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1.
Ann Ist Super Sanita ; 56(3): 359-364, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32959802

RESUMO

Current literature shows that secondary bacterial infections, although less frequent than in previous influenza pandemics, affect COVID-19 patients. Mycoplasma pneumoniae, Staphylococcus aureus, Legionella pneumophila, Streptococcus pneumoniae, Haemophilus and Klebsiella spp. are the main species isolated. Of note, Mycobacterium tuberculosis-COVID-19 coinfections are also reported. However, bacterial coinfection rates increase in patients admitted in the intensive care units, and those diseases can be due to super-infections by nosocomial antibiotic-resistant bacteria. This highlights the urgency to revise frequent and empiric prescription of broad-spectrum antibiotics in COVID-19 patients, with more attention to evidence-based studies and respect for the antimicrobial stewardship principles.


Assuntos
Infecções Bacterianas/epidemiologia , Betacoronavirus , Coinfecção/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Gestão de Antimicrobianos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Resistência Microbiana a Medicamentos , Diagnóstico Precoce , Humanos , Unidades de Terapia Intensiva , Itália/epidemiologia , Micoses/epidemiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Especificidade da Espécie , Tuberculose/epidemiologia
2.
JAMA Netw Open ; 3(9): e2020498, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32902653

RESUMO

Importance: Some patients are avoiding essential care for fear of contracting coronavirus disease 2019 (COVID-19) in hospitals. There are few data, however, on the risk of acquiring COVID-19 in US hospitals. Objective: To assess the incidence of COVID-19 among patients hospitalized at a large US academic medical center in the 12 weeks after the first inpatient case was identified. Design, Setting, and Participants: This cohort study included all patients admitted to Brigham and Women's Hospital (Boston, Massachusetts) between March 7 and May 30, 2020. Follow-up occurred through June 17, 2020. Medical records for all patients who first tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction (RT-PCR) on hospital day 3 or later or within 14 days of discharge were reviewed. Exposures: A comprehensive infection control program was implemented that included dedicated COVID-19 units with airborne infection isolation rooms, personal protective equipment in accordance with US Centers for Disease Control and Prevention recommendations, personal protective equipment donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients. Main Outcomes and Measures: Whether infection was community or hospital acquired based on timing of tests, clinical course, and exposures. Results: Over the 12-week period, 9149 patients (mean [SD] age, 46.1 [26.4] years; median [IQR] age, 51 years [30-67 years]; 5243 female [57.3%]) were admitted to the hospital, for whom 7394 SARS-CoV-2 RT-PCR tests were performed; 697 COVID-19 cases were confirmed, translating into 8656 days of COVID-19-related care. Twelve of the 697 hospitalized patients with COVID-19 (1.7%) first tested positive on hospital day 3 or later (median, 4 days; range, 3-15 days). Of these, only 1 case was deemed to be hospital acquired, most likely from a presymptomatic spouse who was visiting daily and diagnosed with COVID-19 before visitor restrictions and masking were implemented. Among 8370 patients with non-COVID-19-related hospitalizations discharged through June 17, 11 (0.1%) tested positive within 14 days (median time to diagnosis, 6 days; range, 1-14 days). Only 1 case was deemed likely to be hospital acquired, albeit with no known exposures. Conclusions and Relevance: In this cohort study of patients in a large academic medical center with rigorous infection control measures, nosocomial COVID-19 was rare during the height of the pandemic in the region. These findings may inform practices in other institutions and provide reassurance to patients concerned about contracting COVID-19 in hospitals.


Assuntos
Centros Médicos Acadêmicos , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/epidemiologia , Hospitalização , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus , Boston/epidemiologia , Coronavirus , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/virologia , Infecção Hospitalar/virologia , Feminino , Humanos , Incidência , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/etiologia , Pneumonia Viral/virologia , Medição de Risco , Síndrome Respiratória Aguda Grave , Visitas a Pacientes , Adulto Jovem
3.
Epidemiol Infect ; 148: e217, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32951627

