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Kawamura H, Imuta N, Ooka T, Shigemi A, Nakamura M, Mougi K, Obama Y, Fukuyama R, Arimura S, Murata N, Tominaga H, Sasaki H, Nagano S, Taniguchi N, Nishi J. Impact of control measures including decolonization and hand hygiene for orthopaedic surgical site infection caused by MRSA at a Japanese tertiary-care hospital. J Hosp Infect 2024; 146:151-159. [PMID: 37516280 DOI: 10.1016/j.jhin.2023.07.011] [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: 04/22/2023] [Revised: 06/16/2023] [Accepted: 07/01/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Meticillin-resistant Staphylococcus aureus (MRSA) is the most common pathogen in orthopaedic surgical site infections (SSIs). However, few studies have investigated the transmission process of orthopaedic MRSA SSI. AIM To investigate the transmission process of orthopaedic MRSA SSI using epidemiological and molecular analyses and to determine a method to prevent MRSA SSI in nosocomial orthopaedic surgery. METHODS Active MRSA surveillance, preoperative decolonization and contact precautions for MRSA-positive cases was performed at our institution. Changes in epidemic strains were evaluated and the possibility of transmission from patients in an orthopaedic ward of a Japanese tertiary-care hospital was assessed by genotyping stored MRSA strains. In addition, data on the prevalence of MRSA SSI, MRSA colonization, and use of an alcohol antiseptic agent (mL/patient-days) during 2005-2022 were retrospectively assessed. FINDINGS SCCmec type II strain in the SSI group decreased over time, associated with fewer outbreaks. Even during a period of high infection rates, no cases of transmission-induced SSI from nasal MRSA carriers were identified. The infection rate correlated negatively with the use of an alcohol antiseptic agent (r = -0.82; P < 0.0001). Two cases among five nasal carriers developed MRSA SSI caused by strains different from those related to nasal colonization. CONCLUSION The infection control measures for transmission from the hospital reservoirs including strict adherence to hand hygiene and decolonization of carriers is likely to be important for the prevention of orthopaedic MRSA SSI. However, the need for contact precautions for decolonized nasal carriers might be low.
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Affiliation(s)
- H Kawamura
- Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan; Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - N Imuta
- Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - T Ooka
- Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - A Shigemi
- Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan
| | - M Nakamura
- Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan; Clinical Laboratory, Kagoshima University Hospital, Kagoshima, Japan
| | - K Mougi
- Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan; Clinical Laboratory, Kagoshima University Hospital, Kagoshima, Japan
| | - Y Obama
- Clinical Laboratory, Kagoshima University Hospital, Kagoshima, Japan
| | - R Fukuyama
- Clinical Laboratory, Kagoshima University Hospital, Kagoshima, Japan
| | - S Arimura
- Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan
| | - N Murata
- Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan
| | - H Tominaga
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - H Sasaki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - S Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - N Taniguchi
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - J Nishi
- Department of Infection Control and Prevention, Kagoshima University Hospital, Kagoshima, Japan; Department of Microbiology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Dukes KC, Reisinger HS, Schweizer M, Ward MA, Chapin L, Ryken TC, Perl TM, Herwaldt LA. Examining barriers to implementing a surgical-site infection bundle. Infect Control Hosp Epidemiol 2024; 45:13-20. [PMID: 37493031 PMCID: PMC10782202 DOI: 10.1017/ice.2023.114] [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: 02/06/2023] [Revised: 04/27/2023] [Accepted: 05/04/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Surgical-site infections (SSIs) can be catastrophic. Bundles of evidence-based practices can reduce SSIs but can be difficult to implement and sustain. OBJECTIVE We sought to understand the implementation of SSI prevention bundles in 6 US hospitals. DESIGN Qualitative study. METHODS We conducted in-depth semistructured interviews with personnel involved in bundle implementation and conducted a thematic analysis of the transcripts. SETTING The study was conducted in 6 US hospitals: 2 academic tertiary-care hospitals, 3 academic-affiliated community hospitals, 1 unaffiliated community hospital. PARTICIPANTS In total, 30 hospital personnel participated. Participants included surgeons, laboratory directors, clinical personnel, and infection preventionists. RESULTS Bundle complexity impeded implementation. Other barriers varied across services, even within the same hospital. Multiple strategies were needed, and successful strategies in one service did not always apply in other areas. However, early and sustained interprofessional collaboration facilitated implementation. CONCLUSIONS The evidence-based SSI bundle is complicated and can be difficult to implement. One implementation process probably will not work for all settings. Multiple strategies were needed to overcome contextual and implementation barriers that varied by setting and implementation climate. Appropriate adaptations for specific settings and populations may improve bundle adoption, fidelity, acceptability, and sustainability.
