Measures to prevent outbreaks of hospital infections

On the basis of the analysis of 69 outbreaks of hospital infections registered in the USSR in 1986-1989, as well as additional observations made by the authors, a number of factors which determined the present state of the problems concerning this kind of morbidity in the USSR were established: an insufficient level (in cases of enteric infections) or a low level (in cases of purulent septic infections) of etiological diagnosis; poor efficiency of the epidemiological investigation of outbreaks; defects in the work on the prophylactic detection of potential sources of infection among medical staff, parturient women or mothers taking care of their infants. Some possible solutions on these aspects were proposed. Cases of outbreaks of hospital infections among newborns were used as an example demonstrating that such outbreaks were caused mainly by breaches of antiepidemic and sanitary rules in respective hospitals; thus, in one-third of the cases of outbreaks such breaches were observed in maternity clinics with insufficient material and technical equipment. The prevention of these breaches is considered to be the main road to the solution of the whole problem of the prevention of epidemic outbreaks in hospitals.     

A Survey of Hospital Infection in a Pediatric Hospital: Part I. Description of Hospital,Organization of Survey,Population Studied and Some General Findings

Of 17,836 children admitted in 1959, 6.5% developed infection following admission; most of these seemed to be hospital-acquired. Respiratory infections were commonest (2.7%), then gastroenteritis (1.3%), staphylococcal infections including miscellaneous and postoperative wounds (1.1%), pyrexias (0.5%), miscellaneous and post-operative wound infections due to other bacteria (0.4%), “communicable” diseases (0.3%) and monilial infections (0.2%). Incidences were highest in infants and on certain wards incapable of segregating all infected cases. Only 14.3% of infections were severe. They contributed to 16 deaths but not as the sole cause. Hospital infections made over 2070 extra patient-days necessary. Wound infection followed 3.1% of 5052 surgical operations-2.1% when considering only clean sites. Seventy per cent were staphylococcal; antibiograms suggested that some were not of hospital origin. Staphylococcal disease, present on admission or hospital-acquired, occurred in 2.6% of patients. None of these incidences seemed unduly high. Many varied factors underlie hospital infections, and complete control is unlikely with present knowledge and facilities.     

Genetic characterization of high-level gentamicin-resistant strains of Enterococcus faecalis in Iran

The prevalence of resistance to high levels of gentamicin among 182 isolates of Enterococcus faecalis from 2 Iranian hospitals was 42%. Gentamicin resistance was associated with conjugative plasmids (>70 kb) in most strains. Fingerprinting using EcoRI and HindIII showed genetic variation among these plasmids and gave evidence of nosocomial outbreaks and persistence of infection in different wards of the study hospitals, as well as transfer of plasmids between genetically diverse isolates. Using EcoRI, hospital-based specific plasmid fingerprints were detected for the isolates that had previously proved to be unrelated by multilocus enzyme electrophoresis, suggesting the persistence of related plasmids at each hospital, though minor changes in these related plasmids could be detected with HindIII.     

Antibiotic resistant staphylococci

An antibiotic resistant staphylococcus with bacteriophage pattern 52/42B/80/81* is frequently responsible for infectious outbreaks in the newborn nursery. Some time after an outbreak had occurred in the University of California's hospital nursery, family members of the infants were found to be infected with this strain. Two families were studied in detail. In one of them, infection developed in six of the seven members within eight months after the infant's arrival. In the other, half of the family members had recurrent infections during a 13-month period.Infants who left the nursery as asymptomatic carriers were found as likely to transmit the infectious strain as those with clinical infection. Considerable time sometimes elapsed before infection developed in either the infant or the family members. In one instance the first familial infection occurred six months after the infant had left the nursery as an asymptomatic carrier. Newborn infants are quite likely to disseminate antibiotic resistant staphylococci which they may acquire from a hospital nursery. Infections developing among persons in contact with a young infant must be treated with the possibility of a resistant hospital staphylococcus in mind.     

Immunoglobulin efficacy for intravenous administration in the therapy of newborn infants with a suppurative infection

The data on the results of clinico-immunological examination of 46 infants having purulent inflammatory infections in the first month of their life and treated with (a) immunoglobulin for intravenous injection, (b) with hyperimmune antistaphylococcal plasma and immunoglobulin for intravenous injection and (c) without the use of specific hyperimmune preparations are presented. The clinico-laboratory data thus obtained (the levels of serum immunoglobulins and the content of T-rosette-forming lymphocytes) are indicative of the expediency of including the intravenous injection of donor immunoglobulin into the complex therapy of newborn infants with severe and moderate forms of purulent inflammatory infections at an early period of the disease irrespective of its etiology.     

