#Infection #control influence of #MERS #coronavirus: A #hospital-based analysis (Am J Infect Control, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Infect Control. 2018 Nov 27. pii: S0196-6553(18)30944-1. doi: 10.1016/j.ajic.2018.09.015. [Epub ahead of print]

Infection control influence of Middle East respiratory syndrome coronavirus: A hospital-based analysis.

Al-Tawfiq JA1, Abdrabalnabi R2, Taher A2, Mathew S2, Rahman KA2.

Author information: 1 Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jaltawfi@yahoo.com. 2 Infection Control Unit, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.




Middle East respiratory syndrome coronavirus (MERS-CoV) caused multiple outbreaks. Such outbreaks increase economic and infection control burdens. We studied the infection control influence of MERS-CoV using a hospital-based analysis.


Our hospital had 17 positive and 82 negative cases of MERS-CoV between April 1, 2013, and June 3, 2013. The study evaluated the impact of these cases on the use of gloves, surgical masks, N95 respirators, alcohol-based hand sanitizer, and soap, as well as hand hygiene compliance rates.


During the study, the use of personal protective equipment during MERS-CoV compared with the period before MERS-CoV increased dramatically from 2,947.4 to 10,283.9 per 1,000 patient-days (P <.0000001) for surgical masks and from 22 to 232 per 1,000 patient-days (P <.0000001) for N95 masks. The use of alcohol-based hand sanitizer and soap showed a significant increase in utilized amount (P <.0000001). Hand hygiene compliance rates increased from 73% just before the occurrence of the first MERS case to 88% during MERS cases (P = .0001). The monthly added cost was $16,400 for included infection control items.


There was a significant increase in the utilization of surgical masks, respirators, soap and alcohol-based hand sanitizers. Such an increase is a challenge and adds cost to the health care system.

Copyright © 2018. Published by Elsevier Inc.

KEYWORDS: Cost; Economic impact; Healthcare; MERS; Personal Protective Equipment

PMID: 30502108 DOI: 10.1016/j.ajic.2018.09.015

Keywords: MERS-CoV; Nosocomial Outbreaks.



#Antimicrobial-resistant #pathogens in #Canadian #ICUs: results of the #CANWARD 2007 to 2016 study (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Antimicrobial-resistant pathogens in Canadian ICUs: results of the CANWARD 2007 to 2016 study

Andrew J Denisuik, Lauren A Garbutt, Alyssa R Golden, Heather J Adam, Melanie Baxter, Kimberly A Nichol, Philippe Lagacé-Wiens, Andrew J Walkty, James A Karlowsky, Daryl J Hoban, Michael R Mulvey, George G Zhanel

Journal of Antimicrobial Chemotherapy, dky477, https://doi.org/10.1093/jac/dky477

Published: 29 November 2018




To describe the microbiology and antimicrobial resistance patterns of cultured samples acquired from Canadian ICUs.


From 2007 to 2016, tertiary care centres from across Canada submitted 42 938 bacterial/fungal isolates as part of the CANWARD surveillance study. Of these, 8130 (18.9%) were from patients on ICUs. Susceptibility testing guidelines and MIC interpretive criteria were defined by CLSI.


Of the 8130 pathogens collected in this study, 58.2%, 36.3%, 3.1% and 2.4% were from respiratory, blood, wound and urine specimens, respectively. The top five organisms collected from Canadian ICUs accounted for 55.4% of all isolates and included Staphylococcus aureus (21.5%), Pseudomonas aeruginosa (10.6%), Escherichia coli (10.4%), Streptococcus pneumoniae (6.5%) and Klebsiella pneumoniae (6.4%). MRSA accounted for 20.7% of S. aureus collected, with community-associated (CA) MRSA genotypes increasing in prevalence over time (P < 0.001). The highest susceptibility rates among MRSA were 100% for vancomycin, 100% for ceftobiprole, 100% for linezolid, 99.7% for ceftaroline, 99.7% for daptomycin and 99.7% for tigecycline. The highest susceptibility rates among E. coli were 100% for tigecycline, 99.9% for meropenem, 99.7% for colistin and 94.2% for piperacillin/tazobactam. MDR was identified in 26.3% of E. coli isolates, with 10.1% producing an ESBL. The highest susceptibility rates among P. aeruginosa were 97.5% for ceftolozane/tazobactam, 96.1% for amikacin, 94.7% for colistin and 93.3% for tobramycin.