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Affiliation(s)
- Kimberly C. Dukes
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System (ICVAHCS), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- College of Public Health, University of Iowa, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research & Evaluations (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System (ICVAHCS), Iowa City, Iowa
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Marin Schweizer
- Department of Internal Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Melissa A. Ward
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Timothy C. Ryken
- MercyOne Northeast Iowa Neurosurgery, Iowa City, Iowa
- Department of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Trish M. Perl
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Loreen A. Herwaldt
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- College of Public Health, University of Iowa, Iowa City, Iowa
- University of Iowa Hospitals and Clinics (UIHC), Iowa City, Iowa
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Wang Z, Sun L, Xu Y, Liang P, Xu K, Huang J. Discovery of novel JAK1 inhibitors through combining machine learning, structure-based pharmacophore modeling and bio-evaluation. J Transl Med 2023; 21:579. [PMID: 37641144 PMCID: PMC10464202 DOI: 10.1186/s12967-023-04443-6] [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: 05/25/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Janus kinase 1 (JAK1) plays a critical role in most cytokine-mediated inflammatory, autoimmune responses and various cancers via the JAK/STAT signaling pathway. Inhibition of JAK1 is therefore an attractive therapeutic strategy for several diseases. Recently, high-performance machine learning techniques have been increasingly applied in virtual screening to develop new kinase inhibitors. Our study aimed to develop a novel layered virtual screening method based on machine learning (ML) and pharmacophore models to identify the potential JAK1 inhibitors. METHODS Firstly, we constructed a high-quality dataset comprising 3834 JAK1 inhibitors and 12,230 decoys, followed by establishing a series of classification models based on a combination of three molecular descriptors and six ML algorithms. To further screen potential compounds, we constructed several pharmacophore models based on Hiphop and receptor-ligand algorithms. We then used molecular docking to filter the recognized compounds. Finally, the binding stability and enzyme inhibition activity of the identified compounds were assessed by molecular dynamics (MD) simulations and in vitro enzyme activity tests. RESULTS The best performance ML model DNN-ECFP4 and two pharmacophore models Hiphop3 and 6TPF 08 were utilized to screen the ZINC database. A total of 13 potentially active compounds were screened and the MD results demonstrated that all of the above molecules could bind with JAK1 stably in dynamic conditions. Among the shortlisted compounds, the four purchasable compounds demonstrated significant kinase inhibition activity, with Z-10 being the most active (IC50 = 194.9 nM). CONCLUSION The current study provides an efficient and accurate integrated model. The hit compounds were promising candidates for the further development of novel JAK1 inhibitors.
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Affiliation(s)
- Zixiao Wang
- Department of Pharmacy, Honghui Hospital, Xi' an Jiaotong University, Xi' an, 710054, China.
| | - Lili Sun
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yu Xu
- State Key Laboratory of Natural Medicines,Jiangsu Key Laboratory of Drug Discovery for Metabolic Diseases, Center of Drug Discovery,China Pharmaceutical University, Nanjing, 210009, China
| | - Peida Liang
- Department of Pharmacy, Honghui Hospital, Xi' an Jiaotong University, Xi' an, 710054, China
| | - Kaiyan Xu
- School of Pharmacy, Lanzhou University, Lanzhou, 730000, China
| | - Jing Huang
- Department of Pharmacy, Honghui Hospital, Xi' an Jiaotong University, Xi' an, 710054, China.
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Marrone M, Caricato P, Mele F, Leonardelli M, Duma S, Gorini E, Stellacci A, Bavaro DF, Diella L, Saracino A, Dell'Erba A, Tafuri S. Analysis of Italian requests for compensation in cases of responsibility for healthcare-related infections: A retrospective study. Front Public Health 2023; 10:1078719. [PMID: 36684913 PMCID: PMC9849901 DOI: 10.3389/fpubh.2022.1078719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction The aim of this study was to examine the type of compensation claims for alleged medical malpractice in the field of healthcare-related infections in Italy. Methods It was analyzed which was the most frequent clinical context, the characteristics of the disputes established, which were the alleged damages most often complained of, which were the possibly censurable behaviors of the health professionals, and which were the reasons for acceptance or rejection of the request for compensation. Results In 90.2%, the issue questioned regarded surgical site infections. The most common pathogens involved were coagulase-negative Staphylococci (34.1%) and Staphylococcus aureus (24.4%). The lack or non-adherence to protocols of prophylaxis and/or prevention of healthcare-related infections was the most reported cause of acceptance of the request of compensation. Discussion According to our data, a stronger effort should be made in terms of risk management perspective in order to ensure the develop and application of protocols for prevention of Gram-positive healthcare-related infections and strengthen infection control and antimicrobial stewardship programs.
