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Lerminiaux N, Mitchell R, Bartoszko J, Davis I, Ellis C, Fakharuddin K, Hota SS, Katz K, Kibsey P, Leis JA, Longtin Y, McGeer A, Minion J, Mulvey M, Musto S, Rajda E, Smith SW, Srigley JA, Suh KN, Thampi N, Tomlinson J, Wong T, Mataseje L. Plasmid genomic epidemiology of blaKPC carbapenemase-producing Enterobacterales in Canada, 2010-2021. Antimicrob Agents Chemother 2023; 67:e0086023. [PMID: 37971242 PMCID: PMC10720558 DOI: 10.1128/aac.00860-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/07/2023] [Indexed: 11/19/2023] Open
Abstract
Carbapenems are considered last-resort antibiotics for the treatment of infections caused by multidrug-resistant Enterobacterales, but carbapenem resistance due to acquisition of carbapenemase genes is a growing threat that has been reported worldwide. Klebsiella pneumoniae carbapenemase (blaKPC) is the most common type of carbapenemase in Canada and elsewhere; it can hydrolyze penicillins, cephalosporins, aztreonam, and carbapenems and is frequently found on mobile plasmids in the Tn4401 transposon. This means that alongside clonal expansion, blaKPC can disseminate through plasmid- and transposon-mediated horizontal gene transfer. We applied whole genome sequencing to characterize the molecular epidemiology of 829 blaKPC carbapenemase-producing isolates collected by the Canadian Nosocomial Infection Surveillance Program from 2010 to 2021. Using a combination of short-read and long-read sequencing, we obtained 202 complete and circular blaKPC-encoding plasmids. Using MOB-suite, 10 major plasmid clusters were identified from this data set which represented 87% (175/202) of the Canadian blaKPC-encoding plasmids. We further estimated the genomic location of incomplete blaKPC-encoding contigs and predicted a plasmid cluster for 95% (603/635) of these. We identified different patterns of carbapenemase mobilization across Canada related to different plasmid clusters, including clonal transmission of IncF-type plasmids (108/829, 13%) in K. pneumoniae clonal complex 258 and novel repE(pEh60-7) plasmids (44/829, 5%) in Enterobacter hormaechei ST316, and horizontal transmission of IncL/M (142/829, 17%) and IncN-type plasmids (149/829, 18%) across multiple genera. Our findings highlight the diversity of blaKPC genomic loci and indicate that multiple, distinct plasmid clusters have contributed to blaKPC spread and persistence in Canada.
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Affiliation(s)
| | | | | | - Ian Davis
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Chelsey Ellis
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Ken Fakharuddin
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Susy S. Hota
- University Health Network, Toronto, Ontario, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Pamela Kibsey
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Jerome A. Leis
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yves Longtin
- Jewish General Hospital, Montréal, Québec, Canada
| | | | - Jessica Minion
- Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Michael Mulvey
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Sonja Musto
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Ewa Rajda
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Jocelyn A. Srigley
- BC Women’s and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | | | - Nisha Thampi
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Titus Wong
- Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Laura Mataseje
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - on behalf of the Canadian Nosocomial Infection Surveillance Program
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
- The Moncton Hospital, Moncton, New Brunswick, Canada
- University Health Network, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Jewish General Hospital, Montréal, Québec, Canada
- Sinai Health, Toronto, Ontario, Canada
- Saskatchewan Health Authority, Regina, Saskatchewan, Canada
- Health Sciences Centre, Winnipeg, Manitoba, Canada
- McGill University Health Centre, Montréal, Québec, Canada
- University of Alberta Hospital, Edmonton, Alberta, Canada
- BC Women’s and BC Children’s Hospital, Vancouver, British Columbia, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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2
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Hota SS, Poutanen SM. Microbiome-based therapeutics for Clostridioides difficile infection: helpful solutions or unclear cocktails? Lancet Infect Dis 2023; 23:999-1000. [PMID: 37516128 DOI: 10.1016/s1473-3099(23)00484-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Susy S Hota
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Division of Infectious Diseases, Department of Medicine, University Health Network and Sinai Health, Toronto, ON, Canada; Infection Prevention and Control Department, University Health Network, Toronto, ON M5G 2C4 Canada.
| | - Susan M Poutanen
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Division of Infectious Diseases, Department of Medicine, University Health Network and Sinai Health, Toronto, ON, Canada; Department of Microbiology, Sinai Health, Toronto, ON, Canada
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3
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Tan C, Hota SS, Fan E, Marquis K, Vicencio E, Vaisman A. Bloodstream infection and ventilator-associated pneumonia in patients with coronavirus disease 2019 (COVID-19) supported by extracorporeal membrane oxygenation. Infect Control Hosp Epidemiol 2023; 44:1443-1450. [PMID: 36451285 PMCID: PMC10507515 DOI: 10.1017/ice.2022.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Extracorporeal membrane oxygenation (ECMO) has been widely used in the care of patients with respiratory failure from coronavirus disease 2019 (COVID-19). We characterized bloodstream infections (BSIs) and ventilator-associated pneumonias (VAPs) in COVID-19 patients supported with ECMO, and we investigated their impact on patient outcomes. DESIGN Retrospective cohort study from March 1, 2020, to June 30, 2021. SETTING Academic tertiary-care referral center. PATIENTS Consecutive adult patients admitted for COVID-19 who received ECMO. METHODS We identified BSIs and VAPs and described their epidemiology and microbiology. Cumulative antimicrobial use and the specific management of BSIs were determined. Multivariate time-dependent Cox proportional hazards models were constructed to evaluate the impact of BSIs and VAPs on mortality, controlling for age, receipt of COVID-19-specific therapeutics, and new renal replacement therapy. RESULTS We identified 136 patients who received ECMO for COVID-19 pneumonia during the study period. BSIs and VAPs occurred in 81 patients (59.6%) and 93 patients (68.4%), respectively. The incidence of BSIs was 29.5 per 1,000 ECMO days and increased with duration of ECMO cannulation. Enterococci, Enterobacterales, and Staphylococcus aureus were the most common causes of BSIs, whereas S. aureus, Klebsiella species, and Pseudomonas aeruginosa comprised the majority of VAPs. Mean antibiotic use comprised 1,031 days of therapy per 1,000 ECMO days (SD, 496). We did not detect an association between BSIs or VAPs and mortality. CONCLUSIONS BSIs and VAPs are common in COVID-19 ECMO-supported patients. Efforts to optimize their diagnosis, prevention, and management should be prioritized.
