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PubMed2000

Health surveillance for health care workers. A vital role for the occupational and environmental health nurse.

Health surveillance for the general health care worker includes surveillance for immunity to infectious diseases such as measles, mumps, rubella, varicella, and hepatitis B. Post exposure surveillance for bloodborne pathogens includes HIV, hepatitis B, and hepatitis C. Periodic surveillance of specialty practice areas as mandated by OSHA include workers exposed to lasers, radiation, formaldehyde, ethylene oxide, hazardous drugs, anesthetic gases, and tuberculosis.

Environmental Health↗
PubMed1996

Trends in antibiotic resistance of respiratory pathogens: an analysis and commentary on a collaborative surveillance study.

The evolution of antibiotic resistance was studied among common respiratory tract pathogens in five countries of the European Union and in the USA during 1992-1993. The data obtained from a collaborative surveillance study were submitted to population analysis, to detect possible shifts in antibiotic susceptibility and, therefore, associated mechanisms of resistance. Among the emerging haemophilus influenzae phenotypes were isolates that did not correspond to the beta-lactamase negative, amino-penicillin resistant (BLNAR) phenotype, but were beta-lactamase producers showing low level ceftriaxone resistance (early extended spectrum beta-lactamases?) amoxycillin susceptible strains with low level ceftriaxone resistance (PBP modification?) and isolates with high-level fluoroquinolone resistance. Moraxella catarrhalis resistance to ceftriaxone erythromycin or fluoroquinolones was noted. The quantitative evolution of antibiotic resistance may reach saturation in some countries with a very high proportion of resistant strains, for example, Spain and France. Qualitatively, resistant strains may be selected that have broader or more effective mechanisms of resistance, particularly under the recently introduced pressure of more active antibiotics of the same family. In countries with modest levels of antibiotic resistance (UK, Germany, Italy), attention should be paid to the misuse of antibiotics with a propensity to select low-level resistant strains. In this respect, the relative prescribing of aminopenicillins and oral cephalosporins in the UK (a high ratio and low prevalence of Streptococcus pneumoniae) and resistance to penicillin in the USA (a low ratio and high prevalence of resistance) is of potential importance.

Anti-Bacterial Agents↗
PubMed1999

Reduction in the incidence of methicillin-resistant Staphylococcus aureus and ceftazidime-resistant Klebsiella pneumoniae following changes in a hospital antibiotic formulary.

In 1995, changes in our hospital formulary were made to limit an outbreak of vancomycin-resistant enterococci and resulted in decreased usage of cephalosporins, imipenem, clindamycin, and vancomycin and increased usage of beta-lactam/beta-lactamase-inhibitor antibiotics. In this report, the effect of this formulary change on other resistant pathogens is described. Following the formulary change, there was a reduction in the monthly number (mean +/- SD) of patients with methicillin-resistant Staphylococcus aureus (from 21.9 +/- 8.1 to 17.2 +/- 7.2 patients/1,000 discharges; P = .03) and ceftazidime-resistant Klebsiella pneumoniae (from 8.6 +/- 4.3 to 5.7 +/- 4.0 patients/1,000 discharges; P = .02). However, there was an increase in the number of patients with cultures positive for cefotaxime-resistant Acinetobacter species (from 2.4 +/- 2.2 to 5.4 +/- 4.0 patients/1,000 discharges; P = .02). Altering an antibiotic formulary may be a possible mechanism to contain the spread of selected resistant pathogens. However, close surveillance is needed to detect the emergence of other resistant pathogens.

Acinetobacter↗
PubMedDate not supplied

Wild primate populations in emerging infectious disease research: the missing link?

Wild primate populations, an unexplored source of information regarding emerging infectious disease, may hold valuable clues to the origins and evolution of some important pathogens. Primates can act as reservoirs for human pathogens. As members of biologically diverse habitats, they serve as sentinels for surveillance of emerging pathogens and provide models for basic research on natural transmission dynamics. Since emerging infectious diseases also pose serious threats to endangered and threatened primate species, studies of these diseases in primate populations can benefit conservation efforts and may provide the missing link between laboratory studies and the well-recognized needs of early disease detection, identification, and surveillance.