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Affiliation(s)
- Maricla Marrone
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Pierluigi Caricato
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Federica Mele
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Mirko Leonardelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Stefano Duma
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Ettore Gorini
- Attorney of Supreme Court, Department of Economics and Finance, Aldo Moro University of Bari, Bari, Italy
| | - Alessandra Stellacci
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, Aldo Moro University of Bari, Bari, Italy
| | - Lucia Diella
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, Aldo Moro University of Bari, Bari, Italy
| | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area, Clinic of Infectious Diseases, Aldo Moro University of Bari, Bari, Italy
| | - Alessandro Dell'Erba
- Section of Legal Medicine, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Silvio Tafuri
- Section of Public Health, Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Bari, Italy
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Righi E, Mutters NT, Guirao X, Del Toro MD, Eckmann C, Friedrich AW, Giannella M, Kluytmans J, Presterl E, Christaki E, Cross ELA, Visentin A, Sganga G, Tsioutis C, Tacconelli E. ESCMID/EUCIC clinical practice guidelines on perioperative antibiotic prophylaxis in patients colonized by multidrug-resistant Gram-negative bacteria before surgery. Clin Microbiol Infect 2022; 29:463-479. [PMID: 36566836 DOI: 10.1016/j.cmi.2022.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
SCOPE The aim of the guidelines is to provide recommendations on perioperative antibiotic prophylaxis (PAP) in adult inpatients who are carriers of multidrug-resistant Gram-negative bacteria (MDR-GNB) before surgery. METHODS These evidence-based guidelines were developed after a systematic review of published studies on PAP targeting the following MDR-GNB: extended-spectrum cephalosporin-resistant Enterobacterales, carbapenem-resistant Enterobacterales (CRE), aminoglycoside-resistant Enterobacterales, fluoroquinolone-resistant Enterobacterales, cotrimoxazole-resistant Stenotrophomonas maltophilia, carbapenem-resistant Acinetobacter baumannii (CRAB), extremely drug-resistant Pseudomonas aeruginosa, colistin-resistant Gram-negative bacteria, and pan-drug-resistant Gram-negative bacteria. The critical outcomes were the occurrence of surgical site infections (SSIs) caused by any bacteria and/or by the colonizing MDR-GNB, and SSI-attributable mortality. Important outcomes included the occurrence of any type of postsurgical infectious complication, all-cause mortality, and adverse events of PAP, including development of resistance to targeted (culture-based) PAP after surgery and incidence of Clostridioides difficile infections. The last search of all databases was performed until April 30, 2022. The level of evidence and strength of each recommendation were defined according to the Grading of Recommendations Assessment, Development and Evaluation approach. Consensus of a multidisciplinary expert panel was reached for the final list of recommendations. Antimicrobial stewardship considerations were included in the recommendation development. RECOMMENDATIONS The guideline panel reviewed the evidence, per bacteria, of the risk of SSIs in patients colonized with MDR-GNB before surgery and critically appraised the existing studies. Significant knowledge gaps were identified, and most questions were addressed by observational studies. Moderate to high risk of bias was identified in the retrieved studies, and the majority of the recommendations were supported by low level of evidence. The panel conditionally recommends rectal screening and targeted PAP for fluoroquinolone-resistant Enterobacterales before transrectal ultrasound-guided prostate biopsy and for extended-spectrum cephalosporin-resistant Enterobacterales in patients undergoing colorectal surgery and solid organ transplantation. Screening for CRE and CRAB is suggested before transplant surgery after assessment of the local epidemiology. Careful consideration of the laboratory workload and involvement of antimicrobial stewardship teams before implementing the screening procedures or performing changes in PAP are warranted. High-quality prospective studies to assess the impact of PAP among CRE and CRAB carriers performing high-risk surgeries are advocated. Future well-designed clinical trials should assess the effectiveness of targeted PAP, including the monitoring of MDR-GNB colonization through postoperative cultures using European Committee on Antimicrobial Susceptibility Testing clinical breakpoints.
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Affiliation(s)
- Elda Righi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nico T Mutters
- University Hospital Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | - Xavier Guirao
- Surgical Endocrine Unit, Department of General Surgery, Surgical Site Prevention Unit, Parc Tauli, Hospital Universitari Sabadell, Spain
| | - Maria Dolores Del Toro
- Division of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla. Biomedicine Institute of Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Spain
| | - Christian Eckmann
- Klinikum Hannoversch-Muenden, Academic Hospital of Goettingen University, Germany
| | - Alex W Friedrich
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, the Netherlands; Institute for European Prevention Networks in Infection Control, University Hospital Münster, Münster, Germany
| | - Maddalena Giannella
- Infectious Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Jan Kluytmans
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Eirini Christaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Elizabeth L A Cross
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Alessandro Visentin
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; Division of Infectious Diseases, Department of Internal Medicine I, University of Tübingen, Tübingen, Germany.
