient reduction in the rate of contamination. High creatinine level, isolation of Streptococcus viridans, and multiple positive BCs were predictors of TrueB, while growth of CoNS was strongly predictive of contamination. This model could assist in diagnostic and therapeutic decision making.

Microbiologic Data in Acute Cholecystitis: Ten Years' Experience from Bile Cultures Obtained during Percutaneous Cholecystostomy.

BACKGROUND: The aim of the study was to describe the microbiology and susceptibility patterns in acute cholecystitis by examining bile culture results from patients who underwent percutaneous cholecystostomy and examine concordance with empiric treatment. PATIENTS AND METHODS: A total of 124 patients with acute cholecystitis underwent percutaneous cholecystostomy between 2003 and 2012 at Emek Medical Center, Israel. Data on bile and blood culture results, isolate susceptibility, and clinical outcomes were retrieved from patient files. RESULTS: Bile cultures obtained from 116 patients were positive in 70 (60.3%) patients. Blood cultures obtained from 77 patients were positive in 23 (31.1%). Escherichia coli was the most common isolate in 28.6% of bile cultures and 43.5% of blood cultures. The concordance between empiric treatment coverage and culture isolate susceptibility was 67.6%. In most discordant cases, the isolates were Enterobacter spp. (40.9%) and Enterococcus spp. (31.8%). Overall, the in-hospital mortality rate was 7%: 2% in patients with concordant treatment compared with 14% in patients with discordant treatment (p = 0.09). Empiric antibiotic regimens were adequate in only two-thirds of patients. CONCLUSIONS: There might be a trend for poorer outcome in patients treated with inadequate antibiotic agents, emphasizing the importance of tailoring antibiotic treatment.

Susceptibility of Group A Streptococcus to Antimicrobial Agents in Northern Israel: A Surveillance Study.

BACKGROUND: Resistant pathogens are an increasing threat affecting millions of people globally. More complicated patients are presented with pathogens harboring new resistance mechanisms, while the pipeline of new antimicrobials hardly proposes solutions. In such a scenario, more severely ill patients remain with no adequate treatment to offer. In addition, massive misuse of antimicrobials, including excessive length of treatment or wrong dosage, also contributes to increasing the rate of pathogens resistance to antimicrobials. Isolation of Streptococcus pyogenes (Group A Streptococcus-GAS) is the main indication for antibiotic treatment to patients diagnosed with acute tonsillitis. Hence, GAS resistance to antibiotics requires periodic monitoring. OBJECTIVES: To assess susceptibility rates of GAS to penicillin, macrolides, clindamycin, and tetracycline in northern Israel and to compare the findings to the high antimicrobial susceptibility of GAS isolates reported in the same region in 2004 and to other geographical areas. METHODS: Throat samples from 300 outpatients were collected and cultured at the regional laboratory of Emek Medical Center during September to October 2011. RESULTS: In 300 samples, the susceptibility rates of GAS to penicillin, erythromycin, azithromycin, clindamycin, and tetracycline in northern Israel still remain very high. CONCLUSIONS: Continuous control of antimicrobials usage and periodic surveillance of susceptibility rates, together with educational programs and appropriate and targeted treatment protocols, are essential and highly recommended to keep these high susceptibility rates for as long as possible.

Providing detailed information about latent tuberculosis and compliance with the PPD test among healthcare workers in Israel: a randomized controlled study.

BACKGROUND: The compliance of screening for latent tuberculosis (TB) with the tuberculin purified protein derivative (PPD) test is very low among healthcare workers (HCWs) in Israel. METHODS: This randomized controlled study uses the Health Belief Model (HBM) as a conceptual framework to examine whether providing more information about latent TB and the PPD test increases the response rate for PPD screening among HCWs. All candidate HCWs for latent TB screening were randomly allocated to one of the following two invitations to perform the PPD test: regular letter (control group, n=97), and a letter with information about latent TB and the PPD test (intervention group, n=196). RESULTS: 293 HCWs were included (185 nurses, and 108 physicians). Overall, 36 (12.3%) HCWs were compliant with the PPD test screening. Compliance with PPD testing in the intervention group was not statistically different from the control group, RR 0.87 (95% CI, 0.46-1.65). CONCLUSIONS: Compliance for latent TB screening is low among HCWs in northeastern Israel. Providing detailed information about latent TB was not associated with increased test compliance. Understanding existing disparities in screening rates and potential barriers to latent TB screening among HCWs is important in order to move forward and successfully increase screening rates.

