A Case Study Evaluating the #Risk of #Infection from Middle Eastern Respiratory Syndrome #Coronavirus (#MERS-CoV) in a #Hospital Setting Through #Bioaerosols (Risk Anal., abstract)

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

Risk Anal. 2019 Sep 16. doi: 10.1111/risa.13389. [Epub ahead of print]

A Case Study Evaluating the Risk of Infection from Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) in a Hospital Setting Through Bioaerosols.

Adhikari U1, Chabrelie A1, Weir M2, Boehnke K3, McKenzie E4, Ikner L5, Wang M6, Wang Q7, Young K8, Haas CN9, Rose J8, Mitchell J1.

Author information: 1 Department of Biosystems and Agricultural Engineering, Michigan State University, East Lansing, MI, USA. 2 Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH, USA. 3 Department of Anesthesiology & the Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA. 4 Department of Civil and Environmental Engineering, Temple University, Philadelphia, PA, USA. 5 Department of Soil, Water and Environmental Science, University of Arizona, Tucson, AZ, USA. 6 Department of Civil & Environmental Engineering, University of South Florida, Tampa, FL, USA. 7 Department of Animal and Food Sciences, University of Delaware, Newark, DE, USA. 8 Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI, USA. 9 Department of Civil, Architectural and Environmental Engineering, Drexel University, Philadelphia, PA, USA.



Middle Eastern respiratory syndrome, an emerging viral infection with a global case fatality rate of 35.5%, caused major outbreaks first in 2012 and 2015, though new cases are continuously reported around the world. Transmission is believed to mainly occur in healthcare settings through aerosolized particles. This study uses Quantitative Microbial Risk Assessment to develop a generalizable model that can assist with interpreting reported outbreak data or predict risk of infection with or without the recommended strategies. The exposure scenario includes a single index patient emitting virus-containing aerosols into the air by coughing, leading to short- and long-range airborne exposures for other patients in the same room, nurses, healthcare workers, and family visitors. Aerosol transport modeling was coupled with Monte Carlo simulation to evaluate the risk of MERS illness for the exposed population. Results from a typical scenario show the daily mean risk of infection to be the highest for the nurses and healthcare workers (8.49 × 10-4 and 7.91 × 10-4 , respectively), and the lowest for family visitors and patients staying in the same room (3.12 × 10-4 and 1.29 × 10-4 , respectively). Sensitivity analysis indicates that more than 90% of the uncertainty in the risk characterization is due to the viral concentration in saliva. Assessment of risk interventions showed that respiratory masks were found to have a greater effect in reducing the risks for all the groups evaluated (>90% risk reduction), while increasing the air exchange was effective for the other patients in the same room only (up to 58% risk reduction).

© 2019 Society for Risk Analysis.

KEYWORDS: Hospital; MERS-CoV; QMRA; mitigation; risk characterization

PMID: 31524301 DOI: 10.1111/risa.13389

Keywords: MERS-CoV.



#Isolation of #Candida auris from invasive and non-invasive samples of a #patient suffering from #vascular disease, #Italy, July 2019 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

Isolation of Candida auris from invasive and non-invasive samples of a patient suffering from vascular disease, Italy, July 2019

Francesca Crea1,2, Giulia Codda2,3, Andrea Orsi4, Alberto Battaglini4, Daniele Roberto Giacobbe5, Emanuele Delfino5, Riccardo Ungaro5, Anna Marchese6

Affiliations: 1 Unità Operativa di Microbiologia, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; 2 FC and GC contributed equally to this article; 3 Microbiology Unit, DISC University of Genoa, Genoa, Italy; 4 Unità Operativa di Igiene, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; 5 Unità Operativa Clinica Malattie Infettive, University of Genoa (DISSAL) and Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; 6 Unità Operativa di Microbiologia, University of Genoa (DISC) and Ospedale Policlinico San Martino-IRCCS, Genoa, Italy

Correspondence:  Anna Marchese

Citation style for this article: Crea Francesca, Codda Giulia, Orsi Andrea, Battaglini Alberto, Giacobbe Daniele Roberto, Delfino Emanuele, Ungaro Riccardo, Marchese Anna. Isolation of Candida auris from invasive and non-invasive samples of a patient suffering from vascular disease, Italy, July 2019. Euro Surveill. 2019;24(37):pii=1900549. https://doi.org/10.2807/1560-7917.ES.2019.24.37.1900549

Received: 02 Sep 2019;   Accepted: 11 Sep 2019



We recently isolated Candida auris from a blood culture and cutaneous swabs of a patient in her mid-70s. Our routine phenotypic methods failed to identify the microorganism, but it was identified by molecular tests and MALDI-TOF MS analysis. Our report, the first from Italy, further underlines the geographically wide distribution of C. auris and the need to confirm species identification of any suspicious colony as soon as possible to stop its spread.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: Candida auris; Nosocomial outbreaks; Italy.