A comparison of hexachlorophene and Lactacyd on growth of skin flora in healthy term newborn infants

Reports of toxicity from the routine bathing of newborn infants with hexachlorophene resulted in discontinuing its use in the newborn nurseries of the Ottawa Civic Hospital, only to be followed by an outbreak of skin infections. As a result, a controlled trial of bathing newborn babies with either Lactacyd or pHisoHex was begun. The efficacy of the soaps was evaluated by comparing the colonization of the nose and umbilical cords of 158 pHisoHex-washed babies and 156 Lactacyd-washed babies on the day of discharge from hospital. The gram-negative and gram-positive bacterial flora of nose and cord of infants washed with pHisoHex and Lactacyd were identical in frequency and distribution.     

Serological and epidemiological characteristics of acute pneumonias caused by Mycoplasma pneumoniae in Belgorod

The etiology of the outbreaks of acute pneumonia in Belgorod was established and their epidemiological features were studied. The mycoplasmal etiology of all cases of acute pneumonia in children and adults, appearing alongside acute respiratory infections resulting from the preceding outbreaks caused by influenza viruses A/Prague/, B/Leningrad/369/75, and all types of parainfluenza viruses, was shown. The droplet mechanism of the transfer of infection was established, which was confirmed by the severity of the outbreak and a high rate of infection of the medical staff at hospitals for children and adults, where patients with mycoplasma-induced pneumonia were treated.     

Prospective means of decreasing suppurative-septic diseases in puerperae and newborn infants

The comparative analysis of the occurrence of purulent septic diseases in mothers during the puerperal period and in newborns, observed in a maternity hospital before and after the introduction of the system of keeping newborns together with their mothers, showed a considerable decrease in the morbidity rate among newborn infants (6 times) and in occurrence of mastitis among puerperae (30 times). This is attributed to a decrease in the frequency of the colonization of newborns and mothers in the puerperal period by the hospital strains of staphylococci belonging to epidemic phagotypes. The gradual elimination of staphylococci of phagotype 80, which dominated for several years, from the hospital was observed. To decrease the morbidity rate, the introduction of the system of keeping newborn infants with their mothers in all maternity hospitals of the USSR is proposed.     

Etiology of Maculopapular Rash in Measles and Rubella Suspected Patients from Belarus

As a result of successful implementation of the measles/rubella elimination program, the etiology of more and more double negative cases remains elusive. The present study determined the role of different viruses as causative agents in measles or rubella suspected cases in Belarus. A total of 856 sera sent to the WHO National Laboratory between 2009 and 2011 were tested for specific IgM antibodies to measles virus (MV), rubella virus (RV) and human parvovirus B19 (B19V). The negatives were further investigated for antibodies to enterovirus (EV) and adenovirus (AdV). Children of up to 3 years were tested for IgM antibodies to human herpesvirus 6 (HHV6). A viral etiology was identified in 451 (52.7%) cases, with 6.1% of the samples being positive for MV; 2.6% for RV; 26.2% for B19V; 9.7% for EV; 4.6% for AdV; and 3.6% for HHV6. Almost all measles and rubella cases occurred during limited outbreaks in 2011 and nearly all patients were at least 15 years old. B19V, EV and AdV infections were prevalent both in children and adults and were found throughout the 3 years. B19V occurred mainly in 3–10 years old children and 20–29 years old adults. EV infection was most common in children up to 6 years of age and AdV was confirmed mainly in 3–6 years old children. HHV6 infection was mostly detected in 6–11 months old infants. Laboratory investigation of measles/rubella suspected cases also for B19V, EV, AdV and HHV6 allows diagnosing more than half of all cases, thus strengthening rash/fever disease surveillance in Belarus.     

ANTIBIOTIC RESISTANT STAPHYLOCOCCI—Familial Infections Caused by Exposure of Babies in Hospital Nurseries

An antibiotic resistant staphylococcus with bacteriophage pattern 52/42B/80/81^* is frequently responsible for infectious outbreaks in the newborn nursery. Some time after an outbreak had occurred in the University of California''s hospital nursery, family members of the infants were found to be infected with this strain. Two families were studied in detail. In one of them, infection developed in six of the seven members within eight months after the infant''s arrival. In the other, half of the family members had recurrent infections during a 13-month period.Infants who left the nursery as asymptomatic carriers were found as likely to transmit the infectious strain as those with clinical infection. Considerable time sometimes elapsed before infection developed in either the infant or the family members. In one instance the first familial infection occurred six months after the infant had left the nursery as an asymptomatic carrier.Newborn infants are quite likely to disseminate antibiotic resistant staphylococci which they may acquire from a hospital nursery. Infections developing among persons in contact with a young infant must be treated with the possibility of a resistant hospital staphylococcus in mind.     

