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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.

References

1. Asencio-Duran, M, Romero-Martin, R, Garcia-Martinez, JR, et al. Nosocomial outbreak of epidemic keratoconjunctivitis in a neonatal intensive care unit. Arch Sociedad Española de Oftalmol 2007;82:73–80.Google Scholar
2. Birenbaum, E, Linder, N, Varsano, N, et al. Adenovirus type 8 conjunctivitis outbreak in a neonatal intensive care unit. Arch Dis Childhood 1993;68:610–611.Google Scholar
3. Calkavur, S, Olukman, O, Ozturk, AT, et al. Epidemic adenoviral keratoconjunctivitis possibly related to ophthalmological procedures in a neonatal intensive care unit: lessons from an outbreak. Ophthal Epidemiol 2012;19:371–379.Google Scholar
4. Chaberny, IE, Schnitzler, P, Geiss, HK, et al. An outbreak of epidemic keratoconjunctivitis in a pediatric unit due to adenovirus type 8. Infect Control Hosp Epidemiol 2003;24:514–519.Google Scholar
5. Ersoy, Y, Otlu, B, Turkcuoglu, P, et al. Outbreak of adenovirus serotype 8 conjunctivitis in preterm infants in a neonatal intensive care unit. J Hosp Infect 2012;80:144–149.Google Scholar
6. Faden, H, Wynn, RJ, Campagna, L, et al. Outbreak of adenovirus type 30 in a neonatal intensive care unit. J Pediatr 2005;146:523–527.Google Scholar
7. Percivalle, E, Sarasini, A, Torsellini, M, et al. A comparison of methods for detecting adenovirus type 8 keratoconjunctivitis during a nosocomial outbreak in a neonatal intensive care unit. J Clin Virol 2003;28:257–264.Google Scholar
8. Piedra, PA, Kasel, JA, Norton, HJ, et al. Description of an adenovirus type 8 outbreak in hospitalized neonates born prematurely. Pediatr Infect Dis J 1992;11:460–465.Google Scholar
9. Gordon, YJ, Gordon, RY, Romanowski, E, et al. Prolonged recovery of desiccated adenoviral serotypes 5, 8, and 19 from plastic and metal surfaces in vitro. Ophthalmology 1993;100:1835–1840.Google Scholar
10. American Academy of Pediatrics. “Adenovirus.” In Kimberlin DW, Brady MT, Jackson MA, Long, SS, eds. Red Book: 2015 Report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2015:226–228.Google Scholar
11. Allen, UD, Demmler, GJ. Adenoviruses. In Long SS Principles and Practice of Pediatric Infectious Diseases. 4th ed. Edinburgh, Scotland: Elsevier Saunders; 2012:1067–1070.Google Scholar
12. Prodesse ProAdeno [package insert]. Hologic Gen-Probe, Inc. San Diego, California; July 2011.Google Scholar
13. Grove, DS. Quantitative real-time polymerase chain reaction for the core facility using TaqMan and the Perkin-Elmer/Applied Biosystems Division 7700 sequence detector. J Biomolec Tech 1999;10:11–16.Google Scholar
14. Smit, PM, Pronk, Sm, Kaandorp, JC, et al. RT-PCR detection of respiratory pathogens in newborn children admitted to a neonatal medium care unit. Pediatr Res 2013;73:355–361.Google Scholar
15. Phillips, G, Lopman, B, Tam, CC, et al. Diagnosing norovirus-associated infectious intestinal disease using viral load. BMC Infect Dis 2009;9:63.Google Scholar
16. Hernes, SS, Quarsten, H, Hamre, R, et al. A comparison of nasopharyngeal and oropharyngeal swabbing for the detection of influenza virus by real-time PCR. Eur J Clin Microbiol Infect Dis 2013;32:381–385.Google Scholar
17. Naghipour, M, Hart, CA, Dove, W, et al. Adenovirus infections within a family cohort in Iran. Pediatr Pulmonol 2009;44:749–753.Google Scholar
18. Kalu, SU, Loeffelholz, M, Beck, E, et al. Persistence of adenovirus nucleic acids in nasopharyngeal secretions: a diagnostic conundrum. Pediatr Infect Dis J 2010;29:746–750.Google Scholar
19. Hamada, N, Gotoh, K, Hara, K, et al. Nosocomial outbreak of epidemic keratoconjunctivitis accompanying environmental contamination with adenoviruses. J Hosp Infect 2008;68:262–268.Google Scholar
20. American Academy of Pediatrics, Section on Ophthalmology. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2013;131:189–195.Google Scholar
21. Guyer, B, O’Day, DM, Hierholzer, JC, et al. Epidemic keratoconjunctivitis: a community outbreak of mixed adenovirus type 8 and type 19 infection. J Infect Dis 1975;132:142–150.Google Scholar
22. Cheung, D, Bremner, J, Chan, JTK. Epidemic keratoconjunctivitis—Do outbreaks have to be epidemic? Eye 2003;17:356–363.Google Scholar
23. Centers for Disease Control. Recommendations for preventing possible transmission of human T-lymphotropic virus type III/lymphadenopathy-associated virus from tears. MMWR Morbid Mortal Weekly Rept 1985;34:533–534.Google Scholar
24. Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313–342.Google Scholar
25. Rutala, WA, Peacock, JE, Gergen, MF, et al. Efficacy of hospital germicides against adenovirus 8, a common cause of epidemic keratoconjunctivitis in health care facilities. Antimicrob Agent Chemother 2006;50:1419–1424.Google Scholar
26. Rutala, WA, Weber, DJ, and the Healthcare Infection Control Practices Advisory Committee. Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention website. http://www.cdc.gov/hicpac/Disinfection_Sterilization/toc.html. Published 2009. Accessed January 11, 2013.Google Scholar
27. Woodman, TJ, Coats, DK, Paysse, EA, et al. Disinfection of eyelid speculums for retinopathy of prematurity examination. Arch Ophthalmol 1998;116:1195–1198.Google Scholar
28. Hered, RW. Use of nonsterile instruments for examinations for retinopathy of prematurity in the neonatal intensive care unit. J Pediatrics 2004;145:308–311.Google Scholar