Washington, DC, November 1, 2011 — Multidrug-resistant Acinetobacter baumannii (MDR-AB) was found in the environment of 48 percent of the rooms of patients colonized or infected with the pathogen, according to a new study published in the November issue of the American Journal of Infection Control, the official publication of APIC – the Association for Professionals in Infection Control and Epidemiology.

The study examined how frequently the environment surrounding the patient becomes contaminated and which environmental surfaces are most commonly contaminated.

A team of researchers from the University of Maryland School of Medicine took samples from ten surfaces in each of 50 rooms inhabited by patients with a recent (less than two months prior to environmental sampling) or remote (more than two months) history of MDR-AB.  Surfaces sampled included the door knob, bedrails, bedside table, vital sign monitor touchpad, nurse call button, sink, supply cart drawer handles, infusion pump, ventilator surface touch pad, as well as the floor on both sides of the patient’s bed.  Of these, 9.8 percent of surface samples representing 48 percent of the tested rooms showed environmental growth of A. baumannii.

Further, the study found that patients with a recent history of MDR-AB colonization or infection were not significantly more likely than those with a remote history of MDR-AB to contaminate their environment.

The authors note several potential limitations including small sample size, lack of a comparison group, and the inability to determine which came first: environmental contamination or patient colonization/infection. In addition, the study did not evaluate healthcare worker or patient movement and therefore cannot demonstrate transmission of Acinetobacter baumannii to patients as a result of environmental contamination.

Since the study was conducted, new strategies to reduce transmission of the pathogen have resulted in a significant decrease in infections and acquisition.

The research found that supply cart drawer handles (20 percent), floors (16 percent), infusion pumps (14 percent), ventilator touchpads (11.4 percent) and bedrails (10.2 percent) were most commonly contaminated, and 85 percent of environmental cultures matched the strain of the infected patient in that room.  These results are of particular concern due to the frequency with which healthcare workers may touch infected surfaces during patient care.

“For patients with MDR-AB, the surrounding environment is frequently contaminated, even among patients with a remote history of MDR-AB,” conclude the authors. “In addition, surfaces often touched by healthcare workers during routine patient care are commonly contaminated and may be a source of nosocomial transmission. The results of this study are consistent with studies of other important hospital pathogens such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus and Clostridium difficile.”

Please read more here

Numerous studies have demonstrated that contaminated environmental surfaces in healthcare facilities can contribute to the transmission of infectious pathogens and that the cleaning and disinfection of these high-touch surfaces has been suboptimal.

As Carling, et al. (2008) notes, “It has now been well documented that pathogens such as methicillin‐susceptible S. aureus, MRSA and VRE, are readily transmitted from environmental surfaces to healthcare workers’ hands.

Recently, the link between environmental contamination and patient acquisition has been more convincingly demonstrated.

Epidemiologic studies have shown that patients admitted to rooms previously occupied by individuals infected or colonized with MRSA, VRE or Acinetobacter baumanii are at significant risk of acquiring these organisms from previously contaminated environmental sites.”

“There is no doubt in my mind that contamination of the environment (surfaces in patient care areas and mobile medical equipment) play a major role in the transmission of potential pathogens,” says Michael Phillips, MD, the hospital epidemiologist at New York University Langone Medical Center.

“There are well-designed studies which show patients who occupy the bed of a patient previously infected with a resistant pathogen are at greater risk of acquiring that pathogen. The key to convincing healthcare workers of the importance of the environment is data – posting unit or service specific rates of C. difficile infections, for example.”

“There is no debate as to the role that contaminated surfaces play in the transmission of MDROs in the healthcare delivery setting,” says Irena L. Kenneley, PhD, APRN-BC, CIC, assistant professor at Case Western Reserve University’s Frances Payne Bolton School of Nursing.

“There are many compelling studies that point to an environmental cause in outbreak situations, but one study regarding the impact of environmental MRSA and VRE contamination was conducted that really underscores the role of contaminated fomites (Huang, Datta and Platt, 2006).

In this study it was found that after retrospective review of 10,000 ICU patients they found patients had significantly higher risk for acquiring MRSA or VRE if the most recent previous occupant of the same room had tested positive for the organisms. These results (and numerous other studies) point directly to an environmental reservoir and provide an explanation for transmission, the links to the chain of infection, and healthcare-associated infection.”

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The Metropolitan Police Department has begun investigation on suspicion of manslaughter. So far, 3 cases of in-hospital infection involving malpractice have been accused and convicted in Japan.

The authors of this article do not agree with this method but the authors of this blog do !!