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Affiliation(s)
- Charlie Tan
- Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Susy S. Hota
- Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
- Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Krista Marquis
- Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
| | - Elisa Vicencio
- Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
| | - Alon Vaisman
- Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
- Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
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Choi KB, Du T, Silva A, Golding GR, Pelude L, Mitchell R, Rudnick W, Hizon R, Al-Rawahi GN, Chow B, Davis I, Evans GA, Frenette C, Johnstone J, Kibsey P, Katz KC, Langley JM, Lee BE, Longtin Y, Mertz D, Minion J, Science M, Srigley JA, Stagg P, Suh KN, Thampi N, Wong A, Comeau JL, Hota SS. Trends in Clostridioides difficile infection rates in Canadian hospitals during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2023; 44:1180-1183. [PMID: 35978535 PMCID: PMC9433867 DOI: 10.1017/ice.2022.210] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed significant burden on healthcare systems. We compared Clostridioides difficile infection (CDI) epidemiology before and during the pandemic across 71 hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Using an interrupted time series analysis, we showed that CDI rates significantly increased during the COVID-19 pandemic.
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Affiliation(s)
- Kelly B. Choi
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Tim Du
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Anada Silva
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Linda Pelude
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | | | - Romeo Hizon
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Ghada N Al-Rawahi
- British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Blanda Chow
- Alberta Health Services, Calgary, Alberta, Canada
| | - Ian Davis
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | | | - Pamela Kibsey
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Kevin C. Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Joanne M. Langley
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Bonita E. Lee
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Yves Longtin
- Jewish General Hospital, Montréal, Quebec, Canada
| | | | | | | | | | - Paula Stagg
- Western Memorial Regional Hospital, Corner Brook, Newfoundland, Canada
| | | | - Nisha Thampi
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alice Wong
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | | | - Susy S. Hota
- University Health Network, Toronto, Ontario, Canada
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Yadav J, Liang T, Qin T, Nathan N, Schwenger KJP, Pickel L, Xie L, Lei H, Winer DA, Maughan H, Robertson SJ, Woo M, Lou W, Banks K, Jackson T, Okrainec A, Hota SS, Poutanen SM, Sung HK, Allard JP, Philpott DJ, Gaisano HY. Gut microbiome modified by bariatric surgery improves insulin sensitivity and correlates with increased brown fat activity and energy expenditure. Cell Rep Med 2023; 4:101051. [PMID: 37196633 PMCID: PMC10213984 DOI: 10.1016/j.xcrm.2023.101051] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/20/2022] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Alterations in the microbiome correlate with improved metabolism in patients following bariatric surgery. While fecal microbiota transplantation (FMT) from obese patients into germ-free (GF) mice has suggested a significant role of the gut microbiome in metabolic improvements following bariatric surgery, causality remains to be confirmed. Here, we perform paired FMT from the same obese patients (BMI > 40; four patients), pre- and 1 or 6 months post-Roux-en-Y gastric bypass (RYGB) surgery, into Western diet-fed GF mice. Mice colonized by FMT from patients' post-surgery stool exhibit significant changes in microbiota composition and metabolomic profiles and, most importantly, improved insulin sensitivity compared with pre-RYGB FMT mice. Mechanistically, mice harboring the post-RYGB microbiome show increased brown fat mass and activity and exhibit increased energy expenditure. Moreover, improvements in immune homeostasis within the white adipose tissue are also observed. Altogether, these findings point to a direct role for the gut microbiome in mediating improved metabolic health post-RYGB surgery.
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Affiliation(s)
- Jitender Yadav
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Tao Liang
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tairan Qin
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nayanan Nathan
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | | | - Lauren Pickel
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada
| | - Li Xie
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Helena Lei
- Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Daniel A Winer
- Department of Immunology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Buck Institute for Research on Aging, Novato, CA, USA
| | | | - Susan J Robertson
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Minna Woo
- Department of Immunology, University of Toronto, Toronto, ON, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of Cellular and Molecular Biology, Diabetes Research Group, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kate Banks
- Department of Comparative Medicine, University of Toronto, Toronto, ON, Canada
| | - Timothy Jackson
- Division of General Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, Canada; Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Susy S Hota
- Department of Medicine, University of Toronto, Toronto, ON, Canada; Infection Prevention and Control, University Health Network, Toronto, ON, Canada
| | - Susan M Poutanen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Microbiology & Division of Infectious Diseases, University Health Network and Sinai Health, Toronto, ON, Canada
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Johane P Allard
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada.
| | - Dana J Philpott
- Department of Immunology, University of Toronto, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| | - Herbert Y Gaisano
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.
