By: Ashley Parker, Ph.D
Second Los Angeles hospital identifies “superbug” infections and Hartford Hospital says patients might have been exposed to E. coli
Recent “superbug” outbreaks in at least three hospitals have been associated with a sophisticated surgical instrument known as a duodenoscope. Duodenscopes are fiber-optic instruments used to examine the duodenum (small intestine), and are inserted into the mouth, through the stomach and into the top of the small intestine. Two Los Angeles hospitals, UCLA Ronald Reagan Medical Center and Cedars-Sinai Medical Center have reported seven and four carbapenem-resistant Enterobacteriaceae (CRE) infections, respectively, with two of the UCLA incidents resulting in death. 67 more patients at Cedars-Sinai Medical Center, who were treated with the same instrument are currently at risk. In Connecticut, Hartford Hospital reported at least five patients infected with a strain of drug resistant E. coli. These “superbug” infections were also linked to the use of two duodenoscopes in procedures that involved 281 patients. Dr. Rocco Orlando, the Chief Medical Officer at Hartford, stated that the patients found infected were treated successfully. The hospital remains confident that the 281 patients exposed to the instruments are not at greater risk for infection due to laboratory test revealing the strain’s sensitivity to other antibiotics. However, additional safety measures, including contacting these patients and bringing them in for screening, are currently taking place. In the earlier cases in Los Angeles, both hospitals offered free home monitoring kits to potentially exposed patients.
Hospital officials at all three hospitals stated that they followed the manufacturers’ disinfection procedures correctly to clean and disinfect the instruments. Since the reported outbreaks, both Los Angeles hospitals have enhanced their disinfection procedures beyond those recommended by the manufacturers. Proper sanitation of these instruments is currently under investigation. The U.S. Food and Drug Administration (FDA) released its first warning on February 19 regarding problems with the design of the instrument that may prevent effective cleaning. In this report, the FDA discussed reported issues of disinfecting these surgical instruments and the potential risk associated with the transmission of multi-drug resistant bacterial infections. The FDA Safety Communication also provided recommendations for healthcare providers regarding their responsibility to communicate the potential benefits and risks, and included information for patients who undergo such procedures with these duodenoscopes. The situation is still being monitored and the FDA will continue provide updates regarding the related use of these devices. (Steve Gorman, Reuters and Josh Kovner, Hartford Courant)
Healthcare and Infectious Disease
CDC puts C. difficile burden at 453,000 cases, 29,000 deaths
Hospital-acquired infections and the resulting costs of treating them continues to be an issue in the United States. The Center for Disease Control and Prevention (CDC) has recently reported that the bacterium Clostridium difficile is responsible for more than 450,000 cases per year and results in death in approximately 6.5% of cases. C. difficile is one of the major pathogens responsible for antibiotic-associated colitis, an infection resulting in inflammation of the large intestines. Further damage to the colon can cause the bacterial infection to leak into the bloodstream, resulting in septicemia. This is a major concern, primarily for patients who are treated with antibiotics in hospitals and long-term care facilities such as nursing homes.
Surveillance studies have been reported in the New England Journal of Medicine (NEJM) to monitor new cases of C. difficile. Although there were a considerable number of community-acquired cases in these studies, a significant number of infections were attributed to healthcare-associated environments. Strikingly, 10% of the patients with healthcare-associated infections died within a month.
As a result, serious efforts to reduce the incidence of C. difficile infections have been implemented. Hospitals are now required to report infection rates and healthcare workers are encouraged to use proper hand-washing techniques rather than rely on hand sanitizers to prevent the spread of C. difficile spores. In addition, measures to avoid the unnecessary use and prescribing of antibiotics have improved the incidence of antibiotic-associated hospital cases. Moving forward, additional evidence is needed to better understand the spread of infection and improve the disinfection of healthcare environments. (Robert Roos, Center for Infectious Disease Research and Policy)
Global Health and Infectious Disease
Malawi: Cholera Scare Hitting Malawi, Govt Alert
The United Nations Children’s Fund (UNICEF) is on high alert after a cholera outbreak in Malawi, Africa and its borders. Cholera is an infectious disease caused by the bacterium Vibrio cholerae which infects the small intestine. While some infected persons can be initially asymptomatic, progress of the infection can lead to excessive watery diarrhea, vomiting, severe dehydration, and death in 25-50% of untreated infections. The Ministry of Health in Malawi has reported 39 cases of cholera with two confirmed deaths. These reports are in the southern border areas of Malawi which is shared with the neighboring country of Mozambique. UNICEF has also reported more than 3400 cholera cases in Mozambique, including 37 deaths since December, many of which were children.
The continued spread of this disease is a pressing concern. In Malawi, the disease is associated with major flooding that occurred in January and the more than 230,000 people who are still displaced due to continued rainfall. Mahimbo Mdoe, the UNICEF representative in Malawi stated “[that] as humanitarian actors in Malawi, we need to move quickly.” UNICEF along with other organizations such as the European Union and UK’s Department for International Development are contributing to efforts to prevent the spread of cholera such as providing safe water, sanitation and hygiene services. In addition, UNICEF, in partnership with governmental and non-profit organizations, has dispatched essential medications and healthcare equipment to control the outbreak. (Paul Nthala, Malawi24)
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