1
|
de Oliveira VF, de Britto-Costa LF, de Aragão GL, Scaccia N, Mamana AC, Côrtes MF, de Oliveira MS, de Melo Tavares B, Manuli ER, Leal FE, de Oliveira Xavier GT, Grespan RMZ, Sequeira CCR, Nunes FLS, Dropa M, Martone-Rocha S, Razzolini MTP, Sabino EC, Padoveze MC, Holmes A, Costa SF, Levin AS. Colonisation by multidrug-resistant organisms in health workers in primary care: narrow spectrum oral antimicrobials are a risk factor. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04953-1. [PMID: 39320520 DOI: 10.1007/s10096-024-04953-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 09/20/2024] [Indexed: 09/26/2024]
Abstract
BACKGROUND Limited information exists on carriage of multidrug-resistant organisms (MDRO) by health workers (HWs) in primary care settings. This study aims to determine the prevalence of MDRO carriage among HWs in primary care and to identify associated risk factors. METHODS A cross-sectional study was conducted across all 12 primary care units in São Caetano do Sul-SP, Brazil, from October to December 2023. Self-collected samples (nasal, oropharyngeal, and inguinal) were obtained. Environment cultures (potable water, sewage and stream water) were evaluated. Stenotrophomonas maltophilia isolates (human and environmental) were typed. RESULTS The study included 265/288 (92%) of HWs in primary care teams, mostly women with a median age of 47 years (IQR 38-57); 78% had no comorbidities. MDRO colonisation was found in 8.7% (23 HWs). The following bacteria were found: S. maltophilia (n = 9; 3.4%) in inguinal swabs; methicillin-resistant Staphylococcus aureus (n = 8; 3%) from all sites; extended-spectrum ß-lactamase-producing bacteria (n = 5; 2%) in inguinal swabs; and vancomycin-resistant enterococci in an inguinal swab (n = 1; 0.4%). Previous antibiotic use was significantly associated with MDRO colonisation (OR 2.91, 95% CI 1.19-7.09, p = 0.018), mainly narrow spectrum oral beta-lactams and macrolides. S. malthophilia was polyclonal and human and environmental isolates differed. CONCLUSION Colonisation by MRSA, VRE, and ESBL-producing bacteria was low; however, 4% were surprisingly colonized by polyclonal S. maltophilia. This pathogen may also suggest using narrow-spectrum rather than the expected broad-spectrum antimicrobials. Antibiotic use was the only risk factor found, mainly with oral narrow-spectrum drugs.
Collapse
Affiliation(s)
- Vítor Falcão de Oliveira
- Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | | | | | - Nazareno Scaccia
- Institute of Tropical Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Carolina Mamana
- Institute of Tropical Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marina Farrel Côrtes
- Institute of Tropical Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maura Salaroli de Oliveira
- Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruno de Melo Tavares
- Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Erika Regina Manuli
- Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Institute of Tropical Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Departamento de Pesquisa Clínica E Inovação Em Saúde, Universidade Municipal de São Caetano Do Sul, Sao Paulo, Brazil
| | - Fábio Eudes Leal
- Departamento de Pesquisa Clínica E Inovação Em Saúde, Universidade Municipal de São Caetano Do Sul, Sao Paulo, Brazil
- Divisão de Pesquisa Clínica (DIPETEC), Instituto Nacional Do Câncer, Rio de Janeiro, Brazil
| | | | - Regina Maura Zetone Grespan
- Departamento de Pesquisa Clínica E Inovação Em Saúde, Universidade Municipal de São Caetano Do Sul, Sao Paulo, Brazil
| | - Cibele Cristine Remondes Sequeira
- Municipal Health Department, Primary Health System, Sao Caetano Do Sul, Sao Paulo, Brazil
- Departamento de Pesquisa Clínica E Inovação Em Saúde, Universidade Municipal de São Caetano Do Sul, Sao Paulo, Brazil
| | - Fatima L S Nunes
- Laboratory for Informatics Applications in Health, School of Arts, Humanities and Science, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Milena Dropa
- School of Public Health, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | - Ester Cerdeira Sabino
- Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Institute of Tropical Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Departamento de Pesquisa Clínica E Inovação Em Saúde, Universidade Municipal de São Caetano Do Sul, Sao Paulo, Brazil
| | | | - Alison Holmes
- University of Liverpool and Imperial College London, London, UK
| | - Silvia F Costa
- Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Institute of Tropical Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Anna S Levin
- Division of Infectious Diseases, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Institute of Tropical Medicine, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
2
|
Kim UJ, Choi SM, Kim MJ, Kim S, Shin SU, Oh SR, Park JW, Shin HY, Kim YJ, Lee UH, Choi OJ, Park HY, Shin JH, Kim SE, Kang SJ, Jung SI, Park KH. Hospital water environment and antibiotic use: key factors in a nosocomial outbreak of carbapenemase-producing Serratia marcescens. J Hosp Infect 2024; 151:69-78. [PMID: 38740300 DOI: 10.1016/j.jhin.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The healthcare water environment is a potential reservoir of carbapenem-resistant organisms (CROs). AIM To report the role of the water environment as a reservoir and the infection control measures applied to suppress a prolonged outbreak of Klebsiella pneumoniae carbapenemase-producing Serratia marcescens (KPC-SM) in two intensive care units (ICUs). METHODS The outbreak occurred in the ICUs of a tertiary hospital from October 2020 to July 2021. Comprehensive patient contact tracing and environmental assessments were conducted, and a case-control study was performed to identify factors associated with the acquisition of KPC-SM. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). Antibiotic usage was analysed. FINDINGS The outbreak consisted of two waves involving a total of 30 patients with KPC-SM. Multiple environmental cultures identified KPC-SM in a sink, a dirty utility room, and a communal bathroom shared by the ICUs, together with the waste bucket of a continuous renal replacement therapy (CRRT) system. The genetic similarity of the KPC-SM isolates from patients and the environment was confirmed by PFGE. A retrospective review of 30 cases identified that the use of CRRT and antibiotics was associated with acquisition of KPC-SM (P < 0.05). There was a continuous increase in the use of carbapenems; notably, the use of colistin has increased since 2019. CONCLUSION Our study demonstrates that CRRT systems, along with other hospital water environments, are significant potential sources of resistant micro-organisms, underscoring the necessity of enhancing infection control practices in these areas.
Collapse
Affiliation(s)
- U J Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S-M Choi
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - M J Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - S Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - S U Shin
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - S-R Oh
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - J-W Park
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - H Y Shin
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Y J Kim
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - U H Lee
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - O-J Choi
- Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - H-Y Park
- Department of Pharmacy, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - J-H Shin
- Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S E Kim
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S-J Kang
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - S I Jung
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - K-H Park
- Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
| |
Collapse
|
3
|
Travi G, Peracchi F, Merli M, Lo Re N, Matarazzo E, Tartaglione L, Bielli A, Casalicchio G, Crippa F, Vismara CS, Puoti M. Cefiderocol-Based Regimen for Acinetobacter NDM-1 Outbreak. Antibiotics (Basel) 2024; 13:770. [PMID: 39200070 PMCID: PMC11350908 DOI: 10.3390/antibiotics13080770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 08/09/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024] Open
Abstract
Variable outcomes have been reported with cefiderocol in infections due to carbapenem-resistant Acinetobacter baumannii (CRAB). Nonetheless, it may be the only option for metallo-beta-lactamase-producing strains. We describe an outbreak of NDM-CRAB infections treated with cefiderocol. Thirty-eight patients were colonized and/or infected. Thirteen patients developed a systemic infection. A clinical cure was achieved in 10 (83%) patients, one VAP and 9 BSIs, at day 7. In vitro, the activity of cefiderocol does not appear to match in vivo effectiveness using currently available commercial tests. Despite high clinical cures, overall mortality remains high in severely ill patients. Cefiderocol may be considered in this specific setting, though the implementation of susceptibility tests and infection control measures is mandatory.
Collapse
Affiliation(s)
- Giovanna Travi
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.T.); (M.M.); (F.C.); (M.P.)
| | - Francesco Peracchi
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.T.); (M.M.); (F.C.); (M.P.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20854 Monza, Italy
| | - Marco Merli
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.T.); (M.M.); (F.C.); (M.P.)
| | - Noemi Lo Re
- Clinical Microbiology Department, University Sacro Cuore, 00168 Rome, Italy;
| | - Elisa Matarazzo
- Division of Clinical Microbiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (E.M.); (L.T.); (A.B.); (G.C.); (C.S.V.)
| | - Livia Tartaglione
- Division of Clinical Microbiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (E.M.); (L.T.); (A.B.); (G.C.); (C.S.V.)
| | - Alessandra Bielli
- Division of Clinical Microbiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (E.M.); (L.T.); (A.B.); (G.C.); (C.S.V.)
| | - Giorgia Casalicchio
- Division of Clinical Microbiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (E.M.); (L.T.); (A.B.); (G.C.); (C.S.V.)
| | - Fulvio Crippa
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.T.); (M.M.); (F.C.); (M.P.)
| | - Chiara S. Vismara
- Division of Clinical Microbiology, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (E.M.); (L.T.); (A.B.); (G.C.); (C.S.V.)
| | - Massimo Puoti
- Division of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (G.T.); (M.M.); (F.C.); (M.P.)
- School of Medicine and Surgery, University of Milano-Bicocca, 20854 Monza, Italy
| |
Collapse
|
4
|
Elsheikh R, Makram AM. Multidrug-Resistant Organisms: The Silent Plight of Burn Patients. J Burn Care Res 2024; 45:877-886. [PMID: 38695094 PMCID: PMC11303128 DOI: 10.1093/jbcr/irae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 07/20/2024]
Abstract
The global increasing spread of multidrug-resistant organisms (MDROs) is threatening the control of various infections in vulnerable populations and patient groups. One of the most affected groups is patients with burns, who are prone to hyperinfection as they suffer from a hypermetabolic state and weaken immune barriers. Those patients also share the infection risk of patients hospitalized for a long time, including ventilator-associated pneumonia and urinary tract infections. While some preventative and therapeutic management styles are still controversial, we discuss consensuses here. In this review, we aim to present the current knowledge on multidrug resistance with a special focus on patients with burns, discuss various causative organisms and their treatment options, and highlight the importance of antibiotic stewardship and teamwork in responding to an outbreak of MDROs.
Collapse
Affiliation(s)
- Randa Elsheikh
- Deanery of Biomedical Sciences at Edinburgh Medical School, University of Edinburgh, Edinburgh EH8 9YL, UK
| | | |
Collapse
|
5
|
Pan H, Zhang C, Song J, Yang R, Zhang Z. Does the removal of isolation for VRE-infected patients change the incidence of health care-associated VRE?: A systematic review and meta-analysis. Am J Infect Control 2024:S0196-6553(24)00633-3. [PMID: 39111343 DOI: 10.1016/j.ajic.2024.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/27/2024] [Accepted: 07/27/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Several single-center studies have suggested that eliminating isolation for vancomycin-resistant enterococci (VRE) control in the context of endemic or nonoutbreak settings, has no impact on infection rates. We performed a systematic review and meta-analysis on the impact of discontinuing isolation. METHODS We searched PubMed, Embase, the Cochrane Library, and Web of Science through April 10, 2024 for studies evaluating discontinuation of isolation for VRE. Subgroup analyses assessed sources of heterogeneity. RESULTS Nine studies were included in the final review. Four reported the incidence of hospital-acquired VRE (HA-VRE) infections and 5 reported the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). No significant difference between the rates of HA-VRE infection before and after stopping isolation was observed (risk ratios, 0.93; 95% confidence interval, 0.68-1.26; P = .62), as well as no significant difference on the incidence of HA-VRE BSI (risk ratios, 0.68; 95% confidence interval, 0.44-1.07, P = .09). Furthermore, we conducted 2 subgroup analyses: one stratified by whether the studies were conducted during Coronavirus Disease 19 (COVID-19), and the other stratified by whether clinicians continued to use personal protective equipment. Both analyses revealed no significant differences in the incidence of HA-VRE BSI and termination of isolation between the subgroups. CONCLUSIONS In the context of endemic or nonoutbreak settings, discontinuation of isolation for VRE patients has not been associated with an increased rate of HA-VRE infections.
Collapse
Affiliation(s)
- Huiling Pan
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
| | - Chuanlai Zhang
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China.
| | - Jie Song
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
| | - Ruiqi Yang
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
| | - Zonghong Zhang
- Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, Yuzhong, Chongqing, People's Republic of China
| |
Collapse
|
6
|
Deer TR, Russo MA, Sayed D, Pope JE, Grider JS, Hagedorn JM, Falowski SM, Al-Kaisy A, Slavin KV, Li S, Poree LR, Eldabe S, Meier K, Lamer TJ, Pilitsis JG, De Andrés J, Perruchoud C, Carayannopoulos AG, Moeschler SM, Hadanny A, Lee E, Varshney VP, Desai MJ, Pahapill P, Osborn J, Bojanic S, Antony A, Piedimonte F, Hayek SM, Levy RM. The Neurostimulation Appropriateness Consensus Committee (NACC)®: Recommendations for the Mitigation of Complications of Neurostimulation. Neuromodulation 2024; 27:977-1007. [PMID: 38878054 DOI: 10.1016/j.neurom.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION The International Neuromodulation Society convened a multispecialty group of physicians based on expertise and international representation to establish evidence-based guidance on the mitigation of neuromodulation complications. This Neurostimulation Appropriateness Consensus Committee (NACC)® project intends to update evidence-based guidance and offer expert opinion that will improve efficacy and safety. MATERIALS AND METHODS Authors were chosen on the basis of their clinical expertise, familiarity with the peer-reviewed literature, research productivity, and contributions to the neuromodulation literature. Section leaders supervised literature searches of MEDLINE, BioMed Central, Current Contents Connect, Embase, International Pharmaceutical Abstracts, Web of Science, Google Scholar, and PubMed from 2017 (when NACC last published guidelines) to October 2023. Identified studies were graded using the United States Preventive Services Task Force criteria for evidence and certainty of net benefit. Recommendations are based on the strength of evidence or consensus when evidence was scant. RESULTS The NACC examined the published literature and established evidence- and consensus-based recommendations to guide best practices. Additional guidance will occur as new evidence is developed in future iterations of this process. CONCLUSIONS The NACC recommends best practices regarding the mitigation of complications associated with neurostimulation to improve safety and efficacy. The evidence- and consensus-based recommendations should be used as a guide to assist decision-making when clinically appropriate.
