Evidence-based insertion and maintenance bundles are effective in reducing the incidence of central line-associated bloodstream infections (CLABSI) in intensive care unit (ICU) settings. We studied the adoption and compliance of CLABSI prevention bundle programs and CLABSI rates in ICUs in a large network of acute care hospitals across Canada.

Two independent temporal-spatial clusters of hospital-onset Rhizopus infections were evaluated using whole-genome sequencing (WGS). Phylogenetic analysis confirmed that isolates within each cluster were unrelated despite epidemiological suspicion of outbreaks. The ITS1 region alone was insufficient for accurate analysis. WGS has utility for rapid rule-out of suspected nosocomial Rhizopus outbreaks.

Background: Nosocomial central-line–associated bloodstream infections (CLABSIs) are an important cause of morbidity and mortality in hospitalized patients. CLABSI surveillance establishes rates for internal and external comparison, identifies risk factors, and allows assessment of interventions. Objectives: To determine the frequency of CLABSIs among adult patients admitted to intensive care units (ICUs) in CNISP hospitals and evaluate trends over time. Methods: CNISP is a collaborative effort of the Canadian Hospital Epidemiology Committee, the Association of Medical Microbiologists and Infectious Disease Canada and the Public Health Agency of Canada. Since 1995, CNISP has conducted hospital-based sentinel surveillance of healthcare-associated infections. Overall, 55 CNISP hospitals participated in ≥1 year of CLABSI surveillance. Adult ICUs are categorized as mixed ICUs or cardiovascular (CV) surgery ICUs. Data were collected using standardized definitions and collection forms. Line-day denominators for each participating ICU were collected. Negative-binomial regression was used to test for linear trends, with robust standard errors to account for clustering by hospital. We used the Fisher exact test to compare binary variables. Results: Each year, 28–42 adult ICUs participated in surveillance (27–37 mixed, 6–8 CV surgery). In both mixed ICUs and CV-ICUs, rates remained relatively stable between 2011 and 2018 (Fig. 1). In mixed ICUs, CLABSI rates were 1.0 per 1,000 line days in 2011, and 1.0 per 1,000 line days in 2018 (test for linear trend, P = .66). In CV-ICUs, CLABSI rates were 1.1 per 1,000 line days in 2011 and 0.8 per 1,000 line days in 2018 (P = .19). Case age and gender distributions were consistent across the surveillance period. The 30-day all-cause mortality rate was 29% in 2011 and in 2018 (annual range, 29%–35%). Between 2011 and 2018, the percentage of isolated microorganisms that were coagulase-negative staphylococci (CONS) decreased from 31% to 18% (P = .004). The percentage of other gram-positive organisms increased from 32% to 37% (P = .34); Bacillus increased from 0% to 4% of isolates and methicillin-susceptible Staphylococcus aureus from 2% to 6%). The gram-negative organisms increased from 21% to 27% (P = .19). Yeast represented 16% in 2011 and 18% in 2018; however, the percentage of yeast that were Candida albicans decreased over time (58% of yeast in 2011 and 30% in 2018; P = .04). Between 2011 and 2018, the most commonly identified species of microorganism in each year were CONS (18% in 2018) and Enterococcus spp (18% in 2018). Conclusions: Ongoing CLABSI surveillance has shown stable rates of CLABSI in adult ICUs from 2011 to 2018. The causative microorganisms have changed, with CONS decreasing from 31% to 18%.

Funding: CNISP is funded by the Public Health Agency of Canada.