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6
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Ghorbani Y, Schwenger KJP, Sharma D, Jung H, Yadav J, Xu W, Lou W, Poutanen S, Hota SS, Comelli EM, Philpott D, Jackson TD, Okrainec A, Gaisano HY, Allard JP. Effect of faecal microbial transplant via colonoscopy in patients with severe obesity and insulin resistance: A randomized double-blind, placebo-controlled Phase 2 trial. Diabetes Obes Metab 2023; 25:479-490. [PMID: 36239189 DOI: 10.1111/dom.14891] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/03/2022] [Accepted: 10/12/2022] [Indexed: 02/02/2023]
Abstract
AIM To assess the effects of faecal microbial transplant (FMT) from lean people to subjects with obesity via colonoscopy. MATERIAL AND METHODS In a double-blind, randomized controlled trial, subjects with a body mass index ≥ 35 kg/m2 and insulin resistance were randomized, in a 1:1 ratio in blocks of four, to either allogenic (from healthy lean donor; n = 15) or autologous FMT (their own stool; n = 13) delivered in the caecum and were followed for 3 months. The main outcome was homeostatic model assessment of insulin resistance (HOMA-IR) and secondary outcomes were glycated haemoglobin levels, lipid profile, weight, gut hormones, endotoxin, appetite measures, intestinal microbiome (IM), metagenome, serum/faecal metabolites, quality of life, anxiety and depression scores. RESULTS In the allogenic versus autologous groups, HOMA-IR and clinical variables did not change significantly, but IM and metabolites changed favourably (P < 0.05): at 1 month, Coprococcus, Bifidobacterium, Bacteroides and Roseburia increased, and Streptococcus decreased; at 3 months, Bacteroides and Blautia increased. Several species also changed significantly. For metabolites, at 1 month, serum kynurenine decreased and faecal indole acetic acid and butenylcarnitine increased, while at 3 months, serum isoleucine, leucine, decenoylcarnitine and faecal phenylacetic acid decreased. Metagenomic pathway representations and network analyses assessing relationships with clinical variables, metabolites and IM were significantly enhanced in the allogenic versus autologous groups. LDL and appetite measures improved in the allogenic (P < 0.05) but not in the autologous group. CONCLUSIONS Overall, in those with obeisty, allogenic FMT via colonoscopy induced favourable changes in IM, metabolites, pathway representations and networks even though other metabolic variables did not change. LDL and appetite variables may also benefit.
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Affiliation(s)
- Yasaman Ghorbani
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | | | - Divya Sharma
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Hyejung Jung
- Dalla Lana Public Health Department, University of Toronto, Toronto, Ontario, Canada
| | - Jitender Yadav
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Wendy Lou
- Dalla Lana Public Health Department, University of Toronto, Toronto, Ontario, Canada
| | - Susan Poutanen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Sinai Health System, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susy S Hota
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University Health Network, Toronto, Ontario, Canada
- Infection Prevention and Control Department, University Health Network, Toronto, Ontario, Canada
| | - Elena M Comelli
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Dana Philpott
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Timothy D Jackson
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Allan Okrainec
- Division of General Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of General Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Herbert Y Gaisano
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Johane P Allard
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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7
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Silva A, Du T, Choi KB, Pelude L, Golding GR, Hizon R, Lee BE, Chow B, Srigley JA, Hota SS, Comeau JL, Thampi N. Epidemiology of primary and recurrent healthcare-associated and community-associated pediatric Clostridioides difficile infection in Canada, 2015-2020. J Pediatric Infect Dis Soc 2023; 12:222-225. [PMID: 36718660 PMCID: PMC10146919 DOI: 10.1093/jpids/piad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/30/2023] [Indexed: 02/01/2023]
Abstract
Clostridioides difficile infection (CDI) among children remains a concerning cause of morbidity in hospital settings. We present epidemiological and molecular trends in healthcare- and community-associated CDI among children in Canadian inpatient and outpatient settings, including those who experienced recurrent infections.
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Affiliation(s)
| | - Tim Du
- National Microbiology Laboratory, Winnipeg, CA
| | | | | | | | - Romeo Hizon
- National Microbiology Laboratory, Winnipeg, CA
| | | | | | | | | | | | - Nisha Thampi
- Children's Hospital of Eastern Ontario, Ottawa, CA
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8
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Vaisman A, Cairns R, De Graeve D, Dus T, Hota SS, Granton J. 1524. SARS-CoV-2 Infection Incidence Following Exposure Assessments for Healthcare Workers. Open Forum Infect Dis 2022. [PMCID: PMC9752059 DOI: 10.1093/ofid/ofac492.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Although healthcare worker (HCW) absenteeism due to COVID-19 exposure represents a significant challenge, there are currently no evidence-based criteria for assessing infection risk based on COVID-19 exposure type. We aimed to identify the incidence of acquiring infection following varying exposures to COVID-19 to guide safe return-to-work policies for staff in healthcare settings. Methods We analyzed prospectively collected data at an academic centre with approximately 17 000 active staff between January 1 - April 30, 2022 during a large BA.1 Omicron surge. More than 99% of staff received >2 vaccine doses. All staff self-reporting household, community, and workplace exposure to confirmed cases of COVID-19 submitted attestation to the Occupational Health department detailing the nature of the exposure, the duration, and setting. Staff were required to report all positive test results by rapid antigen or PCR testing. Results A total of 3209 staff submitted exposure reports (2493 household, 539 community, and 177 workplace). Of these, 1008 (31.4%) tested positive 2 days prior to or 14 days after the exposure (36% household; 19% community, 7% workplace). In the community exposure group, 19% tested positive due to a discrete exposure of < 4 hours and 21% tested positive with an exposure >4 hours. For household exposures and workplace exposures, these values were 25%/27% and 6%/10%, respectively (Figure 1). The median time to testing positive was 2 days for household exposures and 3 days for community and workplace exposures (Figure 2, Panels A-C). By day 4 post-exposure, more than 80% of positive results were reported (Figure 2, Panel D). Risk of testing positive differed based on baseline symptom status at the time of reporting (Table 1). Risk of infection during the peri-exposure period (2 days before reported exposure and 14 days after) according to type and duration of exposure. Background rate of infection based on regional incidence of disease due to BA.1 Omicron wave. SARS-CoV-2 Infection Risk (A - household; B - Community; C - Workplace) after exposure. Time to infection in all groups is shown in panel D. The risk of infection amongst healthcare workers reporting exposures, according to their symptom status at the time of reporting their exposures. Conclusion Our data suggests that the highest risk of acquiring SARS-CoV-2 was via household contacts, regardless of exposure duration, with workplace exposures carrying less risk. Using a cut-off of 4 hours for exposure duration to delineate risk may be of limited value. These data could help workplaces predict infection risk following exposure and guide return-to-work policies that balance the need to staff workplaces, including hospitals, with reducing risk of on-site transmission during periods of increased community transmission (Figure 3). Risk of Infection in the Context of Background Infection Background general population infection risk based on regional incidence of disease due to BA.1 Omicron wave. Disclosures All Authors: No reported disclosures.
