Infection Prevention
eBug Bytes
January 2015
Influenza virus
MRSA infections increased risk for
death after discharge
• VA Researchers evaluated the long-term effects of MRSA health care-associated
infections (HAIs) by conducting a retrospective cohort study of patients
hospitalized at 123 VA acute care facilities from October 2007 to September 2010.
The patients were followed after discharge until death or 365 days. The researchers
also evaluated a propensity score matched subsample of patients.
• The cohort included 369,743 patients, including 3,599 with a positive MRSA
culture, an incidence of 0.83 infections per 1,000 patient-days at risk. The
propensity score matched sample included 3,592 patients with MRSA and 3,592
matched patients without MRSA. In the entire cohort, a multivariable model
indicated patients with MRSA were more likely to die than those without MRSA
(HR=1.42; 95% CI, 1.32-1.53). Patients with MRSA HAIs were 49% more likely to die
than non-MRSA patients. Patients with MRSA colonization were 41% more likely to
die. In the propensity score-matched sample, the estimates were similar. Positive
MRSA cultures increased the adjusted risk for death by 35%, and MRSA HAIs
increased the risk by 46%. Also - further investigations are needed to determine if
the increased mortality related to MRSA infections is due to reinfection or due to
complications from the initial infection.
• Source: Nelson RE. Am J Infect Control. 2015:43:38-43
Superbug spread through contaminated
scopes sickened dozens in Seattle
• A drug-resistant superbug infected 32 people at a Seattle hospital over a twoyear period, with the bacteria spreading through contaminated medical scopes
that had been cleaned to the manufacturer's recommendation. Eleven of the
patients infected at Virginia Mason Medical Center between 2012 and 2014
eventually died, the hospital and city health officials said. But those patients
were critically ill before being infected and it was unclear what role, if any, the
bacteria played in their deaths.
• The patients were infected with drug-resistant bacteria, including the rare
Carbapenem-resistant enterobacteriaceae. The report follows similar incidents in
Pittsburgh in 2012 and Chicago in 2014, where contaminated endoscopes
infected dozens of patients, health officials said. No fatalities were directly linked
to the infections. In the Seattle case, public health officials said the germs
apparently spread from patient to patient by endoscopes used to treat liver and
pancreatic illnesses. The scopes at Virginia Mason Medical Center were sterilized
to existing standards before each use. It took investigators many months to
pinpoint the contamination, and the hospital has since instituted a rigorous
decontamination process that exceeds national standards.
Bacterial 'bunches' linked
to some colorectal cancers
• Researchers from Johns Hopkins have found that dense mats of interacting bacteria, called
biofilms, were present in the majority of cancers and polyps, particularly those on the right
side of the colon. The presence of these bacterial bunches, they say, may represent an
increased risk for colon cancer and could form the basis of new diagnostic tests.
• Like tooth plaque and slime on pond stones, bacterial biofilms may coat the mucus layer of
cells lining the colon, causing inflammation and some noncancerous bowel diseases. The
bacteria invade the layer of mucus that protects epithelial cells in these areas and upend the
whole biology of the system.
• In an examination of healthy and cancerous tissue biopsied from 118 people undergoing
surgery or colonoscopy at The Johns Hopkins Hospital or at the University of Malaya Medical
Centre in Malaysia, researchers found that biofilms were present on 89 percent of tumors 13 of 15 cancers and four of four polyps - removed from the right or ascending colon. By
contrast, biofilms, for reasons not known, were found only 12 percent of the time on tumors
on the left side of the colon - two of 15 cancers and no polyps. Overall, the researchers say,
their data suggest the risk of developing colorectal cancer might be fivefold higher in
patients with biofilms on the right side of the colon, compared to patients without the
bacterial mats. The research team also noted that probiotic treatments might be one
strategy to reduce biofilms, but there is as yet no evidence that their use will reduce cancer
risk or should be recommended to the public.
CDC chief: 'World of difference' in
Ebola fight, but complacency a risk
• Dr. Frieden, CDC Director, visited West Africa countries with Ebola recently and
highlighted some of the most alarming concerns in the region, including that
medical aid group Doctors Without Borders recently reported a one-day shortage
of beds to isolate patients in the capital of Guinea for the first time since the
outbreak began. He also pointed out that in Liberia, where health officials have
vastly scaled up their Ebola response in the capital, Monrovia, and gained the
upper hand in the fight against the disease, small response teams are now busy
responding to hot spots of transmission in remote areas of the country.
• He said that in Sierra Leone, currently the country with the highest number of
Ebola cases, at least 10 people confirmed to have Ebola are dying every day
outside of treatment centers, meaning they can potentially spread the disease
farther. The latest numbers released by the World Health Organization show that
the disease is believed to have infected more than 19,000 people and killed more
than 7,500, a picture vastly different from the dire one the CDC painted in
September with its projection that there could be as many as 1.4 million cases of
Ebola by January's end if nothing further was done. (12/22/2014)
• Source:
Trumenba Vaccine for Meningococcal
Clinical Features
Fever, headache and stiff neck in meningococcal meningitis cases, and sepsis and rash in
Etiologic Agent
Multiple serogroups of Neisseria meningitidis. Serogroups B, C, and Y cause the majority of
disease in the United States. Serogroup W causes a small portion of disease, and serogroup
A causes disease in developing countries and the meningitis belt of sub-Saharan Africa.
