Epidemiology and management of candidaemia--a retrospective, multicentre study in five hospitals in the UK.

Candidaemia is associated with high mortality. Despite the fact that Candida species account for close to 10% of all nosocomial bloodstream infections, relatively few studies have investigated the management of candidaemia in hospitals. Our objective was to find out how candidaemia is managed in hospitals. Data relating to all episodes of candidaemia for the year 2008 were retrospectively collected in five centres in Scotland and Wales. A total of 96 candidaemic episodes were recorded in the year 2008, yielding 103 isolates of Candida. Fifty candidaemic episodes were caused by Candida albicans. Fluconazole was the most common agent prescribed for the treatment of candidaemia. There was great variation in the prescribed dose of fluconazole. Forty per cent of patients who survived received <2 weeks of systemic antifungal therapy. Central venous catheters (CVC) were removed in 57% of patients. CVC removal was not associated with better survival. The overall mortality was 40.4%. Management of candidaemia varies between the UK centres and is often inadequate. There is need to have consensus on the dosages of antifungal agents and the duration of therapy. The current guidance on removal of CVC in all cases of candidaemia should be reviewed.

Cost burden of Clostridioides difficile infection to the health service: A retrospective cohort study in Scotland.

BACKGROUND: Clostridioides difficile infection (CDI) is associated with high healthcare demands and related costs. AIM: To evaluate the healthcare and economic burden of CDI in hospitalized patients with community- (HOCA-CDI) or hospital-associated CDI (HOHA-CDI) in the National Health Service in Scotland. METHODS: A retrospective cohort study was conducted, examining data between August 2010 and July 2013 from four patient-level Scottish datasets, linked to death data. Data examined included prior antimicrobial prescriptions in the community, hospitalizations, length of stay and mortality. Each CDI case was matched to three hospital-based controls on the basis of age, gender, hospital and date of admission. Descriptive economic evaluations were based on bed-day costs for different types of wards. FINDINGS: Overall, 3304 CDI cases were included in the study. CDI was associated with additional median lengths of stay of 7.2 days for HOCA-CDI and 12.0 days for HOHA-CDI compared with their respective, matched controls. The 30-day mortality rate was 6.8% for HOCA-CDI and 12.4% for HOHA-CDI. Overall, recurrence within 90 days of the first CDI episode occurred in 373/2740 (13.6%) survivors. The median additional expenditure for each initial CDI case compared with matched controls was £1713. In the 6 months after the index hospitalization, the cost associated with a CDI case was £5126 higher than for controls. CONCLUSION: Using routinely collected national data, we demonstrated the substantial burden of CDI on healthcare services, including lengthy hospital stays and readmissions, which increased the costs of managing patients with CDI compared with matched controls.

Citrobacter diversus brain abscess: case reports and molecular epidemiology.

Citrobacter diversus brain abscess occurred in two infants in Aberdeen, 5 months apart. These are the first reported cases of this condition in the UK since 1976. Restriction endonuclease analysis with SacI enzyme showed blood and CSF isolates from both patients to be identical and different from 10 other clinical isolates of C. diversus and one C. amalonaticus strain. Furthermore, isolates of C. diversus from patients belonged to biotype "d" whereas control isolates were of biotypes "a" or "e". Because both infants attended the same central and peripheral maternity units, this raised suspicions of long term contamination of the hospital environment by this organism. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) patterns of whole-cell proteins and immunoblotting with normal human serum were remarkably homogeneous for all 13 C. diversus strains and thus were not useful for typing. However, the only C. amalonaticus strain was clearly differentiated from C. diversus strains by SDS-PAGE. Management of the infants included multiple intravenous antibiotic therapy for 4-6 weeks and repeated computerised tomography (CT) scanning and drainage of the abscess cavity. Both children survived albeit with some minor degree of brain damage.

Water, water everywhere nor any a sterile drop to rinse your endoscope.