Collapse
Affiliation(s)
- Timothy R Deer
- The Spine and Nerve Center of the Virginias, Charleston, WV, USA.
| | | | - Dawood Sayed
- The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Adnan Al-Kaisy
- Guy's and St. Thomas National Health Service (NHS) Foundation Trust, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA; Neurology Section, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | - Sean Li
- National Spine & Pain Centers, Shrewsbury, NJ, USA
| | - Lawrence R Poree
- Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA, USA
| | - Sam Eldabe
- The James Cook University Hospital, Middlesbrough, UK
| | - Kaare Meier
- Department of Anesthesiology (OPINord), Aarhus University Hospital, Aarhus, Arhus, Denmark; Department of Neurosurgery (Afd. NK), Aarhus University Hospital, Aarhus, Arhus, Denmark
| | | | | | - Jose De Andrés
- Valencia School of Medicine, Anesthesia Critical Care and Pain Management Department, General University Hospital, Valencia, Spain
| | | | - Alexios G Carayannopoulos
- Department of Physical Medicine and Rehabilitation and Comprehensive Spine Center, Rhode Island Hospital, Providence, RI, USA; Brown University Warren Alpert Medical School (Neurosurgery), Providence, RI, USA
| | - Susan M Moeschler
- Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir Hadanny
- Department of Neurosurgery, Albany Medical College, Albany, NY, USA
| | - Eric Lee
- Mililani Pain Center, Mililani, HI, USA
| | - Vishal P Varshney
- Anesthesiology and Pain Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Virginia Hospital Center, Monument Research Institute, George Washington University School of Medicine, Arlington, VA, USA
| | - Peter Pahapill
- Functional Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Osborn
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Stana Bojanic
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ajay Antony
- The Orthopaedic Institute, Gainesville, FL, USA
| | - Fabian Piedimonte
- School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Salim M Hayek
- Case Western Reserve University, University Hospitals of Cleveland, Cleveland, OH, USA
| | - Robert M Levy
- Neurosurgical Services, Clinical Research, Anesthesia Pain Care Consultants, Tamarac, FL, USA
| |
Collapse
|
7
|
Tsukada M, Miyazaki T, Aoki K, Yoshizawa S, Kondo Y, Sawa T, Murakami H, Sato E, Tomida M, Otani M, Kumade E, Takamori E, Kambe M, Ishii Y, Tateda K. The outbreak of multispecies carbapenemase-producing Enterobacterales associated with pediatric ward sinks: IncM1 plasmids act as vehicles for cross-species transmission. Am J Infect Control 2024; 52:801-806. [PMID: 38613526 DOI: 10.1016/j.ajic.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND This study describes an outbreak caused by multispecies carbapenemase-producing Enterobacterales (CPE) occurring in a pediatric ward at an academic medical center in Tokyo. METHODS The index case involved a 1-year-old boy with Klebsiella variicola (CPE) detected in anal swabs in June 2016. The second case was Klebsiella quasipneumoniae (CPE) occurred in March 2017 followed by further spread, leading to the declaration of an outbreak in April 2017. Extensive environmental and patient microbiological sampling was performed. The relatedness of the isolates was determined using draft-whole-genome sequencing. RESULTS CPE surveillance cultures of patients and environments were positive in 19 patients and 9 sinks in the ward. The sinks in hospital rooms uninhabited by CPE patients exhibited no positive CPE-positive specimen during the outbreak. All CPE strains analyzed using draft-whole-genome sequencing harbored blaIMP-1, except for one harboring blaIMP-11; these strains harbored identical blaIMP-1-carrying IncM1 plasmids. CPE was detected even after sink replacement; infection-control measures focused on sinks were implemented and the CPE outbreak ended after 7 months. CONCLUSIONS Multiple bacterial species can become CPE via blaIMP-1-carrying IncM1 plasmids of the same origin and spread through sinks in a hospital ward. Thorough infection-control measures implemented as a bundle might be crucial.
Collapse
Affiliation(s)
- Mayumi Tsukada
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan
| | - Taito Miyazaki
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan; Department of General Medicine and Emergency Care, Toho University School of Medicine, Tokyo, Japan
| | - Kotaro Aoki
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Sadako Yoshizawa
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan; Department of Clinical Laboratory, Toho University Omori Medical Center, Tokyo, Japan.
| | - Yoko Kondo
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan
| | - Tomoka Sawa
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan; Department of Pediatrics, Toho University School of Medicine, Tokyo, Japan
| | - Hinako Murakami
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan; Department of Clinical Laboratory, Toho University Omori Medical Center, Tokyo, Japan
| | - Emi Sato
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan
| | - Manabu Tomida
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan
| | - Mariko Otani
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan
| | - Eri Kumade
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan; Department of General Medicine and Emergency Care, Toho University School of Medicine, Tokyo, Japan
| | - Emi Takamori
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan
| | - Masako Kambe
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan
| | - Yoshikazu Ishii
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan; Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan
| | - Kazuhiro Tateda
- Department of Infection Prevention and Control, Toho University Omori Medical Center, Tokyo, Japan; Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan; Department of Clinical Laboratory, Toho University Omori Medical Center, Tokyo, Japan
| |
Collapse
|
8
|
Berk H, Oztoprak N, Kizilates F, Kurtoğlu E, Seremet Keskin A. Carbapenem Versus Non-carbapenem Therapy in Hematology Patients: Extended-Spectrum Beta-Lactamase Positive Enterobacteriaceae Colonization Impact. Cureus 2024; 16:e63570. [PMID: 39087172 PMCID: PMC11289854 DOI: 10.7759/cureus.63570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Extended-spectrum beta-lactamase-producing Enterobacteriacea (ESBL-E) infections are a major source of mortality and morbidity in patients with hematologic cancers. One of the most significant risk factors for bacterial illness is prior colonization with resistant germs. Empiric usage of carbapenems is recommended for the treatment of infections in patients with a positive colonization history. OBJECTIVES We aimed to determine the outcome of empirical carbapenem (de-escalation) versus non-carbapenem (escalation) therapy in adult hematology patients who have rectal extended-spectrum beta-lactamase positive ESBL-E colonization. METHODS Two hundred three rectal swab cultures were collected from 130 patients, admission or during hospitalization between June 2014 and May 2015. Patients were followed till January 2016 for future infections due to ESBL-E. Empirical antibiotic treatment was started according to the patient's medical condition without consideration of previous colonization status. Stable patients received empirical escalation therapy. All-cause and early mortality of infections are analyzed. RESULTS Seventy-three (36%) swabs were positive for ESBL-E. Patients with rectal ESBL-E colonization were defined as cases; patients without colonization were defined as controls. Prospective infection due to ESBL-E in the case and control group was 6.8% and 2.3%, respectively. No statistically significant relation was found between colonization and prospective infection due to ESBL-E (p=0.110). There was no all-cause or early mortality in prospective infections with ESBL-E. Among case patients, one patient each died from all-cause mortality in the escalation (n=55) and de-escalation (n=3) group. The all-cause mortality in the antibiotic switch group (n=30) was eight, including five patients in the early mortality group although the bacteriologic agents were susceptible to the given antibiotics. CONCLUSION In our institution, rectal colonization with ESBL-E was high, but contracting an infection due to ESBL-E was surprisingly low. Colonization with ESBL-E may not necessarily end with an infection in some situations. In stable patients, disregarding colonization features before empirical therapy did not seem to be inappropriate.
Collapse
Affiliation(s)
- Hande Berk
- Infectious Diseases and Clinical Microbiology Clinic, Antalya Education and Research Hospital, Antalya, TUR
| | - Nefise Oztoprak
- Infectious Diseases and Clinical Microbiology Clinic, Antalya Education and Research Hospital, Antalya, TUR
| | - Filiz Kizilates
- Infectious Diseases and Clinical Microbiology Clinic, Anatolia Hospital Lara, Antalya, TUR
| | - Erdal Kurtoğlu
- Hematology Clinic, Antalya Education and Research Hospital, Antalya, TUR
| | - Aysegul Seremet Keskin
- Infectious Diseases and Clinical Microbiology Clinic, Antalya Education and Research Hospital, Antalya, TUR
| |
Collapse
|
9
|
Wong SC, Chen JH, Kwok MO, Siu CY, Yuen LL, AuYeung CH, Li CK, Li BH, Chan BW, So SY, Chiu KH, Yuen KY, Cheng VC. Air dispersal of multi-drug-resistant organisms including meticillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii and carbapenemase-producing Enterobacterales in general wards: surveillance culture of air grilles. J Hosp Infect 2024; 149:26-35. [PMID: 38705476 DOI: 10.1016/j.jhin.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND The environmental surveillance of air grilles in clinical areas has not been systematically analysed. METHODS Samples were collected from frequently touched items (N = 529), air supply (N = 295) and exhaust (N = 184) grilles in six medical and 11 surgical wards for the cultures of multi-drug-resistant organisms (MDROs): meticillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenemase-producing Enterobacterales (CPE), and isolates were selected for whole-genome sequencing (WGS). The contamination rates were correlated with the colonization pressures of the respective MDROs. RESULTS From 3rd October to 21st November 2023, 9.8% (99/1008) of the samples tested positive, with MRSA (24.2%, 24/99), CRAB (59.6%, 59/99) and CPE (2.0%, 2/99), being the only detected MDROs. The contamination rate in air exhaust grilles (26.6%, 49/184) was significantly higher than in air supply grilles (5.8%, 17/295; P<0.001). The contamination rate of air exhaust grilles with any MDRO in acute medical wards (73.7%, 14/19) was significantly higher than in surgical wards (12.5%, 4/32; P<0.001). However, there was no difference in the contamination rate of air exhaust grilles between those located inside and outside the cohort cubicles for MDROs (27.1%, 13/48 vs 28.8%, 30/104; P=0.823). Nevertheless, the weekly CRAB colonization pressure showed a significant correlation with the overall environmental contamination rate (r = 0.878; 95% confidence interval (CI): 0.136-0.986; P=0.004), as well as with the contamination rate in air supply grilles (r = 0.960; 95% CI: 0.375-0.999; P<0.001) and air exhaust grilles (r = 0.850; 95% CI: 0.401-0.980; P=0.008). WGS demonstrated clonal relatedness of isolates collected from patients and air exhaust grilles. CONCLUSIONS Air grilles may serve as MDRO reservoirs. Cohort nursing in open cubicles may not completely prevent MDRO transmission through air dispersal, prompting the consideration of future hospital design.
Collapse
Affiliation(s)
- S C Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - J H Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - M O Kwok
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - C Y Siu
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - L L Yuen
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - C H AuYeung
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - C K Li
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - B H Li
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - B W Chan
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - S Y So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - K H Chiu
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - K Y Yuen
- State Key Laboratory for Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - V C Cheng
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China; Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
| |
Collapse
|
10
|
Van Nieuwenhuyse B, Merabishvili M, Goeders N, Vanneste K, Bogaerts B, de Jode M, Ravau J, Wagemans J, Belkhir L, Van der Linden D. Phage-Mediated Digestive Decolonization in a Gut-On-A-Chip Model: A Tale of Gut-Specific Bacterial Prosperity. Viruses 2024; 16:1047. [PMID: 39066209 PMCID: PMC11281504 DOI: 10.3390/v16071047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Infections due to antimicrobial-resistant bacteria have become a major threat to global health. Some patients may carry resistant bacteria in their gut microbiota. Specific risk factors may trigger the conversion of these carriages into infections in hospitalized patients. Preventively eradicating these carriages has been postulated as a promising preventive intervention. However, previous attempts at such eradication using oral antibiotics or probiotics have led to discouraging results. Phage therapy, the therapeutic use of bacteriophage viruses, might represent a worthy alternative in this context. Taking inspiration from this clinical challenge, we built Gut-On-A-Chip (GOAC) models, which are tridimensional cell culture models mimicking a simplified gut section. These were used to better understand bacterial dynamics under phage pressure using two relevant species: Pseudomonas aeruginosa and Escherichia coli. Model mucus secretion was documented by ELISA assays. Bacterial dynamics assays were performed in GOAC triplicates monitored for 72 h under numerous conditions, such as pre-, per-, or post-bacterial timing of phage introduction, punctual versus continuous phage administration, and phage expression of mucus-binding properties. The potential genomic basis of bacterial phage resistance acquired in the model was investigated by variant sequencing. The bacterial "escape growth" rates under phage pressure were compared to static in vitro conditions. Our results suggest that there is specific bacterial prosperity in this model compared to other in vitro conditions. In E. coli assays, the introduction of a phage harboring unique mucus-binding properties could not shift this balance of power, contradicting previous findings in an in vivo mouse model and highlighting the key differences between these models. Genomic modifications were correlated with bacterial phage resistance acquisition in some but not all instances, suggesting that alternate ways are needed to evade phage predation, which warrants further investigation.
Collapse
Affiliation(s)
- Brieuc Van Nieuwenhuyse
- Institute of Experimental and Clinical Research, Pediatric Department (IREC/PEDI), Université Catholique de Louvain—UCLouvain, 1200 Brussels, Belgium
| | - Maya Merabishvili
- Laboratory for Molecular and Cellular Technology, Queen Astrid Military Hospital, 1120 Brussels, Belgium
| | - Nathalie Goeders
- Transversal Activities in Applied Genomics, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium (B.B.)
| | - Kevin Vanneste
- Transversal Activities in Applied Genomics, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium (B.B.)
| | - Bert Bogaerts
- Transversal Activities in Applied Genomics, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium (B.B.)
| | - Mathieu de Jode
- Bacterial Diseases, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Joachim Ravau
- Institute of Experimental and Clinical Research, Pediatric Department (IREC/PEDI), Université Catholique de Louvain—UCLouvain, 1200 Brussels, Belgium
| | - Jeroen Wagemans
- Laboratory of Gene Technology, KU Leuven, 3000 Leuven, Belgium;
| | - Leïla Belkhir
- Division of Internal Medicine and Infectious Disease, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain—UCLouvain, 1200 Brussels, Belgium
- Louvain Centre for Toxicology and Applied Pharmacology, Institute of Experimental and Clinical Research (IREC/LTAP), Université Catholique de Louvain—UCLouvain, 1200 Brussels, Belgium
| | - Dimitri Van der Linden
- Institute of Experimental and Clinical Research, Pediatric Department (IREC/PEDI), Université Catholique de Louvain—UCLouvain, 1200 Brussels, Belgium
- Pediatric Infectious Diseases, General Pediatrics Department, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain—UCLouvain, 1200 Brussels, Belgium
| |
Collapse
|
11
|
Karunakaran S, Pless LL, Ayres AM, Ciccone C, Penzelik J, Sundermann AJ, Martin EM, Griffith MP, Waggle K, Hodges JC, Harrison LH, Snyder GM. Impact of discontinuation of contact precautions on surveillance- and whole genome sequencing-defined methicillin-resistant Staphylococcus aureus healthcare-associated infections. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e97. [PMID: 38836046 PMCID: PMC11149034 DOI: 10.1017/ash.2024.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/06/2024]
Abstract
Objective Prior studies evaluating the impact of discontinuation of contact precautions (DcCP) on methicillin-resistant Staphylococcus aureus (MRSA) outcomes have characterized all healthcare-associated infections (HAIs) rather than those likely preventable by contact precautions. We aimed to analyze the impact of DcCP on the rate of MRSA HAI including transmission events identified through whole genome sequencing (WGS) surveillance. Design Quasi experimental interrupted time series. Setting Acute care medical center. Participants Inpatients. Methods The effect of DcCP (use of gowns and gloves) for encounters among patients with MRSA carriage was evaluated using time series analysis of MRSA HAI rates from January 2019 through December 2022, compared to WGS-defined attributable transmission events before and after DcCP in December 2020. Results The MRSA HAI rate was 4.22/10,000 patient days before and 2.98/10,000 patient days after DcCP (incidence rate ratio [IRR] 0.71 [95% confidence interval 0.56-0.89]) with a significant immediate decrease (P = .001). There were 7 WGS-defined attributable transmission events before and 11 events after DcCP (incident rate ratio 0.90 [95% confidence interval 0.30-2.55]). Conclusions DcCP did not result in an increase in MRSA HAI or, in WGS-defined attributable transmission events. Comprehensive analyses of the effect of transmission prevention measures should include outcomes specifically measuring transmission-associated HAI.
