The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections最新文献

{"title":"Translating metagenomics into clinical practice of complex paediatric neurological presentations","authors":"Justin Penner, J. Hassell, Julianne R. Brown, K. Mankad, N. Storey, Laura Atkinson, Nisha Ranganathan, Alexander Lennon, Jack C. D. Lee, Dimitrios Champsas, Angelika Kopec, D. Shah, C. Venturini, G. Dixon, S. De, J. Hatcher, K. Harris, K. Aquilina, Maaike Kusters, K. Moshal, D. Shingadia, A. Worth, G. Lucchini, A. Merve, T. Jacques, A. Bamford, M. Kaliakatsos, J. Breuer, S. Morfopoulou","doi":"10.1101/2023.06.02.23290816","DOIUrl":"https://doi.org/10.1101/2023.06.02.23290816","url":null,"abstract":"Background Atypical or complex paediatric neurological presentations are common clinical conundrums and often remain undiagnosed despite extensive investigations. This is particularly pronounced in immunocompromised patients. Here we show that clinical metagenomics (CMg) is a valuable adjunct diagnostic tool to be used by neuro-infection multidisciplinary teams (MDTs). Methods We included patients referred to the Great Ormond Street Hospital neuro-infection MDT in whom diagnostic uncertainty remained, despite a standardised comprehensive set of investigations, and who were referred for untargeted CMg on brain tissue and/or cerebrospinal fluid (CSF). In a retrospective review, two clinicians independently assessed whether CMg in conjunction with the MDT resulted in a change of management. Findings 60 undiagnosed patients met the inclusion criteria. We detected the causative pathogen by CMg in 14/60 (23%), with 12/36 patients known to be immunocompromised. CMg results, even when negative, informed patient care, resulting in changes in clinical management in 42/57 (74%). Six patients had unexpected findings of pathogens not identified on prior samples. In four patients, the pathogen was found solely in the brain biopsy and was absent from all other specimens, including CSF. Interpretation CMg is particularly useful when conventional diagnostic techniques for meningoencephalitis are exhausted and proved to be an important diagnostic tool for immunocompromised patients. CMg provided increased reassurance against an infective aetiology prior to recommending immunosuppressive or immunomodulatory treatment. Specialised MDTs should advocate for early brain biopsies and routine CMg in an experienced laboratory for undiagnosed complex neurological cases affecting immunocompromised patients. Funding: the authors declare no funding","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"77 21-22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72454726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Thermal Imaging to Measure Hand Hygiene Quality","authors":"Chaofan Wang, Weiwei Jiang, Kangning Yang, Zhanna Sarsenbayeva, Benjamin Tag, Tilman Dingler, Jorge Gonçalves, V. Kostakos","doi":"10.48550/arXiv.2302.02233","DOIUrl":"https://doi.org/10.48550/arXiv.2302.02233","url":null,"abstract":"OBJECTIVES\u0000Hand hygiene has long been promoted as the most effective way to prevent the transmission of infection. However, due to the low compliance and quality of hand hygiene reported in previous studies, constant monitoring of healthcare workers' hand hygiene compliance and quality is crucial. In this study, we investigate the feasibility of using a thermal camera together with an RGB camera to detect hand coverage of alcohol-based formulation, thereby monitoring handrub quality.\u0000\u0000\u0000METHODS\u0000We recruited 32 participants for this study. Participants were required to perform four types of handrubs to produce different hand coverage of alcohol-based formulation. After each task, participants' hands were photographed under a thermal camera and an RGB camera, while an ultraviolet (UV) test was used to provide the ground truth of hand coverage of alcohol-based formulation. Then, a U-Net was used to segment areas covered with alcohol-based formulations from thermal images, and the system performance was evaluated by comparing coverage differences between thermal images and UV images regarding accuracy and Dice coefficient.\u0000\u0000\u0000RESULTS\u0000The system yields promising results in terms of accuracy (93.5%) and Dice coefficient (87.1%) when observations take place 10 seconds after performing handrub. In addition, we also examine the system performance change over a 60-second observation period, and the accuracy and Dice coefficient still remain at about 92.4% and 85.7% when observation happens at the 60-second time point.