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Hatcher JB, de Castro-Abeger A, LaRue RW, Hingorani M, Mawn L, Donahue SP, Sternberg P, Shieh C. MRSA Decolonization and the Eye: A Potential New Tool for Ophthalmologists. Semin Ophthalmol 2022; 37:541-553. [DOI: 10.1080/08820538.2022.2039220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Jeremy B Hatcher
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Alex de Castro-Abeger
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Richard W LaRue
- Department of Medicine, Division of Infectious Disease, Vanderbilt Medical Center, Nashville, TN, United States
| | - Melanie Hingorani
- Department of Paediatrics, Moorfields Eye Hospital, NHS Foundation Trust, London, UK
| | - Louise Mawn
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sean P Donahue
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Paul Sternberg
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Christine Shieh
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN, United States
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Evidence of the medical and economic benefits of implementing hygiene measures by a prevention link physician in trauma surgery: Study protocol for a biphasic multicenter prospective interventional pre-post cohort study using a structured intervention bundle development and tools of behavior change management. Contemp Clin Trials Commun 2021; 23:100815. [PMID: 34286158 PMCID: PMC8274293 DOI: 10.1016/j.conctc.2021.100815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction The German Commission for Hospital Hygiene and Infection Prevention recommends nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). It has been roughly described that a PLP serves as a link between the infection prevention team and the respective clinical departments. No detailed evidence about the contribution made by PLPs to the decrease of infection rates is available in Germany. The “HygArzt” project aims to demonstrate the medical and economic benefits of the implementation of hygiene measures by PLP in trauma surgery/orthopedics. Methods A multicenter interventional pre/post cohort study design was chosen. The study will run for a three-year period, including a pre-, post-, and an intervention phase, in four different hospitals, one of which will serve as pilot. A complex intervention containing evidence-based infection control measures will be developed and implemented by a PLP to proof efficacy. After the successful implementation of the preventive measures in the pilot hospital, the concept will be transposed to the three remaining trauma and orthopedic departments to confirm the transferability and generalizability. To enable the PLPs of the non-pilot departments, a subject-specific training program will be developed based on the study results of the pilot hospital and offered to the PLPs. Discussion Data are intended to provide evidence that and, if so, to which extent the implementation of specific preventive measures by a medical department-specific PLP is possible and results in a reduction of nosocomial infections in orthopedic surgery and traumatology. Contribution to the literature The present study describes a novel complex study design to prove the effectiveness of intervention measures for infection prevention. The study design and newly developed methodological approach could serve as a model for similar studies on infection prevention in the future. For the first time, the presented research project “HygArzt” focuses on the implementation of hygiene measures by an infection prevention link physician (PLP) and investigates whether nosocomial infections, especially surgical site infections, can be reduced by the measures implemented. Trial registration German clinical Trials register DRKS-ID:00013,296. Registered on March 5, 2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013296.
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Hajikhani M, Emam-Djomeh Z, Askari G. Fabrication and characterization of mucoadhesive bioplastic patch via coaxial polylactic acid (PLA) based electrospun nanofibers with antimicrobial and wound healing application. Int J Biol Macromol 2021; 172:143-153. [PMID: 33450342 DOI: 10.1016/j.ijbiomac.2021.01.051] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 12/13/2022]
Abstract
Polylactic acid (PLA) is the second-highest consumed bioplastic in the world. PVP/PLA-PEO complex nanofibers encapsulating collagen and cefazolin dressing scaffold were fabricated using a coaxial electrospinning method to target the release of the encapsulated compounds. It was observed that in collagen doses of 10 and 20%, the speed of healing showed a significant difference with the control sample, but the dose of 40% caused a decrease in wound healing rate in mice. The nanofibers' morphology and surface roughness were investigated by scanning electron microscopy (SEM) and atomic force microscopy (AFM), respectively. The mechanical properties and adhesion strength of the scaffolds were investigated. The scaffolds' antimicrobial activity was evaluated by disk diffusion method against the E. coli, S. aureus, and P. aeruginosa. The results indicated a positive effect on the antimicrobial activity of the samples. In this study, we were able to prolong the effect of scaffolds by changing the pattern of release of cefazolin from inside the nanofibers. Possible interactions between the polymers and the encapsulated compounds were investigated using Fourier-transform infrared spectroscopy (FTIR). Finally, in-vivo and histological tests were performed to evaluate the efficacy of the scaffolds in accelerating wound healing.
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Affiliation(s)
- Mehdi Hajikhani
- Transfer Phenomena Laboratory (TPL), Controlled Release Center, Department of Food Science, Technology and Engineering Faculty of Agricultural Engineering and Technology, University of Tehran, Karaj Campus, Karaj, Iran
| | - Zahra Emam-Djomeh
- Transfer Phenomena Laboratory (TPL), Controlled Release Center, Department of Food Science, Technology and Engineering Faculty of Agricultural Engineering and Technology, University of Tehran, Karaj Campus, Karaj, Iran; Center of Excellence in Biothermodynamics, University of Tehran, Tehran, Iran.