Animals↗
PubMed2003

Antimicrobial resistance among gram-negative organisms in the intensive care unit.

PURPOSE OF REVIEW: We review the hospital-acquired gram-negative organisms commonly encountered among patients in the intensive care unit and discuss pertinent surveillance data, resistance mechanisms and patterns, and optimal treatment regimens for these pathogens. RECENT FINDINGS: There has been a notable increase in antibiotic resistance among gram-negative intensive care unit pathogens. Data from surveillance programs such as National Nosocomial Infections Surveillance System, Intensive Care Antimicrobial Resistance Epidemiology, and others have documented undesirable trends in antibiotic resistance, indicating decreasing efficacy of antibiotic classes such as third-generation cephalosporins, carbapenems, and fluoroquinolones, The increased prevalence of extended-spectrum beta-lactamases has contributed to the finding of multidrug resistance among bacteria such as Klebsiella and Escherichia coli. Furthermore, organisms such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia display intrinsic resistance to many antibiotics, making selection of optimal therapy difficult. Studies have correlated infection by these organisms with prior antibiotic exposure, and containment of the spread of infection can be achieved by careful antibiotic use and infection control practices. SUMMARY: Antibiotic resistance continues to rise among hospital-acquired gram-negative pathogens. Optimal management of these infections requires knowledge of local epidemiology and practices to control their spread.

Anti-Bacterial Agents↗
PubMed2006

The comparison of susceptibility patterns of Gram-negative invasive and non-invasive pathogens in Estonian hospitals.

A total of 560 invasive and 1062 non-invasive isolates were collected. The antimicrobial susceptibility of invasive versus non-invasive Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae isolates were evaluated using the E-tests. The equal domination of Gram-negative among both invasive and non-invasive pathogens was estimated in our study if contaminants were excluded. The emergence trend of Gram-positive microbes especially of coagulase negative staphylococci may be proved only after application of exclusive algorithms. Due to similar susceptibility, the data of non-invasive Gram-negative pathogens can be useful to predict resistance of invasive ones. Also, the surveillance of invasive pathogens provides useful information about the general susceptibility of pathogens.

Acinetobacter baumannii↗
PubMed2025

How does date-rounding affect phylodynamic inference for public health?

Phylodynamic analyses infer epidemiological parameters from pathogen genome sequences for enhanced genomic surveillance in public health. Pathogen genome sequences and their associated sampling dates are the essential data in every analysis. However, sampling dates are usually associated with hospitalisation or testing and can sometimes be used to identify individual patients, posing a threat to patient confidentiality. To lower this risk, sampling dates are often given with reduced date-resolution to the month or year, which can potentially bias inference. Here, we introduce a practical guideline on when date-rounding biases the inference of epidemiologically important parameters across a diverse range of empirical and simulated datasets. We show that the direction of bias varies for different parameters, datasets, and tree priors, while compounding with lower date-resolution and higher substitution rates. We also find that bias decreases for datasets with longer sampling intervals, implying that our guideline is most applicable to emerging datasets. We conclude by discussing future solutions that prioritise patient confidentiality and propose a method for safer sharing of sampling dates that translates them them uniformly by a random number.

Humans↗
PubMed1993

Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System.

To identify pathogens causing nosocomial fungal infections and the secular trend in their incidence in US hospitals, data from the National Nosocomial Infections Surveillance System, 1980-1990, were analyzed. During that period, 30,477 fungal infections were reported. The rate rose from 2.0 to 3.8 infections/1000 discharges. The highest number of nosocomial fungal infections/1000 discharges was reported from the burn/trauma service (16.1). Candida albicans was the most frequently isolated fungal pathogen (59.7%), followed by other Candida species (18.6%). The rate increased at all four major anatomic sites of infection. Patients with bloodstream infections who had a central intravascular catheter were more likely to have a fungal pathogen isolated than were other patients with bloodstream infection (relative risk = 3.2; P < .001): 29% of fungemia patients and 17% of patients with bloodstream infection due to other pathogens died during hospitalization (P < .001). Fungi are emerging as important nosocomial pathogens and control efforts should target fungal infections, especially fungemia.

