Comparison of commercial antimicrobial susceptibility test methods for testing of Staphylococcus aureus and Enterococci against vancomycin, daptomycin, and linezolid.

Three commercial antimicrobial susceptibility testing (AST) methods were compared to broth microdilution for testing of Staphylococcus aureus and enterococci against vancomycin, daptomycin, and linezolid. Despite high levels of categorical agreement and essential agreement, vancomycin MICs determined by MicroScan were often 1 log2 concentration higher and MICs determined by Phoenix 1 log2 concentration lower. Daptomycin MICs were 1 to 2 log2 concentrations higher by all AST methods, except Etest, potentially impacting definitive antimicrobial therapy for bloodstream infections due to these organisms.

Bridging the gap in healthcare: creating an online health information prototype for individuals with intellectual disabilities to promote equity and knowledge transfer.

Introduction: The prevalence of intellectual disabilities (ID) in Austria is estimated to be approximately 1% of the population. Growing awareness of the major challenges faced by individuals with ID, including difficulties in comprehending written health information, communication barriers with healthcare professionals, and limited inclusion in health education research, necessitates concerted efforts to address these issues. The utilization of guidelines promoting easy-to-read language, web accessibility, and usability can significantly enhance access to health information and improve health literacy among people with ID. The "LUCHS-Gesundheitsinformationen (Health Information)" project aimed to improve knowledge transfer of health information for people ID by creating a website prototype. Methods: Unstructured interviews were conducted with two focus groups (n = 20) people with ID and their caretakers to elicit relevant topics and ensure the quality, comprehensibility, and usability of a website prototype. A convenience sample of 20 adults employed in sheltered workshops of the Caritas Lower Austria West facility who met the inclusion criteria participated. Results: The prototype addressed four main topics, namely nutrition, medical specialization, first aid, and patient information, offering comprehensive information using easy-to-read language and pictorial content. The website prototype followed web accessibility suggestions and incorporated external resources, such as brochures and emergency contact details, to enhance usability and provide a reliable source of health information for individuals with ID. Discussion: The findings suggest that a website format is a feasible means of providing accessible online health information for people with ID. However, further research is warranted to explore the potential of digital health applications for individuals with ID, as inclusion in the Austrian register for digital health applications necessitates meeting multiple quality standards, thereby instilling trust among the target group.

Access, understanding, promotion and maintenance of good health: Evaluation of knowledge transfer of people with intellectual disabilities to bridge the health information and disease prevention in public health.

The importance of patient empowerment among people with intellectual disabilities (ID) is steadily growing, yet multiple health and health literacy challenges still make this population more vulnerable to health disparities. Inadequate access to essential health and other basic services and the lack of involvement in health and educational research are some of the most crucial factors contributing to this inequality. A greater effort must be made to include people with ID in health literacy and communication research, preliminary focusing on language, including pictorial language. This community case study aimed to document the experiences of answering a pilot questionnaire to evaluate the problems of people with mild to moderate ID, 6A00.0 and 6A00.1 according to ICD-11. Our results show that most patients acquire health information from their physician or a medical professional. In preparing appropriate questionnaires, special education teachers can give valuable insight. However, participants were easily distracted and needed support in focusing on the questionnaire. Easy-to-read language, a simple format, big fonts and the presence of confidential caretakers are needed. This indicates, that semi-structured interviews with a trained interviewer might be most suitable for measuring the knowledge transfer of people with ID. The results of this case study highlight the need to develop an appropriate questionnaire and emphasize the need for a continued dialogue between people with ID and healthcare providers.

Comparison of BD Bactec Plus Aerobic/F medium to VersaTREK Redox 1 blood culture medium for detection of Candida spp. in seeded blood culture specimens containing therapeutic levels of antifungal agents.

Recovery of Candida spp. using the BD Bactec FX blood culture (BC) system (Bactec Plus Aerobic/F medium) and the VersaTREK system (aerobic Redox medium) was evaluated using seeded BC bottles with and without the addition of commonly used antifungal agents. BC bottles (n = 1,442) were each inoculated with 10 ml human whole blood and 0.1 ml of suspensions of Candida spp., with or without antifungal agents. BC bottles were incubated in the corresponding system for a maximum of 5 days. In the absence of antifungal agents, Bactec FX recovered 97.4% of Candida spp., and VersaTREK recovered 99.1% (P = 0.154). With regard to length of time to detection (LTD) and overall recovery, both systems had various levels of effectiveness in recovering C. glabrata. In bottles containing antifungal agents, Bactec FX recovered 83.1% of isolates, whereas VersaTREK recovered 50.7% of Candida spp. (P < 0.001). For BC bottles without the addition of antifungal agents, the median LTD for VersaTREK was 2.2 h faster than that of Bactec FX (P < 0.001). In the presence of antifungal agents, the Bactec FX recovery time was significantly faster than that of VersaTREK (median difference of 10.8 h, P < 0.001). We conclude that both systems have comparable abilities to recover Candida spp. from seeded blood cultures in the absence of antifungal agents. In the presence of therapeutic levels of commonly used antifungal agents, the Bactec FX system demonstrated a significantly greater recovery of various Candida spp., as well as a shorter LTD.

