Vital Signs: Containment of Novel Multidrug-Resistant Organisms and Resistance Mechanisms - United States, 2006-2017.

BACKGROUND: Approaches to controlling emerging antibiotic resistance in health care settings have evolved over time. When resistance to broad-spectrum antimicrobials mediated by extended-spectrum ß-lactamases (ESBLs) arose in the 1980s, targeted interventions to slow spread were not widely promoted. However, when Enterobacteriaceae with carbapenemases that confer resistance to carbapenem antibiotics emerged, directed control efforts were recommended. These distinct approaches could have resulted in differences in spread of these two pathogens. CDC evaluated these possible changes along with initial findings of an enhanced antibiotic resistance detection and control strategy that builds on interventions developed to control carbapenem resistance. METHODS: Infection data from the National Healthcare Safety Network from 2006-2015 were analyzed to calculate changes in the annual proportion of selected pathogens that were nonsusceptible to extended-spectrum cephalosporins (ESBL phenotype) or resistant to carbapenems (carbapenem-resistant Enterobacteriaceae [CRE]). Testing results for CRE and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are also reported. RESULTS: The percentage of ESBL phenotype Enterobacteriaceae decreased by 2% per year (risk ratio [RR] = 0.98, p<0.001); by comparison, the CRE percentage decreased by 15% per year (RR = 0.85, p<0.01). From January to September 2017, carbapenemase testing was performed for 4,442 CRE and 1,334 CRPA isolates; 32% and 1.9%, respectively, were carbapenemase producers. In response, 1,489 screening tests were performed to identify asymptomatic carriers; 171 (11%) were positive. CONCLUSIONS: The proportion of Enterobacteriaceae infections that were CRE remained lower and decreased more over time than the proportion that were ESBL phenotype. This difference might be explained by the more directed control efforts implemented to slow transmission of CRE than those applied for ESBL-producing strains. Increased detection and aggressive early response to emerging antibiotic resistance threats have the potential to slow further spread.

Use of standard, contact, and droplet precautions with eye protection for the prevention of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission among home healthcare personnel in hospice and home healthcare settings-King and Snohomish counties, Washington, February-October 2020.

Among EvergreenHealth Home Care Service professionals, no coronavirus disease 2019 (COVID-19) cases were reported when they were instructed to use standard, contact, and droplet precautions with eye protection while providing home health care to patients diagnosed with laboratory-confirmed severe acute respiratory coronavirus virus 2 (SARS-CoV-2). These precautions might provide some level of protection against coronavirus disease 2019 (COVID-19) among home healthcare personnel.

Trends in head injury incidence in New Zealand: a hospital-based study from 1997/1998 to 2003/2004.

Traumatic brain injury (TBI) is a leading cause of disability and death in young adults. Globally, the incidence of TBI hospitalizations is estimated at 200-300 people per 100,000 annually. Using a national health database, we examined the incidence of TBI-related hospital discharges (including 1-day stays) to New Zealand Hospitals from 1997/1998 to 2003/2004. Crude annual hospital-based incidence rates for the total population ranged from 226.9 per 100,000 in 1998/1999 to a high rate of 349.2 in 2002/2003. There was a noticeable increase in rates with the change from ICD-9 to ICD-10 diagnostic codes and there was also disparity in incidence rates according to ethnicity, age and gender. Crude annual hospital-based incidence rates for males and females in Maori (689/100,000 and 302.8/100,000 person-years) and Pacific Island populations (582.6/100,000 and 217.6/100,000 person-years) were much higher than those for the remaining population (435.4/100,000 and 200.9/100,000 person-years), particularly for males. The overall age-standardized hospital- based incidence rate for 2003/2004 was 342 per 100,000 per year (95% CI = 337-349/100,000), and 458 per 100,000 per year for Maori (95% CI = 438-479/100,000) with Maori males experiencing a peak in incidence between 30 and 34 years of age that was not evidenced for the wider population. Standardized hospital-based incidence rates for the total population and for Maori by age, gender and ICD-10 diagnostic codes are also examined.