Cross Infection↗
PubMed2002

Strategies for minimizing antimicrobial resistance.

Various interventions for reducing antimicrobial resistance are described. Prudent and appropriate use of antimicrobials may help reduce the selective pressure that promotes the emergence of resistance. Limiting antimicrobial use for the promotion of growth in animals may also decrease the potential for transmission of resistant microorganisms to humans through the food supply. Clinical practice guidelines provide a standard of care for the use of antimicrobials in specific infectious syndromes, promoting appropriate antimicrobial use. Excluding certain antimicrobials from institutional formularies and restricting prescribing of some agents or classes of agents included in the formulary may reduce the emergence of resistance. Therapeutic failure can be avoided by considering pharmacokinetic and pharmacodynamic factors when selecting an antimicrobial regimen. A sufficient dose and an appropriate administration interval are necessary to ensure that the antimicrobial concentration at the site of infection is high enough to kill or inhibit the growth of the pathogen. Routine antimicrobial susceptibility surveillance can detect the emergence of resistant pathogens and allow for prompt intervention. Implementation of infection control practices can prevent or stem outbreaks of infection caused by resistant microorganisms. Vaccinations may reduce antimicrobial resistance indirectly by decreasing the need for antimicrobial therapy. Antimicrobial resistance can be reduced through a combination of interventions. The management of antimicrobial resistance requires a multidisciplinary approach, including participation from physicians, nurses, pharmacists, and infection control and housekeeping staff.

Anti-Infective Agents↗
PubMed1999

Characteristics of pathogens causing urinary tract infections in hospitals in North America: results from the SENTRY Antimicrobial Surveillance Program, 1997.

Urinary tract infection (UTI) is common and involves pathogens with changing susceptibility patterns. The SENTRY Antimicrobial Surveillance Program evaluates international pathogen incidence patterns to detect and manage the emergence of resistant strains. We describe the antimicrobial resistance patterns among 1617 pathogens recovered from UTIs during the third-quarter of 1997 in North America (United States and Canada), as part of this worldwide program. The isolates were tested against more than 50 antimicrobial agents (20 reported) by reference broth microdilution methods, and selected isolates were characterized by pulsed-field gel electrophoresis (PFGE) and automated ribotyping. The five most frequently isolated species were Escherichia coli (48.6%), Enterococcus spp. (13.7%), Klebsiella spp. (12.0%), Pseudomonas aeruginosa (6.2%), and Enterobacter spp. or Proteus mirabilis (3.8% each). For each nation, imipenem and cefepime produced the widest spectrum of coverage among the beta-lactams and amikacin was best among the aminoglycosides. For Gram-negative species, high resistance among beta-lactam antimicrobial agents was noted especially for various penicillins against E. coli (37.9% to 42.8%) and for the cephalosporins tested against enterococci (99.4% and 100%). Approximately 7.0% of enterococci in the USA were vancomycin-resistant (88% with Van A). P. aeruginosa provided the most consistent levels of resistance, but the following agents were most active against these organisms: amikacin (96.6 to 97.4% susceptible), tobramycin (89.5 to 100.0%), piperacillin/tazobactam (89.5 to 100.0%), piperacillin (89.5 to 96.6%), imipenem (89.7 to 92.1%), cefepime (77.6 to 89.7%), and ceftazidime (82.9 to 86.2%). E. coli (2.2 to 2.7%), K. pneumoniae (6.2 to 6.4%), and a single Enterobacter cloacae strain produced extended-spectrum beta-lactamases; and five other Enterobacter spp. were likely to have expressed chromosomally mediated (Amp C) Stably derepressed cephalosporinases with associated resistance to ceftazidime (16.7 to 21.2% resistance). These data demonstrated that several UTI isolates in SENTRY hospitals have high levels of resistance to various classes of antimicrobial agents with little evidence of clonal dissemination.