\u0000\u0000\u0000CONCLUSIONS\u0000Given these encouraging results, thermal imaging shows its potential feasibility in providing accurate, constant, and systematic hand hygiene quality monitoring.","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89879896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmission of monkeypox virus through sexual contact - A novel route of infection.","authors":"Joseph Heskin, Amy Belfield, Charlotte Milne, Nicklas Brown, Yasmin Walters, Christopher Scott, Margherita Bracchi, Luke Sp Moore, Nabeela Mughal, Tommy Rampling, Alan Winston, Mark Nelson, Sarah Duncan, Rachael Jones, D Ashley Price, Borja Mora-Peris","doi":"10.1016/j.jinf.2022.05.028","DOIUrl":"10.1016/j.jinf.2022.05.028","url":null,"abstract":"","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"14 1","pages":"334-363"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9534114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76446750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suitability assessment of CD24 targeted-therapy in the cancer patients with COVID-19: Preliminary results from pan-cancer.","authors":"Bin Wang, Jiantao Fu, Anqian Lu, Jin Yang","doi":"10.1016/j.jinf.2022.05.030","DOIUrl":"10.1016/j.jinf.2022.05.030","url":null,"abstract":"","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"42 1","pages":"334-363"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9151458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85710210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of pharmacy-led versus conventionally delivered antiviral treatment for hepatitis C in patients receiving opioid substitution therapy: an economic evaluation alongside a pragmatic cluster randomised trial.","authors":"G. Myring, Aaron G. Lim, William Hollingworth, Hugh McLeod, Lewis Beer, P. Vickerman, Matthew Hickman, A. Radley, John F. Dillon","doi":"10.2139/ssrn.4019338","DOIUrl":"https://doi.org/10.2139/ssrn.4019338","url":null,"abstract":"BACKGROUND\u0000Elimination targets for hepatitis C have been set across the world. In the UK almost 90% of infections are in people who inject drugs. Evidence shows community case-finding is effective at identifying and treating undiagnosed patients. The aim of this analysis was to assess, from a healthcare provider perspective, the cost-effectiveness of a new pharmacist-led test and treat pathway for hepatitis C in opioid agonist treatment (OAT) patients attending community pharmacies compared to conventional care.\u0000\u0000\u0000METHODS\u0000In a cluster randomised controlled trial, pharmacies were randomised to the pharmacist-led or conventional care pathway. Mean cost per OAT patient and per patient initiating treatment was identified for each pathway. A Markov model tracking disease progression was developed, with a 50-year time horizon and 3·5% time discount rate, to estimate the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained and the probability of being cost-effective at a £30,000 per QALY willingness-to-pay threshold. Probabilistic sensitivity analysis was performed for a range of drug discounts, re-infection rates, and model assumptions.\u0000\u0000\u0000FINDINGS\u0000Mean cost per OAT patient (£3,674 vs £1,965) and per patient initiating treatment (£863 vs £404) was higher in the pharmacist-led pathway, due to higher uptake of testing and pharmacist time requirements. Over a 50-year time horizon the ICER per QALY gained was £31,612 at NHS indicative price for treatment (£38,979 for 12 weeks) and 12·1/100 person-years re-infection rate, reducing to £21,027/£10,220/-£501 per QALY gained with 30%/60%/90% drug price discounts and £25,373/£21,738/£14,912 per QALY gained at re-infection rates of 8/5/2 per 100 person-years. At 30%/60%/90% drug discount rates, the pharmacist-led pathway has an 80%/98%/100% probability of being cost-effective.\u0000\u0000\u0000INTERPRETATION\u0000The pharmacist-led pathway is effective at increasing testing and treatment uptake, with cost-effectiveness being highly dependent on drug price discounts.