During the period April, 1985 to March, 1986, Trichosporon beigelii was isolated from the urine of 15 intensive care unit patients. All of these patients had Foley catheters in place at the time of T beigelii isolation. None of them had urinary tract infections on admission, and it was initially felt that this organism was a source of infection in these critically ill individuals. Subsequent investigation revealed this to be a pseudoepidemic secondary to contamination of the urinary catheter drainage system. Urine obtained by gravity drainage from the outlet port of urimeters yielded growth of T beigelii, whereas urines obtained concurrently from the proximal tubing sampling port were negative. T beigelii was isolated from the drainage port as well as from various items used in the collection and sampling of urine specimens. It is felt that these items were the source of perpetuation of this pseudoepidemic due to the repeated contamination and colonization of the distal portion of the urine catheter collection system. In-services to nursing and housekeeping personnel in the proper collection of urine specimens and cleaning of potentially contaminated items, the replacement of metal urine graduates with disposable plastic ones and increased monitoring of personnel's activities stopped the outbreak abruptly.

The epidemiology of influenza in the hospital is frequently confounded by failure to separate community-acquired from nosocomial transmission. An 83-year-old woman was hospitalized one day after returning from Asia with complications resulting from acute influenza A (H3N2) infection; she was the first culture-confirmed case in the region during the 1987-1988 influenza season, and her illness antedated other influenza cases in the area by at least four weeks. The patient shed virus at least four days after admission and transmitted influenza to her primary physician; both had received trivalent influenza vaccine four weeks earlier. Surveillance data from the 28 health care providers (HCPs) in contact with the index case (mean age: 34.5 years; median time of contact: four hours, none receiving vaccine) revealed no evidence of transmission as detected by paired type-specific complement-fixation antibodies and throat culture (20 subjects) or acute serologies and culture (7 subjects). No febrile respiratory illnesses were detected among other patients on the same ward, although three were reported among HCPs. Thus, neither secondary spread of influenza from infected patient to hospital HCPs nor nosocomial transmission apparently took place, although transmission did occur to the primary physician.

The correlations between census-derived sociodemographic variables and hospital-onset methicillin-resistant Staphylococcus aureus bacteremia (HO-MRSAB) rates were examined at the US state level. On multivariable analysis, only percent African American remained statistically significant. This finding highlights an important disparity and suggests that risk adjustment is needed when comparing HO-MRSAB rates among US states.

Infect Control Hosp Epidemiol 2018;39:479–481

Antimicrobial resistance is an increasing problem in healthcare institutions and in the community. Public concern about resistance is also increasing. The issue is broad and complex and not readily addressed by government, industry, or professional societies alone. On October 29-30,1998,19 representatives of various professional societies and governmental agencies met under the auspices of the Society for Healthcare Epidemiology of America (SHEA) at Brook Lodge Conference Center in Augusta, Michigan. The purpose of the meeting was to discuss the current status of antimicrobial resistance in the United States and Canada, including present society and governmental efforts to address the problem. Representatives exchanged experiences through presentations and discussions on the first day, then on the second day held a brainstorming session to address future needs and priorities in addressing the resistance problem. It was agreed that a national coordinated effort was needed. As part of this national effort, representatives called for the creation of a National Coalition on Antibiotic Resistance (NCAR) to combat antibiotic resistance through education, research, prevention, and advocacy. Priorities for NCAR were focused in four areas: (1) education of the public and professionals; (2) support of basic and applied research; (3) provision of an information resource and clearinghouse; and (4) advocacy initiatives. At the recommendation of the SHEA Board, discussions with the National Foundation for Infectious Diseases for the joint development of NCAR have begun.

Hospital antibiotic use in Argentina has not been described. We present results of point prevalence surveys on antibiotic use conducted in 109 Argentinian hospitals in November 2018 and submitted to the National Program of Epidemiology and Control of Hospital-Acquired Infections, and we discuss potential areas for improvement.

Plasmid profiling was used to determine the variability of normal flora isolates of Staphylococcus epidermidis in order to evaluate the usefulness of plasmid profiling for identifying pathogens. Fifteen hospital staff members and patients repeatedly had cultures taken from the hands and nares, and multiple isolates were examined for plasmid profiles. S epidermidis isolated from the nares of 15 neonates were also examined. The total number of isolates examined for plasmid profiles was 726. Repetition of profiles was common among the different isolates from a single sampling (one swab). The frequency of re-isolating similar profiles on different days varied from 7% to 13%. Simultaneous isolation of similar profiles from nares and hands on the same individual varied from 0% to 11%, the percentage being lower for personnel. Isolation of the same plasmid profile from different individuals occurred only twice and resulted in an assignment probability of Pa = 0.002 for isolates obtained from different individuals. Significantly more isolates from nares contained plasmids (97%) compared with isolates from hands (89%).Patients who had two or more isolates of coagulase-negative staphylococci with similar profiles were judged, clinically, to have infections in 12 of 13 cases. However, the likelihood of re-isolating an S epidermidis strain with a similar plasmid profile twice from the same person at different times was sufficiently high to prevent plasmid profiling from being used as an absolute criterion for infection.

In this randomized study, use of alcohol-based hand-rub disinfection significantly reduced bacterial bioburden of stethoscopes in routine clinical use. Prior cleaning of stethoscopes on the study day did not affect baseline contamination rates, which suggests that the efficacy of alcohol disinfection is short-lived and may need to be repeated between patients.

We estimated the annual bed days lost and economic burden of healthcare-associated infections to Singapore hospitals using Monte Carlo simulation. The mean (standard deviation) cost of a single healthcare-associated infection was S$1,809 (S$440) [or US$1,362 (US$331)]. This translated to annual lost bed days and economic burden of 55,978 (20,506) days and S$152.0 million (S$37.1 million) [or US$114.4 million (US$27.9 million)], respectively.

Optimal surveillance strategies for identifying patients colonized with and at risk for transmitting carbapenem-resistant Enterobacteriaceae (CRE) are urgently needed. We instituted an enhanced surveillance program for CRE that identified unrecognized CRE-colonized patients but failed to identify possible CRE transmissions. We also identified risk factors associated with transmitting CRE.

We examined the persistence of hepatitis B surface antibody following hepatitis B vaccination in a group of health care workers. Of the 187 vaccine recipients screened, 39 were found to be antibody negative. Life table analysis showed the proportion retaining antibody at one, two, three, and four years from the first dose of vaccine was 92%, 84%, 73%, and 55% respectively. The likelihood of retaining antibody was significantly decreased as the age of the vaccine recipient increased. These results indicate that a large proportion of vaccine recipients no longer had detectable antibody four years after receipt of the vaccine. It remains to be shown if such individuals who have lost antibody are susceptible to the development of clinical hepatitis.