Collapse
Affiliation(s)
- Sharon Karunakaran
- Division of Pediatric Infectious Diseases, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Lora Lee Pless
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Microbial Genomics Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley M. Ayres
- Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PA, USA
| | - Carl Ciccone
- Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PA, USA
| | - Joseph Penzelik
- Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PA, USA
| | - Alexander J. Sundermann
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Microbial Genomics Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elise M. Martin
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Veterans’ Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Marissa P. Griffith
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Microbial Genomics Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kady Waggle
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Microbial Genomics Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Lee H. Harrison
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Microbial Genomics Epidemiology Laboratory, Center for Genomic Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Graham M. Snyder
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Infection Prevention and Control, UPMC Presbyterian/Shadyside, Pittsburgh, PA, USA
| |
Collapse
|
12
|
Howard-Anderson JR, Gottlieb LB, Beekmann SE, Polgreen PM, Jacob JT, Uslan DZ. Implementation of contact precautions for multidrug-resistant organisms in the post-COVID-19 pandemic era: An updated national Emerging Infections Network (EIN) survey. Infect Control Hosp Epidemiol 2024; 45:703-708. [PMID: 38351872 PMCID: PMC11102826 DOI: 10.1017/ice.2024.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/14/2023] [Accepted: 01/03/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE To understand how healthcare facilities employ contact precautions for patients with multidrug-resistant organisms (MDROs) in the post-coronavirus disease 2019 (COVID-19) era and explore changes since 2014. DESIGN Cross-sectional survey. PARTICIPANTS Emerging Infections Network (EIN) physicians involved in infection prevention or hospital epidemiology. METHODS In September 2022, we sent via email an 8-question survey on contact precautions and adjunctive measures to reduce MDRO transmission in inpatient facilities. We also asked about changes since the COVID-19 pandemic. We used descriptive statistics to summarize data and compared results to a similar survey administered in 2014. RESULTS Of 708 EIN members, 283 (40%) responded to the survey and 201 reported working in infection prevention. A majority of facilities (66% and 69%) routinely use contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) respectively, compared to 93% and 92% in 2014. Nearly all (>90%) use contact precautions for Candida auris, carbapenem-resistant Enterobacterales (CRE), and carbapenem-resistant Acinetobacter baumannii. More variability was reported for carbapenem-resistant Pseudomonas aeruginosa and extended-spectrum β-lactamase-producing gram-negative organisms. Compared to 2014, fewer hospitals perform active surveillance for MRSA and VRE. Overall, 90% of facilities used chlorhexidine gluconate bathing in all or select inpatients, and 53% used ultraviolet light or hydrogen peroxide vapor disinfection at discharge. Many respondents (44%) reported changes to contact precautions since COVID-19 that remain in place. CONCLUSIONS Heterogeneity exists in the use of transmission-based precautions and adjunctive infection prevention measures aimed at reducing MDRO transmission. This variation reflects a need for updated and specific guidance, as well as further research on the use of contact precautions in healthcare facilities.
Collapse
Affiliation(s)
- Jessica R. Howard-Anderson
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lindsey B. Gottlieb
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Susan E. Beekmann
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Philip M. Polgreen
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Jesse T. Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Daniel Z. Uslan
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California– Los Angeles, Los Angeles, California
| |
Collapse
|
13
|
Chagas ADLD, Araújo JCDS, Serra JCP, de Araújo KM, Cunha MDO, Correia ADR, Gonçalves LMB, Carneiro LC. Co-Infection of SARS-CoV-2 and Klebsiella pneumoniae: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2024; 14:1149. [PMID: 38893674 PMCID: PMC11171625 DOI: 10.3390/diagnostics14111149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
The study aimed to assess the prevalence of COVID-19 and Klebsiella spp. coinfection across continents. Conducted following PRISMA guidelines, a systematic review utilized PubMed, Embase, SCOPUS, ScienceDirect, and Web of Science databases, searching for literature in English published from December 2019 to December 2022, using specific Health Sciences descriptors. A total of 408 records were identified, but only 50 were eligible, and of these, only 33 were included. Thirty-three references were analyzed to evaluate the correlation between COVID-19 and Klebsiella spp. infections. The tabulated data represented a sample group of 8741 coinfected patients. The findings revealed notable disparities in co-infection rates across continents. In Asia, 23% of individuals were infected with Klebsiella pneumoniae, while in Europe, the proportion of co-infected patients stood at 15%. Strikingly, on the African continent, 43% were found to be infected with Klebsiella pneumoniae, highlighting significant regional variations. Overall, the proportion of Klebsiella pneumoniae co-infections among COVID-positive individuals were determined to be 19%. Particularly concerning was the observation that 1 in 6 ICU coinfections was attributed to Klebsiella pneumoniae, indicating its substantial impact on patient outcomes and healthcare burden. The study underscores the alarming prevalence of co-infection between COVID-19 and Klebsiella pneumoniae, potentially exacerbating the clinical severity of patients and posing challenges to treatment strategies. These findings emphasize the importance of vigilant surveillance and targeted interventions to mitigate the adverse effects of bacterial coinfections in the context of the COVID-19 pandemic.
Collapse
Affiliation(s)
- Angelica de Lima das Chagas
- Health Science Post Graduation, Federal University of Goias, Goiania 74605-050, Goias, Brazil; (A.d.L.d.C.); (J.C.P.S.); (K.M.d.A.); (M.d.O.C.); (A.d.R.C.)
| | | | - Jaqueline Correia Pontes Serra
- Health Science Post Graduation, Federal University of Goias, Goiania 74605-050, Goias, Brazil; (A.d.L.d.C.); (J.C.P.S.); (K.M.d.A.); (M.d.O.C.); (A.d.R.C.)
| | - Kelliane Martins de Araújo
- Health Science Post Graduation, Federal University of Goias, Goiania 74605-050, Goias, Brazil; (A.d.L.d.C.); (J.C.P.S.); (K.M.d.A.); (M.d.O.C.); (A.d.R.C.)
| | - Marcos de Oliveira Cunha
- Health Science Post Graduation, Federal University of Goias, Goiania 74605-050, Goias, Brazil; (A.d.L.d.C.); (J.C.P.S.); (K.M.d.A.); (M.d.O.C.); (A.d.R.C.)
| | - Amanda dos Reis Correia
- Health Science Post Graduation, Federal University of Goias, Goiania 74605-050, Goias, Brazil; (A.d.L.d.C.); (J.C.P.S.); (K.M.d.A.); (M.d.O.C.); (A.d.R.C.)
| | - Laura Maria Barbosa Gonçalves
- Postgraduate Program in Biology of Host Parasite Relationship, Federal University of Goias, Goiania 74690-900, Goias, Brazil;
| | - Lilian Carla Carneiro
- Health Science Post Graduation, Federal University of Goias, Goiania 74605-050, Goias, Brazil; (A.d.L.d.C.); (J.C.P.S.); (K.M.d.A.); (M.d.O.C.); (A.d.R.C.)
| |
Collapse
|
14
|
Al Oweidat K, Toubasi AA, Khraisat FA, Aldahabi MN, Alghrabli A, Khater Y, Saleh N, Al-Sayegh TN, Albtoosh AS. The impact of COVID-19 on antibiotic resistance and clinical outcomes among critically ill patients. Am J Infect Control 2024; 52:546-551. [PMID: 38142778 DOI: 10.1016/j.ajic.2023.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND There is conflicting evidence regarding the impact of the Coronavirus 2019 (COVID-19) pandemic on antimicrobial resistance, with few studies conducted in low- and middle-income countries. We investigated the impact of the COVID-19 pandemic on multidrug resistant organisms (MDROs) among critically ill patients and their clinical outcomes. METHODS This was a retrospective observational study of patients admitted to the medical Intensive Care Unit at Jordan University Hospital and had blood, urine, or bronchoalveolar bacterial cultures taken during 2 time periods: prepandemic (ie, 1/2016 to 1/2019) and pandemic (ie, 1/2020 to 1/2023). We compared the clinical outcomes (ie, in-hospital deaths, the need for O2 devices, intubation, the length of hospital stay, and the occurrence of complications) and prevalence of MDROs between the 2 periods and conducted multivariate analyses. RESULTS There were 1,254 patients (479 prepandemic and 775 postpandemic. The percentage of patients who had MDROs was significantly higher among patients with a culture taken during the pandemic (82.4%) compared to before it (17.6%) (P-value=.000). Multivariate analysis demonstrated that patients cultured during the pandemic were more than 3 times as likely to have an MDRO (odds ratio = 3.210; 95% confidence interval: 2.236-4.609). CONCLUSIONS The increase in MDROs during the COVID-19 pandemic is an alarming threat to public health; thus, investigating the antibiotic resistance situation as the pandemic subsides is crucial.
Collapse
Affiliation(s)
- Khaled Al Oweidat
- Associate Professor at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad A Toubasi
- Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | | | | | - Ahmad Alghrabli
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Yasmeen Khater
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Noor Saleh
- Critical Care Fellow at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Asma S Albtoosh
- Associate Professor at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| |
Collapse
|
15
|
Park S, Bae S, Kim EO, Chang E, Kim MJ, Chong YP, Choi SH, Lee SO, Kim YS, Jung J, Kim SH. The impact of discontinuing single-room isolation of patients with vancomycin-resistant enterococci: a quasi-experimental single-centre study in South Korea. J Hosp Infect 2024; 147:77-82. [PMID: 38492645 DOI: 10.1016/j.jhin.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVES There is limited data on the effects of discontinuing single-room isolation while maintaining contact precautions, such as the use of gowns and gloves. In April 2021, our hospital ceased single-room isolation for patients with vancomycin-resistant enterococci (VRE) because of single-room unavailability. This study assessed the impact of this policy by examining the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). METHODS This retrospective quasi-experimental study was conducted at a tertiary-care hospital in Seoul, South Korea. Time-series analysis was used to evaluate HA-VRE BSI incidence at the hospital level and in the haematology unit before (phase 1) and after (phase 2) the policy change. RESULTS At the hospital level, HA-VRE BSI incidence level (VRE BSI per 1000 patient-days per month) and trend did not change significantly between phase 1 and phase 2 (coefficient -0.015, 95% confidence interval (CI): -0.053 to 0.023, P=0.45 and 0.000, 95% CI: -0.002 to 0.002, P=0.84, respectively). Similarly, HA-VRE BSI incidence level and trend in the haematology unit (-0.285, 95% CI: -0.618 to 0.048, P=0.09 and -0.018, 95% CI: -0.036 to 0.000, P = 0.054, respectively) did not change significantly across the two phases. CONCLUSIONS Discontinuing single-room isolation of VRE-colonized or infected patients was not associated with an increase in the incidence of VRE BSI at the hospital level or among high-risk patients in the haematology unit. Horizontal intervention for multi-drug-resistant organisms, including measures such as enhanced hand hygiene and environmental cleaning, may be more effective at preventing VRE transmission.
Collapse
Affiliation(s)
- S Park
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - S Bae
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - E O Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - E Chang
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - M J Kim
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y P Chong
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-H Choi
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - S-O Lee
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Y S Kim
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - J Jung
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea; Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - S-H Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea; Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
16
|
Kim A, Song BG, Kang W, Sinn DH, Gwak GY, Paik YH, Choi MS, Lee JH, Goh MJ. Prevalence and predictors of multidrug-resistant bacteremia in liver cirrhosis. Korean J Intern Med 2024; 39:448-457. [PMID: 38715233 PMCID: PMC11076886 DOI: 10.3904/kjim.2023.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/07/2023] [Accepted: 01/02/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND/AIMS Improved knowledge of local epidemiology and predicting risk factors of multidrug-resistant (MDR) bacteria are required to optimize the management of infections. This study examined local epidemiology and antibiotic resistance patterns of liver cirrhosis (LC) patients and evaluated the predictors of MDR bacteremia in Korea. METHODS This was a retrospective study including 140 LC patients diagnosed with bacteremia between January 2017 and December 2022. Local epidemiology and antibiotic resistance patterns and the determinants of MDR bacteremia were analyzed using logistic regression analysis. RESULTS The most frequently isolated bacteria, from the bloodstream, were Escherichia coli (n = 45, 31.7%) and Klebsiella spp. (n = 35, 24.6%). Thirty-four isolates (23.9%) were MDR, and extended-spectrum beta-lactamase E. coli (52.9%) and methicillin-resistant Staphylococcus aureus (17.6%) were the most commonly isolated MDR bacteria. When Enterococcus spp. were cultured, the majority were MDR (MDR 83.3% vs. 16.7%, p = 0.003), particularly vancomycin-susceptible Enterococcus faecium. Antibiotics administration within 30 days and/or nosocomial infection was a significant predictor of MDR bacteremia (OR: 3.40, 95% CI: 1.24-9.27, p = 0.02). MDR bacteremia was not predicted by sepsis predictors, such as positive systemic inflammatory response syndrome (SIRS) or quick Sequential Organ Failure Assessment (qSOFA). CONCLUSION More than 70% of strains that can be treated with a third-generation cephalosporin have been cultured. In cirrhotic patients, antibiotic administration within 30 days and/or nosocomial infection are predictors of MDR bacteremia; therefore, empirical administration of broad-spectrum antibiotics should be considered when these risk factors are present.
Collapse
Affiliation(s)
- Aryoung Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong Geun Song
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wonseok Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Geum-Youn Gwak
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Han Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Moon Seok Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Hyeok Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Ji Goh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Colaneri M, Genovese C, Lombardi A, Holmes D, Bandera A, Gori A. Carbapenem or new β-lactam-β-lactamase inhibitors? An Italian survey supported by SITA, SIMIT and SIAARTI to identify the factors affecting empiric antimicrobial therapy choice in real-life clinical practice. Eur J Clin Microbiol Infect Dis 2024; 43:1017-1023. [PMID: 38457097 PMCID: PMC11108948 DOI: 10.1007/s10096-024-04798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
While a tailored antibiotic treatment plan is often straightforward, what we often observe in daily clinical practice is a highly variable approach when defining empirical therapy. Specifically, a debate exists on preference to spare the new β-lactams and β-lactamase inhibitors (BL-BLIs) or to apply a carbapenem-sparing strategy first. To investigate, we designed a web survey aimed at investigating the variables considered relevant to empirically choosing one antibiotic over the other. Submitted to Italian infectious diseases and intensive care physicians through the support of Società Italiana di Malattie Infettive e Tropicali (SIMIT), Società Italiana di Terapia Antinfettiva (SITA) and Società Italiana Anestesia, Analgesia, Rianimazione e Terapia Intensiva (SIAARTI). We found that demographic characteristics were irrelevant when deciding for empirical therapy. Clinical and anamnestic data were most meaningful. Significantly considered were underlying comorbidities and previous exposure to antimicrobial treatments. History of third-generation cephalosporin-resistant, carbapenem-resistant and/or metallo-β-lactamase-producing Enterobacterales rectal colonisation and/or infection were considered the most relevant by most physicians. Unexpectedly, clinicians considered less the source of infection. These results prompt the need of straightforward methods to retrieve medical histories and the magnitude of rectal colonisation data, often not routinely obtained.
Collapse
Affiliation(s)
- Marta Colaneri
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy.