\u0000\u0000\u0000FUNDING\u0000Trial funding provided by the Scottish Government, Gilead Sciences, and Bristol-Myers Squibb.","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83958649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gargle pool PCR testing in a hospital during medium and high SARS-CoV-2 incidence.","authors":"P Kheiroddin, V D Gaertner, P Schöberl, E Fischer, J Niggel, P Pagel, B M J Lampl, A Ambrosch, M Kabesch","doi":"10.1016/j.jhin.2022.05.018","DOIUrl":"10.1016/j.jhin.2022.05.018","url":null,"abstract":"<p><strong>Background: </strong>Hospitals need to be protected from SARS-CoV-2 infections to protect vulnerable patients. Thus, a safe, efficient, and cost-effective SARS-CoV-2 testing system for hospitals, in addition to standard hygiene measures and vaccination of staff, is necessary. Here we report on the feasibility and performance of a pool real-time reverse-transcriptase polymerase-chain-reaction (rRT-PCR) test system at, medium and high incidence.</p><p><strong>Methods: </strong>We implemented a testing concept based on gargling at home and pooling of samples in the hospital before PCR testing in the laboratory. We used two PCR systems (point of care and standard 96-well plate system) to adapt to challenges in the hospital setting and respond to a rising incidence in the Omicron wave.</p><p><strong>Findings: </strong>During our 10-week study period, we performed 697 pool PCRs (8793 tests in total) and identified 65 asymptomatic staff members by pool PCR and 94 symptomatic staff members by positive individual PCR. Virus loads in those detected by pool testing were significantly lower (P<0.001). The test system remained workable even during the peak of the Omicron wave and no outbreaks occurred in any specific area of the hospital during the study period. Unvaccinated individuals were over-represented in the positively tested (37% vs 22% positive tests, P=0.04). The test procedure was well accepted by a majority of the hospital staff (84%).</p><p><strong>Conclusion: </strong>Repeated gargle pool rRT-PCR testing can be implemented quickly in hospitals and is an effective, easily adaptable and well-accepted test system for hospitals, even during phases with very high infection rates.</p>","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"39 1","pages":"69-76"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9166272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88824924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genome characterization of monkeypox cases detected in India: Identification of three sub clusters among A.2 lineage","authors":"A. Shete, P. Yadav, Abhinendra Kumar, S. V. Patil, D. Patil, Yash Joshi, T. Majumdar, V. Relhan, R. Sahay, Meenakshy Vasu, P. Gawande, Ajay Verma, Arbind Kumar, Shivram Dhakad, Anukumar Bala Krishnan, Shubin Chenayil, Suresh Kumar, P. Abraham","doi":"10.1101/2022.09.16.507742","DOIUrl":"https://doi.org/10.1101/2022.09.16.507742","url":null,"abstract":"Since May 2022, Monkeypox, a zoonotic Orthopox DNA virus was reported in more than 102 countries indicating expansion of its geographic range. We analyzed the complete genomes sequences of Monkeypox cases from Kerala (n=5 travelled from UAE) and Delhi (n=5 no travel history), India confirmed during July to August 2022. All the retrieved MPXV sequences from India covering 90 to 99% genome belong to A.2 lineage of clade IIb. The A.2 MPXV lineage divided in three sub clusters; first cluster Kerala n=5, Delhi n=2 aligned with the USA-2022 ON674051.1; while second of Delhi n=3 aligned with USA-2022 ON675438.1 and third consists of the UK, USA and Thailand. Recent update in MPXV lineage designated all the five sequences from Kerala as A.2.1. In addition to known 16 single nucleotide polymorphisms (SNPs) along with 13 APOBEC3 cytosine deaminase activity determined specific lineage defining mutations in A.2 lineage, 25 additional APOBEC3 mutations were found in 10 reported sequences. The study emphasizes need of enhancing genomic surveillance to understand the mutation and its linkage.","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"81 1","pages":"66 - 117"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78275521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidrug-resistant OXA-48/CTX-M-15 Klebsiella pneumoniae cluster in a COVID-19 intensive care unit: salient lessons for infection prevention and control during the COVID-19 pandemic.","authors":"A R Howard-Jones, I Sandaradura, R Robinson, S R Orde, J Iredell, A Ginn, S van Hal, J Branley","doi":"10.1016/j.jhin.2022.05.001","DOIUrl":"10.1016/j.jhin.2022.05.001","url":null,"abstract":"<p><strong>Background: </strong>Wards caring for COVID-19 patients, including intensive care units (ICUs), have an important focus on preventing transmission of SARS-CoV-2 to other patients and healthcare workers.