Disclosures: Allison McGeer reports funds to her for studies, for which she is the principal investigator, from Pfizer and Merck, as well as consulting fees from Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

Glyphosate [N-(phosphonomethyl)glycine] significantly decreased the chlorophyll content of field-grown soybeans (Glycine max L. Merr. ‘Williams’) within 48 h after a 2.24-kg/ha treatment. In laboratory studies, 0.0001, 0.001, 0.01, 0.1, and 1 mM glyphosate reduced chlorophyll content of 7-day-old etiolated barley (Hordeum vulgare L. ‘Barsoy’) shoots 8, 12, 25, 49, and 77%, respectively, following 8 h dark incubation and 24 h illumination. Reduction of chlorophyll accumulation ranged from 6% with 0.001 mM glyphosate to 82% with 1.0 mM glyphosate. In studies with 8-day-old etiolated corn (Zea mays L. ‘Pioneer Brand 3535’) shoots, 0.1, 1.0, and 10.0 mM glyphosate decreased chlorophyll content of corn shoots 24, 42, and 50%, respectively, after 12 h of illumination. The rate of chlorophyll accumulation in corn shoots was significantly reduced 64% by 1.0 mM glyphosate over a 15-h illumination period. These rapid and substantial effects on chlorophyll accumulation suggest that interference with greening may be important in the mechanism of action of glyphosate.

The effect of glyphosate [N-(phosphonomethyl) glycine] on barley (Hordeum vulgare L.) and corn (Zea mays L.) shoot δ-aminolevulinic acid (ALA) production was examined by monitoring ALA content in the tissue and measuring incorporation of 14C precursors into ALA and chlorophyll a. Barley shoot ALA content was significantly decreased by 1 mM glyphosate after 9, 11, and 15 h of illumination. ALA production by treated barley shoots was 30 nmoles•g fresh weight-1•h-1 at each interval tested, compared with 75 to 120 nmoles•g fresh weight-1•h-1 for the control. In corn shoots, ALA content was reduced 32, 45, and 58% by 0.1, 1.0, and 10.0 mM glyphosate, respectively, after 12 h illumination. Incorporation studies with 14C-glutamate, 14C-α-ketoglutarate, and 14C-glycine into ALA showed a 77, 92, and 91% inhibition, respectively, in barley shoots treated with 1 mM glyphosate. Incorporation of 14C-ALA into chlorophyll a was not affected by 1 mM glyphosate. Thus, the site of action of glyphosate may involve two enzyme pathways:one controlling the conversion of α-ketoglutarate to ALA, and the other controlling the condensation of glycine with succinyl CoA to form ALA and carbon dioxide. Inhibition of ALA synthesis blocks synthesis of chlorophyll, as well as all other porphyrin ring compounds found in higher plants. Thus, inhibition of ALA synthesis may be an integral component of the herbicidal mode of action of glyphosate.

Developmental psychopathologists face the difficult task of identifying the environmental conditions that may contribute to early childhood behavior problems. Highly stressed caregivers can exacerbate behavior problems, while children with behavior problems may make parenting more difficult and increase caregiver stress. Unknown is: (a) how these transactions originate, (b) whether they persist over time to contribute to the development of problem behavior and (c) what role resilience factors, such as child executive functioning, may play in mitigating the development of problem behavior. In the present study, transactional relations between caregiving stress, executive functioning, and behavior problems were examined in a sample of 1,388 children with prenatal drug exposures at three developmental time points: early childhood (birth to age 5), middle childhood (ages 6 to 9), and early adolescence (ages 10 to 13). Transactional relations differed between caregiving stress and internalizing versus externalizing behavior. Targeting executive functioning in evidence-based interventions for children with prenatal substance exposure who present with internalizing problems and treating caregiving psychopathology, depression, and parenting stress in early childhood may be particularly important for children presenting with internalizing behavior.

Background: To compare the frequencies of risk factors, we describe risks for depression as a function of race among consecutively admitted participants in a randomized clinical trial of indicated depression prevention in later life.

Methods: Seventy-two black and 143 white participants were screened for risk factors for depression.

Results: Black participants were more likely to have fewer years of education and lower household income. They were more likely to be obese, live alone, experience functional disability, have a history of alcohol and drug abuse, and have lower scores on the Mini-mental State Examination and the Executive Interview (EXIT). White participants were not found to have greater prevalence or higher mean score on any risk factor. On average, black participants experienced approximately one more risk factor than white participants (t(213) = 3.32, p = 0.0011).

Conclusions: In our sample, black participants had higher frequencies of eight risk factors for depression and a greater mean number of risk factors compared to white participants.