Epidemiological aspects of cytomegalovirus infection in babies aged under one

Sreening data obtained on babies aged under one and selected by random (1,910 children) or target (2,658 children) choice for cytomegalovirus (CMV) infection during the period of 10 years (1992-2001) were compared with mortality rate. The methods used were enzyme immunoassay, immunofluorescence and polymerase chain reaction. The babies were divided as follows: newborn infants (group I), babies aged 1-3 months (group II), 4-6 months (group III) and 7-12 months (group IV). Specific clinical features of CMV infection in newborn infants were studied on 69 cases (37--with CMV monoinfection and 32--with mixed infection). The serological screening revealed a 2.1-fold growth of the infection rate among randomly selected newborn infants during the 10 year period. Positive correlation between the infection rate among children of this age group and the neonatal mortality rate was established. High risk factors of CMV infection were revealed as well as increased infection rate and frequency of clinical cases with the prevailing neurological pathology in group III. Early diagnosis, the exclusion of mixed infections and early adequate therapy were shown to play a decisive role in the outcome of the disease. The algorithm of epidemiological surveillance and the regional program of prophylaxis were worked out.     

Streptococcus group B in meningitis and infection of newborn infants

Streptococci were isolated from the liquor or blood of 102 newborn infants and 16 infants in the first month of their life, suspected of having purulent meningitis, in 22 cases (18,5%). 5 isolated streptococcal strains were classified with group B on the basis of their cultural, biochemical and serological features. All of these strains were isolated from newborn infants during the first 3-4 days of their life. The occurrence of group B streptococci among all examined newborn infants was 4.8%; among the newborns with the positive results of bacteriological examination (73 infants) this figure was as high as 6.8%. The authors emphasize the necessity of producing, on an industrial scale, diagnostic preparations for the identification of group B streptococci playing a significant role in septic diseases and meningitides in newborns.     

Recent changes in candidemia trends in a tertiary hospital (2011–2018)

BackgroundThe epidemiology of candidemia has changed over the last decades and varies widely among geographic areas.AimsWe examined in children (aged 0–14) with candidemia the trends in the incidence rate of this infection, as well as the clinical characteristics of the patients, in order to optimize the prognosis and the control measures of this serious disease.MethodsA retrospective cohort study of candidemia in the period 2011–2018 in the neonatal intensive care unit (NICU), pediatric ICU (PICU) and pediatric wards of a tertiary hospital, was conducted. The clinical course, Candida species isolated, antifungal susceptibility, outcome and incidence rates were analyzed and compared.ResultsWe diagnosed 68 episodes of candidemia in 62 children, 48% occurred in the NICU, 31% in the PICU and 21% in pediatric wards. Candida albicans was the most frequent species isolated in NICU infants (53%), and Candida parapsilosis predominated among PICU patients (59%) and pediatric wards (50%). One third of NICU infants had invasive candidiasis (IC), most of them having extremely low birth weight (ELBW) (35%). All isolates were susceptible to the antifungal administered. Over time, the incidence of candidemia decreased in the PICU (from 2.2 to 0.3 episodes/1000 patient-days, OR = 0.6; 95%CI 0.5–0.8), whereas in the NICU and in the wards remained stable. Mortality occurred mostly in NICU patients (26%), predominated in ELBW infants and did not change over time.ConclusionsThe higher incidence and mortality of candidemia and IC observed in preterm infants requires a continuous evaluation of practices and diagnostic methods which will allow improving the prognosis of this most vulnerable population.     

Outbreaks of alimentary bacterial infections reported in CSR between 1979 and 1982

Outbreaks of alimentary infections of bacterial origin (dg 002--typhoid or paratyphoid fever; dg 003--infections due to other Salmonella species; dg 004--bacillary dysentery; dg 005--alimentary intoxications; dg 008--intestinal infections due to other bacteria; dg 009--intestinal infections of unknown etiology) which had been reported in the Czech socialist republic from 1979 to 1982 are overviewed and analyzed. The outbreaks of alimentary infections were analyzed by the number of epidemic episodes reported annually, by the number of cases involved, by the geographical and seasonal distribution pattern, by the place of onset, and by the mode of spread of infectious agents. Hospital-related salmonelloses were further analyzed by the serotype of Salmonellae responsible for these nosocomial infections. Outbreaks of water-borne alimentary infections were analyzed by the type of contaminated water source. Changes and trends in the epidemiology of alimentary bacterial infections encountered between 1979 and 1982 are discussed in detail. This study confirms that a systematic analysis of these outbreaks should constitute an integral part of the alimentary infections surveillance program for it may help assess the risk of population exposure to the varied causes of these infections.     