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Affiliation(s)
| | - Rob Cairns
- University Health Network, Toronto, Ontario, Canada
| | | | - Tamara Dus
- University Health Network, Toronto, Ontario, Canada
| | - Susy S Hota
- University Health Network, Toronto, Ontario, Canada
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9
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Du T, Choi KB, Silva A, Golding GR, Pelude L, Hizon R, Al-Rawahi GN, Brooks J, Chow B, Collet JC, Comeau JL, Davis I, Evans GA, Frenette C, Han G, Johnstone J, Kibsey P, Katz KC, Langley JM, Lee BE, Longtin Y, Mertz D, Minion J, Science M, Srigley JA, Stagg P, Suh KN, Thampi N, Wong A, Hota SS. Characterization of Healthcare-Associated and Community-Associated Clostridioides difficile Infections among Adults, Canada, 2015-2019. Emerg Infect Dis 2022; 28:1128-1136. [PMID: 35470794 PMCID: PMC9155897 DOI: 10.3201/eid2806.212262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We investigated epidemiologic and molecular characteristics of healthcare-associated (HA) and community-associated (CA) Clostridioides difficile infection (CDI) among adult patients in Canadian Nosocomial Infection Surveillance Program hospitals during 2015–2019. The study encompassed 18,455 CDI cases, 13,735 (74.4%) HA and 4,720 (25.6%) CA. During 2015–2019, HA CDI rates decreased by 23.8%, whereas CA decreased by 18.8%. HA CDI was significantly associated with increased 30-day all-cause mortality as compared with CA CDI (p<0.01). Of 2,506 isolates analyzed, the most common ribotypes (RTs) were RT027, RT106, RT014, and RT020. RT027 was more often associated with CDI-attributable death than was non-RT027, regardless of acquisition type. Overall resistance C. difficile rates were similar for all drugs tested except moxifloxacin. Adult HA and CA CDI rates have declined, coinciding with changes in prevalence of RT027 and RT106. Infection prevention and control and continued national surveillance are integral to clarifying CDI epidemiology, investigation, and control.
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10
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Williams VR, Muller M, Powis J, Ricciuto DR, Mertz D, Katz K, Castellani L, Hota SS, Hota SS, Payne M, Johnstone J, Leis JA. 422. Sustainability of Improvements to Hand Hygiene Performance Throughout the COVID-19 Pandemic. Open Forum Infect Dis 2021. [PMCID: PMC8644840 DOI: 10.1093/ofid/ofab466.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Hand hygiene (HH) is a standard infection prevention and control precaution to be applied in healthcare settings to prevent transmission of COVID-19. Many healthcare institutions observed significant improvements in HH performance during wave one of the COVID-19 pandemic but the sustainability of this change is unknown. Our aim was to evaluate long-term HH performance throughout subsequent waves of the pandemic across acute care hospitals in Ontario, Canada. Methods HH adherence was measured using a previously validated group electronic monitoring system which was installed on all alcohol handrub and sink soap dispensers inside and outside each patient room across 56 inpatient units (35 wards and 21 critical care units) spanning 13 acute care hospitals (6 university and 7 community teaching hospitals) from 1 November 2019 to 31 May 2021. Daily HH adherence was compared with daily COVID-19 case count across Ontario. During this period, weekly performance continued to be reported to units but unit-based quality improvement discussions were inconsistent due to the COVID-19 response. Results Figure 1 depicts daily aggregate HH adherence plotted against the new daily COVID-19 case count across Ontario. An elevation in HH adherence was seen prior to the start of the first wave, rising almost to 80% and then remained above 70% for the peak of wave one. During waves two and three, peak COVID-19 case counts were associated with a maximum HH adherence of 51%, only marginally above the pre-pandemic baseline. After the end of wave one (from 1 July 2020 to 31 May 2021) the median HH performance was only 49% (interquartile range 47%-50%). Figure 1. Hand hygiene adherence across 13 acute care hospitals in comparison to overall new daily COVID-19 cases in Ontario ![]()
Conclusion Initial improvements in HH adherence preceding the start of the COVID-19 pandemic were not sustained, possibly due to increasing comfort and reduced anxiety associated with providing care to COVID-19 patients leading to a perception of reduced COVID-19 transmission risk. These findings highlight the need for HH monitoring to be tied to longitudinal unit-led quality improvement in order to achieve durable changes in practice. Disclosures Susy S. Hota, MSc MD FRCPC, Finch Therapeutics (Research Grant or Support) Susy S. Hota, MSc MD FRCPC, Finch Therapeutics (Individual(s) Involved: Self): Grant/Research Support
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Affiliation(s)
| | | | - Jeff Powis
- University of Toronto, Toronto, ON, Canada
| | | | - Dominik Mertz
- Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, ON, Canada
| | | | - Susy S Hota
- University Health Network, Toronto, ON, Canada
| | - Susy S Hota
- University Health Network, Toronto, ON, Canada
| | - Michael Payne
- London Health Sciences Centre, London, Ontario, Canada
| | | | - Jerome A Leis
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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11
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Khan S, Vaisman A, Hota SS, Bennett S, Trudel S, Reece D, Tiedemann RE. Listeria Susceptibility in Patients With Multiple Myeloma Receiving Daratumumab-Based Therapy. JAMA Oncol 2020; 6:293-294. [PMID: 31774462 DOI: 10.1001/jamaoncol.2019.5098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Sahar Khan
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Alon Vaisman
- Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susy S Hota
- Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Bennett
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Suzanne Trudel
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Donna Reece
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rodger E Tiedemann
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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12
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Affiliation(s)
- Philip W H Peng
- Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Pak-Leung Ho
- Department of Microbiology and Carol Yu Centre for Infection, University of Hong Kong, Hong Kong
| | - Susy S Hota
