Widespread transfer of resistance genes between bacterial species in an intensive care unit: implications for hospital epidemiology

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Positive effects of audit and feedback on antimicrobial use in hospitalized patients limited to audited patients

Objective: Audit and feedback is an antimicrobial stewardship (AMS) strategy, with the potential to also optimize antimicrobial use in non-audited patients. This study aimed to determine whether audit and feedback reduce antimicrobial use in both audited and non-audited patients.Design: Before-after trial with a 1-year intervention period and 2.5-year historical cohort.Setting: 750-bed community hospital in the Netherlands.Patients: All patients admitted to the urology wards during the 3.5-year study period were observed. Patients were classified as using antimicrobials if any antimicrobial was used for therapeutic reasons. Patients using antimicrobials prophylactically were excluded from measurements.Intervention: The AMS team provided audit and feedback on antimicrobial use for patients using antimicrobials for 2 days. Retrospectively, antimicrobial use and length of stay (LOS) were compared with the historical cohort.Results: Audits modified antimicrobial treatment in 52.8% of the cases. De-escalating, stopping, and switching from intravenous to oral treatment accounted for 72% of these modifications. Compared to patients from the cohort, who also used antimicrobials for 2 days, antimicrobial use decreased from 14.21 DDD/patient (95% CI, 13.08–15.34) to 11.45 DDD/patient (95% CI, 8.26–14.64; P = .047) for audited patients. Furthermore, mean LOS decreased from 7.42 days (95% CI, 6.79–8.06) to 6.13 days (95% CI, 5.38–6.89; P = .031). However, looking at all patients admitted to the urology wards, the percentage of patients using antimicrobials and total antimicrobial use remained unchanged.Conclusions: Audit and feedback reduce antimicrobial use and LOS, but only for audited patients. Positive effects are not automatically transferred to patients for whom no audits have been performed

Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit.

Cross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU

Evaluation of a firm model in estimating aggregate supply response

The North Central Regional Research Project NC- 54, “Supply Response and Adjustments for Hog and Beef Cattle Production,” was started in 1961. The project statement lists these objectives: (1) To estimate farm resource use and supply response of hogs and beef cattle in representative farm situations. (2) To estimate total production of hogs and beef cattle and patterns of resource use for states in the North Central Region and for the nation. (3) To determine the production situations and the areas in which a specified output of hogs and beef cattle would or could be produced most efficiently under various projected levels of demand and prices and at a given level of technology representing that now known but not yet generally adopted. Linear-programming, time-series analysis, production function analysis and “outlook” research were used in the study. The linear-programming research was divided into two phases. Phase I involved (a) estimating the optimum organization and production for representative farms at various prices for hogs, cattle and feed grains and (b) aggregating these results to give estimates of regional production. The purpose of Phase II was to examine the effects of permitting acquisition and disposal of factors of production assumed fixed in the Phase I model. This was accomplished by including purchase and sale activities for fixed assets at predetermined prices. Insofar as the purchases and sales were not conducted within a framework of regional constraints and because an appropriate weighting scheme was not readily available, no aggregation of the Phase II results was made. Time-series analysis, production function analysis and “outlook” analysis were used to complement the programming analysis

Plasmid-mediated AmpC

_Objectives:_ The objective of this study was to determine the prevalence of pAmpC beta-lactamases in community-acquired Gram negative bacteria in the Netherlands, and to identify possible risk factors for carriage of these strains. Methods: Fecal samples were obtained from community-dwelling volunteers. Participants also returned a questionnaire for analysis of risk factors. Screening for pAmpC was performed with selective enrichment broth and a selective screening agar. Confirmation of AmpC-production was performed with two double disc combination tests: cefotaxime and ceftazidime with either boronic acid or cloxacillin as inhibitor. Multiplex PCR was used as gold standard for detection of pAmpC. 16S rRNA PCR and AFLP were performed as required, plasmids were identified by PCR-based replicon typing. Questionnaire results were analyzed with SPSS, version 20.0. Results: Fecal samples were obtained from 550 volunteers; mean age 51 years (range: 18-91), 61% were females. pAmpC was present in seven E. coli isolates (7/550, 1.3%, 0.6-2.7 95% CI): six CMY-2-like pAmpC and one DHA. ESBL-encoding genes were found in 52/550 (9.5%, 7.3-12.2 95% CI) isolates; these were predominantly blaCTX-M genes. Two isolates had both ESBL and pAmpC. Admission to a hospital in the previous year was the only risk factor we identified. Conclusions: Our data indicate that the prevalence of pAmpC in the community seems still low. However, since pAmpC-producing isolates were not identified as ESBL producers by routine algorithms, there is consistent risk that further increase of their prevalence might go undetected

Application of minimal sequence quality values prevents misidentification of the blaSHV type in single bacterial isolates carrying different SHV extended-spectrum beta-lactamase genes

Nucleotide sequencing is the standard molecular method for determination of the beta-lactamase gene present in an isolate. Using minimal sequence quality values prevents misidentification of bla(SHV) genes, as illustrated by three strains of three different species that each contained two different bla(SHV) alleles, SHV-2 and SHV-1