| | - Gholamreza Askari
- Transfer Phenomena Laboratory (TPL), Controlled Release Center, Department of Food Science, Technology and Engineering Faculty of Agricultural Engineering and Technology, University of Tehran, Karaj Campus, Karaj, Iran
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Yoshida J, Kikuchi T, Ueno T, Mataga A, Asano I, Otani K, Tamura T, Tanaka M. Interprofessional Antimicrobial Stewardship Influencing Clostridioides difficile Infection: An 8-Year Study Using Antimicrobial Use Density. Infect Drug Resist 2019; 12:3409-3414. [PMID: 31807031 PMCID: PMC6839804 DOI: 10.2147/idr.s184050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/18/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To reduce Clostridioides difficile infection (CDI), we implemented interprofessional antimicrobial, infection control, and diagnostic stewardship (ipAS) conducted by physicians/pharmacists, infection control nurses, and medical technologists, respectively. As a numerical indicator for ipAS, we used antimicrobial use density (AUD) in an 8-year study to validate its efficacy in CDI reduction. PATIENTS AND METHODS This was an observational study. CDI was defined as stool samples or C. difficile isolates containing toxin A and/or B from a patient with diarrhea occurring three or more times per day. From 2011-2018 at a 10-ward single site the subjects were in-patients with CDI, and the following data were collected: AUDs for 23 antibiotics, and antimicrobial test results. By 2015, we had established ipAS, consisting of culture submission before the administration of broad-spectrum antimicrobials, the promotion of point-of-care testing for diagnosis-based antimicrobials, perioperative prophylactic antibiotics, intervention at positive diagnosis of blood culture, team round for diarrhea, and inspection on contact precautions and disinfection in CDI cases. The study outcomes included annual numbers of CDI patients and blood culture sets. We compared annual AUDs between former (2011-14) and latter (2015-18) periods using Kruskal-Wallis tests and examined the correlation between AUDs and CDI numbers. RESULTS Of a total 50,970 patients, 1,750 patients underwent C. difficile toxin tests, of whom 171 patients (9.8%) were positive for CDI. Between the former and latter periods, AUDs for flomoxef (11.96 to 2.71 by medians), panipenem/betamipron (0.30 to 0.00), and clindamycin (3.87 to 2.19) significantly decreased (P<0.05) as did numbers of CDIs (26.5 to 10) (P=0.043). The correlation analysis revealed a significant correlation between AUD for flomoxef and CDIs (P=0.004) and the AUD for piperacillin/tazobactam and CDIs (P=0.010) with a positive Pearson r. CONCLUSION The integrated antimicrobial, diagnostic, and infection control approach used in ipAS may reduce CDIs.
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Affiliation(s)
- Junichi Yoshida
- Division of Infection Control, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Tetsuya Kikuchi
- Division of Infection Control, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Takako Ueno
- Division of Infection Control, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Akiko Mataga
- Division of Infection Control, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Ikuyo Asano
- Division of Infection Control, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Kazuhiro Otani
- Division of Infection Control, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Tetsuro Tamura
- Division of Infection Control, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Masao Tanaka
- Division of Infection Control, Shimonoseki City Hospital, Shimonoseki, Japan
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Kobayashi T, Nakaminami H, Ohtani H, Yamada K, Nasu Y, Takadama S, Noguchi N, Fujii T, Matsumoto T. An outbreak of severe infectious diseases caused by methicillin-resistant Staphylococcus aureus USA300 clone among hospitalized patients and nursing staff in a tertiary care university hospital. J Infect Chemother 2019; 26:76-81. [PMID: 31375457 DOI: 10.1016/j.jiac.2019.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/08/2019] [Accepted: 07/11/2019] [Indexed: 11/30/2022]
Abstract
The USA300 clone, which produces Panton-Valentine leukocidin (PVL), is a major highly pathogenic community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone that is spreading throughout the world. Although the prevalence of the USA300 clone in Japan was very limited a decade ago, its incidence has been increasing in both community and hospital settings in recent years. There is great concern that the USA300 clone will cause more complicated diseases and become a serious threat to immunocompromised patients in hospital settings. Here, we report an outbreak of severe infectious diseases in a tertiary care university hospital involving the incidence of deep infections, including bacteremia, and continuous and frequent isolation of MRSA strains for five months from six patients and a healthy nursing staff member in the same ward. The genotype of all MRSA isolates was identical to that of the USA300 clone. Furthermore, pulsed-field gel electrophoresis analysis indicated that all MRSA had the same patterns. These data demonstrate that a USA300 clone outbreak had occurred in the hospital. Fortunately, this outbreak was terminated subsequent to the interventions of the infection control team and all patients recovered following the appropriate therapies. Our report demonstrates that patients carrying highly pathogenic CA-MRSA have the potential to become a source of nosocomial outbreaks that can spread to healthy healthcare workers. Therefore, stricter standard precautions should be applied for all patients at the time of admission to prevent such nosocomial outbreaks.
