Rates and causative pathogens of surgical site infections attributed to liver transplant procedures and other hepatic, biliary, or pancreatic procedures, 2015-2018.

Liver transplant recipients are at high risk for surgical site infections (SSIs). Limited data are available on SSI epidemiology following liver transplant procedures (LTPs). We analyzed data on SSIs from 2015 to 2018 reported to CDC's National Healthcare Safety Network to determine rates, pathogen distribution, and antimicrobial resistance after LTPs and other hepatic, biliary, or pancreatic procedures (BILIs). LTP and BILI SSI rates were 5.7% and 5.9%, respectively. The odds of SSI after LTP were lower than after BILI (adjusted odds ratio = 0.70, 95% confidence interval 0.57-0.85). Among LTP SSIs, 43.1% were caused by Enterococcus spp., 17.2% by Candida spp., and 15.0% by coagulase-negative Staphylococcus spp. (CNS). Percentages of SSIs caused by Enterococcus faecium or CNS were higher after LTPs than BILIs, whereas percentages of SSIs caused by Enterobacteriaceae, Enterococcus faecalis, or viridans streptococci were higher after BILIs. Antimicrobial resistance was common in LTP SSI pathogens, including E. faecium (69.4% vancomycin resistant); Escherichia coli (68.8% fluoroquinolone non-susceptible and 44.7% extended spectrum cephalosporin [ESC] non-susceptible); and Klebsiella pneumoniae and K. oxytoca (39.4% fluoroquinolone non-susceptible and 54.5% ESC non-susceptible). National LTP SSI pathogen and resistance data can help prioritize studies to determine effective interventions to prevent SSIs and reduce antimicrobial resistance in liver transplant recipients.

The Preservation of the Effects of Preweaning Nutrition on Growth, Immune Competence and Metabolic Characteristics of the Developing Heifer.

This experiment investigated the preservation effects of two preweaning milk feeding nutritional treatments (High: 8 L and Low: 4 L milk per day) on 20, 12-month-old Holstein-Friesian dairy heifers (Bos taurus). A vaccination immune challenge was initially implemented on these 20 heifers at 6 weeks of age and the findings indicated superior growth, immune competence and favorable metabolic characteristics from the calves that had been fed 8 L milk per day. Postweaning, all heifers were treated the same under non-experimental conditions, and the immune challenge was repeated at 12 months of age for the current experiment. Consistent with the first immune challenge, heifers from the High preweaning treatment group still had higher white cell count and neutrophil count, indicating superior immune competence. The differences found in metabolic biomarkers, including beta-hydroxybutyrate, glucose and insulin, in the preweaning phase had disappeared, suggesting these biomarkers were influenced directly by the nutritional input at the time. There were no differences in NEFA levels between treatments at either stage of development. Postweaning, the heifers from the Low preweaning treatment group experienced accelerated growth with slightly numerically higher ADG (0.83 kg/day vs. 0.89 kg/day), resulting in the initial differences in bodyweight recorded at weaning being eliminated by 13 months of age. These results are evidence of a form of immunological developmental programming as a result of accelerated preweaning nutrition and therefore, are not supportive of restricted milk feeding of calves.

Preweaning Nutrition and Its Effects on the Growth, Immune Competence and Metabolic Characteristics of the Dairy Calf.

Feeding increased volumes of milk in the preweaning phase has been shown to improve growth, morbidity and mortality rates in calves (Bos Taurus). This experiment enlisted 20 Holstein-Friesian dairy replacement calves from birth until weaning (at 10 weeks of age) and assessed the effect of feeding either 4 L (Low) or 8 L (High) of milk per calf per day on their growth, immune competence and metabolic characteristics. The responsiveness of these systems was compared through a vaccination immune challenge. Calves in the High treatment group were significantly heavier from two weeks of age and were 19 kg heavier than calves in the Low treatment group at weaning. Calves in the High treatment group also exhibited greater immune responses, with significantly higher white cell counts and neutrophil counts than calves in the Low treatment group post-vaccination. Calves in the High treatment group also had lower beta-hydroxybutyrate both pre- and post-vaccination, and higher glucose and insulin levels post-vaccination, indicating superior metabolic characteristics. Calves had ad libitum access to lucerne hay (Medicago sativa) and a commercial concentrate. Solid feed intakes were mostly the same between treatments, with differences in hay intake only detected at 7 and 8 weeks of age. Results from this experiment are indicative of a positive influence of accelerated preweaning nutrition on growth, immune response and metabolic characteristics.

The Effect of Direct-Fed Lactobacillus Species on Milk Production and Methane Emissions of Dairy Cows.

