Successful control of an outbreak of GES-5 extended-spectrum ß-lactamase-producing Pseudomonas aeruginosa in a long-term care facility in Japan.

BACKGROUND: Little is known about multidrug-resistant Pseudomonas aeruginosa (MDRP) outbreaks in long-term care facilities (LTCFs). AIM: To describe an MDRP outbreak in an LTCF and to clarify risk factors for MDRP acquisition. METHODS: Patients who were positive for MDRP at an LTCF from January 2013 to January 2014 were analysed. A descriptive analysis, a case-control study, and a microbiological analysis were performed. FINDINGS: A total of 23 MDRP cases were identified, 16 of which were confirmed in sputum samples. Healthcare workers were observed violating hand hygiene procedures when performing oral, wound, and genital care. Nasogastric tube and oxygen mask use was associated with MDRP acquisition in the respiratory tract, which might have been confounded by poor hand hygiene. Sharing unhygienic devices, such as portable oral suction devices for oral care, and washing bottles and ointments for wound and genital care with inadequate disinfection could explain the transmission of MDRP in some cases. Isolates from 11 patients were found to be indistinguishable or closely related by pulsed-field gel electrophoresis and harbouring the blaGES-5 gene. Subsequent enhanced infection control measures were supported by nearby hospitals and a local public health centre. No additional cases were identified for a year after the last case occurred in January 2014. CONCLUSION: An outbreak of MDRP with an antimicrobial resistance gene, blaGES-5, occurred in a Japanese LTCF. It was successfully controlled by enhanced infection control measures, which neighbouring hospitals and a local public health centre supported.

[Mortality of SMON patients in relation to their disabilities].

The relationship between mortality and disability, was studied in SMON patients, who had participated in the questionnaire survey in 1980, by following them for 10 years through municipal resident registration information offices. Eighty deaths were observed among 409 subjects during the follow-up period. The effect of each disability on the mortality of SMON was estimated by applying the Cox proportional hazard model. The presence of severe gait disturbance and low levels of activities of daily living (ADL) were associated with significantly higher risk of death after adjustment for age and sex. The relative risk of visual disturbance was not significant after adjusting for age, sex and other kinds of disability. Those who complained of continuous dysesthesia at the time of the initial survey showed better prognosis than those without such dysesthesia. Among subjects who died during the follow-up period, those who had reported low levels of ADL at the time of the initial survey had a greater proportion of deaths attributable to heart failure and pneumonia than those who had reported high levels of ADL.