The first serogroup B meningococcal disease vaccine was approved by the Food and Drug
Administration (FDA). Trumenba would prevent invasive meningococcal disease caused by
Neisseria meningitidis serogroup B. Meningococcal disease is caused by bacteria that infect
the bloodstream and the lining that surrounds the brain and spinal cord. According to the
CDC fewer than 1,000 cases of meningococcal disease occur annually, but 10% - 15% of
cases are fatal and up to 19% of survivors suffer permanent disabilities. The Advisory
Committee on Immunization Practices recommends routine vaccination of adolescents
aged 11 through 18 years (a single dose of vaccine should be administered at age 11 or 12
years, with a booster dose at age 16 years for persons who receive the first dose before age
16 years) and vaccination of persons in at-risk populations.
Infections Increase Death Risk by 35%
for ICU Patients
• Elderly patients admitted to intensive care units (ICUs) are about 35% more likely
to die within five years of leaving the hospital if they develop an infection during
their stay, a new study finds. Preventing two of the most common healthcareacquired infections – bloodstream infections caused by central lines and
pneumonia caused by ventilators – can increase the odds that these patients
survive and reduce the cost of their care by more than $150,000.
• The study looked at outcomes for 17,537 elderly Medicare patients admitted to 31
hospitals in 2002 to assess the cost and effectiveness of infection prevention
efforts. Then, the researchers used an additional five years of Medicare claims data
to assess the long-term outcomes and health costs attributed to healthcareacquired infections. While 57% of all the elderly ICU patients died within five years,
the researchers found that infections made death more likely. For those who
developed CLABSI, 75% died within five years, as did 77% of those who developed
VAP. On average, the ongoing cost of running an infection prevention program in
the ICU is about $145,000, the study found. Prevention efforts reduced ICU costs by
$174,713 per patient for each instance of CLABSI, and by $163,090 for VAP. This
evidence points definitively to the value of investing in infection prevention
Source: Stone P, Larson E. A decade of investment in infection prevention: A cost-effectiveness analysis. Amer Journ
Infec Contr January 2015
Occupationally Acquired HIV Infection Among
Health Care Workers — United States, 1985–2013
• During 1985–2013, 58 confirmed and 150 possible cases of occupationally
acquired HIV infection among HCWs were reported to CDC; since 1999, only one
confirmed case (a laboratory technician sustaining a needle puncture while
working with a live HIV culture in 2008) has been reported. Among the 58
confirmed cases, the routes of exposure resulting in infection were:
percutaneous puncture or cut (49 cases), mucocutaneous exposure (five), both
percutaneous and mucocutaneous exposure (two), and unknown (two).
• A total of 49 HCWs were exposed to HIV-infected blood, four to concentrated
virus in a laboratory, one to visibly bloody fluid, and four to unspecified body
fluids. Occupations of the HCWs with confirmed or possible HIV infection have
varied widely. CDC recommends the use of standard precautions to prevent
exposure of HCWs to potentially infectious body fluids when working with any
patient, whether known to be infected with HIV or not. HCWs should assume
that body fluids from all patients are infectious even if the patients are not
known to be infected with HIV. Proper implementation of standard precautions
(e.g., use of safety devices and barriers such as gloves and goggles) minimizes
exposure risk.
Source: MMWR: January 9, 2015 / 63(53);1245-1246
Antibiotic Resistance Will Kill 10 Million
People A Year By 2050
• According to the CDC, at least two million people become infected with bacteria
resistant to antibiotics each year, and of those at least 23,000 die. A recent review
on antimicrobial resistance released last month estimated that if bacteria keep
evolving at the current rate, by 2050 10 million people will die a year from
otherwise curable diseases. Doctors overprescribing antibiotics and farmers
feeding daily doses of antibiotics to animals helped bring about the current
situation. Not finishing a course of antibiotics and then using the “leftovers”
months later when you feel yourself getting sick helped the bacteria to evolve
resistance at an unnatural and unprecedented rate.
• Scientists throughout the globe are joining forces to both create new antibiotics as
well as devise ways to tackle infection without the need for these drugs in the first
place. The fact that more scientists as well as lay people are becoming aware of the
current issue of antibiotic resistance is cause for optimism. We all play a role in
ensuring that our planet does not revert back to the “dark ages of medicine,” and
in order to ensure the future of our children, it’s time to not only recognize but also
act on the issue of antibacterial resistance.
• Source: Jim O’Neill. Antimicrobial Resistance: Tackling a crisis for the health and
wealth of nations. The Review on Antimicrobial Resistance. 2014.
