Urine culture stewardship linked to reduced catheter infections
A urine culture stewardship initiative at a teaching hospital in Michigan reduced overuse of urine cultures and was associated with a significant decline in catheter-associated urinary tract infections (CAUTIs), researchers reported today in Infection Control & Hospital Epidemiology.
The analysis by researchers with the Henry Ford Health System in Detroit looked at the impact of a urine culture stewardship program implemented at the hospital in 2015 to complement a urinary catheter best-practice bundle that emphasized appropriate use of urinary catheters and optimization of catheter-insertion and maintenance protocols. The stewardship program emphasized obtaining urine cultures from intensive care unit (ICU) patients only if a urinary source of sepsis was suspected.
Previous research has shown that minimizing use of urinary catheters has been one of the most effective interventions for reducing CAUTIs, while inappropriate urine culture testing in catheterized patients can lead to overdiagnosis of CAUTIs and result in antibiotic overuse.
To assess the impact of the complementary programs, the researchers reviewed the urine culture utilization rate (UCUR), the catheter utilization ratio (CUR), and CAUTI incidence in the hospital's ICU from 2015 through 2017.
They found that UCUR decreased from 3,081 in 2015 to 2,158 in 2016 and 1,218 in 2017, while CAUTIs decreased from 78 in 2015 to 60 in 2016 to 28 in 2017. Regression analysis over time showed statistically significant decreases in UCUR and CAUTI rates, a modest decline in CUR, and a correlation between declines in UCUR and the CAUTI rate. No cases of unrecognized pyelonephritis or CAUTI were identified.
"Urine-culture stewardship programs in combination with standard best practices could significantly influence CAUTI rates in ICUs," the study authors concluded.
Jul 8 Infect Control Hosp Epidemiol abstract
Cashew cheese Salmonella outbreak probe wraps up
The US Centers for Disease Control and Prevention (CDC) yesterday reported 7 more illnesses in a multi-serotype Salmonella outbreak that has now sickened 20 people in four states.
In a final outbreak update, the CDC said the outbreak, first announced in April, appears to be over. The trace-back investigation linked the illnesses to Jule's cashew brie. It involved four Salmonella serotypes: Chester, Duisburg, Typhimurium, and Urbana. The latest illness onset was May 9, and five patients were hospitalized for their infections. No deaths were reported.
Health officials used the PulseNet subtyping network to identify infections tied to the outbreak. Testing on Jule's cashew cheese samples from California and Tennessee yielded three of the involved strains. An investigation by the Food and Drug Administration (FDA) and its partners in California found one of the outbreak strains in raw cashews at the Jule's Foods facility. Other Salmonella strains were found in the food and environmental samples, but they weren't the ones involved in the outbreak.
Genetic sequencing to assess antibiotic resistance found that, of 17 bacterial samples from sick people and 29 from food sample, 8 were predicted to be resistant to one or more antibiotics.
In a separate statement, the FDA said the cashews used by Jule's Foods are the likely source of contamination and that its scientists worked with the cashew supplier to ensure that potentially contaminated products were removed from the market. The agency said the cashew supplier has implemented corrective actions.
Jul 7 CDC final outbreak update
Jul 7 FDA update
H5N8 avian flu strikes Danish layer farm
Denmark this week reported a highly pathogenic H5N8 avian flu outbreak in poultry, according to a notification from the World Organization for Animal Health (OIE).
The event began on Jul 4 at a layer farm in southern Denmark, killing 198 of 38,000 susceptible birds. So far, the source of the virus hasn't been determined. The surviving birds are slated for culling, and animal health officials have put a 3-kilometer (km) protection zone around the facility, as well as a 10-km surveillance zone.
In related developments, Sweden reported highly pathogenic H5N4 avian flu in a wild bird, the country's first detection of the subtype. Test results on a dead peregrine falcon found in Blekinge County in the south came back positive for the strain on Jun 27. The falcon was found in March.
Jul 6 OIE report on H5N8 in Denmark
Jul 2 OIE report on H5N4 in falcon in Sweden