Anti-Bacterial Agents↗
PubMed2003

Global epidemiology of antimicrobial resistance among community-acquired and nosocomial pathogens: a five-year summary from the SENTRY Antimicrobial Surveillance Program (1997-2001).

Resistance to antimicrobial agents among clinically important pathogens in the community and hospital settings has compromised therapy and requires constant monitoring of emerging patterns. Although local information indexed by hospital service or ward remains preferred, the initiation of several comprehensive surveillance programs (SENTRY Antimicrobial Surveillance Program, MYSTIC Programme, ICARE, EARSS, etc.) offers quality susceptibility testing results to guide empirical treatment regimens. Enterococci and staphylococci with novel resistance mechanisms to glycopeptides (vancomycin, teicoplanin) require greater use of quinupristin/dalfopristin and linezolid. For streptococci, recent modifications of laboratory interpretive criteria for cefotaxime, ceftriaxone, and cefepime indicates that coverage remains at > or = 95%. Extended-spectrum beta-lactamases in Enterobacteriaceae and multidrug resistance in Acinetobacter spp. and Pseudomonas aeruginosa most challenge our choices of effective agents for nosocomial infections. Few new drugs have surfaced for therapy of these gram-negative bacilli, and two- or three-agent combination regimens may be required with greater frequency, especially to cover the more prevalent resistances among both gram-positive cocci and gram-negative nonfermentative rods.

Journal Article↗
PubMed1994

B virus-specific pathogen-free (SPF) breeding colonies of macaques: issues, surveillance, and results in 1992.

The NIH's National Center for Research Resources, Comparative Medicine Program has sponsored a multi-institutional program for the establishment of specific pathogen-free (SPF) macaque colonies. Herpes B virus (Cercopithecine herpesvirus I) has been targeted as part of this surveillance. Participating institutions have established individual timetables for frequency of testing, types of monitoring, and husbandry techniques, all with the common goal of producing pathogen-free monkeys for research. From January 1990 through December 1992, we screened animals for evidence of B virus infection, using ELISA and immunoblot to detect humoral antibodies. A total of 984 animals were tested during the first year of the program. At the start of the third year, 631 animals remained in our testing program. Of the 36.9% eliminated for all causes over a 3-year period, B virus screening accounted for 12.1, 1.2, and 0.5% during years 1, 2, and 3, respectively. The greatest threat to the success of the program comes from failure to detect seronegative animals with latent infections, if they do indeed exist, either in first-year animals or animals introduced in subsequent years. The best assurance that a colony is SPF comes from negative results of repeated testing. Introducing new animals into an established SPF colony should be done only after careful screening. Simulations using mathematical models suggest that the best way to detect seronegative animals with latent infections is monthly or bimonthly testing separated by a waiting period. Duration of the waiting period cannot be defined precisely until more is known about the reactivation potential of putative seronegative animals with latent infections.

Animals↗
PubMed2006

[Demands on surgeons of the Infectious Disease Control Act].

The German Infectious Disease Control Act of 2001 includes a modified regulation for reporting infectious diseases and infectious pathogens and new clauses for surveillance and infection control in medical institutions. For the first time, all health care facilities are obliged to conduct surveillance of nosocomial infections and multiresistant pathogens. This legal regulation including mandatory monitoring by local health departments aims at reducing the rates of nosocomial infection and frequency and dissemination of highly resistant pathogens. This article describes the effect of the Disease Control Act on surgical departments. Surveillance of postsurgical wound infection should lead to better understanding of the cause and effect of nosocomial infection and greater acceptance of high-quality hospital hygiene management.

Communicable Disease Control↗
PubMed2004

Surveillance of the susceptibility of ocular bacterial pathogens to the fluoroquinolone gatifloxacin and other antimicrobials in Europe during 2001/2002.