RESUMO

Coronavirus disease 2019 (COVID-19) has had a tremendous impact in China and abroad since its onset in December 2019 and poses a major threat to human health. Healthcare workers (HCWs) are at the forefront of the response to outbreaks. This study reviewed literature data and found that HCWs were at high risk of infection during the COVID-19 pandemic, especially at the early stage of the epidemic, and many factors greatly affected their occupational safety. Although SARS-CoV-2 transmission was controlled in China, the Chinese experience can help protect HCWs from COVID-19 and other respiratory diseases.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Exposição Ocupacional/prevenção & controle , Pandemias/prevenção & controle , Equipe de Assistência ao Paciente , Pneumonia Viral/prevenção & controle , Betacoronavirus/genética , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/epidemiologia , Saúde Global , Comunicação em Saúde , Humanos , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Reação em Cadeia da Polimerase , Saúde Pública
4.
Antimicrob Resist Infect Control ; 9(1): 154, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962759

RESUMO

BACKGROUND: Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. METHODS: Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). RESULTS: WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. CONCLUSIONS: Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.


Assuntos
Coinfecção/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Betacoronavirus , Coinfecção/microbiologia , Infecções por Coronavirus/patologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Surtos de Doenças , Genoma Bacteriano/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Controle de Infecções , Unidades de Terapia Intensiva , Tipagem de Sequências Multilocus , Pandemias , Pneumonia Viral/patologia , Prevenção Primária , Enterococos Resistentes à Vancomicina/genética , Enterococos Resistentes à Vancomicina/isolamento & purificação , Sequenciamento Completo do Genoma
5.
S Afr Med J ; 110(8): 783-790, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880307

RESUMO

BACKGROUND: Rates of healthcare-associated infections (HAIs) among babies born in developing countries are higher than among those born in resource-rich countries, as a result of suboptimal infection prevention and control (IPC) practices. Following two reported deaths of neonates with carbapenem-resistant Klebsiella pneumoniae bloodstream infections (BSIs), we conducted an outbreak investigation in a neonatal unit of a regional hospital in Gauteng Province, South Africa. OBJECTIVES: To confirm an outbreak of K. pneumoniae BSIs and assess the IPC programme in the neonatal unit. METHODS: We calculated total and organism-specific BSI incidence risks for culture-confirmed cases in the neonatal unit for baseline and outbreak periods. We conducted a clinical record review for a subset of cases with K. pneumoniae BSI that had been reported to the investigating team by the neonatal unit. An IPC audit was performed in different areas of the neonatal unit. We confirmed species identification and antimicrobial susceptibility, and used polymerase chain reaction for confirmation of carbapenemase genes and pulsed-field gel electrophoresis (PFGE) for typing of submitted clinical isolates. RESULTS: From January 2017 to August 2018, 5 262 blood cultures were submitted, of which 11% (560/5 262) were positive. Of 560 positive blood cultures, 52% (n=292) were positive for pathogenic organisms associated with healthcare-associated BSIs. K. pneumoniae comprised the largest proportion of these cases (32%; 93/292). The total incidence risk of healthcare-associated BSI for the baseline period (January 2017 - March 2018) was 6.8 cases per 100 admissions, and that for the outbreak period (April - September 2018) was 10.1 cases per 100 admissions. The incidence risk of K. pneumoniae BSI for the baseline period was 1.6 cases per 100 admissions, compared with 5.0 cases per 100 admissions during the outbreak period. Average bed occupancy for the entire period was 118% (range 101 - 133%), that for the baseline period was 117%, and that for the outbreak period was 121%. In a subset of 12 neonates with K. pneumoniae bacteraemia, the median (interquartile range (IQR)) gestational age at birth was 27 (26 - 29) weeks, and the median (IQR) birth weight was 1 100 (880 - 1 425) g. Twelve bloodstream and 31 colonising K. pneumoniae isolates were OXA-48-positive. All isolates were genetically related by PFGE analysis (89% similarity). Inadequate IPC practices were noted, including suboptimal adherence to aseptic technique and hand hygiene (57% overall score in the neonatal intensive care unit), with poor monitoring and reporting of antimicrobial use (pharmacy score 55%). CONCLUSIONS: Overcrowding and inadequate IPC and antimicrobial stewardship contributed to a large outbreak of BSIs caused by genetically related carbapenemase-producing K. pneumoniae isolates in the neonatal unit.


