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Use of real-time semiquantitative PCR data in management of a neonatal intensive care unit adenovirus outbreak

Published online by Cambridge University Press:  18 July 2018

Nicholas D. Hysmith ,
Mary R. Tanner ,
Sandra R. Arnold ,
Steven C. Buckingham ,
Anami R. Patel ,
Ramasubbareddy Dhanireddy ,
Katha Comeaux ,
Joy Joyner ,
Mary Ellen Hoehn  and
John P. DeVincenzo
Nicholas D. Hysmith*
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Infection Prevention and Control Department, Le Bonheur Children’s Hospital, Memphis, Tennessee
Mary R. Tanner
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Department of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee
Sandra R. Arnold
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
Steven C. Buckingham
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Infection Prevention and Control Department, Le Bonheur Children’s Hospital, Memphis, Tennessee
Anami R. Patel
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Methodist/Le Bonheur Molecular Diagnostics Laboratory, Le Bonheur Children’s Hospital, Memphis, Tennessee
Ramasubbareddy Dhanireddy
Affiliation:
Department of Pediatrics, Division of Neonatology, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
Katha Comeaux
Affiliation:
Infection Prevention and Control Department, Le Bonheur Children’s Hospital, Memphis, Tennessee
Joy Joyner
Affiliation:
Infection Prevention and Control Department, Le Bonheur Children’s Hospital, Memphis, Tennessee
Mary Ellen Hoehn
Affiliation:
Department of Ophthalmology, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee
John P. DeVincenzo
Affiliation:
Department of Pediatrics, Division of Infectious Diseases, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Methodist/Le Bonheur Molecular Diagnostics Laboratory, Le Bonheur Children’s Hospital, Memphis, Tennessee Department of Microbiology, Immunology, and Molecular Biology, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee Children’s Foundation Research Institute, Le Bonheur Children’s Hospital, Memphis, Tennessee
*
Author for correspondence: Nicholas Hysmith MD, 49 North Dunlap Street, Room 294, Memphis, TN 38103. E-mail: nhysmith@uthsc.edu
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Abstract

Objective

To describe an adenovirus outbreak in a neonatal intensive care unit (NICU), including the use of qualitative and semiquantitative real-time polymerase chain reaction (qPCR) data to inform the outbreak response.

Design

Mixed prospective and retrospective observational study.

Setting

A level IV NICU in the southeastern United States.

Patients

Two adenovirus cases were identified in a NICU. Screening of all inpatients with qPCR on nasopharyngeal specimens revealed 11 additional cases.

Interventions

Outbreak response procedures, including enhanced infection control policies, were instituted. Serial qPCR studies were used to screen for new infections among exposed infants and to monitor viral clearance among cases. Changes to retinopathy of prematurity (ROP) exam procedures were made after an association was noted in those patients. At the end of the outbreak, a retrospective review allowed for comparison of clinical factors between the infected and uninfected groups.

Results

There were no new cases among patients after outbreak identification. One adenovirus-infected patient died; the others recovered their clinical baselines. The ROP exams were associated with an increased risk of infection (odds ratio [OR], 84.6; 95% confidence interval [CI], 4.5–1,601). The duration of the outbreak response was 33 days, and the previously described second wave of cases after the end of the outbreak did not occur. Revisions to infection control policies remained in effect following the outbreak.

Conclusions

Retinopathy of prematurity exams are potential mechanisms of adenovirus transmission, and autoclaved or single-use instruments should be used to minimize this risk. Real-time molecular diagnostic and quantification data guided outbreak response procedures, which rapidly contained and fully terminated a NICU adenovirus outbreak.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 9 , September 2018 , pp. 1074 - 1079
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: Hysmith ND, et al. (2018). Use of real-time semiquantitative PCR data in management of a neonatal intensive care unit adenovirus outbreak. Infection Control & Hospital Epidemiology 2018, 39, 1074–1079. doi: 10.1017/ice.2018.162

a

Authors of equal contribution.

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