Long-lasting outbreak due to CTX-M-15-producing Klebsiella pneumoniae ST336 in a rehabilitation ward: report and literature review.

BACKGROUND: Whereas Klebsiella species are the most frequently occurring agents in nosocomial outbreaks due to multidrug-resistant Gram-negative organisms, very few outbreaks have been reported from rehabilitation wards. AIM: To describe a long-lasting outbreak due to extended-spectrum ß-lactamase-producing (ESBL) Klebsiella pneumoniae in a rehabilitation ward. METHODS: ESBL K. pneumoniae from all in- and outpatients whose specimens were tested at a tertiary care university hospital between 2007 and 2012 were typed by pulsed-field gel electrophoresis and selected isolates were submitted to multi-locus sequence typing and ESBL genotyping. Outbreak characteristics and infection control interventions were summarized. The literature was searched for K. pneumoniae-related outbreaks in rehabilitation wards. FINDINGS: ESBL K. pneumoniae was detected in 69 out of 2478 K. pneumoniae-positive patients (2.8%) during the study period. Eight related outbreak clones from 35 patients, 25 of whom were in the rehabilitation ward, produced CTX-M-15 and belonged to ST336. The outbreak lasted for more than three years and was controlled by sequentially increasing measures culminating in review of all patient-related care, compulsory educational meetings for personnel, profession-specific guidelines and educational flyers for patients. CONCLUSION: Half of ESBL K. pneumoniae-positive patients identified over six years at a tertiary care university hospital harboured related clones, and more than a third were hospitalized in a rehabilitation ward. Rehabilitation wards pose particular challenges for infection control because of patient dependency and an environment that encourages socializing. They are, however, rarely involved in K. pneumoniae-related outbreaks.

Staphylococcus aureus bacteraemia in Iceland, 1995-2008: changing incidence and mortality.

Little is known about temporal changes in the epidemiology of Staphylococcus aureus bacteraemia. The objective of the present study was to analyse changes in the incidence and mortality of adult S. aureus bacteraemia in Iceland. Individuals 18 years or older with a positive blood culture for S. aureus between 1 January 1995 and 31 December 2008 were identified, with the participation of all clinical microbiological laboratories performing blood cultures in Iceland. Infections were categorized as nosocomial, healthcare-associated or community-acquired. National population statistics and dates of death were retrieved from the National Registry. During the study period, 692 individuals from 19 institutions had 721 distinct episodes of S. aureus bacteraemia. The incidence rose from 22.7 to 28.9 per 100,000 per year during the period (p 0.012). Nosocomial infections comprised 46.3% of cases, 14.6% were healthcare-associated, and 39.1% were community-acquired. The proportion of nosocomial infections decreased during the period (p <0.001), whereas an increase was seen in the proportion of community-acquired infections (p <0.001). All-cause 30-day mortality decreased from 25.0% to 8.1% (p 0.001) and 1-year mortality decreased from 37.0% to 27.9% (p 0.061) between the periods 1995-1996 and 2007-2008. Four cases of bacteraemia caused by methicillin-resistant S. aureus were seen (0.6%), none of which was fatal. In conclusion, there was a significant increase in the incidence of S. aureus bacteraemia in Iceland between 1995 and 2008. Concomitantly, there was a significant reduction in mortality, towards one of the lowest reported. Further studies are needed to understand the basis for these changes.

National hand hygiene campaigns in Europe, 2000-2009.

Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.

Pneumoparotitis: a new diagnostic technique and a case report.

Pneumoparotitis is a rare cause of parotid gland swelling. We report a case of self-induced pneumoparotitis that resulted in subcutaneous emphysema and pneumomediastinum after an open biopsy of the parotid gland. We suggest a new method for diagnosing this condition. This is done by insufflation of the cheeks with contrast in the oral cavity. A reflux of air and contrast is subsequently demonstrated by a computed tomography scan of the area.

[Ampicillin resistant enterococci at Landspítalinn University Hospital and antimicrobial susceptibilities of enterococci in Iceland.].

Hospital acquired infections caused by enterococci are an increasing problem, due to an increased number of infections and increasing bacterial resistance to antibiotics. During 1994 ampicillin resistant enterococci were discovered in specimens from three patients in one ward over a short time period. The patients were isolated and stool cultures were taken from everyone in the ward for selective culture for enterococci and subsequent antimicrobial susceptibility tests. Additional screening cultures were taken from patients in the intensive care unit, the oncology ward, one surgical and one paediatric ward. Cultures were also taken from the hospital sewage system. Antibiotic susceptibility of enterococci isolated from urine samples submitted to the Microbiology Department, Landspitalinn, during 1994 and 1995 were reviewed. In the index ward, specimens were obtained from 30 individuals for culture. One additional patient and one staff member were found to be colonised with ampicillin resistant enterococci. In the other wards a total of 23 samples were taken from selected patients for culture, but none of these cultures yielded ampicillin resistant enterococci. No ampicillin resistant enterococci were found in the sewage system of the hospital. Of a total of 41,181 urine specimens cultured at the Microbiology Department, 1,513 contained enterococci of which five were resistant to ampicillin (0.3%, all from 1994). We conclude that ampicillin resistant enterococci have not become established at Landspitalinn. It may be difficult to maintain a susceptible enterococcal population, however isolation of carriers and sensible use of broad spectrum antibiotics are likely to delay the establishment of multiresistant enterococci in Iceland.