Absract Background To describe the course and intervention of an hospital-wide IMI-Producing Enterobacter ludwigii outbreak. Methods This was an outbreak interventional study, done at a tertiary care center in Tel-Aviv, Israel. Data was collected on the course of the outbreak and the demographic and clinical characteristics of all patients involved in the outbreak. The intervention measures included patients’ cohorting, contact isolation precautions, environmental cleaning and screening of contacts. The molecular features and phylogeny of outbreak-related isolates were studied by whole-genome based analysis. Results The outbreak included 34 patients that were colonized by IMI-Producing E. ludwigii and were identified in 24 wards throughout the hospital. Colonization was identified in the first 72 h of admission in 13/34 patients (38.2%). Most patients (91.2%) were admitted from home and had relatively low level of comorbidities. The majority of them (88%) had no recent use of invasive catheters and none had previous carriage of other multi-drug resistant bacteria. All available isolates harbored the bla IMI-17 allele and belonged to Sequence-Type 385. With the exception of two isolates, all isolates were closely related with less than a 20-SNP difference between them. Conclusions This outbreak had most likely originated in the community and subsequently disseminated inside our institution. More studies are required in order to elucidate the epidemiology of IMI-Producing E. ludwigii and the possible role of environmental sources in its dissemination.
Abstract Background : It is essential to detect carriers of carbapenemase-producing Enterobacterales in order to implement infection control measures. The objectives of this study was to evaluate the NG-Test® CARBA 5 (CARBA 5) assay for detection of five carbapenemases and to assess the cross reactivity of other OXA-type carbapenemases with the OXA-48-like specific antibodies. Methods : A total of 197 Enterobacterales isolates were tested. To evaluate the cross reactivity, 73 carbapenem-resistant A. baumannii , harboring OXA-type variants, were tested. Polymerase chain reaction (PCR) served as gold standard for carbapenemase identification. Results : Excellent agreement was found between PCR and CARBA 5, for all but one isolate. The single false positive result (a bla SME positive S. marcescens isolate) was incorrectly positive for bla OXA-48 by CARBA 5. No cross reactivity was observed. The sensitivity and specificity were 100.0% and 98.0%, respectively. Conclusions : The CARBA 5 assay is highly sensitive and specific and is recommended as a tool for the detection of five carbapenemases.
Abstract Background It is essential to detect carriers of carbapenemase-producing Enterobacterales in order to implement infection control measures. The objectives of this study was to evaluate the NG-Test ® CARBA 5 (CARBA 5) assay for detection of five carbapenemases and to assess the cross reactivity of other OXA-type carbapenemases with the OXA-48-like specific antibodies. Methods A total of 197 Enterobacterales isolates were tested. To evaluate the cross reactivity, 73 carbapenem-resistant A. baumannii , harboring OXA-type variants, were tested. Polymerase chain reaction (PCR) served as gold standard for carbapenemase identification. Results Excellent agreement was found between PCR and CARBA 5, for all but one isolate. The single false positive result (a bla SME positive S. marcescens isolate) was incorrectly positive for bla OXA-48 by CARBA 5. No cross reactivity was observed. The sensitivity and specificity were 100.0% and 98.0%, respectively. Conclusions The CARBA 5 assay is highly sensitive and specific and is recommended as a tool for the detection of the main carbapenemases of interest in clinical microbiology laboratories.
Current dust storms, originating from afar, are common in Israel and the eastern Mediterranean, and thus most dust sources are considered to be distal. However, recent studies suggest that the latest Quaternary loess accreted in the Northern Negev can also serve as a proximal source of dust. These sources were mostly neglected in past discussions as contributors of dust. Here, we demonstrate that such proximal dust sources, mostly the Negev loess, currently contribute relatively large amounts of recycled dust to the regional dust cycle. We conducted a sampling campaign of deposited dust during individual dust storms and identified high content of coarse silt grains and quartzo-feldspathic minerals within and adjacent to the Negev loess that gradually decreases toward the north. These grains, characteristics of the Negev loess, indicate a short transport distance. In addition, our data reveal that local wind speed is the limiting factor for emitting proximal dust, regardless of the synoptic system. We determined that proximal sources in Israel emit dust during either local events or as a part of regional dust storms originating from afar. We evaluate the minimal contribution of this proximal dust to the total mass of deposited dust as 58–74%, 54–70%, 52–64%, and 26–34% for the northern Negev, central Negev, central mountainous region, and northern Israel, respectively. These estimates indicate that at the desert fringe, both proximal and distal sources of dust should be considered when inferring dust sources from dust geochemistry that can sometimes be similar due to the long dust history.
Abstract Background We aimed to systematically review articles that reported selenium (Se) concentrations in human milk (HM). Methods using PRISMA guidelines we searched MEDLINE and Embase using the terms “human milk and Selenium”. All clinical trials and systematic reviews were retrieved. Results Out of 1141 articles, we reviewed 76 full-text articles, excluding 26. Thus, 50 articles were included in meta-analyses. Most studies ( N = 31) did not specify whether milk was from mothers of preterm (PT) or fullterm (T) infants. In the other 19 studies, 1 examined PT-EHM, 15 T-EHM, and 3 both PT-EHM and T-EHM. In most studies, Se concentrations were highest in colostrum or until 3 months of lactation, then declined. Metaanalyzed means of PT-EHM or T-EHM provide estimates of Se intake a little higher than those reported to date, but still lower than current recommendations of intake. Conclusion This study provides clinicians with useful estimates of Se intake in breast-fed infants.