Assuntos
Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Surtos de Doenças , Unidades Hospitalares , Infecções por Klebsiella/epidemiologia , Gestão de Antimicrobianos , Bacteriemia/epidemiologia , Proteínas de Bactérias/metabolismo , Auditoria Clínica , Infecção Hospitalar/epidemiologia , Aglomeração , Humanos , Incidência , Recém-Nascido , Controle de Infecções , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Programas Médicos Regionais , África do Sul/epidemiologia , beta-Lactamases/metabolismo
6.
Acta Biomed ; 91(3): e2020016, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921712

RESUMO

The paper wants to present the data of infection of the Health Care Workers of a research and teaching hospital in Milan, Italy. The majority (2554, 55.9%) of 4572 HCWs were tested for SARS-CoV-2 and 8.8% were found positive. Most of the tested workers were women, but we found higher relative frequency of positivity for men, even after adjustment for age, working area, and occupation. The higher frequency of positive tests in the medicine area is probably explained by the higher concentration in that area of COVID-19 patients. Conversely, the low frequency of positive HCWs in intensive care units is  probably explained by the diffuse and continuous use of PPD. Our results show that HCWs in a research and teaching hospital in the most hit Region in Italy had a similar pattern of infection as all other HCWs all over the world. The problem of SARS-CoV-2 infections among the hospital personnel HCWs should remind us  the concerns about hospital acquired infections both for patients and HCWs.


Assuntos
Anticorpos Antivirais/análise , Betacoronavirus/imunologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Pneumonia Viral/transmissão , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia
7.
Acta Biomed ; 91(3): e2020017, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32921713

RESUMO

The aim of this study is to assess the association among species of bacteria and to identify the presence of clusters of patients in sub intensive care unit with different profiles of infection, and to study the relationship between such profiles and patient demographics (gender, age), kind of investigations and  material used to detect the infection. The findings need to analyse a bigger amount of data in the same setting to make evident that it is constant the infection only with Escherichia coli and Staphylocossus epidemidis and a third case in which more bacteria are inlvolved.


Assuntos
Antibacterianos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Idoso , Infecção Hospitalar/tratamento farmacológico , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade
8.
Antimicrob Resist Infect Control ; 9(1): 148, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32887658

RESUMO

BACKGROUND: Healthcare workers (HCWs) are on the front line of the COVID-19 outbreak, and their constant exposure to infected patients and contaminated surfaces puts them at risk of acquiring and transmitting the infection. Therefore, they must employ protective measures. In practice, HCWs in Israel were not fully prepared for this sudden COVID-19 outbreak. This research aimed to identify and compare: (1) Israeli HCWs' perceptions regarding the official COVID-19 guidelines' applicability and their protective value, and (2) HCWs executives' response to HWCs' concern regarding personal protective equipment (PPE) shortage. METHODS: A mixed-methods sequential explanatory design consists of: (1) An online survey of 242 HCWs about the application of the guidelines and PPE, and (2) Personal interviews of 15 HCWs executives regarding PPE shortage and the measures they are taking to address it. RESULTS: A significant difference between the perceived applicability and protective value was found for most of the guidelines. Some of the guidelines were perceived as more applicable than protective (hand hygiene, signage at entrance, alcohol rub sanitizers at entrance, and mask for contact with symptomatic patients). Other were perceived as less applicable than protective (prohibited gathering of over 10 people, maintaining a distance of 2 m', and remote services). CONCLUSIONS: HCWs need the support of the healthcare authorities not only to provide missing equipment, but also to communicate the risk to them. Conveying the information with full transparency, while addressing the uncertainty element and engaging the HCWs in evaluating the guidelines, are critical for establishing trust.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde/psicologia , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Atitude do Pessoal de Saúde , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Inquéritos e Questionários
9.
Trials ; 21(1): 743, 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32843098