Using direct-fed microbials to mitigate enteric methane emissions could be sustainable and acceptable to both consumers and producers. Forty lactating, multiparous, Holstein-Friesian cows were randomly allocated one of two treatments: (1) a base of ad libitum vetch (Vicia sativa) hay and 7.0 kg DM/d of a grain mix, or (2) the basal diet plus 10 mL of MYLO® (Terragen Biotech Pty Ltd., Coolum Beach, Queensland, Australia) delivering 4.17 × 108 cfu of Lactobacillus per mL. Neither feed intake (25.4 kg/d vs. 24.8 kg/d) nor milk yield (29.9 vs. 30.3 kg/d) were affected by treatment. Feed conversion efficiency was not affected by treatment when expressed on an energy-corrected milk basis (1.15 vs. 1.18 kg/kg DMI). Neither methane yield (31.6 vs. 31.1 g/kg DMI) nor methane intensity (27.1 vs. 25.2 g/kg energy corrected milk) were affected by treatments. While these results are contrary to our expectations and not significant, all were numerically in a favorable direction. Given there are reports that diet and dose rate may impact the size of any effect, we recommend a dose-response study be undertaken using a basal diet that is commonly used in pasture-based dairy systems.

Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network Data Quality Collaboration Case Study - Chapter 9 Surgical site infection event (SSI) case study.

This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) healthcare-associated infection (HAI) surveillance definitions. This specific case study focuses on the application of common surveillance concepts included in the Patient Safety Component, Chapter 9 - Surgical Site Infection Event (SSI). The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions and encourage accurate HAI event determination among Infection Preventionists (IPs).

How infection present at time of surgery (PATOS) data impacts your surgical site infection (SSI) standardized infection ratios (SIR), with focus on the complex 30-day SSI SIR model.

This case study is part of a series centered on the Centers for Disease Control and Prevention's National Healthcare Safety Network's (NHSN) health care-associated infection (HAI) surveillance definitions. This is the first analytic case study published in AJIC since the CDC/ NHSN updated its HAI risk adjustment models and rebaselined the standardized infection ratios (SIRs) in 2015. This case describes a scenario that Infection Preventionists (IPs) have encountered during their analysis of surgical site infection (SSI) surveillance data. The case study is intended to illustrate how specific models can impact the SIR results by highlighting differences in the criteria for NHSN's older and newer risk models: the original versions and the updated models introduced in 2015. Understanding these differences provides insight into how SSI SIR calculations differ between the older and newer NHSN baseline models. NHSN plans to produce another set of HAI risk adjustment models in the future, using newer HAI incidence and risk factor data. While the timetable for these changes remains to be determined, the statistical methods used to produce future models and SIR calculations will continue the precedents that NHSN has established. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers, explanations, rationales, and summary of teaching points. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of the NHSN's HAI data analysis. There are 2 baselines available for SSI standardized infection ration (SIRs) in the National Healthcare Safety Network (NHSN); one based on the 2006-2008 national aggregate data and another based on the 2015 data. Each of the 2 baselines has a different set of inclusion criteria for the SSI data, which impact the calculation of the SIR. In this case study, we focused on the impact of the inclusion of PATOS in the calculation of the 2006-2008 baseline SSI SIR and the exclusion of PATOS from the calculation of the 2015 baseline SSI SIR. In the 2006-2008 baseline SSI SIRs, PATOS events and the procedures to which they are linked are included in the calculation of the SSI SIR whereas in the 2015 baseline SSI SIRs, PATOS events and the procedures to which they are linked are excluded from the calculation of the SSI SIR. Meaning, if we control for all other inclusion criteria other than PATOS data for both baselines, we will notice differences in the number of observed events as well as the number of predicted infections for the 2 baselines. For details of the 2015 baseline and risk adjustment calculation, please review the NHSN Guide to the SIR referenced below. For details of the 2006-2008 baseline4 and risk adjustment, please see the SHEA paper "Improving Risk-Adjusted Measures of Surgical Site Infection for the National Healthcare Safety Network" by author Yi Mu.

Prior Forage Type Influences Ruminal Responses to a Wheat Grain Challenge in Lactating Dairy Cows.

To increase the dry matter and metabolisable energy intake of cows, dairy farmers often supplement pasture with concentrates and conserved fodder. Feeding large amounts of highly fermentable concentrates to cows can result in metabolic issues, such as ruminal acidosis, and thus safer but more efficient introduction strategies are desirable. We assessed the role that forages play in ruminal, behavioural and production responses to a wheat grain challenge in dairy cows with no previous wheat adaptation. Multiparous lactating Holstein dairy cows (n = 16) were fed a forage-only diet of either lucerne (Medicago sativa) hay, perennial ryegrass (Lolium perenne L.) hay or one of two cultivars of zero-grazing fresh perennial ryegrass herbage (Bealey or Base), for 3 weeks. The forage diet was then supplemented with crushed wheat grain at 8 kg dry matter/cow day-1, with no adaptation period. Wheat comprised between 32 and 43% of total dry matter intake. Cows fed hay maintained a higher mean ruminal fluid pH than those fed herbage, on both the forage-only diet (6.43 vs. 6.17) and the forage plus wheat diet (6.03 vs. 5.58). Following supplementation of wheat, cows fed herbage exhibited minimum ruminal fluid pH levels indicative of acute ruminal acidosis, at 5.15 and 5.06 for cultivars Bealey and Base, respectively. Furthermore, for both herbage cultivars, adding wheat resulted in a ruminal fluid pH under 6 for >20 h/day. The ruminal environment of cows fed lucerne hay remained most stable throughout the grain challenge, spending the least amount of time below pH 6.0 (9.0 h/day). Hay created a ruminal environment that was better able to cope with the accumulation of acid as wheat was digested. A combination of increased ruminating time and a slower rate of fermentation, due to higher neutral detergent fiber and lower metabolisable energy concentrations in the hays, is likely responsible for the higher ruminal fluid pH values. Forage plays a critical role in wheat introduction strategies; aggressive adaptation strategies could be implemented when a hay such as lucerne is used as the base forage.

