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Katie Rutledge-Taylor,
Anne Matlow,
Denise Gravel,
Joanne Embree,
Nicole Le Saux,
Lynn Johnston, Kathryn Suh,
John Embil,
Elizabeth Henderson,
Michael John,
Virginia Roth,
Alice Wong,
Jayson Shurgold,
Geoff Taylor
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ABSTRACT: Health care-associated infections (HAIs) cause considerable morbidity and mortality to hospitalized patients. The objective of this point prevalence study was to assess the burden of HAIs in the Canadian pediatric population, updating results reported from a similar study conducted in 2002.
A point prevalence survey of pediatric inpatients was conducted in February 2009 in 30 pediatric or combined adult/pediatric hospitals. Data pertaining to one 24-hour period were collected, including information on HAIs, microorganisms isolated, antimicrobials prescribed, and use of additional (transmission based) precautions. The following prevalent infections were included: pneumonia, urinary tract infection, bloodstream infection, surgical site infection, viral respiratory infection, Clostridium difficile infection, viral gastroenteritis, and necrotizing enterocolitis.
One hundred eighteen patients had 1 or more HAI, corresponding to a prevalence of 8.7% (n = 118 of 1353, 95% confidence interval: 7.2-10.2). Six patients had 2 infections. Bloodstream infections were the most frequent infection in neonates (3.0%), infants (3.1%), and children (3.5%). Among all patients surveyed, 16.3% were on additional precautions, and 40.1% were on antimicrobial agents, whereas 40.7% of patients with a HAI were on additional precautions, and 89.0% were on antimicrobial agents.
Overall prevalence of HAI in 2009 has remained similar to the prevalence reported from 2002. The unchanged prevalence of these infections nonetheless warrants continued vigilance on their prevention and control.
American journal of infection control 11/2011; 40(6):491-6. · 3.01 Impact Factor
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Krista Wilkinson,
Denise Gravel,
Geoffrey Taylor,
Allison McGeer,
Andrew Simor, Kathryn Suh,
Dorothy Moore,
Sharon Kelly,
David Boyd,
Michael Mulvey,
Aboubakar Mounchili,
Mark Miller
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ABSTRACT: Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities.
A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005.
Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)-significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program.
Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship.
American journal of infection control 04/2011; 39(3):177-82. · 3.01 Impact Factor
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Andrew Walkty,
David A Boyd,
Denise Gravel,
Jim Hutchinson,
Allison McGeer,
Dorothy Moore,
Andrew Simor, Kathryn Suh,
Geoff Taylor,
Mark Miller,
Michael R Mulvey
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ABSTRACT: Fluoroquinolone resistance in Clostridium difficile has been implicated in recent outbreaks of C. difficile infection. The purpose of this report was to characterize the molecular mechanism conferring resistance to moxifloxacin among C. difficile clinical isolates. Eighty-four C. difficile clinical isolates (collected as part of the Canadian Nosocomial Infection Surveillance Program) were evaluated in the current study. Pulsed-field gel electrophoresis was used to type the isolates. Susceptibility testing was performed using Clinical and Laboratory Standards Institute agar dilution methods. The quinolone resistance-determining region of both gyrA and gyrB was amplified using polymerase chain reaction and sequenced for each isolate. The proportion of isolates studied by the North American pulsed-field (NAP) type was as follows: NAP1 (47.6%), NAP2 (20.2%), NAP3 (5.9%), NAP4 (4.8%), NAP5 (2.4%), NAP6 (3.6%), and other patterns (15.5%). All isolates were resistant to ciprofloxacin. Among moxifloxacin-susceptible isolates (MIC < or =2 microg/mL), no amino acid substitutions were detected in either GyrA or GyrB. Three distinct amino acid substitutions were observed among the 3 isolates that had a moxifloxacin MIC of 8 microg/mL (GyrA Asp71 to Val, GyrB Asp426 to Asn, or Glu466 to Val). Isolates with a moxifloxacin MIC of 16 or 32 microg/mL (moderate-level resistance) all had a single identical amino acid substitution in GyrA (Thr82 to Ile). For isolates with a moxifloxacin MIC of > or =64 microg/mL (high-level resistance), this Thr82 to Ile substitution in GyrA was accompanied by at least 1 other amino acid substitution in either GyrA (Asp71 to Glu, Pro116 to Ala, or Ala118 to Ser) or GyrB (Ser366 to Ala, Asp426 to Asn, Asp426 to Val, or Leu444 to Phe) in all but 1 case. Moderate-level moxifloxacin resistance was associated with a single substitution in GyrA. High-level moxifloxacin resistance was associated with this GyrA substitution plus at least 1 other substitution in GyrA or GyrB.
Diagnostic microbiology and infectious disease 04/2010; 66(4):419-24. · 2.45 Impact Factor
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ABSTRACT: International travel to exotic destinations continues to increase, as does the risk for illness during travel. Health problems during travel are common. Although many medical problems that travelers incur are noninfectious in origin (eg, injuries, environment-associated illness), travelers often are at risk for acquiring a variety of infections. Many travel-related infections also occur commonly in the developed world, whereas other infections of travelers may be geographically restricted to specific world regions and/or are infrequently encountered in developed nations. Antibiotics play an important role in the treatment and prevention of a variety of bacterial and parasitic infections in travelers. This article reviews antibiotics of particularly high utility to travelers, with emphasis on selected agents that, with appropriate advice from a travel medicine specialist, can be used safely for prophylaxis and self-treatment during travel. The role of antibiotics in selected high-risk travelers also is discussed.
Current Infectious Disease Reports 03/2004; 6(1):13-21.