Traditional waterborne infections have been largely controlled in the UK by the provision of clean drinking water. However, water can still cause problems for infection control teams in particular when used in endoscope washer-disinfectors. HTM 2030 states that final rinse water used in washer-disinfectors must not present a microbiological hazard and that there should be no recovery of micro-organisms from the final rinse water. The problems that biofilms may cause in washer-disinfectors, the type of biofilms that may develop, and the nature of the bacteria within them, in particular how biofilm bacteria behave differently to those that are not part of a biofilm (planktonic bacteria), are discussed in this article. Finally, we discuss how knowledge of the growth and control of biofilms may be used to control their growth.

Telephone call contact for post-discharge surveillance of surgical site infections. A pilot, methodological study.

Accurate determination of superficial surgical-site infection (SSI) requires post-discharge surveillance (PDS) for up to 30 days. To be useful for regional or national audit the method must be effective, inexpensive, and acceptable to patients. We assessed the role of telephone calls to patients in PDS of SSI in 3150 patients in 32 Scottish hospitals undergoing groin hernia repair during one year. Overall, 104 (3.3%) patients opted out of the audit by declining to give a contact telephone number, 96 (3.0%) could not provide a personal telephone contact number, and 12 could not be contacted, a compliance rate of 93.3%. Two thousand, nine hundred and thirty-eight patients were contacted at one or all of the call points, i.e. 10, 20, or 30 days postoperatively, from a single call centre by medical records clerks, working to a piloted protocol. Contact data, including contact at all three time points are available on 2665 (84.6%) patients. All patients who believed their wound to be infected were seen by a healthcare worker (HCW) to confirm or refute the diagnosis. Of the 2665 patients in whom complete data are available, 140 (5.3%) patients developed confirmed wound infection and a further 57 (2.1%) thought their wound was infected, but this was not confirmed by the HCW. Patients appeared to welcome the concept of telephone contact. Methods for identifying all patients eligible for surveillance need to be improved. However, we believe this method of patient contact could be appropriate for PDS in regional or national audit.

A retrospective cohort study into acquisition of MRSA and associated risk factors after implementation of universal screening in Scottish hospitals.

OBJECTIVE: To estimate the proportion of patients who acquire methicillin-resistant Staphylococcus aureus (MRSA) while in hospital and to identify risk factors associated with acquisition of MRSA. DESIGN: Retrospective cohort study. PATIENTS: Adult patients discharged from 36 general specialty wards of 2 Scottish hospitals that had implemented universal screening for MRSA on admission. METHODS: Patients were screened for MRSA on discharge from hospital by using multisite body swabs that were tested by culture. Discharge screening results were linked to admission screening results. Genotyping was undertaken to identify newly acquired MRSA in MRSA-positive patients on admission. RESULTS: Of the 5,155 patients screened for MRSA on discharge, 2.9% (95% confidence interval [CI], 2.43-3.34) were found to be positive. In the subcohort screened on both admission and discharge (n = 2,724), 1.3% of all patients acquired MRSA while in hospital (incidence rate, 2.1/1,000 hospital bed-days in this cohort [95% CI, 1.5-2.9]), while 1.3% remained MRSA positive throughout hospital stay. Three risk factors for acquisition of MRSA were identified: age above 64 years, self-reported renal failure, and self-reported presence of open wounds. On a population level, the prevalence of MRSA colonization did not differ between admission and discharge. CONCLUSIONS: Cross-transmission of MRSA takes place in Scottish hospitals that have implemented universal screening for MRSA. This study reinforces the importance of infection prevention and control measures to prevent MRSA cross-transmission in hospitals; universal screening for MRSA on admission will in itself not be sufficient to reduce the number of MRSA colonizations and subsequent MRSA infections.

First rotavirus, now astrovirus: the evolving benefits of RT-PCR.

We compared RT-PCR and a newly developed amplified EIA for the detection of human astrovirus (HAstV) in 48 stool samples taken from children of less than five years of age with gastroenteritis. The RT-PCR classified more samples as positive than the EIA (18 versus 8). Without sensitive diagnosis, infection control policies will be disadvantaged and the true economic burden of HAstV underestimated.