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy.
| | - Camilla Genovese
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
| | - Andrea Lombardi
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Darcy Holmes
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Gori
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy
| |
Collapse
|
18
|
Keneh NK, Kenmoe S, Bowo-Ngandji A, Akoachere JFTK, Kamga HG, Ndip RN, Ebogo-Belobo JT, Kengne-Ndé C, Mbaga DS, Tendongfor N, Assam JPA, Ndip LM, Esemu SN. Methicillin-Resistant Staphylococcus aureus Carriage among Neonate Mothers, Healthcare Workers, and Environmental Samples in Neonatal Intensive Care Units: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2024; 2024:5675786. [PMID: 38623471 PMCID: PMC11018372 DOI: 10.1155/2024/5675786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/12/2023] [Accepted: 03/07/2024] [Indexed: 04/17/2024]
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). The MRSA colonization of neonates, attributed to various sources, including mothers, healthcare workers, and environmental surfaces, can lead to severe infection, prolonged hospital stays, and even death, imposing substantial economic burdens. Given the pressing need to mitigate MRSA spread in these vulnerable environments, further examination of the subject is warranted. This systematic review is aimed at synthesizing available evidence on MRSA carriage proportions among mothers of newborns, healthcare workers, and environmental surfaces in NICUs. Methodology. We included observational studies published in English or French from database inception to March 21, 2023. These studies focused on MRSA in nonoutbreak NICU settings, encompassing healthy neonate mothers and healthcare workers, and environmental surfaces. Literature search involved systematic scanning of databases, including Medline, Embase, Web of Science, Global Health, and Global Index Medicus. The quality of the selected studies was assessed using the Hoy et al. critical appraisal scale. The extracted data were summarized to calculate the pooled proportion of MRSA positives, with a 95% confidence interval (CI) based on the DerSimonian and Laird random-effects model. Results A total of 1891 articles were retrieved from which 16 studies were selected for inclusion. Most of the studies were from high-income countries. The pooled proportion of MRSA carriage among 821 neonate mothers across four countries was found to be 2.1% (95% CI: 0.3-5.1; I2 = 76.6%, 95% CI: 36.1-91.5). The proportion of MRSA carriage among 909 HCWs in eight countries was determined to be 9.5% (95% CI: 3.1-18.4; I2 = 91.7%, 95% CI: 87.1-94.6). The proportion of MRSA carriage among HCWs was highest in the Western Pacific Region, at 50.00% (95% CI: 23.71-76.29). In environmental specimens from five countries, a pooled proportion of 16.6% (95% CI: 3.5-36.0; I2 = 97.7%, 95% CI: 96.6-98.4) was found to be MRSA-positive. Conclusion With a significant heterogeneity, our systematic review found high MRSA carriage rates in neonate mothers, healthcare workers, and across various environmental surfaces in NICUs, posing a potential risk of nosocomial infections. Urgent interventions, including regular screening and decolonization of MRSA carriers, reinforcing infection control measures, and enhancing cleaning and disinfection procedures within NICUs, are crucial. This trial is registered with CRD42023407114.
Collapse
Affiliation(s)
- Nene Kaah Keneh
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | - Hortense Gonsu Kamga
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaoundé, Cameroon
| | - Roland Ndip Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | - Nicholas Tendongfor
- Department of Public Health and Hygiene, University of Buea, P.O. Box 63, Buea, Cameroon
| | | | - Lucy Mande Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
| | - Seraphine Nkie Esemu
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
- Laboratory for Emerging Infectious Diseases, University of Buea, Buea, Southwest Region, Cameroon
| |
Collapse
|
19
|
Barragán-Mayet KF, García-Espinosa G, Sánchez-González MG, Miranda-Antonio L, Maldonado-Reséndiz RI. Antimicrobial Sensitivity Profile in Psittacine Birds at an Avian Teaching Hospital: A Retrospective Study, 2015-2022. J Avian Med Surg 2024; 38:15-20. [PMID: 38686884 DOI: 10.1647/avianms-d-23-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
Veterinary hospitals house patient populations with diverse infectious statuses, microbiota, and histories of prior antibiotic therapy. Choanal swabs are commonly used for assessing the upper respiratory tract of birds for bacterial disease, with the samples submitted for cytologic testing and/or culture and antimicrobial sensitivity testing. The aim of this retrospective study was to identify and quantify bacteria isolated from choanal swabs collected from psittacine patients at a veterinary teaching hospital in Mexico City, Mexico. Data regarding bacterial isolates from choanal swabs were obtained from the medical records of companion psittacines suspected of upper respiratory bacterial disease that presented between November 2015 and December 2022. A total of 47.8% (175 of 366) of the bacterial isolates were from specimens obtained from red-lored Amazons (Amazona autumnalis). Gram-negative bacteria predominated, with 27 different genera identified. Klebsiella, Staphylococcus, and Escherichia were the most frequently isolated genera. A total of 90.4% (331 of 366) of the isolates were resistant to at least 1 antibiotic tested in the sensitivity panel, and a single Klebsiella isolate was resistant to 13 different antibiotics. Gentamicin had a high percentage of efficacy (79.5%; 182 of 229) against the bacterial isolates, whereas isolates tested against sulfonamide-trimethoprim (46.7%, 98 of 210), streptomycin (43.8%; 88 of 201), and clindamycin (12.9%; 15 of 116) had susceptibilities <50%. This is the first study to report common bacterial isolates and their antimicrobial susceptibility patterns from choanal swab samples collected from companion psittacines suspected of upper respiratory disease in Mexico. Clinicians can use the information presented in this study as a guide for therapeutic decision-making when managing upper respiratory bacterial infections in companion psittacine patients.
Collapse
Affiliation(s)
- Kevin Fernando Barragán-Mayet
- Zoological Medicine and Surgery Internship, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Circuit of Scientific Research S/N, Ciudad Universitaria, Coyoacán, Mexico City, CP 04360, Mexico
| | - Gary García-Espinosa
- Avian Medicine and Husbandry Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Circuit of Scientific Research S/N, Ciudad Universitaria, Coyoacán, Mexico City, CP 04360, Mexico
| | - María Guadalupe Sánchez-González
- Genetics and Biostatistics Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Circuit of Scientific Research S/N, Ciudad Universitaria, Coyoacán, Mexico City, CP 04360, Mexico
| | - Lizbeth Miranda-Antonio
- Avian Medicine and Husbandry Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Circuit of Scientific Research S/N, Ciudad Universitaria, Coyoacán, Mexico City, CP 04360, Mexico
| | - Ricardo Itzcóatl Maldonado-Reséndiz
- Ethology, Wildlife, and Laboratory Animal Department, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Circuit of Scientific Research S/N, Ciudad Universitaria, Coyoacán, Mexico City, CP 04360, Mexico,
| |
Collapse
|
20
|
Jaber MA, Kamate W, Luke AM, Karande GS. Knowledge, Practices, and Nasal Carriage Rate of MRSA Amongst Dental Professionals. Int Dent J 2024; 74:199-206. [PMID: 37612155 PMCID: PMC10988263 DOI: 10.1016/j.identj.2023.07.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE Resistance of Staphylococcus aureus (S. aureus) against common antibiotics has been increasing given the rampant use of antibiotics. Methicillin-resistant S. aureus (MRSA) is particularly important because it has been reported to present in hospital-acquired as well as community-acquired infections. Our aim was to study the types and subtypes of MRSA isolated from nasal swabs taken from volunteering dental school students and to assess and analyse the knowledge of dental health care workers (DHCWs) on MRSA and prevention of its infection. METHODS A total of 100 participants, which included staff, students, and dental auxiliaries, from the School of Dental Sciences, Krishna Institute of Medical Sciences, Deemed to Be University, Karad, India, were included in the study which was conducted from June 2020 to 1 June 2021. All the participants completed a survey and underwent collection of nasal swabs. The samples were cultured and underwent microbiological and molecular analysis for MRSA. The questionnaire was sent out electronically via SurveyMonkey. RESULTS Sixty-three percent of the participants were female. The majority were undergraduate students (66%) and younger than 25 years (77%). The prevalence of MRSA in the sample was the MRSA type SCCmec type V (54.8%). The survey reports a lack of knowledge amongst dental students on MRSA and prevention of its infection. The majority (69%) of participants had not heard of MRSA infection and had inadequate knowledge of MRSA infection. Only 29% of the participants think that a healthy person may have MRSA without feeling ill. Eighty-five percent of the participants reported that they have written polices and guidelines to control MRSA. Eighty-five percent of the participants indicated that they are less confident in their knowledge on MRSA infection control protocols, and 94% mentioned that the dental clinics have written guidelines for hand hygiene. CONCLUSIONS DHCWs have limited knowledge of MRSA infection, emphasising the need for appropriate clinical training. Academic institutions should promote effective infection control training to protect students, faculty, and other employees.
Collapse
Affiliation(s)
- Mohamed A Jaber
- Clinical Sciences Department, College of Dentistry, Ajman University, Ajman, UAE; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, UAE
| | - Wasim Kamate
- Department of Oral Pathology and Microbiology, School of Dental Sciences, Krishna Institute of Medical Sciences (Deemed to Be University), Karad, Maharashtra, India
| | - Alexander Maniangat Luke
- Clinical Sciences Department, College of Dentistry, Ajman University, Ajman, UAE; Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, UAE.
| | - G S Karande
- Department of Microbiology, Krishna Institute of Medical Sciences (Deemed to Be University), Karad, Maharashtra, India
| |
Collapse
|
21
|
Pantano D, Friedrich AW. Hub and Spoke: Next level in regional networks for infection prevention. Int J Med Microbiol 2024; 314:151605. [PMID: 38290401 DOI: 10.1016/j.ijmm.2024.151605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
The threat of multidrug-resistant organisms (MDROs) and antimicrobial resistance (AMR) are real and increasing every day. They affect not only healthcare systems but also communities, causing economic and public health concerns. Governments must take action to tackle AMR and prevent the spread of MDROs and regional hubs have a critical role to play in achieving this outcome. Furthermore, bacteria have no borders, consequently, cooperation networks should be extended between countries as a crucial strategy for achieving the success of infection control. Euregions, which are a specific form of cooperation between local authorities of two or more bordering European countries, can help solve common problems and improve the lives of people living on both sides of the border. Regional collaboration strategies can enhance infection control and build resilience against antimicrobial resistance. This review identifies risk factors and the correct approaches to infection prevention and control, including education and awareness programs for healthcare professionals, appropriate prescribing practices, and infection prevention control measures. These measures can help reduce the incidence of antimicrobial resistance in the region and save lives. It is therefore essential to take concrete actions and foster the creation of more effective regional and cross-border centers to ensure the success of infection control policies and the management of healthcare-associated infections. This work sheds light on the issue of MDRO infections within healthcare settings, while also acknowledging the crucial role of the One Health concept in understanding the broader context of these infections. By recognizing the interdependence of human and animal health and the environment, we can take constructive steps toward mitigating the risks of these infections and promoting better health outcomes for all.
Collapse
Affiliation(s)
- Daniele Pantano
- University Hospital Münster, Institute of Hygiene, Münster, Germany.
| | | |
Collapse
|
22
|
Pantha S, Parajuli H, Arjyal C, Karki ST, Shrestha D. Phenotypic characterization of ESBL-producing urinary isolates of E. coli and Klebsiella spp. in a tertiary care children's hospital in Nepal. Trop Med Health 2024; 52:20. [PMID: 38424623 PMCID: PMC10905773 DOI: 10.1186/s41182-024-00587-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 02/21/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The production of extended-spectrum beta-lactamases (ESBLs) among uropathogens, particularly E. coli and Klebsiella spp., poses a severe public health concern. This study explored the epidemiology of ESBL-producing E. coli and Klebsiella spp. isolated from urine samples obtained at a tertiary care children's hospital in Nepal. METHODS A cross-sectional study was conducted from August 2016 to February 2017. A total of 745 clean catch urine samples were obtained from pediatric patients under the age of 13 and subjected to semiquantitative culture. E. coli and Klebsiella spp. were identified using standard laboratory protocols. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and ESBL producers were phenotypically identified using the combined disk method. RESULTS Among the bacterial isolates, E. coli predominated, accounting for 139 (81.8%) positive cases. Notably, E. coli showed high susceptibility to nitrofurantoin, with 117 (84.2%) isolates being susceptible. Meanwhile, K. pneumoniae showed high susceptibility to gentamicin, with 21 (91.3%) isolates being susceptible. Of the 163 isolates of E. coli and Klebsiella spp., 62 (38.0%) were identified as multidrug-resistant (MDR), with 42 (25.8%) confirmed as phenotypic ESBL producers. Remarkably, all 41 (100%) ESBL-producing E. coli isolates were susceptible to imipenem. CONCLUSIONS The prevalence of ESBL producers among E. coli and K. pneumoniae isolates from pediatric patients underscores the importance of antimicrobial stewardship. Nitrofurantoin and gentamicin emerge as effective empirical treatment choices against these pathogens in children. However, the high rates of multidrug resistance and ESBL production highlight the necessity for routine surveillance, and early detection strategies to manage such infections effectively.
Collapse
Affiliation(s)
- Santosh Pantha
- Department of Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal
| | - Hiramani Parajuli
- Department of Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal
- Center for Climate and One Health Research (CCOHR), Kathmandu, Nepal
| | - Charu Arjyal
- Department of Microbiology, Tri-Chandra Multiple Campus, Kathmandu, Nepal
- Department of Microbiology, Padma Kanya Multiple Campus, Kathmandu, Nepal
| | - Shovana Thapa Karki
- Department of Pathology, International Friendship Children Hospital, Kathmandu, Nepal
| | - Dhiraj Shrestha
- Center for Climate and One Health Research (CCOHR), Kathmandu, Nepal.
- Department of Microbiology, Shi-Gan International College of Science and Technology (SICOST), Kathmandu, Nepal.
| |
Collapse
|
23
|
Cui J, Heavey J, Lin L, Klein EY, Madden GR, Sifri CD, Lewis B, Vullikanti AK, Prakash BA. Modeling relaxed policies for discontinuation of methicillin-resistant Staphylococcus aureus contact precautions. Infect Control Hosp Epidemiol 2024:1-6. [PMID: 38404133 DOI: 10.1017/ice.2024.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To evaluate the economic costs of reducing the University of Virginia Hospital's present "3-negative" policy, which continues methicillin-resistant Staphylococcus aureus (MRSA) contact precautions until patients receive 3 consecutive negative test results, to either 2 or 1 negative. DESIGN Cost-effective analysis. SETTINGS The University of Virginia Hospital. PATIENTS The study included data from 41,216 patients from 2015 to 2019. METHODS We developed a model for MRSA transmission in the University of Virginia Hospital, accounting for both environmental contamination and interactions between patients and providers, which were derived from electronic health record (EHR) data. The model was fit to MRSA incidence over the study period under the current 3-negative clearance policy. A counterfactual simulation was used to estimate outcomes and costs for 2- and 1-negative policies compared with the current 3-negative policy. RESULTS Our findings suggest that 2-negative and 1-negative policies would have led to 6 (95% CI, -30 to 44; P < .001) and 17 (95% CI, -23 to 59; -10.1% to 25.8%; P < .001) more MRSA cases, respectively, at the hospital over the study period. Overall, the 1-negative policy has statistically significantly lower costs ($628,452; 95% CI, $513,592-$752,148) annually (P < .001) in US dollars, inflation-adjusted for 2023) than the 2-negative policy ($687,946; 95% CI, $562,522-$812,662) and 3-negative ($702,823; 95% CI, $577,277-$846,605). CONCLUSIONS A single negative MRSA nares PCR test may provide sufficient evidence to discontinue MRSA contact precautions, and it may be the most cost-effective option.