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Affiliation(s)
- Takehito Kobayashi
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan; Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan
| | - Hidemasa Nakaminami
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Hiroshi Ohtani
- Division of General Medicine, Tachikawa Sogo Hospital, 4-1 Midori-Cho, Tachikawa, Tokyo 190-8578, Japan
| | - Kanako Yamada
- Department of Infection Prevention and Control, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Yutaka Nasu
- Department of Infection Prevention and Control, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Shunsuke Takadama
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Norihisa Noguchi
- Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan
| | - Takeshi Fujii
- Department of Infection Prevention and Control, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji, Tokyo 193-0998, Japan
| | - Tetsuya Matsumoto
- Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo 160-8402, Japan; Department of Medicine, International University of Health and Welfare, 4-3 Kozunomori, Narita City, Chiba Prefecture, 286-8686, Japan.
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11
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Spitzmüller R, Gümbel D, Güthoff C, Zaatreh S, Klinder A, Napp M, Bader R, Mittelmeier W, Ekkernkamp A, Kramer A, Stengel D. Duration of antibiotic treatment and risk of recurrence after surgical management of orthopaedic device infections: a multicenter case-control study. BMC Musculoskelet Disord 2019; 20:184. [PMID: 31043177 PMCID: PMC6495646 DOI: 10.1186/s12891-019-2574-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background Device-related infections in orthopaedic and trauma surgery are a devastating complication with substantial impact on morbidity and mortality. Systemic suppressive antibiotic treatment is regarded an integral part of any surgical protocol intended to eradicate the infection. The optimal duration of antimicrobial treatment, however, remains unclear. In a multicenter case-control study, we aimed at analyzing the influence of the duration of antibiotic exposure on reinfection rates 1 year after curative surgery. Methods This investigation was part of a federally funded multidisciplinary network project aiming at reducing the spread of multi-resistant bacteria in the German Baltic region of Pomerania. We herein used hospital chart data from patients treated for infections of total joint arthroplasties or internal fracture fixation devices at three academic referral institutions. Subjects with recurrence of an implant-related infection within 1 year after the last surgical procedure were defined as case group, and patients without recurrence of an implant-related infection as control group. We placed a distinct focus on infection of open reduction and internal fixation (ORIF) constructs. Uni- and multivariate logistic regression analyses were employed for data modelling. Results Of 1279 potentially eligible patients, 269 were included in the overall analysis group, and 84 contributed to an extramedullary fracture-fixation-device sample. By multivariate analysis, male sex (odds ratio [OR] 2.06, 95% confidence interval [CI] 1.08 to 3.94, p = 0.029) and facture fixation device infections (OR 2.05, 95% CI 1.05 to 4.02, p = 0.036) remained independent predictors of reinfection. In the subgroup of infected ORIF constructs, univariate point estimates suggested a nearly 60% reduced odds of reinfection with systemic fluoroquinolones (OR 0.42, 95% CI 0.04 to 2.46) or rifampicin treatment (OR 0.41, 95% CI 0.08 to 2.12) for up to 31 days, although the width of confidence intervals prohibited robust statistical and clinical inferences. Conclusion The optimal duration of systemic antibiotic treatment with surgical concepts of curing wound and device-related orthopaedic infections is still unclear. The risk of reinfection in case of infected extramedullary fracture-fxation devices may be reduced with up to 31 days of systemic fluoroquinolones and rifampicin, although scientific proof needs a randomized trial with about 1400 subjects per group. Concerted efforts are needed to determine which antibiotics must be applied for how long after radical surgical sanitation to guarantee sustainable treatment success.
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Affiliation(s)
- Romy Spitzmüller
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.
| | - Denis Gümbel
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,Department of Trauma and Orthopaedic Surgery, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Str 7, 12683, Berlin, Germany
| | - Claas Güthoff
- Center for Clinical Research, BG Hospital Unfallkrankenhaus Berlin gGmbH, Warener Str 7, 12683, Berlin, Germany
| | - Sarah Zaatreh
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Annett Klinder
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Matthias Napp
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Department of Orthopaedics, University Medicine Rostock, Doberaner Str 142, 18057, Rostock, Germany
| | - Axel Ekkernkamp
- Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany
| | - Axel Kramer
- Department of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str 49A, 17489, Greifswald, Germany
| | - Dirk Stengel
- BG Kliniken Group of Hospitals, Leipziger Pl 1, 10117, Berlin, Germany
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12
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Implementation strategies to reduce surgical site infections: A systematic review. Infect Control Hosp Epidemiol 2019; 40:287-300. [PMID: 30786946 DOI: 10.1017/ice.2018.355] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) portend high patient morbidity and mortality. Although evidence-based clinical interventions can reduce SSIs, they are not reliably delivered in practice, and data are limited on the best approach to improve adherence. OBJECTIVE To summarize implementation strategies aimed at improving adherence to evidence-based interventions that reduce SSIs. DESIGN Systematic reviewMethods:We searched PubMed, Embase, CINAHL, the Cochrane Library, the WHO Regional databases, AFROLIB, and Africa-Wide for studies published between January 1990 and December 2015. The Effective Practice and Organization Care (EPOC) criteria were used to identify an acceptable-quality study design. We used structured forms to extract data on implementation strategies and grouped them into an implementation model called the "Four Es" framework (ie, engage, educate, execute, and evaluate). RESULTS In total, 125 studies met our inclusion criteria, but only 8 studies met the EPOC criteria, which limited our ability to identify best practices. Most studies used multifaceted strategies to improve adherence with evidence-based interventions. Engagement strategies included multidisciplinary work and strong leadership involvement. Education strategies included various approaches to introduce evidence-based practices to clinicians and patients. Execution strategies standardized the interventions into simple tasks to facilitate uptake. Evaluation strategies assessed adherence with evidence-based interventions and patient outcomes, providing feedback of performance to providers. CONCLUSIONS Multifaceted implementation strategies represent the most common approach to facilitating the adoption of evidence-based practices. We believe that this summary of implementation strategies complements existing clinical guidelines and may accelerate efforts to reduce SSIs.
