Beware Biofilm! Dry biofilms containing bacterial pathogens on multiple healthcare surfaces; a multicentre study

BackgroundWet biofilms associated with medical devices have been widely studied and their link with healthcare-associated infections (HCAIs) is well recognized. Little attention has been paid to the presence of dry biofilms on environmental surfaces in healthcare settings.AimTo investigate the occurrence, prevalence, and diversity of dry biofilms on hospital surfaces.MethodsSixty-one terminally cleaned items were received from three different UK hospitals. The presence of dry biofilm was investigated using culture-based methods and scanning electron microscopy (SEM). Bacterial diversity within biofilms was investigated using ribosomal RNA intergenic spacer analysis (RISA)–polymerase chain reaction and next-generation sequencing.FindingsMulti-species dry biofilms were recovered from 95% of 61 samples. Abundance and complexity of dry biofilms were confirmed by SEM. All biofilms harboured Gram-positive bacteria including pathogens associated with HCAI; 58% of samples grew meticillin-resistant Staphylococcus aureus. Dry biofilms had similar physical composition regardless of the type of items sampled or the ward from which the samples originated. There were differences observed in the dominance of particular species: dry biofilms from two hospitals contained mostly staphylococcal DNA, whereas more Bacillus spp. DNA was found on surfaces from the third hospital.ConclusionThe presence of dry biofilms harbouring bacterial pathogens is virtually universal on commonly used items in healthcare settings. The role of dry biofilms in spreading HCAIs may be underestimated. The risk may be further exacerbated by inefficient cleaning and disinfection practices for hospital surface

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Validation of soil moisture and ocean salinity (SMOS). Soil moisture over watershed networks in the U.S.

International audienceEstimation of soil moisture at large scale has been performed using several satellite-based passive microwave sensors and a variety of retrieval methods over the past two decades. The most recent source of soil moisture is the European Space Agency Soil Moisture and Ocean Salinity (SMOS) mission. A thorough validation must be conducted to insure product quality that will, in turn, support the widespread utilization of the data. This is especially important since SMOS utilizes a new sensor technology and is the first passive L-band system in routine operation. In this paper, we contribute to the validation of SMOS using a set of four in situ soil moisture networks located in the U.S. These ground-based observations are combined with retrievals based on another satellite sensor, the Advanced Microwave Scanning Radiometer (AMSR-E). The watershed sites are highly reliable and address scaling with replicate sampling. Results of the validation analysis indicate that the SMOS soil moisture estimates are approaching the level of performance anticipated, based on comparisons with the in situ data and AMSR-E retrievals. The overall root-mean-square error of the SMOS soil moisture estimates is 0.043 m3/m3 for the watershed networks (ascending). There are bias issues at some sites that need to be addressed, as well as some outlier responses. Additional statistical metrics were also considered. Analyses indicated that active or recent rainfall can contribute to interpretation problems when assessing algorithm performance, which is related to the contributing depth of the satellite sensor. Using a precipitation flag can improve the performance. An investigation of the vegetation optical depth (tau) retrievals provided by the SMOS algorithm indicated that, for the watershed sites, these are not a reliable source of information about the vegetation canopy. The SMOS algorithms will continue to be refined as feedback from validation is evaluated, and it is expected that the SMOS estimates will improve