A major outbreak of multidrug-resistant Acinetobacter baumannii (MDRAB) hit Teikyo University Hospital in Tokyo, Japan. Since last year, 53 patients have been infected, and at least 9 may have died as a result of the infection. Japanese mass media blames the hospital officials, saying that they should have prevented in-hospital infection and reported the infections to the authorities earlier [1]. The Metropolitan Police Department has begun investigation on suspicion of manslaughter. So far, 3 cases of in-hospital infection involving malpractice have been accused and convicted in Japan. However, this is the first case in pursuing criminal charges against outbreak of multidrug-resistant bacteria, whose control is difficult to attain.

See the report here

Clostridium difficile infection has risen dramatically among hospitalized children in the U.S., according to a nationally representative study.

The number of cases rose 14.9% per year, more than doubling from 3,565 in 1997 to 7,779 in 2006 (P<0.001), Cade M. Nylund, MD, of the Uniformed Services University of the Health Sciences in Bethesda, Md., and colleagues found.

But unlike recent trends in adults, the severity of C. difficile infections didn’t worsen over time, the researchers reported online in the Archives of Pediatrics & Adolescent Medicine.

In adults, studies have documented a rise in incidence of C. difficile infections along with associated hospitalizations and deaths, thought to be, in part, due to emergence of extra toxic hypervirulent strains of the bacteria resistant to antibiotics, the group noted.

The same may be true for children, they suggested.

“There may also be increasing awareness among healthcare providers, leading to increased testing in symptomatic patients,” they wrote in the paper.

Antibiotic use trended downward in the U.S. over the study period and so couldn’t explain the increase, they added.

Nylund’s group retrospectively examined the triennial Healthcare Cost and Utilization Project Kids’ Inpatient Database for the years 1997, 2000, 2003, and 2006 for discharge diagnoses of C. difficile infection.

The database covered an estimated 88% of all pediatric inpatient visits. Weighting the data to reflect nearly 10.5 million pediatric hospitalizations during these years, 21,274 (0.2%) would have had C. difficile infection as a discharge diagnosis

Please read the entire report here

The Scientist

Plasmodium parasites responsible for deadly outbreaks of malaria synchronize their emergence and development with the circadian rhythms of their hosts to maximize their survival and spread
The results, published online today (January 5) in Proceedings of the Royal Society B, give clues to why circadian clocks are maintained in so many parasite species, and may hold implications for when to administer malaria treatments to infected individuals.

“This study is incredibly important,” said Deborah Bell-Pedersen, a molecular biologist at Texas A&M University, who was not involved in the study. “It helps us appreciate the role of clocks in organisms, and how they provide an advantage to their growth and well-being.”  Please read the entire article here

A new treatment for the tropical disease leishmaniasis might be obtained from a compound of a pepper plant that Peru’s native Chayahuitas people use for its anti-inflammatory properties.

The author of the research, Nicolas Fabre, of the Institute for Research and Development and the University of Toulouse in France, along with colleague Michel Sauvain and teams in France and Peru, tested in vitro the natural leishmaniasis remedies used by this people, whose members are strongly exposed to the disease.

One of the plants they used was the pepper plant called Piper sanguineispicum, a plants whose leaves are used as an anti-inflammatory.

The two researchers identified new compounds from the leaves, tested their effect on the disease, in vitro, and among these compounds they found three new caffeic acid esters, that affected the infecting form of the disease, and only showed moderate toxicity on living cells.

Fabre said that “the most interesting result is the selectivity of the activity; the antileishmanial value is nothing if compounds are toxic to cells.”

His excitement aside, the researcher is the first one to be cautious about the discovery and to say that “it is worth nothing, that these results are very preliminary and in vivo investigations are needed to confirm the interest of these esters.”

Leishmaniasis is a disease transmitted through the bite of an infected sand fly, and it affects two million people every year, with another 350 million thought to be at risk globally.

Cutaneous leishmaniasis is the most common form of the disease and it manifests through sores on the skin, but the more dangerous form – visceral leishmaniasis, can attack internal organs and even cause death.

This disease is mainly present in the developing world and there are not many treatments available, according to the Royal Society of Chemistry.

Fabre says that “current drugs are based on antimony compounds, but these present renal and cardiac toxicity.

“Other drugs such as Amphotericin B, also cause a lot of adverse effects, [and] on top of that these treatments are very expensive and unfortunately this disease affects poor countries.”