What Is Known About #Candida auris (JAMA, summary)

[Source: Journal of the American Medical Association (JAMA), full page: (LINK). Summary, edited.]

JAMA Insights  / Clinical Update / September 6, 2019

What Is Known About Candida auris

Suzanne F. Bradley, MD1,2

Author Affiliations: 1 Infectious Diseases Division, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor; 2 Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan

JAMA. Published online September 6, 2019. doi:10.1001/jama.2019.13843



Candida auris is a new species that was reported in Asia as a rare cause of ear infections in 2009; it had not been found among large repositories of yeast isolates collected prior to 2013.1,2 However, the widespread dissemination of C auris is not due to a single strain. For reasons that are not clear, multiple strains, called clades, have emerged independently in various parts of the world.1,2 Cases of C auris have been identified in 33 countries across 5 continents.1-3



Article Information

Corresponding Author: Suzanne F. Bradley, MD, Infectious Diseases Section 111i, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105 (sbradley@umich.edu).

Published Online: September 6, 2019. doi:10.1001/jama.2019.13843

Conflict of Interest Disclosures: Dr Bradley reported receiving grants from Pfizer and the Veterans Administration and is the editor in chief for the Infection Control & Hospital Epidemiology journal.

Keywords: Candida auris; Emerging diseases; Nosocomial outbreaks; Drugs resistance; Fluconazole.


#Staphylococcus aureus from #hospital-acquired #pneumonia from an #Italian nationwide #survey: activity of #ceftobiprole …, & molecular epidemiology of methicillin-resistant isolates (J Antimicrob Chemother., abstract)

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

Staphylococcus aureus from hospital-acquired pneumonia from an Italian nationwide survey: activity of ceftobiprole and other anti-staphylococcal agents, and molecular epidemiology of methicillin-resistant isolates

Alberto Antonelli, Tommaso Giani, Marco Coppi, Vincenzo Di Pilato, Fabio Arena, Olga Lorenza Colavecchio, Viola Conte, Anne Santerre Henriksen, Gian Maria Rossolini, MRSA-HAP Study Group

Journal of Antimicrobial Chemotherapy, dkz371, https://doi.org/10.1093/jac/dkz371

Published: 06 September 2019




To determine the prevalence of Staphylococcus aureus from hospital-acquired pneumonia (HAP) in Italy and the susceptibility to ceftobiprole and comparators of MSSA and MRSA isolates. A secondary objective was to characterize the clonality and acquired resistance and virulence genes of MRSA.


Consecutive non-replicate isolates from HAP were collected from 13 laboratories distributed across Italy, from January to May 2016. Antimicrobial susceptibility testing was performed by broth microdilution, and results were interpreted according to the EUCAST breakpoints. All MRSA isolates were subjected to WGS using an Illumina platform. Clonality and resistance and virulence gene content were investigated with bioinformatics tools.


Among 333 isolates from HAP, S. aureus was the third most common pathogen (18.6%). The proportion of MRSA was 40.3%. Susceptibility to ceftobiprole was 100% for MSSA and 95.5% for MRSA. Lower susceptibility rates of 78.4% and 94.6% in MSSA and 36.4% and 12.1% in MRSA isolates were observed for erythromycin and levofloxacin, respectively. The MRSA from HAP mostly belonged to clonal complex (CC) 22 (47.0%), CC5 (25.8%) and CC8 (15.2%), with a minority of other lineages (ST1, ST6, ST7, ST30, ST152 and ST398). Acquired resistance and virulence genes in most cases exhibited a clonal distribution. The three ceftobiprole-resistant isolates exhibited an MIC of 4 mg/L and belonged to ST228-MRSA-I of CC5.


S. aureus is an important cause of HAP in Italy. Ceftobiprole exhibited good in vitro activity against S. aureus isolated from HAP, including MRSA. A trend to replacement of ST228 with ST22 was noticed compared with previous studies.


© The Author(s) 2019. 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; Staphylococcus aureus; MRSA; Pneumonia; Nosocomial outbreaks; Italy.


#N95 #Respirators vs Medical #Masks for Preventing #Influenza Among Health Care #Personnel – A #RCT (JAMA, abstract, edited)

[Source: JAMA, full page: (LINK). Abstract, edited.]