RESUMO

OBJECTIVES: The aim of this study is to explore the effectiveness and safety of high dose dexamethasone treatment for Acute Respiratory Distress Syndrome secondary to SARS-Cov-2 pneumonia. TRIAL DESIGN: Multicentre, randomized clinical trial, controlled, open label, parallel group, to evaluate the effectiveness and safety of high dose dexamethasone in adult patients with confirmed COVID-19, with Acute Respiratory Distress Syndrome. PARTICIPANTS: We will include patients with SARS-Cov-2 pneumonia who develop acute respiratory distress syndrome, in several intensive care units (ICU) in Buenos Aires, Argentina (CEMIC, Clinica Bazterrica, Sanatorio Sagrado Corazon) Inclusion criteria: Men and women, age ≥ 18 years old. Confirmed diagnosis of SARS-CoV-2 infection, by RT-PCR. Diagnosis of Acute Respiratory Distress Syndrome (hypoxemic respiratory failure not explained by cardiac disease + PaO2/FiO2 ratio < 300 with a Positive End-Expiratory Pressure ≥ 5 cm H2O + bilateral pulmonary infiltrates) Length of mechanical ventilation of at least 72 hours Informed consent (next of kin / legal guardian) Exclusion criteria: Pregnant or breast-feeding women. Terminal disease (advanced cancer; under palliative care; cardiovascular, respiratory, or renal disease with a life expectancy less ≤ 1 year). Therapeutic limitation (advance directives or do not resuscitate order) Severe immunosuppression (HIV infection, long-term use of immunosuppressive agents, active cancer). Patients under chronic treatment with glucocorticoids for other diseases (≥ 8 mg prednisone, or equivalent) Participation in another randomized clinical trial. INTERVENTION AND COMPARATOR: Eligible patients will be randomized to receive standard ICU patient care (group 1) or standard ICU patient care plus high dose dexamethasone (group 2). Group 1: dexamethasone up to 6 mg/24 hours for up to 10 days + ventilatory, hemodynamic, nutritional, and antimicrobial support according to international guidelines. Group 2: dexamethasone 16 mg/24 hours for 5 days followed by dexamethasone 8 mg/24 hours for 5 days + ventilatory, hemodynamic, nutritional, and antimicrobial support according to international guidelines. MAIN OUTCOME: The main result is ventilator-free days at 28 days (Days without ventilator support in the first 28 days following randomization). Secondary outcomes are 28-days and 90-days mortality, frequency of nosocomial infections in the first 28 days after randomization, Sequential Organ Failure Assessment (SOFA) score variation and prone position in the first 10-days, viral shedding 28-days after randomization, and delirium and muscle weakness at ICU discharge. RANDOMISATION: Treatment will be assigned according to site stratified randomization by permuted random blocks sequence 1:1 generated with a table in R language concealed in a randomization tool in REDCap (Research Electronic Data CAPture) platform. BLINDING (MASKING): This is an open trial, so no masking of treatment assignment will be used. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): Assuming a 3 days difference in ventilator-free days between treatment groups, with a mean of 9 days, and a standard deviation of 9 days; the necessary sample size would be 284 subjects (142 per group), with a power of 80% and a two-tailed alpha error of 0.05. TRIAL STATUS: The protocol with code 1264, version 3.0 on date: May 13, 2020 is approved by the local Ethics Committee. The trial is in the recruitment phase. Recruitment began May 22, 2020 and is anticipated to be complete by the end of December 2021. TRIAL REGISTRATION: The trial was registered under the title "Dexamethasone for COVID-19 Related ARDS: a Multicenter, Randomized Clinical Trial" with ClinicalTrials number NCT04395105, https://clinicaltrials.gov/ct2/show/NCT04395105 , registered on 20 May 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Pneumonia Viral/tratamento farmacológico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Argentina , Betacoronavirus , Infecções por Coronavirus/complicações , Infecção Hospitalar/epidemiologia , Delírio/epidemiologia , Humanos , Mortalidade , Escores de Disfunção Orgânica , Pandemias , Posicionamento do Paciente , Pneumonia Viral/complicações , Decúbito Ventral , Respiração Artificial/estatística & dados numéricos , Síndrome do Desconforto Respiratório do Adulto/etiologia , Eliminação de Partículas Virais
11.
PLoS One ; 15(8): e0237692, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797094