Trends in the burden of infectious disease hospitalizations among the elderly in the last decade.

BACKGROUND: Infectious disease is a leading cause of hospitalization. We investigated trends in infectious disease hospitalizations among the elderly in the last decade. METHODS: A total of 81,077 hospitalizations of elderly patients between 2001 and 2010 were available on the computerized database of the Ha'emek Medical Center, Israel. The proportion of hospitalizations attributable to infectious diseases was calculated. RESULTS: Overall, lower respiratory tract infection (LRTI) accounted for 41.0% of hospitalizations attributable to infectious diseases followed by kidney, urinary tract and bladder infections (UTI) (21.4%), upper respiratory tract infections (URTI) (10.2%), and hepatobiliary tract infections (9.8%). The proportion of hospitalizations attributable to infectious diseases increased by 14.2% during the study period, rising from 16.9% in 2001 (1023 infectious disease hospitalizations of a total of 6043 hospitalizations) to 19.3% in 2010 (1907 infectious disease hospitalizations of a total of 9876 hospitalizations) (P for trend<0.001). A significant increasing trend persisted after adjustment for age, ethnicity, and season, resulting in an increase from 16.9% in 2001 to 18.8% in 2010 (P for trend=0.001). A significant increasing trend was observed in males (P for trend<0.001) and a borderline significant trend was observed in females (P for trend=0.062). The proportion of hospitalizations attributable to infectious diseases was higher in males and increased with age. LRTI and URTI were the major contributors to the increasing trend (P for trend=0.018 and <0.001, respectively). CONCLUSIONS: This study shows an increasing trend in infectious disease hospitalizations among the elderly in the last decade. Public health measures are needed to reduce infectious disease hospitalizations.

Etiology of community-acquired pneumonia in hospitalized patients in northern Israel.

BACKGROUND: Community-acquired pneumonia is a common infection and is associated with high rates of morbidity and mortality. Most patients with CAP are treated empirically. OBJECTIVES: To identify common pathogens causing CAP in hospitalized patients in northern Israel and to evaluate the correlation between etiology and disease severity. METHODS: We conducted a prospective study of patients with CAP hospitalized at HaEmek Medical Center, Afula. We collected demographic, clinical and laboratory data (blood and sputum cultures, serology, pneumococcal urinary antigen test, and respiratory multiplex-polymerase chain reaction from nasopharyngeal swab). Radiologic evaluation was performed. RESULTS: A total of 126 patients and 24 controls were enrolled. At least one pathogen was identified in 84 cases (66.7%), more than one in 43 patients (34.1%), and no pathogens in 42 (33.3%). Typical bacteria were found in 23 (18.3%), atypical bacteria in 66 (52.4%), and viruses in 42 (33.3%). The number (%) of patients with pathogens isolated was: Chlamydophila pneumoniae 26 (20.6%), Streptococcus pneumoniae 23 (18.3%), Mycoplasma pneumoniae 23 (18.3%), influenza virus A-B 20 (15.9%), Coxiella burnetti 8 (6.3%), and parainfluenza and adenovirus 13 (10.3%) each. A correlation was found only between a high PORT score on admission and S. pneumoniae, although atypical pathogens did not show class predominance. CONCLUSIONS: S. pneumoniae, M. pneumoniae and C. pneumoniae were the most common pathogens isolated, while co-infection was very frequent. PORT score did not predict any of the pathogens involved. The choice of empiric antimicrobial treatment for CAP should be made according to local epidemiologic data.

Epidemiology and susceptibility to antimicrobials in community, hospital and long-term care facility bacteremia in northern Israel: a 6 year surveillance.