Nine people infected with measles after
visits to Disney parks
• At least nine people came down with the measles after visiting Disneyland Park
last month. The confirmed cases include seven in five different California cities
and two in Utah. California has three other suspected cases. The confirmed
California patients range in age from 8 months to 21 years, and all but one
hadn't been vaccinated. The people sickened were all at Disneyland between
December 15-20. State health officials say they know of eight who were not
vaccinated, including two who were too young.
• The state is tracing the contacts the patients have had to determine the spread
of the disease, a respiratory infection that causes a rash and can lead to
pneumonia. While the measles is relatively rare in the U.S. because a vaccine is
available, it persists in other countries, making international tourist destinations
like Disneyland vulnerable. The U.S. Centers for Disease Control and Prevention
reported 20 measles outbreaks through November of last year, leading to 610
cases, a record since the disease was temporarily eliminated in 2000.
• Source:
The Santa Barbara Smokehouse Inc
Voluntary Recall Because of Possible Health
• 01/10/2015 07:58 PM EST
• The Santa Barbara Smokehouse Inc. of Santa Barbara, CA, is
voluntarily recalling the following brands and batches of cold
smoked salmon produced and packed between December 17th and
December 24th 2014 because they have the potential to be
contaminated with Listeria monocytogenes, an organism which can
cause serious and sometimes fatal infections in young children, frail
or elderly people, and others with weakened immune systems.
• Although healthy individuals may suffer only short-term symptoms
such as high fever, severe headache, stiffness, nausea, abdominal
pain and diarrhea, Listeria infection can cause miscarriages and
stillbirths among pregnant women.
• Source:
Widespread flu continues; antivirals are
effective but underused
• The CDC reports that there is widespread flu activity in most U.S. states. The most
common circulating virus is influenza A (H3N2) and about two-thirds of these H3N2
viruses are genetically different from those H3N2 viruses in the flu vaccine. This
difference suggests that vaccine effectiveness may be reduced this season. This
particular virus in past flu seasons has been associated with more severe disease
and deaths in older people and young children, and in this flu season, high
hospitalization rates are also being observed. As such, the CDC's recommendation
for the use of influenza antiviral drugs as an adjunct to vaccination becomes even
more important than usual in protecting people from serious complications.
However these antiviral drugs are being underused. The CDC continues to
recommend vaccination as long as flu viruses are circulating. The use of antiviral
medications to treat flu has been shown to reduce symptoms, length of time of
illness and severe outcomes. The CDC recommends that patients with suspected flu
at high risk for serious complications and those hospitalized should be treated as
soon as possible with one of the three available flu antiviral medication without
waiting for confirmatory tests. While antiviral drugs work best when given early,
there is still benefit even when treatment is initiated later.
• Source:
Progress being made in infection
control in U.S. hospitals
• Progress has been made in the effort to eliminate infections that commonly
threaten hospital patients, including a 46 percent decrease in central lineassociated bloodstream infections (CLABSI) between 2008 and 2013. However,
additional work is needed to continue to improve patient safety. CDC's HealthcareAssociated Infections (HAI) progress report is a snapshot of how each state and the
country are doing in eliminating six infection types that hospitals are required to
report to CDC. For the first time, this year's HAI progress report includes statespecific data about hospital lab-identified methicillin-resistant Staphylococcus
aureus (MRSA) bloodstream infections and Clostridium difficile (C. difficile)
infections (deadly diarrhea).
• The annual National and State Healthcare-associated Infection Progress
Report expands upon and provides an update to previous reports detailing progress
toward the goal of eliminating HAIs. The report summarizes data submitted to
CDC's National Healthcare Safety Network (NHSN), the nation's healthcareassociated infection tracking system, which is used by more than 14,500 healthcare
facilities across all 50 states, Washington, D.C., and Puerto Rico.
• Source:
How E. coli passes safely through
stomach acid
• In some parts of the world, many small children become infected with severe
diarrhea which often proves fatal. The condition is usually caused by strains of
Escherichia coli bacteria, and bacteria of the genus Yersinia. These bacteria attach
themselves to the wall of the small intestine and use a needle-like apparatus to
inject toxins into the tissue. Yet these bacteria usually enter the human body via
the mouth -- and you would expect them to be killed off by the strong acid in the
stomach, which provides a barrier against infection. E. coli and Yersinia bacteria
attack cells in the small intestine which absorb nutrients. They use adhesins such as
intimin (a protein; the name comes from "intimate adherence") to stick to
intestinal epithelial cells and to subsequently form tiny channels between the
bacteria and the intestinal cells. In this way they are able to introduce diarrheacausing toxins into the intestine. The intimin is inserted into the bacterial cell
envelope, where it binds with the bacteria´s stabilizing structure, peptidoglycan, a
mesh-like molecule consisting of sugars and amino acids. Researches assume that
this mechanism protects against acidic and mechanical stress and that E. coli
bacteria can pass through the stomach unharmed. The researchers suspect that
intimin boosts the bacteria's virulence.
Source: Jack C. et al. The Intimin periplasmic domain mediates dimerisation and binding to
peptidoglycan. Molecular Microbiology, 2015; 95 (1): 80