- Infection Prevention and Control Department, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada
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13
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Vaisman A, Bannerman G, Matelski J, Tinckam K, Hota SS. Out of sight, out of mind: a prospective observational study to estimate the duration of the Hawthorne effect on hand hygiene events. BMJ Qual Saf 2020; 29:932-938. [DOI: 10.1136/bmjqs-2019-010310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/28/2022]
Abstract
BackgroundHuman auditing has been the gold standard for evaluating hand hygiene (HH) compliance but is subject to the Hawthorne effect (HE), the change in subjects’ behaviour due to their awareness of being observed. For the first time, we used electronic HH monitoring to characterise the duration of the HE on HH events after human auditors have left the ward.MethodsObservations were prospectively conducted on two transplant wards at a tertiary centre between May 2018 and January 2019. HH events were measured using the electronic GOJO Smartlink Activity Monitoring System located throughout the ward. Non-covert human auditing was conducted in 1-hour intervals at random locations on both wards on varying days of the week. Two adjusted negative binomial regression models were fit in order to estimate an overall auditor effect and a graded auditor effect.ResultsIn total, 365 674 HH dispensing events were observed out of a possible 911 791 opportunities. In the adjusted model, the presence of an auditor increased electronic HH events by approximately 2.5-fold in the room closest to where the auditor was standing (9.86 events per hour/3.98 events per hour; p<0.01), an effect sustained across only the partial hour before and after the auditor was present but not beyond the first hour after the auditor left. This effect persisted but was attenuated in areas distal from the auditor (total ward events of 6.91*6.32–7.55, p<0.01). Additionally, there was significant variability in the magnitude of the HE based on temporal and geographic distribution of audits.ConclusionThe HE on HH events appears to last for a limited time on inpatient wards and is highly dynamic across time and auditor location. These findings further challenge the validity and value of human auditing and support the need for alternative and complementary monitoring methods.
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14
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Mikail M, O'Doherty KC, Poutanen SM, Hota SS. Ethical implications of recruiting universal stool donors for faecal microbiota transplantation. The Lancet Infectious Diseases 2020; 20:e44-e49. [DOI: 10.1016/s1473-3099(19)30569-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/21/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022]
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15
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Krensky C, Poutanen SM, Hota SS. Diarrhea after fecal microbiota transplantation for recurrent Clostridioides difficile infection. CMAJ 2020; 191:E559-E561. [PMID: 31113785 DOI: 10.1503/cmaj.181193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Cole Krensky
- Faculty of Medicine (Krensky), University of Toronto; Department of Microbiology (Poutanen), University Health Network and Sinai Health System; Departments of Laboratory Medicine and Pathobiology (Poutanen) and of Medicine (Hota), University of Toronto; Department of Infection Prevention and Control (Hota), University Health Network, Toronto, Ont
| | - Susan M Poutanen
- Faculty of Medicine (Krensky), University of Toronto; Department of Microbiology (Poutanen), University Health Network and Sinai Health System; Departments of Laboratory Medicine and Pathobiology (Poutanen) and of Medicine (Hota), University of Toronto; Department of Infection Prevention and Control (Hota), University Health Network, Toronto, Ont
| | - Susy S Hota
- Faculty of Medicine (Krensky), University of Toronto; Department of Microbiology (Poutanen), University Health Network and Sinai Health System; Departments of Laboratory Medicine and Pathobiology (Poutanen) and of Medicine (Hota), University of Toronto; Department of Infection Prevention and Control (Hota), University Health Network, Toronto, Ont.
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16
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Hota SS, McNamara I, Jin R, Kissoon M, Singh S, Poutanen SM. Challenges establishing a multi-purpose fecal microbiota transplantation stool donor program in Toronto, Canada. J Assoc Med Microbiol Infect Dis Can 2019; 4:218-226. [PMID: 36339288 PMCID: PMC9612805 DOI: 10.3138/jammi.2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/29/2019] [Indexed: 06/16/2023]
Abstract
BACKGROUND The success of fecal microbiota transplantation (FMT) programs depends on maintaining suitable stool donors. We describe challenges recruiting and retaining universal donors in the first 2 years of an FMT clinical and research program in Toronto and identify opportunities for improvement. METHODS A four-stage screening process is used to identify suitable FMT donors in the Microbiota Therapeutics Outcomes Program. Donor screening follows Health Canada recommendations and excludes persons with history or risk for diseases associated with dysbiosis. Donors are rescreened microbiologically approximately every 1-3 months and answer ongoing health, exposure, and dietary questionnaires. RESULTS In the first 2 years of our program, 5 of 322 (1.6%) prospective stool donors passed initial screening, and only 2 (0.6%) were retained. Most prospective donors were excluded on telephone screening, at which point high BMI, medication use, and family history of relevant illness were common exclusions. No candidate was excluded because of a concerning physical examination. Microbiologic reasons for donor exclusion included carriage of Blastocystis hominis (n = 2), Helicobacter pylori (n = 2), extended spectrum beta-lactamase producing organisms (n = 1), Shiga-toxin producing Escherichia coli (n = 1), and sapovirus (n = 1). Universal donors were lost temporarily because of travel, antibiotic exposures, and transient carriage of antibiotic-resistant organisms. CONCLUSIONS Recruiting and retaining suitable donors for FMT is challenging because of rigorous exclusions and labour-intensive screening processes. We present considerations for efficiency in donor screening, including targeting recruitment populations, expanded website self-screening, eliminating physical examinations, and streamlining post-travel risk assessment.