The most active agents against Gram-negative bacilli were the carbapenems, tigecycline and piperacillin/tazobactam. Against Gram-positive cocci, the most active agents were vancomycin, daptomycin and linezolid. The prevalence of CA-MRSA genotypes and ESBL-producing E. coli collected from ICUs increased significantly over time.

Topic: pseudomonas aeruginosa – vancomycin – staphylococcus aureus – amikacin – carbapenem – colistin – canada – daptomycin – drug resistance, microbial – genotype – gram-positive cocci – klebsiella pneumoniae – streptococcus pneumoniae – guidelines – microbiology – tobramycin – meropenem – piperacillin/tazobactam – pathogenic  organism – linezolid – antimicrobials – escherichia coli – tazobactam – surveillance, medical – methicillin-resistant staphylococcus aureus – tigecycline – extended-spectrum beta lactamases – ceftobiprole – community – gram-negative bacillus – ceftaroline – ceftolozane – urine specimens


© The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Canada; Nosocomial Outbreaks; ICUs.


Critically ill #HCWs with the #MERS: A multicenter study (PLoS One, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

PLoS One. 2018 Nov 15;13(11):e0206831. doi: 10.1371/journal.pone.0206831. eCollection 2018.

Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study.

Shalhoub S1, Al-Hameed F2, Mandourah Y3, Balkhy HH4, Al-Omari A5, Al Mekhlafi GA3, Kharaba A6, Alraddadi B7, Almotairi A8, Al Khatib K9, Abdulmomen A10, Qushmaq I7, Mady A11, Solaiman O12, Al-Aithan AM13, Al-Raddadi R14, Ragab A15, Al Harthy A11, Al Qasim E16, Jose J16, Al-Ghamdi G16, Merson L17, Fowler R18, Hayden FG19, Arabi YM16.

Author information: 1 Department of Medicine, Division of Infectious Diseases, University of Western Ontario, London, Canada, Department of Medicine, Division of Infectious Diseases, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. 2 Department of Intensive Care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia. 3 Department of Intensive Care Services, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. 4 Department of Infection Prevention and Control, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. 5 Department of Intensive Care, Alfaisal University, Dr Sulaiman Al-Habib Group Hospitals, Riyadh, Saudi Arabia. 6 Department of Critical Care, King Fahad Hospital, Ohoud Hospital, Al-Madinah Al-Monawarah, Saudi Arabia. 7 Department of Medicine, Alfaisal University, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. 8 Department of Critical Care Medicine, King Fahad Medical City, Riyadh, Saudi Arabia. 9 Intensive Care Department, Al-Noor Specialist Hospital, Makkah, Saudi Arabia. 10 Department of Critical Care Medicine, King Saud University, Riyadh, Saudi Arabia. 11 Intensive Care Department, King Saud Medical City, Riyadh, Saudi Arabia. 12 Intensive Care Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 13 Intensive Care Department, King Abdulaziz Hospital, Al Ahsa, Saudi Arabia. 14 Department of Family and Community Medicine, King Abdulaziz University Hospital, Ministry of Health, Jeddah, Saudi Arabia. 15 Intensive Care Department, King Fahd Hospital, Jeddah, Saudi Arabia. 16 Department of intensive care, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. 17 Infectious Diseases Data Observatory, Oxford University, Headiington, United Kingdom. 18 Department of Critical Care Medicine and Department of Medicine, Sunnybrook Hospital, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. 19 Department of Medicine, Division of Infectious Diseases and International Health University of Virginia School of Medicine, Charlottesville, Virginia, United States of America.




Middle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes.


We aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS.


Data on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012-9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale.


Thirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days.


Approximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies.

PMID: 30439974 DOI: 10.1371/journal.pone.0206831

Keywords: MERS-CoV; Nosocomial Outbreaks; HCWs.


#MERS #coronavirus #outbreak: Implications for emerging viral #infections (Diagn Microbiol Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Diagn Microbiol Infect Dis. 2018 Oct 18. pii: S0732-8893(18)30502-9. doi: 10.1016/j.diagmicrobio.2018.10.011. [Epub ahead of print]

MERS coronavirus outbreak: Implications for emerging viral infections.

Al-Omari A1, Rabaan AA2, Salih S3, Al-Tawfiq JA4, Memish ZA5.