Collapse
Affiliation(s)
- Jiaming Cui
- College of Computing, Georgia Institute of Technology, Atlanta, Georgia
| | - Jack Heavey
- Department of Computer Science, University of Virginia, Charlottesville, Virginia
| | - Leo Lin
- Department of Computer Science, University of Virginia, Charlottesville, Virginia
| | - Eili Y Klein
- Center for Disease Dynamics, Economics & Policy, Washington, DC
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gregory R Madden
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Costi D Sifri
- Division of Infectious Diseases & International Health, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
- Office of Hospital Epidemiology/Infection Prevention & Control, UVA Health, Charlottesville, Virginia
| | - Bryan Lewis
- Biocomplexity Institute, University of Virginia, Charlottesville, Virginia
| | - Anil K Vullikanti
- Department of Computer Science, University of Virginia, Charlottesville, Virginia
- Biocomplexity Institute, University of Virginia, Charlottesville, Virginia
| | - B Aditya Prakash
- College of Computing, Georgia Institute of Technology, Atlanta, Georgia
| |
Collapse
|
24
|
El Ghali A, Kunz Coyne AJ, Lucas K, Tieman M, Xhemali X, Lau SP, Iturralde G, Purdy A, Holger DJ, Garcia E, Veve MP, Rybak MJ. Cefiderocol: early clinical experience for multi-drug resistant gram-negative infections. Microbiol Spectr 2024; 12:e0310823. [PMID: 38206034 PMCID: PMC10846278 DOI: 10.1128/spectrum.03108-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/10/2023] [Indexed: 01/12/2024] Open
Abstract
Multi-drug resistant gram-negative bacteria present a significant global health threat. Cefiderocol (CFDC), a siderophore cephalosporin, has shown potential in combating this threat, but with the currently available data, its role in therapy remains poorly defined. This multi-center, retrospective cohort study evaluated the real-world application of CFDC across six U.S. medical centers from January 2018 to May 2023. Patients aged ≥18 years and who had received ≥72 hours of CFDC were included. The primary outcome was a composite of clinical success: survival at 30 days, absence of symptomatic microbiologic recurrence at 30 days following CFDC treatment initiation, and resolution of signs and symptoms. Secondary outcomes included time to CFDC therapy and on-treatment non-susceptibility to CFDC. A total of 112 patients were included, with median (interquartile range [IQR]) APACHE II scores of 15 (19-18). Clinical success was observed in 68.8% of patients, with a mortality rate of 16.1% and comparable success rates across patients infected with carbapenem-resistant gram-negative infections. The most common isolated organisms were Pseudomonas aeruginosa (61/112, 54.5%, of which 55/61 were carbapenem-resistant) and carbapenem-resistant Acinetobacter baumannii (32/112, 28.6%). Median (IQR) time to CFDC therapy was 77 (14-141) hours. Two patients experienced a non-anaphylactic rash as an adverse drug reaction. On-treatment non-susceptibility to CFDC was found in six patients, notably due to P. aeruginosa and A. baumannii.IMPORTANCECFDC was safe and clinically effective as a monotherapy or in combination in treating a variety of carbapenem-resistant gram-negative infections. Further prospective studies are warranted to confirm these findings.
Collapse
Affiliation(s)
- Amer El Ghali
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Ashlan J. Kunz Coyne
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kristen Lucas
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Molly Tieman
- Department of Pharmacy, Indiana University Health, Bloomington, Indiana, USA
| | - Xhilda Xhemali
- Department of Pharmacy, Cleveland Clinic, Cleveland, Ohio, USA
| | - Suet-ping Lau
- Department of Pharmacy, Orlando Health, Orlando, Florida, USA
| | - Gabriela Iturralde
- Department of Pharmacy, Memorial Hospital West, Pembroke Pines, Florida, USA
| | - Andrew Purdy
- Department of Pharmacy, Indiana University Health, Bloomington, Indiana, USA
| | - Dana J. Holger
- Department of Pharmacy, Memorial Hospital West, Pembroke Pines, Florida, USA
- Department of Pharmacy Practice, Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Esther Garcia
- Department of Pharmacy, Memorial Hospital West, Pembroke Pines, Florida, USA
| | - Michael P. Veve
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Henry Ford Hospital, Detroit, Michigan, USA
| | - Michael J. Rybak
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, USA
| |
Collapse
|
25
|
Tokano M, Tarumoto N, Sakai J, Imai K, Kodana M, Kawamura T, Maeda T, Maesaki S. Vancomycin-resistant Enterococcus faecium in Japan, 2007-2015: a molecular epidemiology analysis focused on examining strain characteristics over time. Microbiol Spectr 2024; 12:e0244423. [PMID: 38100166 PMCID: PMC10783050 DOI: 10.1128/spectrum.02444-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/05/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE Our study emphasizes the efficacy of whole-genome sequencing (WGS) in addressing outbreaks of vancomycin-resistant enterococci. WGS enables the identification and tracking of resistant bacterial strains, early detection and management of novel infectious disease outbreaks, and the appropriate selection and use of antibiotics. Furthermore, our approach deepens our understanding of how resistant bacteria transfer genes and adapt to their environments or hosts. For modern medicine, these insights have significant implications for controlling infections and effectively managing antibiotic use in the current era, where antibiotic resistance is progressing.
Collapse
Affiliation(s)
- Mieko Tokano
- Department of Infectious Disease and Infection Control, Saitama Medical University, Moroyama, Saitama, Japan
- Department of Allergy and Immunology, Faculty of Medicine, Saitama Medical University, Moroyama, Saitama, Japan
| | - Norihito Tarumoto
- Department of Infectious Disease and Infection Control, Saitama Medical University, Moroyama, Saitama, Japan
| | - Jun Sakai
- Department of Infectious Disease and Infection Control, Saitama Medical University, Moroyama, Saitama, Japan
| | - Kazuo Imai
- Department of Infectious Disease and Infection Control, Saitama Medical University, Moroyama, Saitama, Japan
- Department of Clinical Laboratory, Saitama Medical University, Moroyama, Saitama, Japan
| | - Masahiro Kodana
- Department of Clinical Laboratory, Saitama Medical University, Moroyama, Saitama, Japan
| | - Toru Kawamura
- Department of Clinical Laboratory, Saitama Medical University, Moroyama, Saitama, Japan
| | - Takuya Maeda
- Department of Clinical Laboratory, Saitama Medical University, Moroyama, Saitama, Japan
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Moroyama, Saitama, Japan
| |
Collapse
|
26
|
Cultrera R. Place in therapy of dalbavancin to treat Gram-positive infections in antimicrobial resistance era: an overview. GLOBAL & REGIONAL HEALTH TECHNOLOGY ASSESSMENT 2024; 11:1-4. [PMID: 39100521 PMCID: PMC11292619 DOI: 10.33393/grhta.2024.3108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- Rosario Cultrera
- Infectious Diseases, Azienda Ospedaliero-Universitaria e Azienda Unità Sanitaria Locale di Ferrara, Ferrara - Italy
- Antimicrobial Stewardship Program Team, Azienda Ospedaliero-Universitaria e Azienda Unità Sanitaria Locale di Ferrara, Ferrara - Italy
- Department of Traslational Medicine, University of Ferrara, Ferrara - Italy
| |
Collapse
|
27
|
Quirino A, Cicino C, Scarlata GGM, Marascio N, Di Gennaro G, Matera G, Licata F, Bianco A. Prevalence of Colonization with Multidrug-Resistant Bacteria: Results of a 5-Year Active Surveillance in Patients Attending a Teaching Hospital. Antibiotics (Basel) 2023; 12:1525. [PMID: 37887226 PMCID: PMC10604483 DOI: 10.3390/antibiotics12101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023] Open
Abstract
Combating antimicrobial resistance (AMR) requires comprehensive efforts, such as screening to identify patients colonized by multidrug-resistant microorganisms (MDROs). The primary purpose of this study was to estimate the AMR pattern of methicillin-resistant Staphylococcus aureus (MRSA) isolated from nasal surveillance swabs and MDROs isolated from pharyngeal and rectal surveillance swabs in patients attending a teaching hospital. Data were sought retrospectively, from 1 January 2017 to 31 December 2021, from the records produced by the hospital microbiology laboratory. Duplicate isolates, defined as additional isolates of the same microorganism with identical antibiograms, were excluded. Among Staphylococcus aureus isolates from nasal swabs, 18.2% were oxacillin-resistant. Among Gram-negative bacteria, 39.8% of Klebsiella pneumoniae and 83.5% of Acinetobacter baumannii isolates were carbapenem-resistant. Resistance to three antibiotic categories was high among Acinetobacter baumannii (85.8%) and Klebsiella pneumoniae (42.4%). The present data highlight a high prevalence of MDRO colonization among patients admitted to the hospital and suggest that screening for MDROs could be an important tool for infection control purposes, especially in geographical areas where limiting the spread of MDROs is crucial. The results also underline the importance of active surveillance, especially for carbapenem-resistant, Gram-negative bacteria in reducing their transmission, especially in high-risk units.
Collapse
Affiliation(s)
- Angela Quirino
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Claudia Cicino
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Giuseppe Guido Maria Scarlata
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Nadia Marascio
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Gianfranco Di Gennaro
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy;
| | - Giovanni Matera
- Unit of Clinical Microbiology, Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy; (A.Q.); (C.C.); (G.G.M.S.); (N.M.); (G.M.)
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy;
| | - Aida Bianco
- Department of Medical and Surgical Sciences, School of Medicine, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy;
| |
Collapse
|
28
|
Tang YF, Lin YS, Su LH, Liu JW. Increasing trend of healthcare-associated infections due to vancomycin-resistant Enterococcus faecium (VRE-fm) paralleling escalating community-acquired VRE-fm infections in a medical center implementing strict contact precautions: An epidemiologic and pathogenic genotype analysis and its implications. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:1045-1053. [PMID: 37599123 DOI: 10.1016/j.jmii.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To clarify whether there were clandestine intra-hospital spreads of vancomycin-resistant Enterococcus faecium (VRE-fm) isolates that led to specific strain of VRE lingering in the hospital and/or developing outbreaks that rendered a progressively increasing trend of healthcare-associated infections due to VRE-fm (VRE-fm-HAIs). SETTING Despite implementing strict contact precautions for hospitalized patients with VRE-fm-infection/colonization, number of VRE-fm-HAIs in a medical centre in southern Taiwan were escalating in 2009-2019, paralleling an increasing trend of community-acquired VRE-fm- infections. METHODS We analyzed epidemiologic data and genotypes of non-duplicate VRE-fm isolates each grown from a normally sterile site of 89 patients between December 2016 and October 2018; multilocus sequence typing (MLST) and pulse-field gel electrophoresis (PFGE) typing were performed. RESULTS Totally 13 sequence types (STs) were found, and the 3 leading STs were ST17 (44%), ST78 (37%), and ST18 (6%); 66 pulsotypes were generated by PFGE. Four VRE-fm isolates grouped as ST17/pulsotype S, 2 as ST17/pulsotype AS, 2 as ST17/pulsotype AU, and 3 as ST78/pulsotype V grew from clinical specimens sampled less than one week apart from patients staying at different wards/departments and/or on different floors of the hospital. CONCLUSIONS Despite possible small transitory clusters of intra-hospital VRE-fm spreads, there was no specific VRE-fm strain lingering in the hospital leading to increasing trend of VRE-fm-HAIs during the study period. Strict contact precautions were able to curb intra-hospital VRE-fm spreads, but unable to curb the increasing trend of VRE-fm-HAIs with the backdrop of progressively increasing VRE-fm-infections/colorizations in the community.
Collapse
Affiliation(s)
- Ya-Fen Tang
- Infection Control Team, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yin-Shiou Lin
- Infection Control Team, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Li-Hsiang Su
- Infection Control Team, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jien-Wei Liu
- Infection Control Team, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
| |
Collapse
|
29
|
Telli Dizman G, Metan G, Zarakolu P, Tanrıverdi ES, Hazırolan G, Aytaç Ak H, Kılınçarslan D, Uzun M, Çelik Kavaklılar B, Arık Z, Otlu B, Ünal S. Cessation of Rectal Screening for Vancomycin-Resistant Enterococci: Experience from a Tertiary Care Hospital from Türkiye. Healthcare (Basel) 2023; 11:2641. [PMID: 37830678 PMCID: PMC10572918 DOI: 10.3390/healthcare11192641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Here, we compared the impact of different polices on the epidemiology of Vancomycin-resistant Enterococcus faecium bloodstream infections (VRE-BSIs) in a tertiary care hospital including two hospital buildings (oncology and adult hospitals) in the same campus. MATERIAL AND METHODS All patients who were hospitalized in high-risk units were screened weekly for VRE colonization via rectal swab between January 2006 and January 2013. After January 2013, VRE screening was only performed in cases of suspicion of VRE outbreak and during point prevalence studies to evaluate the epidemiology of VRE colonization. Contact precautions were in place for all VRE-positive patients. The incidence density rates of hospital-acquired (HA)-VRE-BSIs were compared between two periods. RESULTS While the rate of VRE colonization was higher in the second period (5% vs. 9.5% (p < 0.01) for the adult hospital, and 6.4% vs. 12% (p = 0.02 for the oncology hospital), there was no increase in the incidence rate HA-VRE BSIs after the cessation of routine rectal screening in either of the hospitals. CONCLUSION Screening policies should be dynamic and individualized according to the epidemiology of VRE as well as the workforce and cost. Periodical rectal screening of VRE can be discontinued if suspicion of an outbreak can be carefully monitored.
Collapse
Affiliation(s)
- Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| | - Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| | - Pınar Zarakolu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
| | - Elif Seren Tanrıverdi
- Molecular Microbiology Laboratory, Department of Medical Microbiology, Faculty of Medicine, İnönü University, Malatya 44280, Türkiye; (E.S.T.); (B.O.)
| | - Gülşen Hazırolan
- Department of Medical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye;
| | - Hanife Aytaç Ak
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| | - Dilek Kılınçarslan
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| | - Mertcan Uzun
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
| | - Başak Çelik Kavaklılar
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye;
| | - Zafer Arık
- Department of Internal Medicine, Section of Oncology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye;
| | - Barış Otlu
- Molecular Microbiology Laboratory, Department of Medical Microbiology, Faculty of Medicine, İnönü University, Malatya 44280, Türkiye; (E.S.T.); (B.O.)
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Hacettepe University, Ankara 06800, Türkiye; (G.M.); (P.Z.); (M.U.); (S.Ü.)
- Infection Control Committee, Hacettepe University Hospitals, Ankara 06800, Türkiye; (H.A.A.); (D.K.)
| |
Collapse
|
30
|
Jiang H, Pu H, Huang N. Risk predict model using multi-drug resistant organism infection from Neuro-ICU patients: a retrospective cohort study. Sci Rep 2023; 13:15282. [PMID: 37714922 PMCID: PMC10504308 DOI: 10.1038/s41598-023-42522-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
The aim of this study was to analyze the current situation and risk factors of multi-drug-resistant organism (MDRO) infection in Neuro-intensive care unit (ICU) patients, and to develop the risk predict model. The data was collected from the patients discharged from Neuro-ICU of grade-A tertiary hospital at Guizhou province from January 2018 to April 2020. Binary Logistics regression was used to analyze the data. The model was examined by receiver operating characteristic curve (ROC). The grouped data was used to verify the sensitivity and specificity of the model. A total of 297 patients were included, 131 patients infected with MDRO. The infection rate was 44.11%. The results of binary Logistics regression showed that tracheal intubation, artery blood pressure monitoring, fever, antibiotics, pneumonia were independent risk factors for MDRO infection in Neuro-ICU (P < 0.05), AUC = 0.887. The sensitivity and specificity of ROC curve was 86.3% and 76.9%. The risk prediction model had a good predictive effect on the risk of MDRO infection in Neuro ICU, which can evaluate the risk and provide reference for preventive treatment and nursing intervention.
