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1261 results

Page 1 of 64

  • Sink-traps are a major source for carbapenemase-producing Enterobacteriaceae transmission

  • Gili Regev-Yochay, Ili Margalit, Gillian Smollan, Rotem Rapaport, Ilana Tal, William P. Hanage, Nani Pinas Zade, Hanaa Jaber, Bradford P. Taylor, You Che, Galia Rahav, Eyal Zimlichman, Nati Keller
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 45 / Issue 3 / March 2024
    Published online by Cambridge University Press:
    27 December 2023, pp. 284-291
    Print publication:
    March 2024
    • Article
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  • Objective:

    We studied the extent of carbapenemase-producing Enterobacteriaceae (CPE) sink contamination and transmission to patients in a nonoutbreak setting.

    Methods:

    During 2017–2019, 592 patient-room sinks were sampled in 34 departments. Patient weekly rectal swab CPE surveillance was universally performed. Repeated sink sampling was conducted in 9 departments. Isolates from patients and sinks were characterized using pulsed-field gel electrophoresis (PFGE), and pairs of high resemblance were sequenced by Oxford Nanopore and Illumina. Hybrid assembly was used to fully assemble plasmids, which are shared between paired isolates.

    Results:

    In total, 144 (24%) of 592 CPE-contaminated sinks were detected in 25 of 34 departments. Repeated sampling (n = 7,123) revealed that 52%–100% were contaminated at least once during the sampling period. Persistent contamination for >1 year by a dominant strain was common. During the study period, 318 patients acquired CPE. The most common species were Klebsiella pneumoniae, Escherichia coli, and Enterobacter spp. In 127 (40%) patients, a contaminated sink was the suspected source of CPE acquisition. For 20 cases with an identical sink-patient strain, temporal relation suggested sink-to-patient transmission. Hybrid assembly of specific sink-patient isolates revealed that shared plasmids were structurally identical, and SNP differences between shared pairs, along with signatures for potential recombination events, suggests recent sharing of the plasmids.

    Conclusions:

    CPE-contaminated sinks are an important source of transmission to patients. Although traditionally person-to-person transmission has been considered the main route of CPE transmission, these data suggest a change in paradigm that may influence strategies of preventing CPE dissemination.

  • Part III - Retirement: 1797–1799

  • George Washington
  • Edited by Carson Holloway, University of Nebraska, Omaha, Bradford P. Wilson, Princeton University, New Jersey
  • Book:
    The Political Writings of George Washington
    Published online:
    10 August 2023
    Print publication:
    31 August 2023, pp 538-649

  • Summary

    Part III covers the years of Washington’s brief final retirement from public life (1797–1799). As is well known, he hoped at last to find relief from the mental strain that had almost constantly accompanied him through many years of consequential, perplexing, and often perilous public service. This hope was not, however, perfectly realized. Even in retirement Washington continued to follow politics closely, forming and expressing opinions on the events of the day, worrying about the dangers of party spirit at home and war abroad. The latter concern drew him one last time into a position of official responsibility: he accepted when President John Adams appointed him commander-in-chief of the provisional army that was planned in the event of open war with France.

Page 1 of 64