[Nosocomial urinary tract infection: an analysis beyond urinary catheterization]. / Epidemiología de las infecciones urinarias asociadas a catéter y no asociadas a catéter en un hospital universitario de tercer nivel.

INTRODUCTION: Nosocomially acquired urinary tract infections (NAUTI) represent an important public health issue, but its characteristics when they are not catheter associated (CA-UTI) or when they take place outside intensive care units (ICU) are poorly understood. OBJECTIVES: To determine the patients' characteristics, etiology and antimicrobial susceptibility of NAUTI, both CA-UTI and no CA-UTI, in general ward and ICU. METHODS: We conducted a retrospective analytic cross-sectional study, between 2009 and 2013, in a third level universitary hospital. All NAUTI episodes were identified, classifying them as CA-UTI and no CA-UTI. RESULTS: We included 253 episodes of NAUTI, being CA-UTI (60,9%) more frequent than no CA-UTI. A 37,4% of no CA-UTI and 59,7% of CA-UTI were identified in ICU. The most frequently isolated microorganisms were Escherichia coli, Klebsiella pneumoniae and Enterococcus sp. A 19% of extended spectrum betalactamase producing gram negative bacilli were found, without differences between groups. CONCLUSION: Patients's comorbidities, microorganisms associated to NAUTI and its antimicrobial susceptibility were similar in CA-UTI and no CA-UTI, as in general ward and ICU.

Epidemiología de las infecciones urinarias asociadas a catéter y no asociadas a catéter en un hospital universitario de tercer nivel / Nosocomial urinary tract infection: an analysis beyond urinary catheterization

Resumen Introducción: Las infecciones urinarias asociadas a la atención de la salud (ITU-AAS) representan un importante problema sanitario, siendo poco conocidas sus características cuando no están asociadas a cateterización urinaria u ocurren fuera de unidades de cuidados intensivos (UCI). Objetivos: Determinar las características de los pacientes con ITU-AAS, etiología y susceptibilidad antimicrobiana de las mismas, tanto asociadas a catéter (ITU-C) como no asociadas a catéter (ITU-noC), en UCI y en sala general. Materiales y Métodos: Se realizó un estudio analítico retrospectivo de corte transversal entre 2009 y 2013 en un hospital universitario de tercer nivel. Se identificaron todos los episodios de ITU-AAS, diferenciándolas en ITU-C e ITU-noC. Resultados: Se incluyeron 253 episodios de ITU-AAS, siendo más frecuentes las ITU-C (60,9%) respecto a ITU-noC. Un 37,4% de ITU-noC y 59,7% de ITU-C ocurrieron en UCI. Los microorganismos aislados más frecuentemente fueron Escherichia coli, Klebsiella pneumoniae y Enterococcus sp. El 19% de los bacilos gramnegativos fueron productores de β-lactamasa de espectro extendido, siendo su frecuencia similar en ambos grupos. Conclusión: Las co-morbilidades de los pacientes con ITU-AAS, los agentes etiológicos responsables y sus correspondientes espectros de sensibilidad, fueron similares en los grupos de ITU-C e ITU-noC, tanto en sala general como en UCI.

Introduction: Nosocomially acquired urinary tract infections (NAUTI) represent an important public health issue, but its characteristics when they are not catheter associated (CA-UTI) or when they take place outside intensive care units (ICU) are poorly understood. Objectives: To determine the patients' characteristics, etiology and antimicrobial susceptibility of NAUTI, both CA-UTI and no CA-UTI, in general ward and ICU. Methods: We conducted a retrospective analytic cross-sectional study, between 2009 and 2013, in a third level universitary hospital. All NAUTI episodes were identified, classifying them as CA-UTI and no CA-UTI. Results: We included 253 episodes of NAUTI, being CA-UTI (60,9%) more frequent than no CA-UTI. A 37,4% of no CA-UTI and 59,7% of CA-UTI were identified in ICU. The most frequently isolated microorganisms were Escherichia coli, Klebsiella pneumoniae and Enterococcus sp. A 19% of extended spectrum betalactamase producing gram negative bacilli were found, without differences between groups. Conclusion: Patients's comorbidities, microorganisms associated to NAUTI and its antimicrobial susceptibility were similar in CA-UTI and no CA-UTI, as in general ward and ICU.

An outbreak of Pseudomonas aeruginosa respiratory tract infections associated with intrinsically contaminated ultrasound transmission gel.

We describe an outbreak of Pseudomonas aeruginosa respiratory tract infections related to intrinsically contaminated ultrasound gel used for intraoperative transesophageal echocardiograms in cardiovascular surgery patients. This investigation led to a product safety alert by the Food and Drug Administration and the development of guidelines for appropriate use of ultrasound gel.