Original Investigation / September 3, 2019

N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel – A Randomized Clinical Trial

Lewis J. Radonovich Jr, MD1; Michael S. Simberkoff, MD2,3; Mary T. Bessesen, MD4,5; et alAlexandria C. Brown, PhD6; Derek A. T. Cummings, PhD7,8; Charlotte A. Gaydos, MD9; Jenna G. Los, MLA9; Amanda E. Krosche, BS9,10; Cynthia L. Gibert, MD11,12; Geoffrey J. Gorse, MD13,14; Ann-Christine Nyquist, MD5,15; Nicholas G. Reich, PhD6; Maria C. Rodriguez-Barradas, MD16,17; Connie Savor Price, MD5,18; Trish M. Perl, MD8,19; for the ResPECT investigators

Author Affiliations: 1 National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania; 2 Veterans Affairs New York Harbor Healthcare System, New York; 3 New York University School of Medicine, New York; 4 Veterans Affairs Eastern Colorado Healthcare System, Denver; 5 University of Colorado School of Medicine, Aurora; 6 University of Massachusetts, Amherst; 7 University of Florida, Gainesville; 8 Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 9 Johns Hopkins School of Medicine, Baltimore, Maryland; 10 Weill Cornell Medicine, New York, New York; 11 Veterans Affairs Medical Center, Washington, DC; 12 George Washington University School of Medical and Health Sciences, Washington, DC; 13 Veterans Affairs St Louis Healthcare System, St Louis, Missouri; 14 St Louis University School of Medicine, St Louis, Missouri; 15 Children’s Hospital Colorado, Aurora; 16 Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; 17 Baylor College of Medicine, Houston, Texas; 18 Denver Health Medical Center, Denver, Colorado; 19 University of Texas Southwestern Medical Center, Dallas

JAMA. 2019;322(9):824-833. doi:10.1001/jama.2019.11645


Key Points

  • Question  – Is the use of N95 respirators or medical masks more effective in preventing influenza infection among outpatient health care personnel in close contact with patients with suspected respiratory illness?
  • Findings  – In this pragmatic, cluster randomized clinical trial involving 2862 health care personnel, there was no significant difference in the incidence of laboratory-confirmed influenza among health care personnel with the use of N95 respirators (8.2%) vs medical masks (7.2%).
  • Meaning  – As worn by health care personnel in this trial, use of N95 respirators, compared with medical masks, in the outpatient setting resulted in no significant difference in the rates of laboratory-confirmed influenza.




Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections.


To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP.

Design, Setting, and Participants  

A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups.


Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness.

Main Outcomes and Measures  

The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed.


Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, −0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, −21.9 per 1000 HCP-seasons [95% CI, −48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, −8.9 per 1000 HCP-seasons, [95% CI, −33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, −8.6 per 1000 HCP-seasons [95% CI, −28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, −11.3 per 1000 HCP-seasons [95% CI, −23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported “always” or “sometimes” wearing their assigned devices vs 90.2% in the mask group.

Conclusions and Relevance  

Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.

Trial Registration  ClinicalTrials.gov Identifier: NCT01249625

Keywords: Seasonal Influenza; HCWs; PPE; Facemasks.


#Evolution of #Outbreak-Causing #Carbapenem-Resistant #Klebsiella pneumoniae ST258 at a Tertiary Care #Hospital over 8 Years (mBio, abstract)

[Source: mBio, full page: (LINK). Abstract, edited.]

Evolution of Outbreak-Causing Carbapenem-Resistant Klebsiella pneumoniae ST258 at a Tertiary Care Hospital over 8 Years

Jane W. Marsh, Mustapha M. Mustapha, Marissa P. Griffith, Daniel R. Evans, Chinelo Ezeonwuka, A. William Pasculle, Kathleen A. Shutt, Alexander Sundermann, Ashley M. Ayres,Ryan K. Shields, Ahmed Babiker, Vaughn S. Cooper, Daria Van Tyne, Lee H. Harrison