Epidemiological features of some acute inflammatory morbid conditions in the neonatal period

In this study, medical records of 231 Prague, Czechoslovakia and 234 Moscow, USSR newborn infants treated for various forms of acute inflammatory diseases acquired in the neonatal period, i.e. during both hospital stay and home nursing period, were reviewed with the aim of assessing the epidemiological characteristics of these morbid conditions. As shown by the analysis of available epidemiological data, most of these inflammatory disease, both in Prague and Moscow, occurred shortly after birth, with a peak at 7 postnatal day, which pointed to hospital stay as a decisive factor in the onset of neonatal inflammation. In Prague, the overall number of inflammation cases diagnosed within the first decade of postnatal days was about three time the number recorded during the second decade; the respective figures for Moscow infants were in both decades identical. Assessed by clinical forms of inflammation, both groups of newborn infants showed concordance for conjunctivitis only (28%), frequencies of other clinical forms varied. In Moscow, the most common form of inflammation, predominant over all other clinical forms especially in the second decade, was pyoderma (29%), followed by conjunctivitis (28%), phlegmon (13%) and gastroenteritis (13%). Cases of gastroenteritis, acquired mostly during the home nursing period, were hospital-unrelated and predominated in the last decade of neonatal life. In the Prague group of infants, cases of catarrhal omphalitis were predominant, accounting for 37% of all diseases; this was due to a local outbreak of epidemic at the time of observation. The frequency of pyoderma, phlegmon and gastroenteritis was here lower than that among the Moscow infants, situation with the inflammation cases classed as "other diseases" was opposite.(ABSTRACT TRUNCATED AT 250 WORDS)     

Higher neonatal morbidity after routine early hospital discharge: Are we sending newborns home too early?

BACKGROUND: A growing body of evidence suggests that the trend toward earlier discharge may affect newborn morbidity. The authors assessed how hospital readmission rates were affected by a clinical guideline aimed at discharging newborns from hospital 24 hours after birth. METHOD: A retrospective before-after cohort study was conducted involving 7009 infants born by uncomplicated vaginal delivery at a large level II hospital in Toronto between Dec. 31, 1993, and Sept. 29, 1997. The primary outcome was a comparison of the rate of hospital readmission among newborns before (5936 infants) and after (1073 infants) the early-discharge policy was implemented (Apr. 1, 1997). The causes for readmission were secondary outcomes. RESULTS: Before the early-discharge guideline was implemented, the mean length of stay declined from 2.25 days (95% confidence interval [CI] 2.18-2.32) to 1.88 days (95% CI 1.84-1.92) (p < 0.001). After implementation there was a further decline, to 1.62 days (95% CI 1.56-1.67) (p < 0.001). A total of 126 infants (11.7%) in the early-discharge cohort required readmission by 1 month, as compared with 396 infants (6.7%) in the preguideline cohort (odds ratio 1.86, 95% CI 1.51-2.30). The main reason for early readmission was neonatal jaundice, with a higher rate among infants in the early-discharge cohort than among those in the preguideline cohort (8.6% v. 3.1%; odds ratio 2.96, 95% CI 2.29-3.84). INTERPRETATION: Decreases in newborn length of stay may result in substantial increases in morbidity. Careful consideration is needed to establish whether a reduction in length of stay to less than 24 to 36 hours is harmful to babies.     

Prevalence of nosocomial infections in selected hospitals

A point prevalence survey of NI in 10 hospitals has been carried out with the aim to obtain more valid results about their occurrence and to raise the interest of clinicians in this problem. Altogether data on 5,553 hospitalized patients have been evaluated. An epidemiologist along with a clinician jointly found a total 365 of NI in 344 patients a point prevalence 6.6%. The prevalence ranged between 3.6 and 10.5% for different hospitals. The highest NI prevalence was found in surgical wards (urology 19.6%, surgery 12.2%). Undesirably high prevalence of NI was observed in paediatrics (mainly diarrhoeal diseases) and neonatal (conjunctivitis) wards. Infections of the upper respiratory tract were most frequently followed by surgical wound infections and infections of the urinary tract. The occurrence of NI of surgical wounds, urinary tract infections and infections of skin was increasing, while the occurrence of infections of gastrointestinal tract and of the eye was decreasing with age. Gram-negative bacteria were more frequently isolated than Gram-positive bacteria (2:1).     