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Barnes CL, Cooper AM, Luque J, Manghwani J, Matar WY, Panda I, Rajgopal A, Vaidya S, Wakde O. General Assembly, Prevention, Hospital Environment: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34:S175-S179. [PMID: 30360982 DOI: 10.1016/j.arth.2018.09.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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14
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Tsutsui A, Yahara K, Shibayama K. Trends and patterns of national antimicrobial consumption in Japan from 2004 to 2016. J Infect Chemother 2018; 24:414-421. [PMID: 29428566 DOI: 10.1016/j.jiac.2018.01.003] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/18/2017] [Accepted: 01/09/2018] [Indexed: 12/19/2022]
Abstract
Frequent use of broad-spectrum antimicrobial classes has been reported in Japan; however, little is known about the long-term trend of national antimicrobial consumption, and that of individual agents. This study analyzed the national sales data of systemic antimicrobials from 2004 to 2016, derived from the IMS Japan Pharmaceutical Market database, to assess the consumption patterns of antimicrobial classes and agents in Japan. The number of defined daily doses per 1000 inhabitants per day (DID) was calculated for each antimicrobial agent. During the last 13 years, total antimicrobial consumption fluctuated by only 5% around the average of 14.41 DID. In 2016, the most used class was macrolides (32%), followed by cephalosporins (28%) and fluoroquinolones (19%). Oral agents comprised a large proportion (93%) of antimicrobial consumption. The most used agent, clarithromycin, accounted for 25% of all oral compounds used in 2016. The consumption of oral agents with high bioavailability, such as fluoroquinolones, amoxicillin, and sulfamethoxazole/trimethoprim increased, whereas that of cephalosporins decreased. In 2016, ceftriaxone was the most consumed parenteral agent, followed by cefazolin. The consumption of parenteral agents increased after 2009 when high-dose regimens of piperacillin/tazobactam, meropenem, and ampicillin/sulbactam were approved by the health insurance system. National antimicrobial consumption has been stable over the last 13 years. Moreover, shifts in the use of agents with high bioavailability and those approved for high-dose regimens were observed. However, the increased use of broad-spectrum agents is worrisome. A multifaceted approach is required to reduce overall antimicrobial consumption.
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Affiliation(s)
- Atsuko Tsutsui
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo 189-0002, Japan.
| | - Koji Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo 189-0002, Japan
| | - Keigo Shibayama
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo 189-0002, Japan
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15
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Cho SY, Chung DR. Infection Prevention Strategy in Hospitals in the Era of Community-Associated Methicillin-Resistant Staphylococcus aureus in the Asia-Pacific Region: A Review. Clin Infect Dis 2018; 64:S82-S90. [PMID: 28475795 DOI: 10.1093/cid/cix133] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an important cause of healthcare-associated infection. CA-MRSA clones have replaced classic hospital MRSA clones in many countries and have shown higher potential in transmission and virulence than hospital MRSA clones. In particular, the emergence of CA-MRSA in the Asia-Pacific region is concerning owing to insufficient infection control measures in the region. The old strategies for infection prevention and control of MRSA comprised adherence to standard precaution and policy of active screening of MRSA carriers and decolonization, and it has been controversial which strategy is better in terms of outcome and cost-effectiveness. Epidemiological changes in MRSA has made the development of infection prevention strategy more complicated. Based on the literature review and the questionnaire survey, we considered infection prevention strategies for healthcare settings in the Asia-Pacific region in the era of CA-MRSA.