Collapse
Affiliation(s)
- Hu Jiang
- Nursing Department, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, 563000, Guizhou, China
| | - Hengping Pu
- Nursing Department, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, 563000, Guizhou, China
| | - Nanqu Huang
- Drug Clinical Trial Institution, The Third Affiliated Hospital of Zunyi Medical University (The First People's Hospital of Zunyi), Zunyi, 563000, Guizhou, China.
| |
Collapse
|
31
|
Luo Y, Guo Z, Li Y, Ouyang H, Huang S, Chen Y, Li K, Ji Y, Zhu H, Luo W, Liu X, Li X, Xia J, Liu X. Appropriateness of Empirical Antibiotic Therapy in Hospitalized Patients with Bacterial Infection: A Retrospective Cohort Study. Infect Drug Resist 2023; 16:4555-4568. [PMID: 37465180 PMCID: PMC10350404 DOI: 10.2147/idr.s402172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/22/2023] [Indexed: 07/20/2023] Open
Abstract
Objective The incidence of inappropriate and excessive empirical antibiotic therapy is unclear. The aim of this study was to determine the prevalence of different empirical antibiotic therapy prescriptions, related factors, and outcomes in hospitalized patients with bacterial infection. Methods A retrospective cohort study was performed and patients with bacterial infection who were admitted between October 1, 2019, and September 30, 2020, were included. Multivariable analysis was performed by the logistic regression model. Results A total of 536 (42.6%) of the 1257 included patients received inappropriate empirical antibiotic therapy (IEAT), and 368 (29.3%) patients received appropriate but unnecessarily broad-spectrum empirical antibiotic therapy (AUEAT). MDRO (adjusted OR 2.932 [95% CI 2.201~3.905]; p < 0.001) and fever on admission (adjusted OR 0.592 [95% CI 0.415~0.844]; p = 0.004) were correlates of IEAT; sepsis (adjusted OR 2.342 [95% CI 1.371~3.999]; p = 0.002), age (adjusted OR 1.019 [95% CI 1.008~1.030]; p < 0.001), MDRO (adjusted OR 0.664 [95% CI 0.469~0.941]; p = 0.021), and urinary tract infection (adjusted OR 0.352 [95% CI 0.203~0.611]; p < 0.001) were correlates of AUEAT. Patients who received AUEAT were more likely to have a poor prognosis (63 [17.8%] vs 101 [27.4%]; p = 0.002). Both IEAT (median [IQR], 24,971 [13,135-70,155] vs 31,489 [14,894-101,082] CNY; p = 0.007) and AUEAT (median [IQR], 24,971 [13,135-70,155] vs 30,960 [16,475-90,881] CNY; p = 0.002) increased hospital costs. 45.3% (570/1257) of patients were infected with MDRO and 62.9% of them received IEAT. Conclusion Inappropriate and excessive empirical antibiotic use was widely prevalent among hospitalized patients. Either inappropriate or excessive use of antibiotics may increase the burden of healthcare costs, the latter of which may be associated with poor prognosis. Clinicians need to be more judicious in choosing antibiotic(s). The MDRO epidemic was severe, especially in patients who received IEAT. It is imperative to take effective measures to improve the current situation of antibiotic abuse and antimicrobial resistance.
Collapse
Affiliation(s)
- Yuting Luo
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Zhaowang Guo
- Clinical Laboratory, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Ying Li
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Hui Ouyang
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Shanfeng Huang
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Yuanli Chen
- Department of Hospital Infection Control, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Kenan Li
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Yuxin Ji
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Hongqiong Zhu
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Wentao Luo
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Xu Liu
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
- Guangdong Provincial Key Laboratory of Biomedical Imaging and Guangdong Provincial Engineering Research Center of Molecular Imaging, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Xinghua Li
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Jinyu Xia
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| | - Xi Liu
- Department of Infectious Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, People’s Republic of China
| |
Collapse
|
32
|
Popovich KJ, Aureden K, Ham DC, Harris AD, Hessels AJ, Huang SS, Maragakis LL, Milstone AM, Moody J, Yokoe D, Calfee DP. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:1039-1067. [PMID: 37381690 PMCID: PMC10369222 DOI: 10.1017/ice.2023.102] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
Collapse
Affiliation(s)
- Kyle J. Popovich
- Department of Internal Medicine, RUSH Medical College, Chicago, Illinois
| | - Kathy Aureden
- Infection Prevention, Advocate Aurora Health, Downers Grove, Illinois
| | - D. Cal Ham
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anthony D. Harris
- Health Care Outcomes Research, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amanda J. Hessels
- Columbia School of Nursing, New York, New York
- Hackensack Meridian Health, Edison, New Jersey
| | - Susan S. Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Moody
- Infection Prevention, HCA Healthcare, Nashville, Tennessee
| | - Deborah Yokoe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
- Transplant Infectious Diseases, UCSF Medical Center, San Francisco, California
| | - David P. Calfee
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| |
Collapse
|
33
|
Sugai M, Yuasa A, Miller RL, Vasilopoulos V, Kurosu H, Taie A, Gordon JP, Matsumoto T. An Economic Evaluation Estimating the Clinical and Economic Burden of Increased Vancomycin-Resistant Enterococcus faecium Infection Incidence in Japan. Infect Dis Ther 2023; 12:1695-1713. [PMID: 37302137 PMCID: PMC10281932 DOI: 10.1007/s40121-023-00826-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 06/13/2023] Open
Abstract
INTRODUCTION While incidence rates of vancomycin-resistant Enterococcus faecium have remained comparatively low in Japan, there have been increasing reports of more vancomycin-resistant Enterococcus (VRE) outbreaks, requiring costly measures to contain. Increased incidence of VRE in Japan may lead to more frequent and harder to contain outbreaks with current control measures, causing a significant burden to the healthcare system in Japan. This study aimed to demonstrate the clinical and economic burden of vancomycin-resistant E. faecium infections to the Japanese healthcare system and the impact of increasing rates of vancomycin resistance. METHODS A de novo deterministic analytic model was developed to assess the health economic outcomes of treating hospital-acquired VRE infections; patients are treated according to a two-line treatment strategy, dependent on their resistance status. The model considers hospitalisation costs and the additional cost of infection control. Scenarios investigated the current burden of VRE infections and the additional burden of increased incidence of VRE. Outcomes were assessed over a 1-year and 10-year time horizon from a healthcare payer's perspective in a Japanese setting. Quality-adjusted life years (QALYs) were valued with a willingness-to-pay threshold of ¥5,000,000 ($38,023), and costs and benefits were discounted at a rate of 2%. RESULTS Current VRE incidence levels in enterococcal infections in Japan equates to ¥130,209,933,636 ($996,204,669) in associated costs and a loss of 185,361 life years (LYs) and 165,934 QALYs over 10 years. A three-fold increase (1.83%) is associated with an additional ¥4,745,059,504 ($36,084,651) in total costs on top of the current cost burden as well as an additional loss of 683 LYs over a lifetime, corresponding to 616 QALYs lost. CONCLUSION Despite low incidence rates, VRE infections already represent a substantial economic burden to the Japanese healthcare system. The substantial increase in costs associated with a higher incidence of VRE infections could result in a significant economic challenge for Japan.
Collapse
Affiliation(s)
- Motoyuki Sugai
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Akira Yuasa
- Pfizer Japan Inc., Shinjuku Bunka Quint Building, 3-22-7, Yoyogi, Shibuya-Ku, Tokyo, 151-8589, Japan.
| | - Ryan L Miller
- Health Economics and Outcomes Research Ltd., Cardiff, UK
| | | | - Hitomi Kurosu
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | | | - Jason P Gordon
- Health Economics and Outcomes Research Ltd., Cardiff, UK
| | - Tetsuya Matsumoto
- Department of Infectious Diseases, School of Medicine, International University of Health and Welfare, Narita, Japan
| |
Collapse
|
34
|
Gelfusa M, Murari A, Ludovici GM, Franchi C, Gelfusa C, Malizia A, Gaudio P, Farinelli G, Panella G, Gargiulo C, Casinelli K. On the Potential of Relational Databases for the Detection of Clusters of Infection and Antibiotic Resistance Patterns. Antibiotics (Basel) 2023; 12:antibiotics12040784. [PMID: 37107146 PMCID: PMC10135313 DOI: 10.3390/antibiotics12040784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
In recent years, several bacterial strains have acquired significant antibiotic resistance and can, therefore, become difficult to contain. To counteract such trends, relational databases can be a powerful tool for supporting the decision-making process. The case of Klebsiella pneumoniae diffusion in a central region of Italy was analyzed as a case study. A specific relational database is shown to provide very detailed and timely information about the spatial-temporal diffusion of the contagion, together with a clear assessment of the multidrug resistance of the strains. The analysis is particularized for both internal and external patients. Tools such as the one proposed can, therefore, be considered important elements in the identification of infection hotspots, a key ingredient of any strategy to reduce the diffusion of an infectious disease at the community level and in hospitals. These types of tools are also very valuable in the decision-making process related to antibiotic prescription and to the management of stockpiles. The application of this processing technology to viral diseases such as COVID-19 is under investigation.
Collapse
Affiliation(s)
- Michela Gelfusa
- Department of Industrial Engineering, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Andrea Murari
- Consorzio RFX (CNR, ENEA, INFN), University of Padua, 35127 Padua, Italy
- Istituto per la Scienza e la Tecnologia dei Plasmi, CNR, 35100 Padua, Italy
| | - Gian Marco Ludovici
- Department of Industrial Engineering, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Cristiano Franchi
- Department of Industrial Engineering, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Claudio Gelfusa
- Department of Industrial Engineering, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Andrea Malizia
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Pasqualino Gaudio
- Department of Industrial Engineering, University of Rome "Tor Vergata", 00133 Rome, Italy
| | | | - Giacinto Panella
- ASL and Fabrizio Spaziani, Frosinone Hospital, 03100 Frosinone, Italy
| | - Carla Gargiulo
- ASL and Fabrizio Spaziani, Frosinone Hospital, 03100 Frosinone, Italy
| | - Katia Casinelli
- ASL and Fabrizio Spaziani, Frosinone Hospital, 03100 Frosinone, Italy
| |
Collapse
|
35
|
Althaqafi A, Yaseen M, Farahat F, Munshi A, Al-Amri A, Essack SY. Risk Factors for Infection With Multidrug-Resistant Gram-Negative Bacteria in a Tertiary Care Hospital in Saudi Arabia: A Case-Control Study. Cureus 2023; 15:e37291. [PMID: 37168219 PMCID: PMC10166184 DOI: 10.7759/cureus.37291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Background The increase in the incidence of multidrug-resistant (MDR) organisms especially Gram-negative bacteria (GNB) in healthcare facilities is a serious cause of concern. This study identified risk factors for the infection with these MDR GNB, such as Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli to inform healthcare workers about strategies for their containment. Methods A case-control study was carried out at a tertiary care hospital where 100 patients with healthcare-associated infections (infections arising 48 hours after admission) caused by MDR GNB were compared with two control groups, i.e., 100 patients with healthcare-associated infections caused by non-MDR GNB (not meeting the criteria of MDR) and 100 patients without infection caused by GNB. MDR bacteria were defined as the ones that were non-susceptible to at least one antibiotic in three or more classes of antibiotics. The data were analyzed using descriptive statistics (frequency and percentage of categorical variables). Multivariate regression analysis was undertaken to identify significant predictors of MDR GNB. Odds ratios with 95% confidence intervals were calculated, and the level of significance was determined at p-value < 0.05. Results A total of 388 organisms were isolated during four months (January-April 2015) from 332 patients. Fifty-six (17%) of the patients were infected with more than one organism. Among the MDR bacteria, the most dominant MDR organism was A. baumannii (38%), followed by K. pneumoniae (31%), P. aeruginosa (20%), and E. coli (11%). Among the non-MDR organisms, the most dominant was P. aeruginosa (47%), followed by E. coli (32%), K. pneumoniae (18%), and A. baumannii (3%). Patients with MDR organisms compared with the first control group (patients with non-MDR organisms) showed that prior antibiotic use (p-value: 0.001), intensive care unit (ICU) admission (p-value: 0.001), and indwelling medical devices (p-value: 0.005) were significant risk factors for MDR infections. It was also found that the risk factors for MDR GNB infection were the same in the second control group (patients without infection): prior antibiotic use (p-value: 0.002), ICU admission (p-value: 0.001), and indwelling medical devices (p-value: 0.03). Based on the comparison of the two control groups, prolonged hospital stays of more than five days (p-value: 0.001), immunosuppressive therapy (p-value: 0.02), and over 60 years of age (p-value: 0.02) were significant risk factors for non-MDR infection. Conclusion The risk factors identified in our study provide guidance to healthcare workers for the prevention and containment of MDR GNB.
Collapse
Affiliation(s)
- Abdulhakeem Althaqafi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU
- Medicine/Infectious Diseases, King Abdulaziz Medical City, Jeddah, SAU
| | - Muhammad Yaseen
- Infection Prevention and Control, Bradford Teaching Hospital National Health Service (NHS) Foundation Trust, Bradford, GBR
| | - Fayssal Farahat
- Public Health and Community Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Public Health and Community Medicine, Menoufia University, Menoufia, EGY
- Infection Prevention and Control, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Adeeb Munshi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU
- Medicine/Infectious Diseases, King Abdulaziz Medical City, Jeddah, SAU
| | - Abdulfattah Al-Amri
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Microbiology, King Abdullah International Medical Research Center, Jeddah, SAU
- Microbiology, King Abdulaziz Medical City, Jeddah, SAU
| | - Sabiha Y Essack
- Antimicrobial Research Unit, University of Kwazulu-Natal, Durban, ZAF
| |
Collapse
|
36
|
Holowka T, van Duin D, Bartelt LA. Impact of childhood malnutrition and intestinal microbiota on MDR infections. JAC Antimicrob Resist 2023; 5:dlad051. [PMID: 37102119 PMCID: PMC10125725 DOI: 10.1093/jacamr/dlad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
The global burden of infection from MDR organisms (MDROs) disproportionately affects children residing in low- and middle-income countries and those with increased healthcare exposure. These populations have high rates of malnutrition making them increasingly vulnerable to infection with intestinal-derived pathogens. Malnourished children experience increased incidence of intestinal carriage and invasive infection with intestinal-derived MDROs including ESBL- and carbapenemase-producing Enterobacterales. However, the relationship between malnutrition and MDRO infection remains to be clearly defined. Impairment in intestinal barrier function and innate and adaptive immunity in malnutrition increases the risk for infection with intestinal-derived pathogens, and there is an increasing appreciation of the role of the intestinal microbiota in this process. Current evidence from human studies and animal models suggests that diet and the intestinal microbiota influence each other to determine nutritional status, with important implications for infectious outcomes. These insights are crucial to developing microbiota-targeted strategies aimed at reversing the growing burden of MDRO infections in malnourished populations worldwide.