Robert A. Bonomo, Editor

DOI: 10.1128/mBio.01945-19



Carbapenem-resistant Klebsiella pneumoniae (CRKP) strains belonging to sequence type 258 (ST258) are frequent causes of hospital-associated outbreaks and are a major contributor to the spread of carbapenemases. This genetic lineage emerged several decades ago and remains a major global health care challenge. In this study, genomic epidemiology was used to investigate the emergence, evolution, and persistence of ST258 carbapenem-resistant K. pneumoniae outbreak-causing lineages at a large tertiary care hospital over 8 years. A time-based phylogenetic analysis of 136 ST258 isolates demonstrated the succession of multiple genetically distinct ST258 sublineages over the 8-year period. Ongoing genomic surveillance identified the emergence and persistence of several distinct clonal ST258 populations. Patterns of multidrug resistance determinants and plasmid replicons were consistent with continued evolution and persistence of these populations. Five ST258 outbreaks were documented, including three that were caused by the same clonal lineage. Mutations in genes encoding effectors of biofilm production and iron acquisition were identified among persistent clones. Two emergent lineages bearing K. pneumoniae integrative conjugative element 10 (ICEKp10) and harboring yersiniabactin and colibactin virulence factors were identified. The results show how distinct ST258 subpopulations have evolved and persisted within the same hospital over nearly a decade.



The carbapenem class of antibiotics is invaluable for the treatment of selected multidrug-resistant Gram-negative pathogens. The continued transmission of carbapenem-resistant bacteria such as ST258 K. pneumoniae is of serious global public health concern, as treatment options for these infections are limited. This genomic epidemiologic investigation traced the natural history of ST258 K. pneumoniae in a single health care setting over nearly a decade. We found that distinct ST258 subpopulations have caused both device-associated and ward-associated outbreaks, and some of these populations remain endemic within our hospital to the present day. The finding of virulence determinants among emergent ST258 clones supports the idea of convergent evolution of drug-resistant and virulent CRKP strains and highlights the need for continued surveillance, prevention, and control efforts to address emergent and evolving ST258 populations in the health care setting.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Klebsiella pneumoniae; Nosocomial outbreaks.


#Flavobacteriaceae #Bacteremia in #Children: A Multicenter Study (Pediatr Infect Dis J., abstract)

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

Pediatr Infect Dis J. 2019 Aug 28. doi: 10.1097/INF.0000000000002449. [Epub ahead of print]

Flavobacteriaceae Bacteremia in Children: A Multicenter Study.

Cooper S1,2, Levy I2,3, Ben-Zvi H4, Ashkenazi-Hoffnung L1,2,3, Ben-Shimol S5,6, Shachor-Meyouhas Y7,8, Grisaru-Soen G2,9, Kriger O2,10, Yahav D2,11, Scheuerman O1,2,3.

Author information: 1 From the Department of Pediatrics B, Schneider Children’s Medical Center, Petach Tikva, Israel. 2 Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv. 3 Department of Pediatric Infectious Disease Unit, Schneider Children’s Medical Center. 4 Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. 5 Pediatric Infectious Disease Unit, Soroka Medical Center. 6 Faculty of Health Sciences, Ben-Gurion University, Beer Sheva, Israel. 7 Pediatric Infectious Disease Unit, Rambam Medical Center. 8 Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. 9 Pediatric Infectious Disease Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 10 Pediatric Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel. 11 Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.




The Flavobacteriaceae family includes rare pathogens in children; Chryseobacterium indologenes and Elizabethkingia meningosepticum are the most common pathogenic species, with a wide range of clinical presentations and high mortality rate. Although rare, diagnosis is important due to inherent resistance to multiple antibiotics, especially those typically prescribed for empiric treatment of aerobic Gram-negative bacterial infections.


A multicenter retrospective study conducted in 5 Israeli hospitals, describing Flavobacteriaceae bacteremia confirmed by positive blood culture from 1998 to 2018.


Thirteen cases were included; 9 isolates were C. indologenes. Bacteremia was nosocomial or healthcare-associated in all cases. Bacteremia was associated with young age (median, 1 year, range 24 days-17 years), with only 2 (15.4%) cases in neonates, Central line-associated bloodstream infection as a source (5/13, 38%) and malignancy (7/13, 54.8%). Thirty-day all-cause mortality was 23% (3/13). Ninety-one percent of isolates were susceptible to trimethoprim-sulfamethoxazole, 82% to piperacillin-tazobactam and 92% to ciprofloxacin.


C. indologenes and E. meningosepticum are rare, nosocomial- or healthcare-associated pediatric bacteremia pathogens. Bacteremia was associated with young age, but in contrast to the literature, the majority of our cases were older than the neonatal age period. In addition, they were associated with central line-associated bloodstream infection and malignancy. The most adequate antibiotics according to resistance patterns were ciprofloxacin, trimethoprim-sulfamethoxazole and piperacillin-tazobactam.

PMID: 31469778 DOI: 10.1097/INF.0000000000002449

Keywords: Flavobacteriaceae; Chryseobacterium indologenes; Elizabethkingia meningosepticum; Bacteremia; Pediatrics.