High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April 2020.

BACKGROUND: Elderly people in nursing homes are particularly vulnerable to COVID-19 due to their age, the presence of comorbidities, and community living. On March 14, 2020, at the beginning of the first epidemic wave of COVID-19 in France, a cluster was reported in a nursing home in the Nouvelle-Aquitaine region. We monitored the outbreak as well as the infection prevention and control (IPC) measures implemented. METHODS: A confirmed case was defined as laboratory-confirmed COVID-19 in a resident or staff member present in the nursing home between March 7 and May 1, 2020; and a probable case as a person presenting an acute respiratory illness after contact with a confirmed case. Symptomatic inpatient residents and symptomatic staff members were systematically tested for SARS-CoV-2. In addition, two screening sessions were held on site. RESULTS: We identified 109 cases (98 confirmed, 11 probable). The attack rate was 66% among residents and 45% among staff. Half of all cases were identified during the screening sessions. One-quarter of cases had minor symptoms or were asymptomatic. The case fatality rate among residents was 29%. IPC measures were rapidly implemented such as the quarantine of residents, the reinforcement of staff personal protective equipment, and home quarantine of staff testing positive, which were supplemented in April by systematic controls at the entrance of the nursing home and the creation of additional staff break rooms. CONCLUSIONS: This outbreak confirmed the considerable health impact of SARS-CoV-2 transmission in a nursing home. In addition to the implementation of IPC measures, the early detection of cases through the screening of residents and staff is essential to identify asymptomatic and pre-symptomatic cases and limit the spread of the virus.

Nosocomial outbreak of Pseudomonas aeruginosa associated with a drinking water fountain.

Over a four-month period, ten patients were suspected of having acquired nosocomial infection to P. aeruginosa in the ear, nose, and throat department. Environmental and clinical isolates were compared. Only water from a drinking water fountain was contaminated by P. aeruginosa. This isolate and those of three patients had indistinguishable random amplified polymorphic DNA profiles. These patients had serious oncology diseases. The drinking water fountain was used for their alimentation by percutaneous endoscopic gastrostomy and was the origin of the outbreak. Another type of drinking fountain with a terminal ultraviolet treatment was installed, following which no new infections linked to drinking water were identified.

Control of multi-drug-resistant Acinetobacter baumannii outbreaks in an intensive care unit: feasibility and economic impact of rapid unit closure.

From January to May 2006, a nosocomial outbreak caused by a multi-drug-resistant strain of Acinetobacter baumannii (MDRAB) occurred in a multi-specialty surgical ICU (SICU). During this episode, 20 patients were colonized by an identical MDRAB strain. Despite introduction of control measures, the outbreak was only stopped after complete closure of the unit. When a second MDRAB outbreak was confirmed in the same unit in January 2009, the SICU was closed as soon as possible. This measure allowed faster control of the outbreak, which only involved seven patients and lasted for 25 days. The economic impact of the outbreak was also considerably lower; estimated costs were €202,214 in 2009 compared with €539,325 in 2006. This study found that rapid closure of the SICU, with patients cohorted elsewhere, was a cost-effective way of controlling an MDRAB outbreak.

[Rapid detection of tolerance of streptococci and enterococci to beta-lactam antibiotics by measurement of bacterial TPA]. / Détection rapide de la tolérance des streptocoques et des entérocoques aux bêtalactamines par mesure de l'ATP bactérien.

The authors developed a rapid method for determination of tolerance of streptococci and enterococci to ampicillin by measuring the bacterial TPA. Of thirty three strains from blood cultures, 11 were tolerant with a MBC/MIC ratio > 32. For these strains, the free TPA/total TPA ratio measuring the bacterial lysis after a 2hrs incubation with 2 MIC of ampicillin, had an average of 38% (SD = 21) versus 88.6% (SD = 17.9) for the non-tolerant strains. There is a good correlation between the values of MBC/MIC ratios and the free TPA/total TPA ratios. The authors concluded that TPA assessment after 2hrs incubation with antibiotic can predict the antibiotic tolerance of streptococci or enterococci.