OBJECTIVES: To determine the identity of European ocular bacterial pathogens and their susceptibility to topical antimicrobial agents. METHODS: Bacterial isolates derived from clinically significant ocular infections were collected from 10 European centres. Bacteria were re-identified and susceptibility to gatifloxacin, ciprofloxacin, ofloxacin, fusidic acid, gentamicin and chloramphenicol was determined using the NCCLS agar incorporation method at a central testing laboratory. RESULTS: Five hundred and thirty-two isolates were submitted for analysis. The most common pathogen was methicillin-susceptible Staphylococcus aureus, followed by Haemophilus influenzae and Streptococcus pneumoniae. Gatifloxacin was the most potent antimicrobial agent tested for isolates from each European country as measured by pure MIC or percentage resistance (using 95% confidence intervals). Only methicillin-resistant S. aureus was in any way refractory to the action of gatifloxacin and other fluoroquinolones. CONCLUSIONS: Fluoroquinolones offer broad-spectrum coverage for the treatment of ocular pathogens. Gatifloxacin ophthalmic solution should be a significant improvement on currently available fluoroquinolones mainly due to enhanced activity against streptococci and coagulase-negative staphylococci (which accounted for almost one-third of ocular pathogens).

Administration, Topical↗
PubMed2003

Stenotrophomonas (Xanthomonas) maltophilia as an emerging opportunistic pathogen in association with HIV infection: a 10-year surveillance study.

BACKGROUND: Stenotrophomonas (Xanthomonas) maltophilia has been increasingly reported as a nosocomial opportunistic pathogen, responsible for serious infectious complications in immunocompromised patients. At present very limited information is available concerning its clinical significance in the setting of HIV infection. PATIENTS AND METHODS: A retrospective survey of clinical and microbiological records of 1,374 HIV-infected patients referring to our tertiary care center during a 10-year period (1991-2000) was performed to identify all episodes of S. maltophilia infection and analyze epidemiological, clinical and laboratory variables. The episodes of S. maltophilia bacteremia were compared with those caused by non-typhoid Salmonella spp. occurring in HIV-infected patients referring to our center during the same period, in order to evaluate eventual predisposing risk factors. RESULTS: 61 episodes of S. maltophilia infection were observed in 59 HIV-infected patients: sepsis/bacteremia in 48 cases (78.7%), lower airways infection in five, urinary tract infection in four, pharyngitis in two, lymphadenitis and liver abscess in one case each. 47 of 61 episodes (77%) of S. maltophilia infection occurred as nosocomial disease (i.e. were diagnosed after the 3rd day of hospitalization) and bacterial isolates showed an elevated resistance profile against many beta-lactam compounds, aztreonam, imipenem and aminoglycosides. At the same time, 38 episodes of bacteremia due to non-typhoid Salmonella spp. were diagnosed in our patients, 13 of which were nosocomial infections. CONCLUSION: When compared with non-typhoid Salmonella spp. bacteremia, a significantly higher risk of developing S. maltophilia disseminated infection was seen in association with advanced immunodeficiency, leukopenia-neutropenia, central venous catheterization, prior broad-spectrum antimicrobial therapy and/or corticosteroid treatment.

AIDS-Related Opportunistic Infections↗
PubMed2006

Multilocus sequence typing for global surveillance of meningococcal disease.

The global surveillance of bacterial pathogens is particularly important for bacteria with diverse and dynamic populations that cause periodic epidemics or pandemics. The isolate characterization methods employed for surveillance should: (1) generate unambiguous data; (2) be readily implemented in a variety of scenarios and be reproducible among laboratories; (3) be scalable and preferably available in a high throughput format; and (4) be cost effective. Multilocus sequence typing (MLST) was designed to meet these criteria and has been implemented effectively for a wide range of microorganisms. The 'Impact of meningococcal epidemiology and population biology on public health in Europe (EU-MenNet)' project had amongst its objectives: (1) to disseminate meningococcal MLST and sequence-based typing throughout Europe by establishing a centre for training and data generation, and (2) to produce a comprehensive Europe-wide picture of meningococcal disease epidemiology for the first time. Data produced from the project have shown the distribution of a relatively small number of STs, clonal complexes and PorA types that account for a large proportion of the disease-associated isolates in Europe. The project demonstrates how molecular typing can be combined with epidemiological data via the Internet for global disease surveillance.

Computational Biology↗