Evaluation of Bio-Rad MRSASelect agar for detection of methicillin-resistant Staphylococcus aureus directly from blood cultures.

MRSASelect agar (Bio-Rad, Redmond, WA) was evaluated for its performance in detecting MRSA directly from positive blood cultures containing Gram-positive cocci in clusters. Agar plates were evaluated for the presence of pink colonies at 18 to 24 h. Results were compared to organism identification by using standard laboratory methods. Confirming coagulase on pink isolates, the sensitivity and specificity were both 99%.

A polymicrobial fungal outbreak in a regional burn center after Hurricane Sandy.

OBJECTIVE: To describe a polymicrobial fungal outbreak after Hurricane Sandy. DESIGN: An observational concurrent outbreak investigation and retrospective descriptive review. SETTING: A regional burn intensive care unit that serves the greater Baltimore area, admitting 350-450 burn patients annually. PATIENTS: Patients with burn injuries and significant dermatologic diseases such as toxic epidermal necrolysis who were admitted to the burn intensive care unit. METHODS: An outbreak investigation and a retrospective review of all patients with non-candida fungal isolates from 2009-2016 were performed. RESULTS: A polymicrobial fungal outbreak in burn patients was temporally associated with Hurricane Sandy and associated with air and water permeations in the hospital facility. The outbreak abated after changes to facility design. CONCLUSIONS: Our results suggest a possible association between severe weather events like hurricanes and nosocomial fungal outbreaks. This report adds to the emerging literature on the effect of severe weather on healthcare-associated infections.

Pseudo-outbreak of Penicillium in an outpatient obstetrics and gynecology clinic.

We report an unusual pseudo-outbreak of Penicillium that occurred in patients seen in an outpatient obstetrics and gynecology clinic. The pseudo-outbreak was detected in late 2012, when the microbiology department reported a series of vaginal cultures positive for Penicillium spp. Our investigation found Penicillium spp in both patient and environmental samples and was potentially associated with the practice of wetting gloves with tap water by a health care worker prior to patient examination.

A pilot observational study of hydrogen peroxide and alcohol for disinfection of privacy curtains contaminated by MRSA, VRE and Clostridium difficile.

Privacy curtains, frequently used in hospitals to separate patient care areas may have an important role in the transmission of healthcare-associated pathogens. In this pilot study, we inoculated curtain swatches with suspensions of clinical specimens of meticillin resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and Clostridium difficile before using a gloved hand to touch the inoculated curtain swatch and transfer to clean agar plates. Three different commonly used disinfectants were then sprayed onto these swatches before using a clean gloved hand to touch the swatch and transfer onto new agar plates. All plates were incubated at 35°C for 24 and 72 h. Bacterial growth before and after disinfection was assessed and compared. 3.1% hydrogen peroxide effectively eliminated transfer of C. difficile, MRSA and VRE from inoculated curtains.

Evaluation of the BD Vacutainer Plus Urine C&S Preservative Tubes compared with nonpreservative urine samples stored at 4°C and room temperature.

OBJECTIVES: The stability of urine specimens submitted for culture remains a challenge for many laboratories because of delays in specimen transport. We evaluated the usefulness of BD Vacutainer Plus Urine C&S Preservative Tube in ensuring specimen stability. METHODS: Clinical urine specimens collected in sterile collection cups (n = 110) were plated onto sheep blood and MacConkey agar following standard laboratory procedures guidelines. Thereafter, specimens were divided into 3 storage conditions: nonpreservative, refrigerated; nonpreservative, room temperature (RT); BD Vacutainer Plus Urine C&S Preservative Tube, RT. For each sample type, additional cultures were set up at 2, 4, 24, and 48 hours. RESULTS: Initially, 18 specimens had no growth, 32 showed mixed skin flora, and 60 yielded at least 1 uropathogen. Increased colony counts of uropathogens were observed for nonpreserved urine samples stored at RT; these changes were statistically significant. Minor differences between refrigerated urine samples and BD Vacutainer Plus Urine C&S Preservative Tube samples were seen but were not statistically significant. CONCLUSIONS: The use of preservative-containing collection tubes is desirable to ensure specimen stability when prompt processing or refrigeration is not feasible.

Effective detection of toxigenic Clostridium difficile by a two-step algorithm including tests for antigen and cytotoxin.

We evaluated a two-step algorithm for detecting toxigenic Clostridium difficile: an enzyme immunoassay for glutamate dehydrogenase antigen (Ag-EIA) and then, for antigen-positive specimens, a concurrent cell culture cytotoxicity neutralization assay (CCNA). Antigen-negative results were > or = 99% predictive of CCNA negativity. Because the Ag-EIA reduced cell culture workload by approximately 75 to 80% and two-step testing was complete in < or = 3 days, we decided that this algorithm would be effective. Over 6 months, our laboratories' expenses were US dollar 143,000 less than if CCNA alone had been performed on all 5,887 specimens.