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Affiliation(s)
- Sun Young Cho
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, and.,Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, and.,Center for Infection Prevention and Control, Samsung Medical Center, Seoul, Republic of Korea
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16
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Cao Z, Spilker T, Fan Y, Kalikin LM, Ciotti S, LiPuma JJ, Makidon PE, Wilkinson JE, Baker JR, Wang SH. Nanoemulsion is an effective antimicrobial for methicillin-resistant Staphylococcus aureus in infected wounds. Nanomedicine (Lond) 2017; 12:1177-1185. [PMID: 28447896 DOI: 10.2217/nnm-2017-0025] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To develop NB-201, a nanoemulsion compound, as a novel microbicidal agent against methicillin-resistant Staphylococcus aureus (MRSA) infection, which is a common threat to public health but with limited therapeutic options. MATERIALS & METHODS NB-201 was tested in in vitro and in vivo murine and porcine models infected with MRSA. RESULTS Topical treatment of MRSA-infected wounds with NB-201 significantly decreased bacterial load and had no toxic effects on healthy skin tissues. NB-201 attenuated neutrophil sequestration in MRSA-infected wounds and inhibited epidermal and deep dermal inflammation. The levels of proinflammatory cytokines were reduced in NB-201-treated MRSA-infected wounds. CONCLUSION NB-201 can greatly reduce inflammation characteristic of infected wounds and has antimicrobial activity that effectively kills MRSA regardless of the genetic basis of antibiotic resistance.
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Affiliation(s)
- Zhengyi Cao
- Michigan Nanotechnology Institute for Medicine & Biological Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Theodore Spilker
- Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
| | - Yongyi Fan
- Michigan Nanotechnology Institute for Medicine & Biological Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Linda M Kalikin
- Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
| | | | - John J LiPuma
- Department of Pediatrics, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
| | - Paul E Makidon
- Michigan Nanotechnology Institute for Medicine & Biological Sciences, University of Michigan, Ann Arbor, MI 48109, USA.,Unit for Laboratory Animal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
| | - John Erby Wilkinson
- Unit for Laboratory Animal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
| | - James R Baker
- Michigan Nanotechnology Institute for Medicine & Biological Sciences, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
| | - Su He Wang
- Michigan Nanotechnology Institute for Medicine & Biological Sciences, University of Michigan, Ann Arbor, MI 48109, USA.,Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
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17
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Tominaga H, Setoguchi T, Kawamura H, Kawamura I, Nagano S, Abematsu M, Tanabe F, Ishidou Y, Yamamoto T, Komiya S. Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: A retrospective case-control study. Medicine (Baltimore) 2016; 95:e5118. [PMID: 27787365 PMCID: PMC5089094 DOI: 10.1097/md.0000000000005118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Surgical site infection (SSI) after spine instrumentation is difficult to treat, and often requires removal of instrumentation. The removal of instrumentation after spine surgery is a severe complication that can lead to the deterioration of activities of daily living and poor prognosis. Although there are many reports on SSI after spine surgery, few reports have investigated the risk factors for the removal of instrumentation after spine surgery SSI. This study aimed to identify the risk factors for unavoidable removal of instrumentation after SSI of spine surgery. We retrospectively reviewed 511 patients who underwent spine surgery with instrumentation at Kagoshima University Hospital from January 2006 to December 2014. Risk factors associated with SSI were analyzed via multiple logistic regression analysis. Parameters of the group that needed instrumentation removal were compared with the group that did not require instrumentation removal using the Mann-Whitney U and Fisher's exact tests. The posterior approach was used in most cases (453 of 511 cases, 88.6%). SSI occurred in 16 of 511 cases (3.14%) of spine surgery with instrumentation. Multivariate logistic regression analysis identified 2 significant risk factors for SSI: operation time, and American Society of Anesthesiologists physical status classification ≥ 3. Twelve of the 16 patients with SSI (75%) were able to keep the instrumentation after SSI. Pseudarthrosis occurred in 2 of 4 cases (50%) after instrumentation removal. Risk factors identified for instrumentation removal after spine SSI were a greater number of past surgeries, low preoperative hemoglobin, high preoperative creatinine, high postoperative infection treatment score for the spine, and the presence of methicillin-resistant Staphylococcus aureus. In these high risk cases, attempts should be made to decrease the risk factors preoperatively, and careful postoperative monitoring should be conducted.
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Affiliation(s)
- Hiroyuki Tominaga
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences
- Correspondence: Hiroyuki Tominaga, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan (e-mail: )
| | - Takao Setoguchi
- Near-Future Locomotor Organ Medicine Creation Course (Kusunoki Kai), Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Hideki Kawamura
- Division of Medical and Environmental Safety, Kagoshima University Medical and Dental Hospital
| | - Ichiro Kawamura
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences
- Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka
| | - Satoshi Nagano
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences
| | - Masahiko Abematsu
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences
| | | | - Yasuhiro Ishidou
- Medical Joint Materials, Graduate School of Medical and Dental Sciences, Kagoshima University, Sakuragaoka
| | - Takuya Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences
| | - Setsuro Komiya
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences
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18
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Risk factors for surgical site infection and urinary tract infection after spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3908-3915. [DOI: 10.1007/s00586-016-4674-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/16/2016] [Accepted: 06/18/2016] [Indexed: 11/25/2022]
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