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Affiliation(s)
- Susy S Hota
- Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Isabella McNamara
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | - Robbie Jin
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | - Melissa Kissoon
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, Ontario, Canada
| | - Satyender Singh
- Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada
| | - Susan M Poutanen
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, University Health Network/Sinai Health System, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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17
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Hota SS, Doll M, Bearman G. Preventing Clostridioides difficile infection in hospitals: what is the endgame? BMJ Qual Saf 2019; 29:157-160. [PMID: 31582570 DOI: 10.1136/bmjqs-2019-009953] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 01/05/2023]
Affiliation(s)
- Susy S Hota
- Infection Prevention and Control Department, University Health Network, Toronto, Ontario, Canada .,Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Doll
- Department of Medicine, Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Gonzalo Bearman
- Department of Medicine, Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
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18
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Affiliation(s)
- Susy S Hota
- Department of Infection Prevention and Control (Hota), University Health Network; Department of Medicine (Hota), University of Toronto; Department of Microbiology (Poutanen), University Health Network and Mount Sinai Hospital; Department of Laboratory Medicine and Pathobiology (Poutanen), University of Toronto, Toronto, Ont.
| | - Susan M Poutanen
- Department of Infection Prevention and Control (Hota), University Health Network; Department of Medicine (Hota), University of Toronto; Department of Microbiology (Poutanen), University Health Network and Mount Sinai Hospital; Department of Laboratory Medicine and Pathobiology (Poutanen), University of Toronto, Toronto, Ont
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19
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Affiliation(s)
- Susy S Hota
- Department of Infection Prevention and Control, University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto, Canada
| | - Susan M Poutanen
- Department of Medicine, University of Toronto, Canada.,Department of Microbiology, University Health Network/Sinai Health System,Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
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20
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Abstract
PURPOSE OF REVIEW In this review, we summarize recent outbreaks attributed to hospital sinks and examine design features and behaviors that contributed to these outbreaks. The effectiveness of various risk mitigation strategies is presented. Finally, we examine investigational strategies targeted at reducing the risk of sink-related infections. RECENT FINDINGS Outbreaks of hospital sink-related infections involve a diverse spectrum of microorganisms. They can be attributed to defects in sink design and hospital wastewater systems that promote the formation and dispersion of biofilm, as well as healthcare practitioner and patient behaviors. Risk mitigation strategies are often bundled; while they may reduce clinical cases, sink colonization may persist. Novel approaches targeting biofilms show promise but require more investigation. Emphasis should be placed on optimizing best practices in sink design and placement to prevent infections. Hospitals should consider developing a rational surveillance and prevention strategy based on the current design and state of their sinks.
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Affiliation(s)
- Leighanne O Parkes
- Department of Medicine, Division of Infectious Diseases, Jewish General Hospital, McGill University, Pavilion E-0054, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada
| | - Susy S Hota
- Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada.
- Department of Infection Prevention and Control, University Health Network, 9th Floor - 8 PMB 102, 585 University Avenue, Toronto, ON, M5G 2C4, Canada.
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21
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Hota SS, Surangiwala S, Paterson AS, Coburn B, Poutanen SM. Regional variability in fecal microbiota transplantation practices: a survey of the Southern Ontario Fecal Microbiota Transplantation Movement. CMAJ Open 2018; 6:E184-E190. [PMID: 29674329 PMCID: PMC7869690 DOI: 10.9778/cmajo.20170109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There is growing evidence that fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection, but little guidance exists for implementation of FMT programs. The objective of this study is to describe the program characteristics and protocols of 9 planned or operating FMT programs in the Southern Ontario Fecal Microbiota Transplantation (SOFT) Movement, to help guide future FMT program implementation. METHODS A 59-item survey was administered electronically to clinical leads of the SOFT Movement on June 2, 2016. The survey evaluated 7 domains: FMT program characteristics, FMT recipients, donor screening/selection, transplant manufacturing, FMT administration, good manufacturing procedures/biosafety procedures and infection-control procedures. We used descriptive statistics to analyze quantitative data. RESULTS All 9 programs responded to the survey: 6 were active, 1 had FMT standard operating procedures developed but did not have clinical experience, and 2 were in the process of forming FMT programs. All 6 active programs performed FMT in adult patients with C. difficile infection. About 1300 FMT procedures were performed between 2003 and 2016. Five of the 6 operating programs administered the preparation via enema. Programs were driven primarily by physicians. All programs used universal FMT donors and followed Health Canada's screening guidelines, with considerable variability in screening frequency (every 3-6 mo) and modality. Locations for transplant preparation and manufacturing protocols varied across programs. Stool mass for FMT ranged from 20 g to 150 g, and transplant volume ranged from 25 mL to 300 mL. INTERPRETATION The experience of this high-volume regional FMT network highlights current challenges in FMT program development, including a high reliance on physicians and the costly nature of donor screening. Standardization and optimization through development of regional centres of excellence for FMT donor recruitment and administration should be explored.