RESUMO

BACKGROUND: Our hospital experienced the first healthcare-associated COVID-19 outbreak in Seoul at the time the first COVID-19 cases were confirmed in Korea. The first confirmed COVID-19 patient was a hospital personnel who was in charge of transferring patients inside our hospital. To contain the virus spread, we shutdown our hospital, and tested all inpatients, medical staff members, and employees. METHODS: We retrospectively analyzed the results of SARS-CoV-2 RT-PCR testing according to the contact history, occupation, and presence of respiratory symptoms. Closed-circuit television (CCTV) was reviewed in the presence of an epidemiologist to identify individuals who came into contact with confirmed COVID-19 patients. RESULTS: A total of 3,091 respiratory samples from 2,924 individuals were obtained. Among 2,924 individuals, two inpatients, and one caregiver tested positive (positivity rate, 0.1%). Although all confirmed cases were linked to a general ward designated for pulmonology patients, no medical staff members, medical support personnel, or employees working at the same ward were infected. Contact with confirmed COVID-19 cases was frequent among inpatients and medical support personnel. The most common contact area was the general ward for pulmonology patients and medical support areas, including clinical and imaging examination rooms. Finally, the total number of hospital-associated infections was 14, consisting of four diagnosed at our hospital and ten diagnosed outside the hospital. CONCLUSIONS: The robust control of the COVID-19 outbreak further minimized the transmission of SARS-CoV-2 in the hospital and local communities. However, there was also a debate over the appropriate period of hospital shutdown and testing of all hospital staff and patients. Future studies are required to refine and establish the in-hospital quarantine and de-isolation guidelines based on the epidemiological and clinical settings.


Assuntos
Betacoronavirus/genética , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Hospitais Universitários , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/virologia , Infecção Hospitalar/virologia , Feminino , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Quartos de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Quarentena/métodos , Estudos Retrospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Seul/epidemiologia , Adulto Jovem
13.
Artigo em Inglês | MEDLINE | ID: mdl-32846960

RESUMO

South Korea has learned a valuable lesson from the Middle East respiratory syndrome (MERS) coronavirus outbreak in 2015. The 2015 MERS-CoV outbreak in Korea was the largest outbreak outside the Middle Eastern countries and was characterized as a nosocomial infection and a superspreading event. To assess the characteristics of a super spreading event, we specifically analyze the behaviors and epidemiological features of superspreaders. Furthermore, we employ a branching process model to understand a significantly high level of heterogeneity in generating secondary cases. The existing model of the branching process (Lloyd-Smith model) is used to incorporate individual heterogeneity into the model, and the key epidemiological components (the reproduction number and the dispersive parameter) are estimated through the empirical transmission tree of the MERS-CoV data. We also investigate the impact of control intervention strategies on the MERS-CoV dynamics of the Lloyd-Smith model. Our results highlight the roles of superspreaders in a high level of heterogeneity. This indicates that the conditions within hospitals as well as multiple hospital visits were the crucial factors for superspreading events of the 2015 MERS-CoV outbreak.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/virologia , Coronavírus da Síndrome Respiratória do Oriente Médio , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Humanos , Modelos Teóricos , República da Coreia/epidemiologia
15.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(8): 849-853, 2020 Aug 06.
Artigo em Chinês | MEDLINE | ID: mdl-32842314

RESUMO

Objective: To identify the epidemic clones of MRSA isolates at a hospital in shanghai. Methods: A total of 72 MRSA isolates have been isolated from a second grade hospital between 2017 and 2018, including 32 CA-MRSA isolates, 13 HA-MRSA isolates and 26 MRSA isolates from environment. In this study, MLST and PFGE typing methods were used to analyze the molecular epidemiology of the MRSA isolates. Results: A total of 72 MRSA isolates have been obtained including 46 isolates from clinical specimens, 26 isolates from environments. The 46 MRSA isolates from clinical specimens consisted of 33 CA-MRSA (community-acquired MRSA) and 13 HA-MRSA (hospital-acquired MRSA). Furthermore, these patients infected with MRSA isolates were mostly distributed in the department of geriatrics (34.8%, 16/46), internal medicine (26.1%, 12/46) and surgery (26.1%, 12/46). MLST typing results showed that ST764 was predominant in isolates from both clinical specimens and hospital environments. Furthermore, PFGE typing results showed that most ST764 MRSA had high homolog (>90%). Conclusion: ST764 MRSA isolates might spread in community, hospital and environments. Therefore, continuous monitoring of MRSA and its variation may be useful in understanding the involvement of epidemic clone, and in searching new strategies to control MRSA infection.


