Infection Prevention eBug Bytes October 2015 Drug-resistant E. coli continues to climb in community health settings Drug-resistant E. coli infections are on the rise in community hospitals, where more than half of U.S. patients receive their healthcare, according to a new study from Duke Medicine. The study reviewed patient records at 26 hospitals in the Southeast. By examining demographic information, admission dates and tests, the researchers also found increased antibiotic-resistant infections among community members who had limited exposure to health care settings, but who may have acquired the bugs through some other environmental factors. The study data were gathered through the Duke Infection Control Network (DICON), which helps community hospitals and surgery centers across the U.S. prevent infections using education and evidence-based strategies. The data showed that between 2009 and 2014, the incidence of drug- resistant extended-spectrum beta-lactamase (ESBL)-producing E. coli doubled from a rate of 5.28 incidents per 100,000 patients to a rate of 10.5 infections per 100,000. The median age of patients infected with E. coli was 72 years. Looking at the timing of patients' infections and when they were last in contact with a healthcare setting, the researchers also discovered that people with infrequent healthcare contact were acquiring the superbug at an even faster rate than patients who have regular contact with hospitals or nursing homes. The data showed a greater than three-fold increase in community-associated infections between 2009 and Source: Infection Control & Hospital Epidemiology October 2015 (online pub) MSSA Infection in Infants Invasive methicillin-susceptible Staphylococcus aureus (S. aureus) infection (MSSA) caused more infections and more deaths in hospitalized infants than invasive methicillin-resistant S. aureus infection (MRSA), which suggests measures to prevent S. aureus infections should include MSSA in addition to MRSA, according to an article published online by JAMA Pediatrics. Researchers coauthors compared demographics and mortality of infants with MRSA and MSSA at 348 neonatal intensive care units (NICUs) around the United States to determine the annual proportion of S. aureus infections that were MRSA and to contrast the risk of death after invasive MRSA and MSSA infections. The authors identified 3,888 of 887,910 infants (0.4 percent) with 3,978 invasive S. aureus infections. Infections were more commonly caused by MSSA (2,868 of 3,978 or 72.1 percent) than MRSA (1,110 of 3,978 or 27.9 percent). More infants with invasive MSSA infections (n=237) died before hospital discharge than infants with invasive MRSA infections (n=110). However, the proportions of infants who died after invasive MSSA and MRSA infections were similar at 237 of 2,474 (9.6 percent) and 110 of 926 (11.9 percent). The absolute numbers of infections and deaths due to MSSA exceed those due to MRSA. Consideration should be given to expanding hospital infection control efforts targeting MRSA to include MSSA as well. Future studies to better define the relationship between MSSA colonization and subsequent infection will help to clarify the importance of such interventions for preventing MSSA disease. Source: Aaron M. Milstone, MD, MHS et al. Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants. JAMA Pediatrics, October 2015 Biologists discover bacteria communicate like neurons Biologists have discovered that bacteria are actually quite sophisticated in their social interactions and communicate with one another through similar electrical signaling mechanisms as neurons in the human brain. In a study published in this week's advance online publication of Nature, the scientists detail the manner by which bacteria living in communities communicate with one another electrically through proteins called "ion channels. All of our senses, behavior and intelligence emerge from electrical communications among neurons in the brain mediated by ion channels. Bacteria use similar ion channels to communicate and resolve metabolic stress. The discovery suggests that neurological disorders that are triggered by metabolic stress may have ancient bacterial origins, and could thus provide a new perspective on how to treat such conditions. But how bacteria use those ion channels remained a mystery until researchers embarked on an effort to examine long-range communication within biofilms--organized communities containing millions of densely packed bacterial cells. These communities of bacteria can form thin structures on surfaces--such as the tartar that develops on teeth--that are highly resistant to chemicals and antibiotics. The study found that biofilms are able to resolve social conflicts within their community of bacterial cells just like human societies. When a biofilm composed of hundreds of thousands of Bacillus subtilis bacterial cells grows to a certain size, the researchers discovered, the protective outer edge of cells, with unrestricted access to nutrients, periodically stopped growing to allow nutrients--specifically glutamate, to flow to the sheltered center of the biofilm. In this way, the protected bacteria in the colony center were kept alive and could survive attacks by chemicals and antibiotics. Source: Nature Mag Nurse used same 2 syringes on 67 employees The message said the flu shot administered two days earlier at the workplace clinic held at Otsuka Pharmaceutical in West Windsor may have exposed recipients to HIV, Hepatitis B and Hepatitis C. They needed to get tested immediately, then tested again in four to six months. The infection-control lapse occurred Sept. 30 when a nurse inoculated 67 workers using just two syringes. "I have not slept since I have found out. I am tired beyond belief," said one of the shot recipients, who provided theto NJ Advance Media. "At first I viewed it as not a big deal. But then it starts hitting you: HIV, Hepatitis C... this is serious. The bungled clinic came to light when someone at the company noticed something was amiss and reported it. The state Department of Health reportedly interviewed the nurse who gave the injections that night. The U.S. Centers for Disease Control and Prevention also was notified. The Department of Health then informed the state Board of Nursing temporarily surrender the LPN license she'd held for 30 years pending further action against her. Source: Lung Infection Outbreak Linked to Hospital Water Supply A Mycobacterium abscessus outbreak among lung transplant patients at a single hospital was traced to new building construction and its tainted water supply. M. abscessus infections were confirmed in 39 recently hospitalized lung transplant patients, the source of which was traced to 12 tap water supply locations in the ward, prompting the use of sterile water and a new antibiotic prophylaxis regimen, including imipenem and inhaled amikacin, to manage the outbreak. A new medical tower that had largely ICU beds and began to serve patients in late lead to an amplification event where the concentration of M. abscessus grew past a certain threshold, but those isolates were present before the construction and opening of the building. Mycobacterium abscessus, and all rapid growing mycobacteria, can be problematic for hospitals, because they're ubiquitous in the environment. They're in the soil, they're in the water supply, and always a concern when you're building a new building -- potential contamination of the water to patients who could be at risk to acquire infections. From August 2013 through May 2014, the incidence rate was 3.9 cases per month, but that rate dropped back down to an average of 1.0 cases per month after the implementation of intervention in June 2014 through March 2015 (incidence rate ratio 0.26, 95% CI , P19 years. Among adult patients with vaccination records, 123 (70%) had received 2 doses of MCV. Among the 90 unvaccinated patients, 54 (60%) were aged