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Affiliation(s)
- Susy S Hota
- Affiliations: Department of Infection Prevention and Control (Hota), University Health Network; Department of Medicine (Hota, Coburn), University of Toronto; Department of Microbiology (Surangiwala, Paterson, Poutanen), University Health Network/Sinai Health System; Toronto General Hospital Research Institute (Coburn); Department of Laboratory Medicine and Pathobiology (Poutanen), University of Toronto, Toronto, Ont
| | - Salman Surangiwala
- Affiliations: Department of Infection Prevention and Control (Hota), University Health Network; Department of Medicine (Hota, Coburn), University of Toronto; Department of Microbiology (Surangiwala, Paterson, Poutanen), University Health Network/Sinai Health System; Toronto General Hospital Research Institute (Coburn); Department of Laboratory Medicine and Pathobiology (Poutanen), University of Toronto, Toronto, Ont
| | - Aimee S Paterson
- Affiliations: Department of Infection Prevention and Control (Hota), University Health Network; Department of Medicine (Hota, Coburn), University of Toronto; Department of Microbiology (Surangiwala, Paterson, Poutanen), University Health Network/Sinai Health System; Toronto General Hospital Research Institute (Coburn); Department of Laboratory Medicine and Pathobiology (Poutanen), University of Toronto, Toronto, Ont
| | - Bryan Coburn
- Affiliations: Department of Infection Prevention and Control (Hota), University Health Network; Department of Medicine (Hota, Coburn), University of Toronto; Department of Microbiology (Surangiwala, Paterson, Poutanen), University Health Network/Sinai Health System; Toronto General Hospital Research Institute (Coburn); Department of Laboratory Medicine and Pathobiology (Poutanen), University of Toronto, Toronto, Ont
| | - Susan M Poutanen
- Affiliations: Department of Infection Prevention and Control (Hota), University Health Network; Department of Medicine (Hota, Coburn), University of Toronto; Department of Microbiology (Surangiwala, Paterson, Poutanen), University Health Network/Sinai Health System; Toronto General Hospital Research Institute (Coburn); Department of Laboratory Medicine and Pathobiology (Poutanen), University of Toronto, Toronto, Ont
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22
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Abstract
Clostridium difficile infection, a common hospital-associated infection, is a gastrointestinal illness that becomes recurrent in about 25% of infected patients. Fecal microbiota transplantation (FMT) is increasingly supported by clinical trials as an effective treatment for recurrent Clostridium difficile infection, but a number of questions remain about how it can be optimally performed. In this Perspective, we discuss controversies in FMT methodologies and reporting within randomized controlled trials, all of which may influence clinical outcomes in treated patients. Finally, we focus on the question of whether single vs multiple FMTs are necessary to achieve favorable outcomes for the treatment of recurrent Clostridium difficile infection, postulating on why there may be an association between number of FMTs and clinical effectiveness.
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Affiliation(s)
- Susy S Hota
- Department of Infection Prevention and Control, University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Susan M Poutanen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,University Health Network/Mount Sinai Hospital Department of Microbiology, Toronto, Canada
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23
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Hota SS, Sales V, Tomlinson G, Salpeter MJ, McGeer A, Coburn B, Guttman DS, Low DE, Poutanen SM. Oral Vancomycin Followed by Fecal Transplantation Versus Tapering Oral Vancomycin Treatment for Recurrent Clostridium difficile Infection: An Open-Label, Randomized Controlled Trial. Clin Infect Dis 2016; 64:265-271. [DOI: 10.1093/cid/ciw731] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/31/2016] [Indexed: 01/01/2023] Open
Abstract
Abstract
Background
Fecal transplantation (FT) is a promising treatment for recurrent Clostridium difficile infection (CDI), but its true effectiveness remains unknown. We compared 14 days of oral vancomycin followed by a single FT by enema with oral vancomycin taper (standard of care) in adult patients experiencing acute recurrence of CDI.
Methods
In a phase 2/3, single-center, open-label trial, participants from Ontario, Canada, experiencing recurrence of CDI were randomly assigned in a 1:1 ratio to 14 days of oral vancomycin treatment followed by a single 500-mL FT by enema, or a 6-week taper of oral vancomycin. Patients with significant immunocompromise, history of fulminant CDI, or irreversible bleeding disorders were excluded. The primary endpoint was CDI recurrence within 120 days. Microbiota analysis was performed on fecal filtrate from donors and stool samples from FT recipients, as available.
Results
The study was terminated at the interim analysis after randomizing 30 patients. Nine of 16 (56.2%) patients who received FT and 5 of 12 (41.7%) in the vancomycin taper group experienced recurrence of CDI, corresponding with symptom resolution in 43.8% and 58.3%, respectively. Fecal microbiota analysis of 3 successful FT recipients demonstrated increased diversity. A futility analysis did not support continuing the study. Adverse events were similar in both groups and uncommon.
Conclusions
In patients experiencing an acute episode of recurrent CDI, a single FT by enema was not significantly different from oral vancomycin taper in reducing recurrent CDI. Further research is needed to explore optimal donor selection, FT preparation, route, timing, and number of administrations.
Clinical Trials Registration
NCT01226992.
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Affiliation(s)
- Susy S Hota
- Department of Infection Prevention and Control, University Health Network, Toronto
- Department of Medicine, University of Toronto
- Department of Medicine, University Health Network
| | - Valerie Sales
- Department of Medicine, University of Toronto
- Department of Medicine, Markham-Stouffville Hospital, Markham
- Department of Medicine, University Health Network
| | - George Tomlinson
- Department of Medicine, University Health Network
- Institute of Health Policy, Management and Evaluation and Dalla Lana School of Public Health, University of Toronto
| | - Mary Jane Salpeter
- Department of Infection Prevention and Control, University Health Network, Toronto
- Department of Anaesthesia, University Health Network
| | - Allison McGeer
- Department of Medicine, University of Toronto
- Department of Microbiology, University Health Network/Sinai Health System
- Department of Laboratory Medicine and Pathobiology, University of Toronto
| | - Bryan Coburn
- Department of Medicine, University of Toronto
- Department of Medicine, University Health Network
- Toronto General Research Institute, University Health Network
| | - David S Guttman
- Department of Cell and Systems Biology, University of Toronto
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, Canada
| | - Donald E Low
- Department of Medicine, University of Toronto
- Department of Microbiology, University Health Network/Sinai Health System
- Department of Laboratory Medicine and Pathobiology, University of Toronto
| | - Susan M Poutanen
- Department of Medicine, University of Toronto
- Department of Microbiology, University Health Network/Sinai Health System
- Department of Laboratory Medicine and Pathobiology, University of Toronto
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24
