Eurosurveillance - Volume 16, Issue 47, 24 November 2011

Between July 2011 and August 2011, the New Delhi metallo-beta-lactamase 1 (NDM-1) gene was detected in Klebsiella pneumoniae and Escherichia coli isolates obtained from six patients hospitalised in four healthcare facilities in northern Italy. The patient who had been hospitalised in New Delhi, India, from February to May 2011 and subsequently in the Bologna area, Italy, from May to July 2011, may have been the source of the outbreak. Our findings suggest ongoing spread of this carbapenem-resistance gene in Italy and highlight the need for intensive surveillance.

Between July and October 2010, a national outbreak comprising 136 cases of Salmonella Java phage type 3b variant 9 was identified by the Health Protection Agency. Most cases were female. Cases had a median age of 39.5 years and lived in London, the South East and East of England. Parallel case-control and case-case study designs were undertaken to test the generated hypotheses. The case-case study aimed to examine if the infection was associated with eating food items purchased from commercial catering settings, and the reference group comprised non-travel related cases of S. Enteritidis infected during the same time period as the cases. The case-control study was designed to examine if the infection was associated with specific food items purchased from commercial catering settings, and recruited case-nominated controls. However, in response to poor recruitment we adapted our methods to investigate food exposures in the same way. Results of epidemiological investigations are compatible with salad vegetables as the potential source, but no common suppliers of salad were identified and no organisms were isolated from environmental and food samples. Limitations in the case-control study highlight the potential value of using a combination of epidemiological methods to investigate outbreaks. .

Two fatal cases of Streptococcus pyogenes emm st22.6 bacteraemia occurred in a care home in England during April and June 2010, initiating a cluster investigation. The first case had left the home 13 days before the second case took up residence. We sought further cases and carriers. We swabbed throat and chronic skin lesions from residents and staff and examined these specimens for the presence of S. pyogenes. 61 specimens were taken from 18 of 19 residents and 39 of 39 staff. All results from swabbing were culture negative. We observed infection control practices and the environment at the care home for deficiencies. Issues were identified relating to the correct use of personal protective equipment, hand hygiene, clinical waste and laundry. Infection control practices were improved and training given. Infection control practices and the environment at a care home should be examined as part of the investigation of a S. pyogenes cluster. Screening for carriage of S. pyogenes should be done before antibiotic chemoprophylaxis is issued to care home residents and staff.