These three newly discovered compounds demand for further research in vivo, which could one day lead to an effective treatment. Please see the original here

Background

The clinical and epidemiological significance of Leishmania DNA in extralesional sites is obscured by uncertainty of whether the DNA derives from viable parasites. To examine dissemination of Leishmania during active disease and the potential participation of human infection in transmission, Leishmania 7SLRNA was exploited to establish viability and estimate parasite burden in extralesional sites of dermal leishmaniasis patients.

Methods

The feasibility of discriminating parasite viability by PCR of Leishmania 7SLRNA was evaluated in relation with luciferase activity of luc transfected intracellular amastigotes in dose-response assays of Glucantime cytotoxicity. Monocytes, tonsil swabs, aspirates of normal skin and lesions of 28 cutaneous and 2 mucocutaneous leishmaniasis patients were screened by kDNA amplification/Southern blot. Positive samples were analyzed by quantitative PCR of Leishmania 7SLRNA genes and transcripts.

Results

7SLRNA amplification coincided with luciferase activity, confirming discrimination of parasite viability. Of 22 patients presenting kDNA in extralesional samples, Leishmania 7SLRNA genes or transcripts were detected in one or more kDNA positive samples in 100% and 73% of patients, respectively. Gene and transcript copy number amplified from extralesional tissues were comparable to lesions. 7SLRNA transcripts were detected in 13/19 (68%) monocyte samples, 5/12 (42%) tonsil swabs, 4/11 (36%) normal skin aspirates, and 22/25 (88%) lesions; genes were quantifiable in 15/19 (79%) monocyte samples, 12/13 (92%) tonsil swabs, 8/11 (73%) normal skin aspirates.

Conclusion

Viable parasites are present in extralesional sites, including blood monocytes, tonsils and normal skin of dermal leishmaniasis patients. Leishmania 7SLRNA is an informative target for clinical and epidemiologic investigations of human leishmaniasis.

The reports are scheduled to air Tuesday, Sept. 21 and Wednesday, Sept. 22, at 6:30 p.m. EST on the evening broadcast.

A Tokyo hospital’s year-long cover-up of its drug-resistant Acinetobacter outbreak recently made headlines worldwide.

epiNewswire carries continuing Acinetobacter research news.

NEW YORK | Mon Jun 18, 2007 2:24pm EDT

NEW YORK (Reuters Health) – New research suggests that an outbreak of wound and bloodstream infections among U.S. service members in Iraq was acquired at contaminated field hospitals, not on the battlefield.

Army doctors noticed an increasing problem of infection with a drug-resistant microbe called Acinetobacter baumannii-calcoaceticus complex (ABC) among casualties being treated in Iraq.

Acinetobacter bacteria are found in soil and water but usually cause no problem. In fact, it’s quite common for people to carry the germ on their skin without any ill effects. However, with open wounds and reduced immunity there’s an increased risk of ABC infections.

Dr. Paul Scott, from Walter Reed Army Institute of Research in Rockville, Maryland, and colleagues looked into ABC infections seen in wounded soldiers evacuated from Iraq, and examined three possible sources for infection.

Skin samples from 160 soldiers were tested for the presence of ABC bacteria. In addition, samples from the soil and from healthcare environments were also examined for evidence of the microbes.

Just one of the patients tested had evidence of ABC on the skin, the team reports in the journal Clinical Infectious Diseases, and only 1 of 49 soil samples carried the microbes. By contrast, ABC bacteria were present in samples obtained from all seven field hospitals studied.

Taken together, these findings suggest that drug-resistant ABC infection was not acquired in the battlefield, but only after the patients had been treated for wounds at field hospitals.

The results of a second study, which is reported in the journal Infection Control and Hospital Epidemiology, also point to contaminated field hospitals as being the source of these outbreaks.

“We need to know where these infections are coming from,” Dr. Matthew E. Griffith said in a statement. “One of the possibilities was that ABC was on the soldiers’ skin before injury and simply traveled to the wound site to cause the infection. “

The study involved skin testing of 102 active military soldiers stationed in Iraq.

Contrary to what had been expected, Griffith, from Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas, and colleagues found that uninjured soldiers in Iraq do not carry drug-resistant ABC on their skin.

If the organism was not present on the skin before injury, then it is likely to have come from some other source and entered the wound after injury, Dr. Griffith said. One likely source: field hospitals.

These findings add “to the ever growing body of evidence” implicating health care-related transmission as the cause of the ongoing military ABC outbreak.

SOURCES: Clinical Infectious Diseases, June 15, 2007; Infection Control and Hospital Epidemiology, May 16, 2007.