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David HM, Chen J, Seweryniak D, Kondev FG, Gates JM, Gregorich KE, Ahmad I, Albers M, Alcorta M, Back BB, Baartman B, Bertone PF, Bernstein LA, Campbell CM, Carpenter MP, Chiara CJ, Clark RM, Cromaz M, Doherty DT, Dracoulis GD, Esker NE, Fallon P, Gothe OR, Greene JP, Greenlees PT, Hartley DJ, Hauschild K, Hoffman CR, Hota SS, Janssens RVF, Khoo TL, Konki J, Kwarsick JT, Lauritsen T, Macchiavelli AO, Mudder PR, Nair C, Qiu Y, Rissanen J, Rogers AM, Ruotsalainen P, Savard G, Stolze S, Wiens A, Zhu S. Publisher's Note: Decay and Fission Hindrance of Two- and Four-Quasiparticle K Isomers in (254)Rf [Phys. Rev. Lett. 115, 132502 (2015)]. Phys Rev Lett 2015; 115:169902. [PMID: 26550909 DOI: 10.1103/physrevlett.115.169902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Indexed: 06/05/2023]
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25
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David HM, Chen J, Seweryniak D, Kondev FG, Gates JM, Gregorich KE, Ahmad I, Albers M, Alcorta M, Back BB, Baartman B, Bertone PF, Bernstein LA, Campbell CM, Carpenter MP, Chiara CJ, Clark RM, Cromaz M, Doherty DT, Dracoulis GD, Esker NE, Fallon P, Gothe OR, Greene JP, Greenlees PT, Hartley DJ, Hauschild K, Hoffman CR, Hota SS, Janssens RVF, Khoo TL, Konki J, Kwarsick JT, Lauritsen T, Macchiavelli AO, Mudder PR, Nair C, Qiu Y, Rissanen J, Rogers AM, Ruotsalainen P, Savard G, Stolze S, Wiens A, Zhu S. Decay and Fission Hindrance of Two- and Four-Quasiparticle K Isomers in ^{254}Rf. Phys Rev Lett 2015; 115:132502. [PMID: 26451549 DOI: 10.1103/physrevlett.115.132502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Indexed: 06/05/2023]
Abstract
Two isomers decaying by electromagnetic transitions with half-lives of 4.7(1.1) and 247(73) μs have been discovered in the heavy ^{254}Rf nucleus. The observation of the shorter-lived isomer was made possible by a novel application of a digital data acquisition system. The isomers were interpreted as the K^{π}=8^{-}, ν^{2}(7/2^{+}[624],9/2^{-}[734]) two-quasineutron and the K^{π}=16^{+}, 8^{-}ν^{2}(7/2^{+}[624],9/2^{-}[734])⊗8^{-}π^{2}(7/2^{-}[514],9/2^{+}[624]) four-quasiparticle configurations, respectively. Surprisingly, the lifetime of the two-quasiparticle isomer is more than 4 orders of magnitude shorter than what has been observed for analogous isomers in the lighter N=150 isotones. The four-quasiparticle isomer is longer lived than the ^{254}Rf ground state that decays exclusively by spontaneous fission with a half-life of 23.2(1.1) μs. The absence of sizable fission branches from either of the isomers implies unprecedented fission hindrance relative to the ground state.
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Affiliation(s)
- H M David
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - J Chen
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - D Seweryniak
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - F G Kondev
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - J M Gates
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - K E Gregorich
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - I Ahmad
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - M Albers
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - M Alcorta
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - B B Back
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - B Baartman
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - P F Bertone
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - L A Bernstein
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - C M Campbell
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - M P Carpenter
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - C J Chiara
- Argonne National Laboratory, Argonne, Illinois 60439, USA
- Department of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, USA
| | - R M Clark
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - M Cromaz
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - D T Doherty
- School of Physics and Astronomy, University of Edinburgh, Edinburgh EH9 3JZ, United Kingdom
| | - G D Dracoulis
- Department of Nuclear Physics, R.S.P.E., Australian National University, Canberra A.C.T. 2601, Australia
| | - N E Esker
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - P Fallon
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - O R Gothe
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - J P Greene
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - P T Greenlees
- Department of Physics, University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - D J Hartley
- United States Naval Academy, Annapolis, Maryland 21402, USA
| | - K Hauschild
- CSNSM, IN2P3-CNRS, F-91405 Orsay Campus, France
| | - C R Hoffman
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - S S Hota
- Department of Physics, University of Massachusetts, Lowell, Massachusetts 01854, USA
| | - R V F Janssens
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - T L Khoo
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - J Konki
- Department of Physics, University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - J T Kwarsick
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - T Lauritsen
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - A O Macchiavelli
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - P R Mudder
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - C Nair
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - Y Qiu
- Department of Physics, University of Massachusetts, Lowell, Massachusetts 01854, USA
| | - J Rissanen
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - A M Rogers
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - P Ruotsalainen
- Department of Physics, University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - G Savard
- Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - S Stolze
- Department of Physics, University of Jyväskylä, FIN-40014 Jyväskylä, Finland
| | - A Wiens
- Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - S Zhu
- Argonne National Laboratory, Argonne, Illinois 60439, USA
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26
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Hota SS, Achonu C, Crowcroft NS, Harvey BJ, Lauwers A, Gardam MA. Determining mortality rates attributable to Clostridium difficile infection. Emerg Infect Dis 2012; 18:305-7. [PMID: 22305427 PMCID: PMC3310441 DOI: 10.3201/eid1802.101611] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
To determine accuracy of measures of deaths attributable to Clostridium difficile infection, we compared 3 measures for 2007–2008 in Ontario, Canada: death certificate; death within 30 days of infection; and panel review. Data on death within 30 days were more feasible than panel review and more accurate than death certificate data.
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Affiliation(s)
- Susy S Hota
- University Health Network, Toronto, Ontario, Canada.
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27
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Abstract
A case of chronic relapsing pericarditis is presented in which all forms of medical therapy failed. Pericardectomy was performed as a last resort, with complete resolution of symptoms. Incessant pericarditis, as distinguished from recurrent intermittent pericarditis, may respond favourably to surgical removal, especially in the presence of recurrent pericardial effusion.
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Affiliation(s)
- S S Hota
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Ontario, Canada
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