BACKGROUND: Identification of pathogens and their susceptibility to antimicrobials is mandatory for successful empiric antibiotic treatment. OBJECTIVES: To compare the clinical characteristics of patients with bacteremia, as well as the bacterial distribution and antimicrobial susceptibility in community, hospital and long-term care facilities during two periods (2001-2002 and 2005-2006). METHODS: The study was conducted at the HaEmek Medical Center, a community 500-bed teaching hospital in northern Israel serving a population of approximately 500,000 inhabitants. All episodes of bacteremia (n = 1546) during two 2 year periods (2001-2 and 2005-6) were prospectively recorded, evaluated and compared (755 in 2001-2 and 791 in 2005-6). RESULTS: In both periods the urinary tract was the main port of entry in community and long-term care facility bacteremia, while the urinary tract--primary and catheter-related--were similar in frequency as sources of hospital bacteremia. Escherichia coli was the most frequent pathogen isolate. No significant changes in the frequency of methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase-producing bacteria were seen between the two 2 year periods (2001-2 and 2005-6). The susceptibility of non-ESBL-producing E. coli decreased for some antibiotics while non-ESBL-producing Klebsiella pneumoniae susceptibility profile improved in the same period. A non-statistically significant trend of increased resistance in gram-negative isolates to quinolones, piperacillin and piperacillin-tazobactam was observed, but most isolates still remained highly susceptible to carbapenems. There was a small increase in mortality rate in hospital bacteremia during the second period. CONCLUSIONS: Continuous surveillance is imperative for monitoring the local epidemiology and for developing local treatment guidelines.

Self-medication with antibiotics by a population in northern Israel.

BACKGROUND: The current study is part of a larger study--Self-Medication with Antibiotics and Resistance Levels in Europe (SAR project)--coordinated by the University of Groningen in the Netherlands and run in 19 European countries and Israel. OBJECTIVES: To estimate self-medication with antibiotics by a population in northern Israel. METHODS: We sent by post a questionnaire on antibiotic usage to 2,615 adults, both Jewish and Arab, living in northern Israel. RESULTS: The overall response rate was low (17.9%), particularly among the Arab population (9.4% of respondents). Among the 467 respondents, 169 (36.2%) reported 215 antibiotic courses within the last year. Amoxicillin was the antibiotic most commonly used (32.7% of courses); 89.4% of antibiotics were obtained via a physician's prescription; 114 respondents (24.4%) stored leftover antibiotics at home, and 81 (18.7%) would consider self-medication with antibiotics without a medical consultation. CONCLUSIONS: Over-the-counter acquisition of antibiotics is rare in Israel. However, the storage of leftover antibiotics in the home constitutes an alternative potential source of self-medication that can have untoward consequences, not only for the individual patient but also for the general population since inappropriate antibiotic usage contributes to the increasing rates of antimicrobial resistance.

Vaginal colonization by orally administered Lactobacillus rhamnosus GG.

BACKGROUND: The lack of lactobacilli in the vagina of postmenopausal women due to estrogen deficiency plays an important role in the development of bacteriuria. In the last few years the use of lactobacilli for the prevention of genitourinary infections has been explored using different probiotic strains. OBJECTIVES: To evaluate the vaginal colonization by Lactobacillus rhamnosus GG in postmenopausal healthy women following oral administration of the bacteria in a yogurt base for 1 month, as a first step in evaluating the potential probiotic role of LGG in the prevention of recurrent urinary tract infections. METHODS: One or two doses per day of yogurt containing 10(9) colony-forming units of LGG were administered orally to 42 postmenopausal healthy women for 1 month. Vaginal and rectal swabs were cultured at the beginning and end of the study. RESULTS: At the end of the study the vaginas of only four women (9.5%) were colonized with LGG, at a very low number of bacteria, despite the fact that the gastrointestinal tracts of 33 women (78.6%) were colonized. There were no significant differences between one or two doses daily. CONCLUSIONS: LGG should not be considered as a probiotic agent in urinary infections since it does not attach well to the vaginal epithelium.

[Home intravenous antibiotic therapy for osteomyelitis patients].

OBJECTIVES: To evaluate both the safety and the costeffectiveness of the Home Intravenous Antibiotic Therapy (HIAT) program for the treatment of patients with osteomyelitis in the district of Haifa and Western Galilee. METHODS: We checked the medical records of all the patients with osteomyelitis who had been treated at home with intravenous antibiotics during 1999-2000. We reviewed their records for etiological agents, types of antibiotics given, complications and cost evaluation. RESULTS: During the two year period (January 1999 to December 2000), 52 patients received 55 courses of HIAT. The total duration of treatments was 1187 days. Eighty-five percent of the patients were referred from clinical departments from one of the medical centers in our area. In 54.6% of cases the infecting agent is unknown. Among the known ones, Staphylococci and Pseudomonas aeruginosa were the most prevalent pathogens. Penicillins and Cephalosporins were the most common antimicrobial agent prescribed. The HIAT program saved NIS. 1,299,765 (approx. $365,000) during 1999-2000. Only minor complications were present. CONCLUSIONS: HIAT for the treatment of patients with osteomyelitis is effective, safe and comfortable for the patients and has an important economic impact.