</p><p><strong>Aim: </strong>To describe an outbreak of carbapenemase-producing Enterobacterales (CPE) in a COVID-19 ICU and to discuss key infection control measures enabling prompt termination of the cluster.</p><p><strong>Methods: </strong>CPE were isolated from clinical specimens and screening swabs from intensive care patients with COVID-19 disease and from environmental screening. Whole-genome sequencing analysis was instrumental in informing phylogenetic relationships.</p><p><strong>Findings: </strong>Seven clinical isolates and one environmental carbapenemase-producing Klebsiella pneumoniae isolate - all carrying OXA-48, CTX-M-15 and outer membrane porin mutations in ompK35/ompK36 - were identified with ≤1 single nucleotide polymorphism difference, indicative of clonality. A bundle of infection control interventions including careful adherence with contact precautions and hand hygiene, twice weekly screening for multidrug-resistant organisms, strict antimicrobial stewardship, and enhanced cleaning protocols promptly terminated the outbreak.</p><p><strong>Conclusion: </strong>Prolonged use of personal protective equipment is common with donning and doffing stations at the ward entrance, leaving healthcare workers prone to reduced hand hygiene practices between patients. Minimizing transmission of pathogens other than SARS-CoV-2 by careful adherence to normal contact precautions including hand hygiene, even during high patient contact manoeuvres, is critical to prevent outbreaks of multidrug-resistant organisms. Appropriate antimicrobial stewardship and screening for multidrug-resistant organisms must also be maintained throughout surge periods to prevent medium-term escalation in antimicrobial resistance rates. Whole-genome sequencing is highly informative for multidrug-resistant Enterobacterales surveillance strategies.</p>","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"1 1","pages":"64-69"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9088048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84178552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A distinct phylogenetic cluster of Monkeypox genomes suggests an early and cryptic spread of the virus","authors":"B. Jolly, V. Scaria","doi":"10.1101/2022.07.30.502168","DOIUrl":"https://doi.org/10.1101/2022.07.30.502168","url":null,"abstract":"Since its first reports in humans in 1970, monkeypox has been predominantly restricted to countries in Africa where the disease is endemic. Early in 2022, a large number of cases of the disease were reported from Europe and other countries in patients having no history of travel to regions where monkeypox is endemic. Amid a rise in cases, the availability of genome sequences of monkeypox virus isolates in the public domain provides an opportunity to understand the transmission and evolution of the virus. Here, we describe a distinct phylogenetic cluster of monkeypox virus (lineage A.2) using genome sequences available on GISAID. Lineage A.2 currently encompasses 9 genome sequences from 6 viral isolates collected from 3 countries and is distinctly different from the predominant lineage B.1 which is linked to the large European outbreak.","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"75 3","pages":"e24 - e26"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72478684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergence of blaKPC-33-harboring Hypervirulent ST463 Pseudomonas aeruginosa Causing Fatal Infections in China.","authors":"Piao-piao Zhang, Jie Wang, Yue Li, Weixiao Shi, Heng Cai, Q. Yang, X. Li, Yunsong Yu, Ting-ting Qu, Yan Jiang","doi":"10.2139/ssrn.4074661","DOIUrl":"https://doi.org/10.2139/ssrn.4074661","url":null,"abstract":"","PeriodicalId":77413,"journal":{"name":"The Canadian journal of infection control : the official journal of the Community & Hospital Infection Control Association-Canada = Revue canadienne de prevention des infections","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73389297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}