Assuntos
Infecções Comunitárias Adquiridas , Infecção Hospitalar/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/epidemiologia , Antibacterianos , China/epidemiologia , Eletroforese em Gel de Campo Pulsado , Humanos , Meticilina , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Tipagem de Sequências Multilocus
16.
Parasitol Res ; 119(9): 3033-3040, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32748039

RESUMO

We assessed the potential contribution of hospitals to contaminations of wastewater by enteric protists, including Cryptosporidium spp., Giardia duodenalis, and Enterocytozoon bieneusi in raw wastewater. Wastewater samples were collected from storage tanks in two hospitals and one associated wastewater treatment plant in Shanghai, China, from March to November 2009. Enteric pathogens were detected and identified using PCR and DNA sequencing techniques. Among a total of 164 samples analyzed, 31 (18.9%), 45 (27.4%), and 122 (74.4%) were positive for Cryptosporidium spp., G. duodenalis, and E. bieneusi, respectively. Altogether, three Cryptosporidium species, four G. duodenalis assemblages, and 12 E. bieneusi genotypes were detected. Cryptosporidium hominis, G. duodenalis sub-assemblage AII, and E. bieneusi genotype D were the dominant ones in wastewater from both hospitals and the wastewater treatment plant. A similar distribution in genotypes of enteric pathogens was seen between samples from hospitals and the wastewater treatment plant, suggesting that humans are one of the major sources for these pathogens and hospitals are important contributors of enteric parasites in urban wastewater. Data from this study might be useful in the formulation of preventive measures against environmental contamination of waterborne pathogens.


Assuntos
Infecção Hospitalar/microbiologia , Infecção Hospitalar/parasitologia , Cryptosporidium/isolamento & purificação , Enterocytozoon/isolamento & purificação , Giardia lamblia/isolamento & purificação , Águas Residuárias/microbiologia , Águas Residuárias/parasitologia , China/epidemiologia , Infecção Hospitalar/epidemiologia , Criptosporidiose/epidemiologia , Criptosporidiose/parasitologia , Cryptosporidium/classificação , Cryptosporidium/genética , Enterocytozoon/classificação , Enterocytozoon/genética , Genótipo , Giardia lamblia/classificação , Giardia lamblia/genética , Giardíase/epidemiologia , Giardíase/parasitologia , Hospitais , Humanos , Microsporidiose/epidemiologia , Microsporidiose/microbiologia , Reação em Cadeia da Polimerase
17.
BMC Infect Dis ; 20(1): 452, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600270

RESUMO

BACKGROUND: Bacterial infections are the most frequent complications in patients with malignancy, and the epidemiology of nosocomial infections among cancer patients has changed over time. This study aimed to evaluate the characteristics, antibiotic resistance patterns, and prognosis of nosocomial infections due to multidrug-resistant (MDR) bacteria in cancer patients. METHODS: This retrospective observational study analyzed cancer patients with nosocomial infections caused by MDR from August 2013 to May 2019. The extracted clinical data were recorded in a standardized form and compared based on the survival status of the patients after infection and during hospitalization. The data were analyzed using independent samples t-test, Chi-square test, and binary logistic regression. P-values < 0.05 were considered significant. RESULTS: One thousand eight patients developed nosocomial infections during hospitalization, with MDR strains detected in 257 patients. Urinary tract infection (38.1%), respiratory tract infection (26.8%), and bloodstream infection (BSI) (12.5%) were the most common infection types. Extended-spectrum ß-lactamase producing Enterobacteriaceae (ESBL-PE) (72.8%) members were the most frequently isolated MDR strains, followed by Acinetobacter baumannii (11.7%), and Stenotrophomonas maltophilia (6.2%). The results of multivariate regression analysis revealed that smoking history, intrapleural/abdominal infusion history within 30 days, the presence of an indwelling urinary catheter, length of hospitalization, and hemoglobin were independent factors for in-hospital mortality in the study population. The isolated MDR bacteria exhibited high rates of sensitivity to amikacin, meropenem, and imipenem. CONCLUSIONS: The burden of nosocomial infections due to MDR bacteria is considerably high in oncological patients, with ESBL-PE being the most predominant causative pathogen. Our findings suggest that amikacin and carbapenems actively against more than 89.7% of MDR isolates. The precise management of MDR bacterial infections in cancer patients may improve the prognosis of these individuals.


Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/efeitos dos fármacos , Neoplasias/microbiologia , Idoso , Antibacterianos/farmacologia , China/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
18.
Clin Med (Lond) ; 20(5): e173-e177, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32719035

RESUMO

We describe the details of a COVID-19 outbreak in a 25-bedded Birmingham neurology/stroke ward in the early phase of the pandemic (March to May 2020). Twenty-one of 133 admissions (16%) tested positive for COVID-19 and of those, 8 (6% of all admissions to the ward) were determined to be nosocomial. Thus 38% (8/21) of COVID-19 infections were hospital-acquired. Ten of the patients that contracted COVID-19 died; of these three were hospital-acquired cases. Five of the 21 patients had negative swabs prior to receiving a positive test result. This study highlights the importance of appropriate use of personal protective equipment (PPE) with high-risk patients (including those with stroke and complex brain injury with tracheostomies) and the difficulties of COVID-19 management in a high-risk patient population.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/epidemiologia , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Acidente Vascular Cerebral/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Feminino , Departamentos Hospitalares , Hospitais de Distrito , Hospitais Gerais , Humanos , Incidência , Masculino , Auditoria Médica , Neurologia/organização & administração , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Reino Unido , Populações Vulneráveis
19.
PLoS One ; 15(7): e0236184, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687517

RESUMO

BACKGROUND: Healthcare-associated infections (HAI) are a significant burden on the healthcare system. Recent research has suggested the role of copper in reducing HAI. The purpose of this study was to systematically search literature and pool data from studies evaluating the efficacy of copper-impregnated hospital linen in reducing HAI. METHODS: We carried out a systematic electronic search of PubMed, ScienceDirect, BioMed Central, Springer, Embase, and Google Scholar databases for controlled studies evaluating the efficacy of copper-impregnated linen in reducing the incidence of HAI. The last search was carried out on 15th February 2020. RESULTS: Six studies were included. There was no restriction on the type of organism causing HAI in three studies while three trials reported HAI from Clostridioides difficile and multi-drug resistant organisms (MDRO). A meta-analysis of six studies indicated the use of copper-impregnated linen did not reduce the risk of HAI [Incidence rate ratio (IRR):0.66, 95% CI:0.28-1.58, p = 0.36, I2 = 100%)]. On subgroup analysis, while pooled data from three studies HAI indicated a statistical significant reduction in all-HAI with copper-impregnated linen (IRR:0.76, 95% CI:0.75-0.77, p<0.00001, I2 = 0%), no such difference was seen when HAI was defined as infection by Clostridioides difficile and MDROs only (IRR:0.57, 95% CI:0.12-2.75, p = 0.48, I2 = 99%). Meta-regression analysis for study duration and number of days of hospitalization did not demonstrate any influence on the overall effect size. On sensitivity analysis, there was no change in the significance of results after the sequential exclusion of every study. CONCLUSION: Current evidence on the use of copper-impregnated linen to reduce HAI is conflicting. Our results indicate that copper-impregnated linen may reduce HAI, but there is still no evidence of such an effect regarding infections caused by MDRO or Clostridioides difficile. The overall quality of evidence is not high. Homogenous high-quality studies are required to strengthen the evidence on this subject.


Assuntos
Anti-Infecciosos , Roupas de Cama, Mesa e Banho , Infecções por Clostridium/prevenção & controle , Cobre , Infecção Hospitalar/prevenção & controle , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Humanos , Incidência
20.
J Thorac Cardiovasc Surg ; 160(2): 447-451, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32689700

RESUMO

The COVID-19 pandemic necessitates aggressive infection mitigation strategies to reduce the risk to patients and healthcare providers. This document is intended to provide a framework for the adult cardiac surgeon to consider in this rapidly changing environment. Preoperative, intraoperative, and postoperative detailed protective measures are outlined. These are guidance recommendations during a pandemic surge to be used for all patients while local COVID-19 disease burden remains elevated.


Assuntos
Betacoronavirus/patogenicidade , Procedimentos Cirúrgicos Cardíacos/normas , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Cardiopatias/cirurgia , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Salas Cirúrgicas/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sala de Recuperação/normas , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Cardiopatias/epidemiologia , Humanos , Saúde do Trabalhador/normas , Segurança do Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Virulência
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