Jennifer Grant

New Delhi Metallo-β-Lactamase in Klebsiella pneumoniae and Escherichia coli, Canada

Multidrug-resistant Klebsiella pneumoniae and Escherichia coli isolates harboring New Delhi metallo-β-lactamase (NDM-1) were isolated from a patient who had returned to Canada from India. The NDM-1 gene was found on closely related incompatibility group A/C type plasmids. The occurrence of NDM-1 in North America is a major public health concern.

Facial Protective Equipment, Personnel, and Pandemics: Impact of the Pandemic (H1N1) 2009 Virus on Personnel and Use of Facial Protective Equipment

BACKGROUND Before the emergence of the pandemic (H1N1) 2009 virus, estimates of the stockpiles of facial protective equipment (FPE) and the impact that information had on personnel during a pandemic varied. OBJECTIVE To describe the impact of H1N1 on FPE use and hospital employee absenteeism. Setting. One tertiary care hospital and 2 community hospitals in the Vancouver Coastal Health (VCH) region, Vancouver, Canada. Patients. All persons with influenza-like illness admitted to the 3 VCH facilities during the period from June 28 through December 19, 2009. METHODS Data on patients and on FPE use were recorded prospectively. Data on salaried employee absenteeism were recorded during the period from August 1 through December 19, 2009. RESULTS During the study period, 865 patients with influenza-like illness were admitted to the 3 VCH facilities. Of these patients, 149 (17.2%) had laboratory-confirmed H1N1 influenza infection. The mean duration of hospital stay for these patients was 8.9 days, and the mean duration of intensive care unit stay was 9.2 days. A total of 134,281 masks and 173,145 N95 respirators (hereafter referred to as respirators) were used during the 24-week epidemic, double the weekly use of both items, compared with the previous influenza season. A ratio of 3 masks to 4 respirators was observed. Use of disposable eyewear doubled. Absenteeism mirrored the community epidemiologic curve, with a 260% increase in sick calls at the epidemic peak, compared with the nadir. CONCLUSION Overall, FPE use more than doubled, compared with the previous influenza season, with respirator use exceeding literature estimates. A significant proportion of FPE resources were used while managing suspected cases. Planners should prepare for at least a doubling in mask and respirator use, and a 3.6-fold increase in staff sick calls.

The role of leech water sampling in choice of prophylactic antibiotics in medical leech therapy

Medical leech therapy (MLT) with Hirudo medicinalis is well established as a treatment for venous congestion of tissue flaps, grafts, and replants. Unfortunately, this treatment is associated with surgical site infections with bacterial species, most commonly Aeromonas hydrophila, which is an obligate symbiot of H. medicinalis. For this reason, prophylactic antibiotics are recommended in the setting of MLT. After culturing Aeromonashydrophila resistant to ciprofloxacin from a tissue specimen from a patient with a failed replant of three digits post‐MLT, we performed environmental surveillance cultures and antibiotic susceptibility testing on water collected from leech tanks. This surveillance was performed twice weekly for 2.5 months. Fourteen surveillance cultures demonstrated 21 isolates of Aeromonas species, 71.4% of which were ciprofloxacin susceptible. All isolates were sulfamethoxazole‐trimethoprim (SXT) susceptible. The prophylactic antibiotic regimen of choice for leech therapy at our institution is SXT, with culture of tank water to refine antimicrobial choice if necessary. This study demonstrates the importance of regular surveillance to detect resistant Aeromonas species in medical leeches; however optimal practice has not been established.

Actinobaculum schaalii: An Emerging Uropathogen?

A. schaalii is a rare uropathogen. We report urosepsis with Actinobaculum schaalii detected serendipitously in blood and urine culture in a 79-year-old with urinary tract obstruction. This paper illuminates the flaws in our current system in detecting A. schaalii and raises awareness among clinicians and laboratory teams.

Identifying the gaps in infection prevention and control resources for long-term care facilities in British Columbia

BACKGROUND Infection prevention and control (IPC) is a critical, although often neglected, part of long-term care (LTC) management. Little is known about what IPC resources are available for LTC and how that impacts patient care and safety. METHODS One hundred eighty-eight LTC facilities were randomly selected out of all British Columbia facilities and surveyed using a validated survey tool. The tool was used to collect data regarding IPC resources grouped within 6 indices: (1) leadership, (2) infection control professionals (ICP) coverage, (3) policies and procedures, (4) support through partnerships, (5) surveillance, and (6) control activities. All components measured have been identified as key for an effective IPC program. Survey responses were used to calculate scores for IPC programs as a whole and for each of the 6 indices. RESULTS Of 188 randomly selected facilities, 86 institutions participated. Facilities were compared by region, funding source, and ICP coverage. Overall, LTC facilities lacked IPC leadership, especially physician support. Having no dedicated ICP was associated with poorer scores on all indices. Only 41% of practicing ICPs had more than 2 years experience, and only 14% were professionally certified. Twenty-two percent of ICPs had additional roles within the institution, and 44% had additional roles outside of the institution. Thirty-five percent of institutions had no IPC dedicated budget. DISCUSSION LTC institutions-with bed numbers exceeding those in acute care-represent an important aspect of health services. These data show that many LTC facilities lack the necessary resources to provide quality infection control programs.