Collapse
Affiliation(s)
- Thomas Holowka
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, 130 Mason Farm Rd, CB #7030, Chapel Hill, NC 27599, USA
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, 130 Mason Farm Rd, CB #7030, Chapel Hill, NC 27599, USA
| | - Luther A Bartelt
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, 130 Mason Farm Rd, CB #7030, Chapel Hill, NC 27599, USA
| |
Collapse
|
37
|
Gerges B, Rolston K, Shelburne SA, Rosenblatt J, Prince R, Raad I. The in vitro activity of delafloxacin and comparator agents against bacterial pathogens isolated from patients with cancer. JAC Antimicrob Resist 2023; 5:dlad034. [PMID: 36994231 PMCID: PMC10041357 DOI: 10.1093/jacamr/dlad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 03/28/2023] Open
Abstract
Background Fluoroquinolones are used for infection prevention in high-risk patients with haematological malignancies. Fluoroquinolones are active against many Gram-negative bacilli (GNB) but are less active against Gram-positive organisms. We evaluated the in vitro activity of delafloxacin and selected comparators against 560 bacterial pathogens isolated exclusively from patients with cancer. Methods Antimicrobial susceptibility testing and time-kill studies were performed using CLSI-approved methodology and interpretive criteria for 350 Gram-positive organisms and 210 GNB that had been recently isolated from patients with cancer. Results Delafloxacin was more active than ciprofloxacin and levofloxacin against Staphylococcus aureus and CoNS. Overall, 63% of staphylococcal isolates were susceptible to delafloxacin, 37% to ciprofloxacin and 39% to levofloxacin. Activity of delafloxacin against most Enterobacterales was similar to that of ciprofloxacin and levofloxacin. Escherichia coli and MDR Pseudomonas aeruginosa isolates had low susceptibility rates to the three tested fluoroquinolones. In time-kill studies delafloxacin and levofloxacin decreased the bacterial load to 3.0 log10 in 8 and 13 h, respectively, using 8 × MIC. Conclusions Delafloxacin is more active than ciprofloxacin and levofloxacin against S. aureus but has substantial gaps in coverage against GNB. Resistance to all three fluoroquinolones could be high among leading GNB such as E. coli and P. aeruginosa, particularly in cancer centres where these agents are widely used as prophylactic agents.
Collapse
Affiliation(s)
| | - Kenneth Rolston
- Department of Infectious Diseases, Infection Control and Employee Health Research, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd, Houston, TX 77030, USA
| | - Samuel A Shelburne
- Department of Infectious Diseases, Infection Control and Employee Health Research, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd, Houston, TX 77030, USA
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd, Houston, TX 77030, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control and Employee Health Research, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd, Houston, TX 77030, USA
| | - Randall Prince
- Department of Infectious Diseases, Infection Control and Employee Health Research, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd, Houston, TX 77030, USA
| | - Issam Raad
- Department of Infectious Diseases, Infection Control and Employee Health Research, The University of Texas MD Anderson Cancer Center, 1515 Holcomb Blvd, Houston, TX 77030, USA
| |
Collapse
|
38
|
Breijyeh Z, Karaman R. Design and Synthesis of Novel Antimicrobial Agents. Antibiotics (Basel) 2023; 12:628. [PMID: 36978495 PMCID: PMC10045396 DOI: 10.3390/antibiotics12030628] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
The necessity for the discovery of innovative antimicrobials to treat life-threatening diseases has increased as multidrug-resistant bacteria has spread. Due to antibiotics' availability over the counter in many nations, antibiotic resistance is linked to overuse, abuse, and misuse of these drugs. The World Health Organization (WHO) recognized 12 families of bacteria that present the greatest harm to human health, where options of antibiotic therapy are extremely limited. Therefore, this paper reviews possible new ways for the development of novel classes of antibiotics for which there is no pre-existing resistance in human bacterial pathogens. By utilizing research and technology such as nanotechnology and computational methods (such as in silico and Fragment-based drug design (FBDD)), there has been an improvement in antimicrobial actions and selectivity with target sites. Moreover, there are antibiotic alternatives, such as antimicrobial peptides, essential oils, anti-Quorum sensing agents, darobactins, vitamin B6, bacteriophages, odilorhabdins, 18β-glycyrrhetinic acid, and cannabinoids. Additionally, drug repurposing (such as with ticagrelor, mitomycin C, auranofin, pentamidine, and zidovudine) and synthesis of novel antibacterial agents (including lactones, piperidinol, sugar-based bactericides, isoxazole, carbazole, pyrimidine, and pyrazole derivatives) represent novel approaches to treating infectious diseases. Nonetheless, prodrugs (e.g., siderophores) have recently shown to be an excellent platform to design a new generation of antimicrobial agents with better efficacy against multidrug-resistant bacteria. Ultimately, to combat resistant bacteria and to stop the spread of resistant illnesses, regulations and public education regarding the use of antibiotics in hospitals and the agricultural sector should be combined with research and technological advancements.
Collapse
Affiliation(s)
- Zeinab Breijyeh
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem P.O. Box 20002, Palestine
| | - Rafik Karaman
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem P.O. Box 20002, Palestine
- Department of Sciences, University of Basilicata, Via dell’Ateneo Lucano 10, 85100 Potenza, Italy
| |
Collapse
|
39
|
Hristova PM, Nankov VM, Hristov IG, Trifonov SV, Alexandrova AS, Hitkova HY. Gut colonization with vancomicyn-resistant enterococci among patients with hematologic malignancies. Gut Pathog 2023; 15:12. [PMID: 36894979 PMCID: PMC9999504 DOI: 10.1186/s13099-023-00538-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Vancomycin-resistant enterococci (VRE) are well known agents that colonize the gastrointestinal tract of immunocompromised patients, especially those with hematologic malignancies. The aim of the current study was to determine the incidence of and risk factors for colonization with VRE among patients with hematologic malignancies. MATERIALS For a nine-month period, all patients admitted to the Hematology ward at University Hospital in Pleven, Bulgaria who had hematologic malignancy and duration of hospitalization of more than 48 h were screened for colonization with VRE. The data collected from patients and their medical records during the entire hospital stay included: demographic characteristics, clinical information and information about all antimicrobials used. A longitudinal study was used to assesses the risk factors and statistical analysis was performed using SPSS version 27.0. RESULTS A total of 119 patients were enrolled in the study. Colonization with VRE was established in 18 of them. One patient carried two species, resulting in a total of 19 VRE: 12 Enterococcus gallinarum, 4 Enterococcus casseliflavus, 2 Enterococcus faecium and 1 Enterococcus faecalis. VanA phenotype, with high-level resistance of vancomycin (MIC ≥ 256 μg/ml) and teicoplanin (MIC = 96 μg/ml), was demonstrated by one E. faecium, which carried vanA. The other E. faecium and E. faecalis expressed low-level resistance to vancomycin (MICs: 8 μg/ml and 12 μg/ml), susceptibility to teicoplanin (MICs = 0.5 μg/ml) and vanB was detected. All E. gallinarum and E. casseliflavus showed low-level resistance to vancomycin and susceptibility to teicoplanin. E. gallinarum strains were positive for vanC1 and E. casseliflavus for vanC2. Only two patients were colonized with vanA or vanB enterococci and the rest 16 were positive for vanC. The univariate analysis revealed that patient's age (70-79 years; p = 0.025) and multiple myeloma (p = 0.001) are risk factors for VRE acquisition among the investigated patients. In addition, the multivariate analysis confirmed that patient's age (70-79 years) is an independent risk factor for VRE colonization. CONCLUSIONS Our results showed that 15.1% of patients with hematologic malignancies were colonized with VRE. There was a distinct prevalence of vanC enterococci. Among the analyzed risk factors, advanced age and multiple myeloma contributed to VRE acquisition.
Collapse
Affiliation(s)
- Preslava Mihaylova Hristova
- Department of Microbiology and Virology, Faculty of Pharmacy, Medical University Pleven, 1 St. Kliment Ohridski Str., 5800, Pleven, Bulgaria.
| | - Vladislav Milkov Nankov
- Department of Anatomy, Histology, Cytology and Biology, Medical University Pleven, Pleven, Bulgaria
| | - Ivaylo Georgiev Hristov
- Section of Hematology, Department of Nephrology, Hematology and Gastroenterology, Medical University Pleven, Pleven, Bulgaria
| | | | | | - Hristina Yotova Hitkova
- Department of Microbiology and Virology, Faculty of Pharmacy, Medical University Pleven, 1 St. Kliment Ohridski Str., 5800, Pleven, Bulgaria
| |
Collapse
|
40
|
Vecchia M, Colaneri M, Sacchi P, Marvulli LN, Salvaderi A, Lanza J, Boschini S, Ragni F, Marone P, Cutti S, Muzzi A, Marena C, Calvi M, Scudeller L, Marone EM, Bruno R. Implementation of an antimicrobial stewardship program in the Vascular Surgery ward of a university tertiary care hospital in Pavia, Northern Italy. BMC Infect Dis 2023; 23:138. [PMID: 36882761 PMCID: PMC9993681 DOI: 10.1186/s12879-023-08061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/07/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE The commitment of multidisciplinary teams in antimicrobial stewardship programs (ASPs) is often inadequately considered, especially in surgical wards. We wanted to evaluate clinical, microbiological, and pharmacological outcomes before and after the implementation of an ASP in the Vascular Surgery ward of Fondazione IRCCS Policlinico San Matteo, a tertiary care hospital in Pavia, Italy. METHODS This was a quasi-experimental quality-improvement study. The antimicrobial stewardship activity was conducted twice a week for 12 months and consisted of both prospective audit and feedback of all the ongoing antimicrobial prescriptions by the infectious diseases' consultants and educational meetings for the healthcare workers of the Vascular Surgery ward. For comparison between the study periods, Student t test (Mann-Whitney test for skewed distributions) was used for quantitative variables (ANOVA or Kruskall-Wallis for > 2 groups respectively), and Pearson's chi-squared test (Fisher exact test where appropriate) for categorical variables. 2-tailed tests were used. P-value significance cut-off was 0.05. RESULTS During the 12-month intervention period, among a total number of 698 patients, 186 prescriptions were revised, mostly leading to de-escalating an ongoing antimicrobial therapy (39, 20.97%). A statistically significant reduction in isolates of carbapenem-resistant Pseudomonas aeruginosa (p-value 0.003) and the absence of Clostridioides difficile infections were reported. No statistically significant changes were observed in terms of length of stay and all-cause in-hospital mortality. A significant decrease in the administration of carbapenems (p-value 0.01), daptomycin (p-value < 0.01) and linezolid (p-value 0.43) was registered. A significant reduction in antimicrobial costs was also observed. CONCLUSIONS The implementation of a 12-month ASP brought significant clinical and economic results, highlighting the benefits of a multidisciplinary teamwork.
Collapse
Affiliation(s)
- Marco Vecchia
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Marta Colaneri
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paolo Sacchi
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lea Nadia Marvulli
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Salvaderi
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jessica Lanza
- Division of Vascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Boschini
- Division of Vascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Franco Ragni
- Division of Vascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Piero Marone
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Cutti
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alba Muzzi
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carlo Marena
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Monica Calvi
- Pharmacy Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luigia Scudeller
- Head, Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Maria Marone
- Division of Vascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Division of Infectious Diseases Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Medical, Surgical, Diagnostic and Paediatric Science, University of Pavia, Pavia, Italy
| |
Collapse
|
41
|
Huang W, Qiao F, Cai L, Zong Z, Zhang W. Effect of daily chlorhexidine bathing on reducing infections caused by multidrug-resistant organisms in intensive care unit patients: A semiexperimental study with parallel controls. J Evid Based Med 2023; 16:32-38. [PMID: 36779575 DOI: 10.1111/jebm.12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 01/17/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To assess the effectiveness of daily bathing by chlorhexidine bathing on multidrug-resistant organisms in ICU, especially on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Enterobacteriaceae (CRE). METHODS Semiexperimental study which employed both precontrols and a parallel control was conducted. In the intervention period (from July 1 to December 31, 2016), strengthened infection control measures and daily bathing with 2% CHG-impregnated wipes once daily was performed in the ICU. Fifty-seven non-ICU wards with the occurrence of multidrug-resistant organisms (MDRO) infections during the same time were selected as parallel control group (only CHG bathing was not performed). The net effect of the 2% CHG daily bathing was evaluated by the difference in difference (DID) model. RESULTS The DID model analysis showed that CHG bathing reduced the incidence of CRAB- and CRPA-caused infections in ICU by 1.56 and 2.15 cases/1000 patient days, and bathing of every 19 patients (95CI% 13 to 41) and 39 patients (95CI% 24 to 110) were able to prevent one case of HAIs of total MDROs and CRPA, respectively. However, CHG bathing showed no effect on MRSA, VRE, and CRE (p > 0.05). CONCLUSION Daily bathing with 2% CHG-impregnated wipes can reduce HAIs caused by CRAB and CRPA, while it is not effective for the prevalence of infections caused by MRSA, VRE, and CRE.
Collapse
Affiliation(s)
- Wenzhi Huang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, P. R. China
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Fu Qiao
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Lin Cai
- Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Zhiyong Zong
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, P. R. China
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Wei Zhang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, P. R. China
| |
Collapse
|
42
|
Burke KB, Berryhill BA, Garcia R, Goldberg DA, Manuel JA, Gannon PR, Levin BR, Kraft CS, Mumma JM. A methodology for using Lambda phages as a proxy for pathogen transmission in hospitals. J Hosp Infect 2023; 133:81-88. [PMID: 36682626 PMCID: PMC10795484 DOI: 10.1016/j.jhin.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/21/2023]
Abstract
BACKGROUND One major concern in hospitalized patients is acquiring infections from pathogens borne on surfaces, patients, and healthcare workers (HCWs). Fundamental to controlling healthcare-associated infections is identifying the sources of pathogens, monitoring the processes responsible for their transmission, and evaluating the efficacy of the procedures employed for restricting their transmission. AIM To present a method using the bacteriophage Lambda (λ) to achieve these ends. METHODS Defined densities of multiple genetically marked λ phages were inoculated at known hotspots for contamination on high-fidelity mannequins. HCWs then entered a pre-sanitized simulated hospital room and performed a series of patient care tasks on the mannequins. Sampling occurred on the scrubs and hands of the HCWs, as well as previously defined high-touch surfaces in hospital rooms. Following sampling, the rooms were decontaminated using procedures demonstrated to be effective. Following the conclusion of the simulation, the samples were tested for the presence, identity, and densities of these λ phages. FINDINGS The data generated enabled the determination of the sources and magnitude of contamination caused by the breakdown of established infection prevention practices by HCWs. This technique enabled the standardized tracking of multiple contaminants during a single episode of patient care. Unlike other biological surrogates, λ phages are susceptible to common hospital disinfectants, and allow for a more accurate evaluation of pathogen transmission. CONCLUSION Whereas our application of these methods focused on healthcare-associated infections and the role of HCW behaviours in their spread, these methods could be employed for identifying the sources and sites of microbial contamination in other settings.