Author information: 1 Critical Care and Infection Control Department, Dr. Sulaiman Al-Habib Medical Group, and Al-Faisal University, Riyadh, Saudi Arabia. 2 Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia. Electronic address: arabaan@gmail.com. 3 Internal Medicine Department, Dr.Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia. 4 Medical Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. 5 College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia.



In September 2012, a novel coronavirus was isolated from a patient who died in Saudi Arabia after presenting with acute respiratory distress and acute kidney injury. Analysis revealed the disease to be due to a novel virus which was named Middle East Respiratory Coronavirus (MERS-CoV). There have been several MERS-CoV hospital outbreaks in KSA, continuing to the present day, and the disease has a mortality rate in excess of 35%. Since 2012, the World Health Organization has been informed of 2220 laboratory-confirmed cases resulting in at least 790 deaths. Cases have since arisen in 27 countries, including an outbreak in the Republic of Korea in 2015 in which 36 people died, but more than 80% of cases have occurred in Saudi Arabia.. Human-to-human transmission of MERS-CoV, particularly in healthcare settings, initially caused a ‘media panic’, however human-to-human transmission appears to require close contact and thus far the virus has not achieved epidemic potential. Zoonotic transmission is of significant importance and evidence is growing implicating the dromedary camel as the major animal host in spread of disease to humans. MERS-CoV is now included on the WHO list of priority blueprint diseases for which there which is an urgent need for accelerated research and development as they have the potential to cause a public health emergency while there is an absence of efficacious drugs and/or vaccines. In this review we highlight epidemiological, clinical, and infection control aspects of MERS-CoV as informed by the Saudi experience. Attention is given to recommended treatments and progress towards vaccine development.

KEYWORDS: Coronavirus; Infection; MERS; Middle East; Respiratory; Saudi Arabia; Transmission

PMID: 30413355 DOI: 10.1016/j.diagmicrobio.2018.10.011

Keywords: MERS-CoV; Emerging Diseases; Infectious Diseases; Nosocomial Outbreaks.


Agent-Based #Modeling for #SuperSpreading #Events: A Case Study of #MERS-CoV #Transmission Dynamics in the Republic of #Korea (Int J Environ Res Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Int J Environ Res Public Health. 2018 Oct 26;15(11). pii: E2369. doi: 10.3390/ijerph15112369.

Agent-Based Modeling for Super-Spreading Events: A Case Study of MERS-CoV Transmission Dynamics in the Republic of Korea.

Kim Y1, Ryu H2, Lee S3,4.

Author information: 1 Division of Media Communication, Hankuk University of Foreign Studies, Seoul 02450, Korea. yunhwankim2@gmail.com. 2 Department of Applied Mathematics, Kyung Hee University, Yongin 446-701, Korea. kyinr108@gmail.com. 3 Department of Applied Mathematics, Kyung Hee University, Yongin 446-701, Korea. sunmilee@khu.ac.kr. 4 Institute of Natural Sciences, Kyung Hee University, Yongin 446-701, Korea. sunmilee@khu.ac.kr.



Super-spreading events have been observed in the transmission dynamics of many infectious diseases. The 2015 MERS-CoV outbreak in the Republic of Korea has also shown super-spreading events with a significantly high level of heterogeneity in generating secondary cases. It becomes critical to understand the mechanism for this high level of heterogeneity to develop effective intervention strategies and preventive plans for future emerging infectious diseases. In this regard, agent-based modeling is a useful tool for incorporating individual heterogeneity into the epidemic model. In the present work, a stochastic agent-based framework is developed in order to understand the underlying mechanism of heterogeneity. Clinical (i.e., an infectivity level) and social or environmental (i.e., a contact level) heterogeneity are modeled. These factors are incorporated in the transmission rate functions under assumptions that super-spreaders have stronger transmission and/or higher links. Our agent-based model has employed real MERS-CoV epidemic features based on the 2015 MERS-CoV epidemiological data. Monte Carlo simulations are carried out under various epidemic scenarios. Our findings highlight the roles of super-spreaders in a high level of heterogeneity, underscoring that the number of contacts combined with a higher level of infectivity are the most critical factors for substantial heterogeneity in generating secondary cases of the 2015 MERS-CoV transmission.