Case Report: Ivermectin and Albendazole Plasma Concentrations in a Patient with Disseminated Strongyloidiasis on Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy

Disseminated strongyloidiasis is often fatal, despite treatment with oral albendazole and parenteral ivermectin (IVM). Here, we report elevated plasma IVM and albendazole sulfoxide concentrations in the context of extracorporeal membrane oxygenation and continuous renal replacement therapy in a patient with disseminated strongyloidiasis treated with subcutaneous IVM and nasogastric albenzadole. Despite elevated drug plasma concentrations, live filariform larvae were detected in endotracheal aspirates after 2 weeks of treatment.

Less Is More: Surgical Procedure Time and Risk of Infections, Length-of-Stay, and Readmission across Three Distinct Surgeries

Abstract Background Longer surgical total procedure times (TPT) have been associated with increased postoperative complications. It is unclear what the effect of TPT is on length-of-stay (LOS) or 30-day readmission rate (RAR). Methods We performed a retrospective study of patients undergoing knee arthroplasty (KA), colectomy, and craniectomy at NorthShore University HealthSystem from 1/2007 to 12/2013. Clinical data were extracted from the Data Warehouse and charts were reviewed. We standardized surgery times for each procedure and categorized into two groups: times <75‰ (short procedures) vs. times >75‰ (long procedures). We used χ 2 and t-test to compare categorical and continuous variables. We performed multivariate logistic regression for predictors of surgical site infection (SSI). Results In univariate analyses, long procedures were associated with higher incidence of fevers, SSI, longer LOS, and 30-day RAR (Table 1). TPT was not associated with other postoperative complications. TPT remained an independent predictor of SSI in multivariate (MV) analysis (Table 2). Conclusion High TPT was associated with increased SSI, LOS, and 30-day RAR. Understanding variation in TPT may help decrease SSI and healthcare utilization.Table 1: Variables Stratified by (TPT) Characteristic N (%) Short N = 5920 Long N = 1980 P-value Fever ≥ 100.4 1042 (17.6%) 450 (22.7%) * Body mass index ≥ 35 1143 (19.7%) 519 (26.6%) * Female 3867 (65.3%) 1117 (56.4%) * Surgery KA 4788 (80.9%) 1604 (81.0%) 0.99 Colectomy 467 (7.9%) 155 (7.8%) Craniectomy 665 (11.2%) 221 (11.2%) Complication 420 (7.1%) 154 (7.8%) 0.31 Urinary tract infection 76 (1.3%) 26 (1.3%) 0.92 Pneumonia 75 (1.3%) 28 (1.4%) 0.62 SSI 67 (1.1%) 41 (2.1%) * Venous thromboembolism 174 (2.9%) 61 (3.1%) 0.75 SSI w/in 30 day of discharge 84 (1.4%) 48 (2.4%) * Mean LOS, days (SD) 3.69 (2.89) 4.05 (3.38) * 30d RAR 277 (4.7%) 142 (7.2%) * *P-value < 0.01Table 2: MV logistic regression€ of SSI within 30-day of discharge OR (95% CI) P-value Age 0.99 (0.98–1.01) 0.97 Female 1.21 (0.84–1.75) 0.31 Surgery KA Ref. * Colectomy 70.2 (36.6–134.6) Craniectomy 20.3 (10.0–41.0) TPT > 75 th %ile 1.59 (1.08–2.33) 0.02 Fever > 100.4 4.10 (2.85–5.94) * Diabetes 1.92 (1.27–2.91) * €Including only variables with P-value <0.2 in UV analysis. * P-value <0.01. Disclosures All authors: No reported disclosures.

Performance assessment of urine flow cytometry (UFC) to screen urines to reflex to culture in immunocompetent and immunosuppressed hosts

Purpose. Urine flow cytometry (UFC) is an automated method to quantify bacterial and white blood cell (WBC) counts. We aimed to determine whether a threshold for these parameters can be set to use UFC as a sensitive screen to predict which urine samples will subsequently grow in culture. Methodology. Urines submitted to our microbiology laboratory at a tertiary care centre from 22 July 2015‐17 February 2016 underwent UFC (Sysmex UF‐1000i) analysis, regular urinalysis and urine culture. Positive urine cultures were defined as growth ≥104 c.f.u. ml−1 of organisms associated with urinary tract infections. The correlation of UFC bacterial and WBC counts with urine culture was assessed using receiver operating characteristics curves. The sensitivity (SN), specificity (SP), negative predictive values (NPVs), positive predictive values (PPVs) and false negative rate (FNR) were calculated at various thresholds in immunocompetent and immunosuppressed patients. Results. A total of 15046 urine specimens were submitted, of which 14908 were analysable in the study. The average time to UFC result from receipt in the laboratory was 0.76 h (+/−1.04). The test performance at a set threshold of UFC bacteria ≥20 or WBC >5 was: SN=96.0%, SP=39.2%, PPV=47.0%, NPV=94.5% and FNR=4.0%. This threshold eliminates 26% of urine cultures. Immunosuppressed hosts had a lower sensitivity of 90.6% and a higher FNR of 9.4%. Conclusions. UFC is a rapid and sensitive method to screen out urine samples that will subsequently be negative and to reflex urines to culture that will subsequently grow. UFC results are available within 1 h from receipt and enable the elimination of culture when the set threshold is not met.