Collapse
Affiliation(s)
- K B Burke
- Department of Biology, Emory University, Atlanta, GA, USA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - B A Berryhill
- Department of Biology, Emory University, Atlanta, GA, USA; Program in Microbiology and Molecular Genetics, Graduate Division of Biological and Biomedical Sciences, Laney Graduate School, Emory University, Atlanta, GA, USA
| | - R Garcia
- Department of Biology, Emory University, Atlanta, GA, USA
| | - D A Goldberg
- Department of Biology, Emory University, Atlanta, GA, USA
| | - J A Manuel
- Department of Biology, Emory University, Atlanta, GA, USA
| | - P R Gannon
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - B R Levin
- Department of Biology, Emory University, Atlanta, GA, USA
| | - C S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - J M Mumma
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
43
|
Personelle und organisatorische Voraussetzungen zur Prävention nosokomialer Infektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:332-351. [PMID: 36802229 DOI: 10.1007/s00103-022-03647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
44
|
Gaube S, Däumling S, Biebl I, Rath A, Caplunik-Pratsch A, Schneider-Brachert W. (Mis-)Judgment of infection risks is associated with additional workload among healthcare workers when treating isolated patients. J Hosp Infect 2023; 133:95-97. [PMID: 36496091 PMCID: PMC9727961 DOI: 10.1016/j.jhin.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 12/12/2022]
Affiliation(s)
- S Gaube
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; LMU Center for Leadership and People Management, LMU Munich, Munich, Germany.
| | - S Däumling
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - I Biebl
- LMU Center for Leadership and People Management, LMU Munich, Munich, Germany; Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - A Rath
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Caplunik-Pratsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
45
|
Morgan DJ, Dubberke ER, Hink T, Paszkiewicz G, Burnham CAD, Pineles L, Magder L, Johnson JK, Leekha S, Harris AD. The Impact of Universal Glove and Gown Use on Clostridioides Difficile Acquisition: A Cluster-Randomized Trial. Clin Infect Dis 2023; 76:e1202-e1207. [PMID: 35776131 DOI: 10.1093/cid/ciac519] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Clostridioides difficile is the most common cause of healthcare-associated infections in the United States. It is unknown whether universal gown and glove use in intensive care units (ICUs) decreases acquisition of C. difficile. METHODS This was a secondary analysis of a cluster-randomized trial in 20 medical and surgical ICUs in 20 US hospitals from 4 January 2012 to 4 October 2012. After a baseline period, ICUs were randomized to standard practice for glove and gown use versus the intervention of all healthcare workers being required to wear gloves and gowns for all patient contact and when entering any patient room (contact precautions). The primary outcome was acquisition of toxigenic C. difficile determined by surveillance cultures collected on admission and discharge from the ICU. RESULTS A total of 21 845 patients had both admission and discharge perianal swabs cultured for toxigenic C. difficile. On admission, 9.43% (2060/21 845) of patients were colonized with toxigenic C. difficile. No significant difference was observed in the rate of toxigenic C. difficile acquisition with universal gown and glove use. Differences in acquisition rates in the study period compared with the baseline period in control ICUs were 1.49 per 100 patient-days versus 1.68 per 100 patient-days in universal gown and glove ICUs (rate difference, -0.28; generalized linear mixed model, P = .091). CONCLUSIONS Glove and gown use for all patient contact in medical and surgical ICUs did not result in a reduction in the acquisition of C. difficile compared with usual care. CLINICAL TRIALS REGISTRATION NCT01318213.
Collapse
Affiliation(s)
- Daniel J Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine and VA Maryland Healthcare System, Baltimore, Maryland, USA
| | - Erik R Dubberke
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Tiffany Hink
- Department of Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Gwen Paszkiewicz
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Carey-Ann D Burnham
- Departments of Pathology and Immunology, Medicine, Molecular Microbiology, and Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Lisa Pineles
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J Kristie Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
46
|
Impact of Multidisciplinary Collaborative Intervention on Isolation Implementation in Prevention and Control of Multi-drug Resistance Infection. Curr Med Sci 2023; 43:198-205. [PMID: 36867362 DOI: 10.1007/s11596-023-2709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/08/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Contact precautions, especially the initiation of isolation, are important measures to prevent and control multidrug-resistant organisms (MDROs). However, the implementation in clinical practice remains weak. This study aimed to analyze the impact of multidisciplinary collaborative intervention on isolation implementation in multidrug-resistant infection, and determine the factors that affect the implementation of isolation measures. METHODS A multidisciplinary collaborative intervention related to isolation was conducted at a teaching tertiary hospital in central China on November 1, 2018. The information of 1338 patients with MDRO infection and colonization at 10 months before and after the intervention was collected. Then, the issuance of isolation orders was retrospectively analyzed. Univariate analysis and multivariate logistic regression analysis were performed to analyze the factors that affected the isolation implementation. RESULTS The overall issuance rate of isolation orders was 61.21%, which increased from 33.12% to 75.88% (P<0.001) after the implementation of the multidisciplinary collaborative intervention. The intervention (P<0.001, OR=0.166) was a promoting factor for the issuance of isolation orders, in addition to the length of stay (P=0.004, OR=0.991), department (P=0.004), and microorganism (P=0.038). CONCLUSION The isolation implementation remains far lower than policy standards. Multidisciplinary collaborative interventions can effectively improve the compliance to isolation measures implemented by doctors, thereby promoting the standardized management of MDROs, and providing reference for further improving the quality of hospital infection management.
Collapse
|
47
|
Lau MT, Wong OF. Risk factors associated with bacteremia with drug-resistant organisms: Review of blood culture results in emergency department of a regional hospital. HONG KONG J EMERG ME 2023. [DOI: 10.1177/10249079231151518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Early antibiotic administration in sepsis improves patient survival. Treatment with antibiotics should cover potential pathogens and should avoid overusing broad-spectrum antibiotics. We have to identify patients who have high risks of infection with drug-resistant organisms. Objectives: A retrospective cohort study was conducted to identify potential risk factors associated with bloodstream infections with drug-resistant organisms to help the choice of empirical antibiotics in the emergency department. Methods: Adult patients with bloodstream infection diagnosed by blood culture in the emergency department in the period of 1 January 2020 to 31 December 2020 were included. Clinical features including chronic medical illnesses, clinical presentation and severity, and patients’ outcomes were identified in the electronic medical records. Bloodstream infection with drug-resistant organisms is defined as positive blood culture with bacteria resistant to either (1) amoxicillin/ clavulanic acid AND ceftriaxone or (2) amoxicillin/ clavulanic acid or ceftriaxone PLUS amikacin or levofloxacin. Univariate and multivariate analyses were conducted to identify risk factors associated with the study outcome. Results: Among 105 patients with bloodstream infection, 17% were caused by drug-resistant organisms. Multivariate analysis showed that age is a risk factor associated with bloodstream infection with drug-resistant organisms (odds ratio: 1.04, 95% confidence interval: 1.0–1.08, p = 0.03). Conclusion: In conclusion, age is a significant risk factor for drug-resistant bloodstream infection in emergency department patients. Further research may be needed to find out the relationship between frailty and infection with drug-resistant organisms.
Collapse
Affiliation(s)
- Man Ting Lau
- Accident and Emergency Department, North Lantau Hospital, Lantau, Hong Kong
| | - Oi Fung Wong
- Accident and Emergency Department, North Lantau Hospital, Lantau, Hong Kong
| |
Collapse
|
48
|
Kakimoto K, Nishiki S, Kaga Y, Harada T, Kawahara R, Takahashi H, Ueda E, Koshimo N, Ito H, Matsui T, Oishi K, Yamagishi T. Effectiveness of patient and staff cohorting to reduce the risk of vancomycin-resistant enterococcus (VRE) acquisition: a retrospective cohort study during a VRE outbreak in Japan. J Hosp Infect 2023; 134:35-42. [PMID: 36669647 DOI: 10.1016/j.jhin.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patient and staff cohorting is part of a bundle approach in the response to multi-drug-resistant organisms, but its effectiveness is not fully clarified. This study compared the risks of acquiring vancomycin-resistant Enterococcus faecium (VREfm) at a hospital during a VREfm outbreak based on contact characteristics in order to better understand the effectiveness of cohorting. METHODS Exposure came from contact with patients with VREfm (infectors), including existing patients with VREfm and patients who acquired VREfm during the study period. Contact was defined as length of contact time, degree of sharing space, and care by the same nurses as those caring for infectors between January and March 2018. The outcome was VREfm acquisition as determined through monthly stool or rectal screening cultures. Incidence rates were calculated based on contact patterns, and incidence rate ratios (IRRs) were compared. FINDINGS Among 272 inpatients (4038 patient-days), 43 patients acquired VREfm with the same or similar pulsotype. Incidence rates were 8.45 per 1000 patient-days when susceptible inpatients were on the same ward as an infector but cared for by different nurses (reference), 16.96 when susceptible inpatients were on the same ward as an infector and cared for by the same nurses [IRR 2.01, 95% confidence interval (CI) 0.62-10.28], and 52.91 when susceptible inpatients shared a room with an infector (IRR 6.26, 95% CI 1.61-35.40). CONCLUSION Compared with susceptible inpatients in a different room from infectors and not being cared for by the same nurses, the risk of VREfm acquisition could be six times higher for susceptible inpatients who are in the same room as infectors, and could be double for susceptible inpatients cared for by the same nurses as infectors.
Collapse
Affiliation(s)
- K Kakimoto
- Field Epidemiology Training Programme, National Institute of Infectious Diseases, Tokyo, Japan; Osaka Field Epidemiologic Investigation Team, Division of Public Health, Osaka Institute of Public Health, Osaka, Japan
| | - S Nishiki
- Field Epidemiology Training Programme, National Institute of Infectious Diseases, Tokyo, Japan; Centre for Field Epidemiology Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - Y Kaga
- Field Epidemiology Training Programme, National Institute of Infectious Diseases, Tokyo, Japan; Inba Public Health Centre, Chiba, Japan
| | - T Harada
- Division of Microbiology, Osaka Institute of Public Health, Osaka, Japan
| | - R Kawahara
- Division of Microbiology, Osaka Institute of Public Health, Osaka, Japan
| | - H Takahashi
- Infection Control Team, Nagayama Hospital, Osaka, Japan
| | - E Ueda
- Izumisano Public Health Centre, Osaka, Japan
| | - N Koshimo
- Izumisano Public Health Centre, Osaka, Japan
| | - H Ito
- Izumisano Public Health Centre, Osaka, Japan
| | - T Matsui
- Centre for Field Epidemiology Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan
| | - K Oishi
- Centre for Field Epidemiology Intelligence, Research and Professional Development, National Institute of Infectious Diseases, Tokyo, Japan; Toyama Institute of Health, Toyama, Japan
| | - T Yamagishi
- Antimicrobial Resistance Research Centre, National Institute of Infectious Diseases, Tokyo, Japan.
| |
Collapse
|
49
|
Wu C, Lu J, Ruan L, Yao J. Tracking Epidemiological Characteristics and Risk Factors of Multi-Drug Resistant Bacteria in Intensive Care Units. Infect Drug Resist 2023; 16:1499-1509. [PMID: 36945682 PMCID: PMC10024905 DOI: 10.2147/idr.s386311] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/04/2023] [Indexed: 03/17/2023] Open
Abstract
Objectives Multi-drug resistance (MDR) emerged as a serious threat in intensive care unit (ICU) settings. Our study aimed to investigate the major pathogens in ICU and identify the risk factors for MDR infection. Methods We performed a retrospective analysis of patients admitted to the ICU. Multivariate logistic regression was applied to identify the independent predictors, and then a nomogram to predict the probability of MDR infection. Results A total of 278 patients with 483 positive cultures were included. 249 (51.55%) had at least one MDR pathogen, including extensively drug-resistant (XDR) 77 (30.92%) and pan drug-resistant (PDR) 39 (15.66%), respectively. Klebsiella pneumonia was the most frequently isolated pathogen. We identified the number of bacteria (OR 2.91, 95% CI 1.97-4.29, P < 0.001), multiple invasive procedures (OR 2.23, 95% CI 1.37-3.63, P = 0.001), length of stay (LOS) (OR 1.01, 95% CI 1.00-1.02, P = 0.007), Hemoglobin (Hb) (OR 0.99, 95% CI 0.98-1.00, P = 0.01) were independent risk factors for MDR infection. Our nomogram displayed good discrimination with curve AUC was 0.75 (95% CI: 0.70-0.81). The decision curves also indicate the clinical utility of our nomogram. Additionally, the in-hospital mortality with MDR pathogens was independently associated with XDR (HR, 2.60; 95% CI: 1.08-6.25; P = 0.03) and total protein (TP) (HR, 0.95; 95% CI: 0.91-0.99; P = 0.03). Conclusion The number of bacteria, multiple invasive procedures, LOS, and Hb were the independent predictors associated with MDR pathogens. Our nomogram is potentially useful for predicting the occurrence of MDR infection. Besides, we also identify XDR and TP as the independent risk factors for in-hospital mortality with MDR infection. The current prevalence of MDR strains was also described. The results will contribute to the identification and preventive management of patients at increased risk of infection.
Collapse
Affiliation(s)
- Cuiyun Wu
- Department of Clinical Laboratory, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China
| | - Jiehong Lu
- Department of Clinical Laboratory, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China
| | - Lijin Ruan
- Department of Radiology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People’s Republic of China
| | - Jie Yao
- Department of Clinical Laboratory, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde), Foshan, Guangdong, People’s Republic of China
- Correspondence: Jie Yao, Department of Clinical Laboratory, Shunde Hospital, Southern Medical University (The First People’s Hospital of Shunde) Foshan, Guangdong, People's Republic of China, No. 1, Jiazi Road, Lunjiao, Shunde District, Foshan City, Guangdong Province, 528308, People’s Republic of China, Tel +86 0757 22318169, Email
| |
Collapse
|
50
|
Padmanabhan R, Elomri A, Taha RY, El Omri H, Elsabah H, El Omri A. Prediction of Multiple Clinical Complications in Cancer Patients to Ensure Hospital Preparedness and Improved Cancer Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:526. [PMID: 36612856 PMCID: PMC9819091 DOI: 10.3390/ijerph20010526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
Reliable and rapid medical diagnosis is the cornerstone for improving the survival rate and quality of life of cancer patients. The problem of clinical decision-making pertaining to the management of patients with hematologic cancer is multifaceted and intricate due to the risk of therapy-induced myelosuppression, multiple infections, and febrile neutropenia (FN). Myelosuppression due to treatment increases the risk of sepsis and mortality in hematological cancer patients with febrile neutropenia. A high prevalence of multidrug-resistant organisms is also noted in such patients, which implies that these patients are left with limited or no-treatment options amidst severe health complications. Hence, early screening of patients for such organisms in their bodies is vital to enable hospital preparedness, curtail the spread to other weak patients in hospitals, and limit community outbreaks. Even though predictive models for sepsis and mortality exist, no model has been suggested for the prediction of multidrug-resistant organisms in hematological cancer patients with febrile neutropenia. Hence, for predicting three critical clinical complications, such as sepsis, the presence of multidrug-resistant organisms, and mortality, from the data available from medical records, we used 1166 febrile neutropenia episodes reported in 513 patients. The XGboost algorithm is suggested from 10-fold cross-validation on 6 candidate models. Other highlights are (1) a novel set of easily available features for the prediction of the aforementioned clinical complications and (2) the use of data augmentation methods and model-scoring-based hyperparameter tuning to address the problem of class disproportionality, a common challenge in medical datasets and often the reason behind poor event prediction rate of various predictive models reported so far. The proposed model depicts improved recall and AUC (area under the curve) for sepsis (recall = 98%, AUC = 0.85), multidrug-resistant organism (recall = 96%, AUC = 0.91), and mortality (recall = 86%, AUC = 0.88) prediction. Our results encourage the need to popularize artificial intelligence-based devices to support clinical decision-making.
Collapse
Affiliation(s)
- Regina Padmanabhan
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
| | - Adel Elomri
- Division of Engineering Management and Decision Sciences, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha 34110, Qatar
| | - Ruba Yasin Taha
- Department of Hematology and Bone Marrow Transplant, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha 3050, Qatar
| | - Halima El Omri
- Department of Hematology and Bone Marrow Transplant, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha 3050, Qatar
| | - Hesham Elsabah
- Department of Hematology and Bone Marrow Transplant, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha 3050, Qatar
| | - Abdelfatteh El Omri
- Surgical Research Section, Department of Surgery, Hamad Medical Corporation, Doha 3050, Qatar
| |
Collapse
|