Long-term cognitive outcome of hemiconvulsion-hemiplegia-epilepsy syndrome affecting the left cerebral hemisphere.

Long-term cognitive outcome following hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome has been poorly studied, with little attention to the implications of side of involvement in HHE. This retrospective study describes language lateralization and cognitive performance in five patients with HHE syndrome affecting the left cerebral hemisphere. All of the patients had to have intracarotid sodium amytal testing (IAT) to be included in this study. The mean age of the patients was 30.2 years (range: 13-50). All patients had their hemiconvulsive seizures before age 1(1/2) years (range: 6-13 months). All patients had right-sided hemiatrophy of the body, left mesial temporal sclerosis, and seizures originating from the left temporal lobe. The habitual seizures began at a mean age of 4.5 years (range: 1.5-12 years). Performance on tests of intelligence, verbal memory, and visual memory was examined. Language was represented in the right cerebral hemisphere in three patients, the left hemisphere in one patient, and both hemispheres with predominance on the right side in the fifth patient. Intellectual functioning was in the borderline to extremely low range among the patients with right hemispheric or bilateral representation for language. These patients were variably impaired on measures of verbal and visual memory. The patient with left hemispheric representation for language performed in the average range on tests of intellectual functioning and verbal memory, whereas scores on visual memory were variable. This study demonstrated that reorganization of language to the right cerebral hemisphere or its bilateral representation is common in patients with HHE syndrome affecting the left cerebral hemisphere, and is associated with poor cognitive outcome.

Confirmatory factor analysis of the WMS-III in patients with temporal lobe epilepsy.

Five competing models specifying the factor structure underlying the Wechsler Memory Scale-Third Edition (D. Wechsler, 1997b) primary subtest scores were evaluated in a sample of patients with intractable temporal lobe epilepsy (N = 254). Models specifying separate immediate and delayed constructs resulted in inadmissible parameter estimates and model specification error. There were negligible goodness-of-fit differences between a 3-factor model of working memory, auditory memory, and visual memory and a nested--more parsimonious--2-factor model of working memory and general memory. The results suggest that specifying a separate visual memory factor provides little advantage for this sample--an unexpected finding in a population with lateralized dysfunction, for which one might have predicted separate auditory and visual memory dimensions.

Functional equivalence of WAIS-III/WMS-III digit and spatial span under forward and backward recall conditions.

The purpose of the current study was to examine the performance characteristics of the Wechsler Spatial Span subtest in a mixed clinical sample. Contrary to expectation, differential patterns of performance were obtained on the Digit and Spatial Span tasks. Forward Digit Span scores were significantly higher than backward recall scores, but this was not the case for Spatial Span. There were no differences between forward and backward raw Spatial Span scores at the mean level. Further, about one third of the sample showed better performance on backward compared to forward Spatial Span. In addition, performance on the Spatial Span backward task correlated unexpectedly with that of the WMS-III Immediate and Delayed Auditory Index scores. Overall, the findings suggest that clinicians should be hesitant when interpreting the Spatial Span task, and the backward condition in particular, as a measure of working memory. Finally, methodological concerns with the Spatial Span task are noted, raising additional concerns regarding the meaning of this task.

Memory span on the Wechsler Scales.

This study had two goals. One was to assess whether the WMS-III Spatial Span subtest operates as a visual analogue of Digit Span while the second was to determine whether backward span is a more sensitive measure of working memory than the forward span condition. Analyses based on the WAIS-III-WMS-III standardization and clinical group data revealed some important distinctions between Digit and Spatial Span. The two tasks exhibited differences in patterns of performance on the forward versus backward conditions, in their relationships with age, and in their methodology. Moreover, the backward conditions of both Digit and Spatial Span did not appear more affected by risk factors such as aging or pathology than the forward scores. This runs contrary to the widespread notion that backward span provides differential sensitivity regarding working memory processing.