Eurosurveillance - Volume 21, Issue 46, 17 November 2016

We report an enterovirus D68 (EV-D68) outbreak in Stockholm Sweden in 2016. Between 22 August and 25 September EV-D68 was detected in 74/495 respiratory samples analysed at the Karolinska University Hospital. During the peak week, 30/91 (33%) samples were EV-D68 positive. Viral protein (VP)P4/VP2 sequencing revealed that cases were caused by B3 lineage strains. Forty-four (59%) EV-D68-positive patients were children aged ≤ 5 years. Ten patients had severe respiratory or neurological symptoms and one died.

We report 59 cases of severe paediatric conditions linked with enterovirus (EV)-A71 and EV-D68 in France between May and October 2016. Fifty-two children had severe neurological symptoms. EV sequence-based typing for 42 cases revealed EV-A71 in 21 (18 subgenotype C1, detected for the first time in France) and EV-D68 in eight. Clinicians should be encouraged to obtain stool and respiratory specimens from patients presenting with severe neurological disorders for EV detection and characterisation.

Following the reported link between heater–cooler unit (HCU) colonisation with Mycobacterium chimaera and endocarditis, mycobacterial sampling of all HCUs in use in Western Australia was initiated from August 2015, revealing M. chimaera colonisation in 10 of 15 HCUs. After M. chimaera was isolated from a pleural biopsy from a cardiothoracic patient who may have been exposed to a colonised HCU, a whole genome sequencing investigation was performed involving 65 specimens from 15 HCUs across five hospitals to assess if this infection was related to the HCU. Genetic relatedness was found between the 10 HCU M. chimaera isolates from four hospitals. However the M. chimaera isolate from the cardiothoracic patient was not genetically related to the HCU M. chimaera isolates from that hospital, nor to the other HCU isolates, indicating that the HCUs were not the source of the infection in this patient.

Mycobacterium chimaera, a non-tuberculous mycobacterium, was recently identified as causative agent of deep-seated infections in patients who had previously undergone open-chest cardiac surgery. Outbreak investigations suggested an aerosol-borne pathogen transmission originating from water contained in heater-cooler units (HCUs) used during cardiac surgery. Similar thermoregulatory devices are used for extracorporeal membrane oxygenation (ECMO) and M. chimaera might also be detectable in ECMO treatment settings. We performed a prospective microbiological study investigating the occurrence of M. chimaera in water from ECMO systems and in environmental samples, and a retrospective clinical review of possible ECMO-related mycobacterial infections among patients in a pneumological intensive care unit. We detected M. chimaera in 9 of 18 water samples from 10 different thermoregulatory ECMO devices; no mycobacteria were found in the nine room air samples and other environmental samples. Among 118 ECMO patients, 76 had bronchial specimens analysed for mycobacteria and M. chimaera was found in three individuals without signs of mycobacterial infection at the time of sampling. We conclude that M. chimaera can be detected in water samples from ECMO-associated thermoregulatory devices and might potentially pose patients at risk of infection. Further research is warranted to elucidate the clinical significance of M. chimaera in ECMO treatment settings.

We assessed the impact of 2% daily patient bathing with chlorhexidine gluconate (CHG) washcloths on the incidence of hospital-acquired (HA) and central line-associated (CLA) bloodstream infections (BSI) in intensive care units (ICUs). We searched randomised studies in Medline, EMBASE, Cochrane Library (CENTRAL) and Web of Science databases up to April 2015. Primary outcomes were total HABSI, central line, and non-central line-associated BSI rates per patient-days. Secondary outcomes included Gram-negative and Gram-positive BSI rates and adverse events. Four randomised crossover trials involved 25 ICUs and 22,850 patients. Meta-analysis identified a total HABSI rate reduction (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.60–0.90; p = 0.002) with moderate heterogeneity (I² = 36%). Subgroup analysis identified significantly stronger rate reductions (p = 0.01) for CLABSI (OR: 0.50; 95% CI: 0.35–0.71; p < 0.001) than other HABSI (OR: 0.82; 95% CI: 0.70–0.97; p = 0.02) with low heterogeneity (I² = 0%). This effect was evident in the Gram-positive subgroup (OR: 0.55; 95% CI: 0.31–0.99; p = 0.05), but became non-significant after removal of a high-risk-of-bias study. Sensitivity analysis revealed that the intervention effect remained significant for total and central line-associated HABSI. We suggest that use of CHG washcloths prevents HABSI and CLABSI in ICUs, possibly due to the reduction in Gram-positive skin commensals.