Aplicación de las técnicas de tipificación molecular al estudio de brotes hospitalarios de candidemia

Candidemia is an infectious complication mainly affecting hospitalized patients, particularly those admitted to intensive care units. Patient mortality can reach up to 40%. Candidemia is typically nosocomially-acquired, and horizontal transmission of Candida spp. can lead to the presence of outbreaks of candidemia. Genotyping of isolates of Candida causing candidemia can help us to understand the source of the infection, detect the hospital wards with active Candida spp. transmission and, consequently, improve the prevention of the infection. Several genotyping tools have been used for the molecular characterization of Candida isolates involved in outbreaks of candidemia. Genotyping procedures based on microsatellites are reproducible and show a high discriminatory power. Microsatellites are recommended for the study of outbreaks of candidemia. In most hospital outbreaks of candidemia, patients admitted to intensive care units are involved, mostly neonatal patients. The role of genotyping Candida isolates causing candidemia for the study of nosocomial outbreaks of candidemia is reviewed, as well as the patients more commonly affected by epidemic strains.     

Presence of maternal anti-HBs antibodies does not influence hepatitis B vaccine response in Brazilian neonates

Recently, it was suggested that maternal hepatitis B surface antigen antibodies (anti-HBs) acquired transplacentally could play a negative role in newborn infants' immune response to the hepatitis B vaccine. We compared the hepatitis B virus (HBV) vaccine response in infants born to mothers previously vaccinated against HBV (n = 91) to infants born to mothers who were not previously vaccinated (n = 221). All newborn infants received three intramuscular doses (10 μg) of HBV vaccine (Butang?) at 0,1 and six months. The first dose was administered at the maternity hospital within 12 h of birth. The geometric mean titres of anti-HBs were not different among newborn infants born to mothers who were anti-HBs-negative (492.7 mIU/mL) and anti-HBs-positive (578.7 mIU/mL) (p = 0.38). Eight infants did not respond to the HBV vaccine. Of them, six were born to anti-HBs-negative mothers and two were born to mothers with anti-HBs titres less than 50 mlU/mL. Despite the mother's anti-HBs-positive status, our data show a good immunogenicity of the Brazilian HBV recombinant vaccine in neonates.     

奇异变形杆菌耐药性及亚胺培南不敏感株感染的临床特点研究

目的研究奇异变形杆菌的临床分布和耐药情况、亚胺培南不敏感奇异变形杆菌感染的临床特点。方法分析浙江大学医学院附属第一医院2013年1月至2013年12月分离的非重复奇异变形杆菌的药物敏感性、临床分布,回顾性分析亚胺培南不敏感奇异变形杆菌感染患者的临床资料、治疗及预后情况。结果2013年该院共分离107株奇异变形杆菌,以分离自尿液最多,其次为痰液;来源最多的是外科病房和重症监护病房。体外药敏显示：奇异变形杆菌对美罗培南、厄他培南、头孢吡肟、氨曲南、哌拉西林/他唑巴坦、头孢他啶、头孢哌酮/舒巴坦、阿米卡星等抗菌药物敏感性良好,敏感率达85%以上;对亚胺培南敏感率为80.4%;对头孢呋辛、环丙沙星、氨苄西林、头孢曲松、庆大霉素耐药率较高,超过30%;对呋喃妥因耐药率为99%。其中21株亚胺培南不敏感奇异变形杆菌对包括美罗培南、厄他培南在内的其他各类抗菌药物耐药率与亚胺培南敏感株基本相仿。亚胺培南不敏感奇异变形杆菌引起院内获得性感染主要发生在入住ICU、外科术后、广谱抗菌药物使用后、留置各类置管和梗阻性尿路疾病的患者,可引起泌尿系统、皮肤创面、腹腔、血流、生殖道等部位感染,表现为全身炎症反应及局部感染症状。选择敏感抗菌药物治疗后该部分患者预后良好。结论奇异变形杆菌对三、四代头孢菌素,β-内酰胺酶抑制剂合剂等抗生素敏感性良好。亚胺培南不敏感奇异变形杆菌对其他碳青酶烯类抗生素仍保持较高的敏感性。亚胺培南不敏感奇异变形杆菌所引起院内获得性感染主要发生在入住ICU、外科术后、广谱抗菌药物使用后、留置各类置管和梗阻性尿路疾病的患者,预后良好。