KEYWORDS: 2015 MERS-CoV; agent-based models; basic reproduction number; isolation interventions; super-spreading events

PMID: 30373151 DOI: 10.3390/ijerph15112369

Keywords: MERS-CoV; S. Korea; Nosocomial Outbreaks.


Multiple introductions and subsequent #transmission of #MDR #Candida auris in the #USA: a molecular epidemiological survey (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Multiple introductions and subsequent transmission of multidrug-resistant Candida auris in the USA: a molecular epidemiological survey

Nancy A Chow, PhD  *, Lalitha Gade, MPharm *, Sharon V Tsay, MD, Kaitlin Forsberg, MPH, Jane A Greenko, MPH, Karen L Southwick, MD, Patricia M Barrett, MS, Janna L Kerins, VMD, Shawn R Lockhart, PhD, Tom M Chiller, MD, Anastasia P Litvintseva, PhD, on behalf of theUS Candida auris Investigation Team †

Published: October 04, 2018 / DOI: https://doi.org/10.1016/S1473-3099(18)30597-8




Transmission of multidrug-resistant Candida auris infection has been reported in the USA. To better understand its emergence and transmission dynamics and to guide clinical and public health responses, we did a molecular epidemiological investigation of C auris cases in the USA.


In this molecular epidemiological survey, we used whole-genome sequencing to assess the genetic similarity between isolates collected from patients in ten US states (California, Connecticut, Florida, Illinois, Indiana, Maryland, Massachusetts, New Jersey, New York, and Oklahoma) and those identified in several other countries (Colombia, India, Japan, Pakistan, South Africa, South Korea, and Venezuela). We worked with state health departments, who provided us with isolates for sequencing. These isolates of C auriswere collected during the normal course of clinical care (clinical cases) or as part of contact investigations or point prevalence surveys (screening cases). We integrated data from standardised case report forms and contact investigations, including travel history and epidemiological links (ie, patients that had shared a room or ward with a patient with C auris). Genetic diversity of C auris within a patient, a facility, and a state were evaluated by pairwise differences in single-nucleotide polymorphisms (SNPs).


From May 11, 2013, to Aug 31, 2017, isolates that corresponded to 133 cases (73 clinical cases and 60 screening cases) were collected. Of 73 clinical cases, 66 (90%) cases involved isolates related to south Asian isolates, five (7%) cases were related to South American isolates, one (1%) case to African isolates, and one (1%) case to east Asian isolates. Most (60 [82%]) clinical cases were identified in New York and New Jersey; these isolates, although related to south Asian isolates, were genetically distinct. Genomic data corroborated five (7%) clinical cases in which patients probably acquired C auris through health-care exposures abroad. Among clinical and screening cases, the genetic diversity of C auris isolates within a person was similar to that within a facility during an outbreak (median SNP difference three SNPs, range 0–12).


Isolates of C auris in the USA were genetically related to those from four global regions, suggesting that C auris was introduced into the USA several times. The five travel-related cases are examples of how introductions can occur. Genetic diversity among isolates from the same patients, health-care facilities, and states indicates that there is local and ongoing transmission.


US Centers for Disease Control and Prevention

Keywords: Antibiotics; Drugs Resistance; Candida auris; USA; Nosocomial outbreaks.


A high rate of #ceftobiprole #resistance among clinical #MRSA from a #hospital in central #Italy (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

A high rate of ceftobiprole resistance among clinical MRSA from a hospital in central Italy

Gianluca Morroni, Andrea Brenciani, Lucia Brescini, Simona Fioriti, Serena Simoni, Antonella Pocognoli, Marina Mingoia, Eleonora Giovanetti, Francesco Barchiesi, Andrea Giacometti,Oscar Cirioni

DOI: 10.1128/AAC.01663-18



Ceftobiprole is a fifth-generation cephalosporin with activity against MRSA. One-year surveillance at the Regional Hospital of Ancona (Italy) disclosed a 12% ceftobiprole resistance rate (12/102 isolates, MIC ≥4 mg/L). Epidemiological characterization demonstrated that the resistant isolates all belonged to different clones. PBP analysis showed substitutions in all PBPs and a novel insertion in PBP2a. Genes mecB and mecC were not detected. Ceftobiprole susceptibility screening is essential to avoid therapeutic failure and spread of ceftobiprole-resistant strains.

Copyright © 2018 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Cephalosporins; Staphylococcus aureus; MRSA; Nosocomial Outbreaks; Italy; Ceftobiprole.