RESUMEN
Nocardia thailandica is a rare pathogen related to Nocardia asteroides, Nocardia neocaledoniensis, and Nocardia caishijiensis that, since its original description in 2004, has only been reported to cause wound and ocular infections in humans. We report a case of pulmonary nocardiosis caused by Nocardia thailandica in a 66-year-old solid organ transplant patient from Connecticut, which was identified at the molecular taxonomic level by secA1 analysis, 16S rRNA gene sequencing, and matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). To our knowledge, this is the first reported case of N. thailandica in the United States and the first report of pulmonary infection by this pathogen in the literature.
Asunto(s)
Huésped Inmunocomprometido/inmunología , Enfermedades Pulmonares/diagnóstico , Nocardiosis/diagnóstico , Nocardiosis/inmunología , Nocardia/aislamiento & purificación , Adenosina Trifosfatasas/genética , Anciano , Proteínas Bacterianas/genética , Secuencia de Bases , Connecticut , ADN Bacteriano/genética , ADN Ribosómico/genética , Trasplante de Corazón/efectos adversos , Humanos , Terapia de Inmunosupresión/efectos adversos , Enfermedades Pulmonares/inmunología , Enfermedades Pulmonares/microbiología , Masculino , Proteínas de Transporte de Membrana/genética , Datos de Secuencia Molecular , Nocardiosis/microbiología , ARN Ribosómico 16S/genética , Canales de Translocación SEC , Proteína SecA , Análisis de Secuencia de ADN , Espectrometría de Masa por Láser de Matriz Asistida de Ionización DesorciónRESUMEN
BACKGROUND: Stethoscope hygiene is rarely done despite guideline recommendations. We wanted to determine whether demonstrating what is growing on the stethoscopes of providers via culture or bioluminescence technology alters perceptions and improves compliance. METHODS: Providers were given the opportunity to (1) culture their stethoscopes before and after disinfection with alcohol pads, alcohol-based hand rub, or hydrogen peroxide disinfectant wipes and (2) swab stethoscopes for bioluminescence-based adenosine triphosphate testing before and after disinfection. Outcomes were observed for hand and stethoscope hygiene rates and before and after intervention survey responses. The bacteria that were isolated, colony-forming units (CFU), and bioluminescence scores were tracked. RESULTS: A total of 1,245 observed hand hygiene opportunities showed that compliance improved from 72.5%-82.3% (P < .001). In addition, 590 observed patient-provider encounters revealed no significant change in stethoscope hygiene rates of 10% initially and 5% afterward (Pâ¯=â¯.08), although self-reported rates trended from 56%- 67% postintervention (Pâ¯=â¯.06). Perceptions regarding stethoscope hygiene importance improved (8.5/10 to 9.3/10; Pâ¯=â¯.04). Disinfection with alcohol pads, alcohol-based hand rub, and hydrogen peroxide disinfectant wipes were equivalent in CFU reduction (Pâ¯=â¯.21). CONCLUSIONS: Showing providers what is growing on their stethoscopes via cultures and bioluminescence technology before and after disinfection improved "buy in" regarding stethoscope hygiene importance. Both methods were rated as having an equal impact, however, objective observations failed to show improvement.