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Goodman KE, Taneja M, Magder LS, Klein EY, Sutherland M, Sorongon S, Tamma PD, Resnik P, Harris AD. A multi-center validation of the electronic health record admission source and discharge location fields against the clinical notes for identifying inpatients with long-term care facility exposure. Infect Control Hosp Epidemiol 2024:1-6. [PMID: 38634555 DOI: 10.1017/ice.2024.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Identifying long-term care facility (LTCF)-exposed inpatients is important for infection control research and practice, but ascertaining LTCF exposure is challenging. Across a large validation study, electronic health record data fields identified 76% of LTCF-exposed patients compared to manual chart review. OBJECTIVE Residence or recent stay in a long-term care facility (LTCF) is an important risk factor for antibiotic-resistant bacterial colonization. However, absent dedicated intake questionnaires or resource-intensive chart review, ascertaining LTCF exposure in inpatients is challenging. We aimed to validate the electronic health record (EHR) admission and discharge location fields against the clinical notes for identifying LTCF-exposed inpatients. METHODS We conducted a retrospective study of 1020 randomly sampled adult admissions between 2016 and 2021 across 12 University of Maryland Medical System hospitals. Using study-developed guidelines, we categorized the following data for LTCF exposure: each admission’s history & physical (H&P) note, each admission’s EHR-extracted “Admission Source,” and (3) the EHR-extracted admission and discharge locations for previous admissions (≤90 days). We estimated sensitivities, with 95% CIs, of H&P notes and of EHR admission/discharge location fields for detecting “current” and “any recent” (≤90 days, including current) LTCF exposure. RESULTS For detecting current LTCF exposure, the sensitivity of the index admission’s EHR-extracted “Admission Source” was 46% (95% CI: 35%–58%) and of the H&P note was 92% (83%–97%). For detecting any recent LTCF exposure, the sensitivity of “Admission Source” across the index and previous admissions was 32% (24%–41%), “Discharge Location” across previous admission(s) was 57% (47%–66%), and of the H&P note was 68% (59%–76%). The combined sensitivity of admission source and discharge location for detecting any recent LTCF exposure was 76% (67%–83%). CONCLUSIONS The EHR-obtained admission source and discharge location fields identified 76% of LTCF-exposed patients compared to chart review but disproportionately missed currently exposed patients.
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Affiliation(s)
- Katherine E Goodman
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA
- The University of Maryland Institute for Health Computing, Bethesda, MD, USA
| | - Monica Taneja
- The University of Maryland School of Medicine, Baltimore, MD, USA
| | - Laurence S Magder
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eili Y Klein
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mark Sutherland
- Departments of Emergency Medicine and Internal Medicine, The University of Maryland School of Medicine, Baltimore, MD, USA
| | - Scott Sorongon
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA
| | - Pranita D Tamma
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philip Resnik
- Department of Linguistics and Institute for Advanced Computer Studies, The University of Maryland, College Park, College Park, MD, USA
| | - Anthony D Harris
- Department of Epidemiology and Public Health, The University of Maryland School of Medicine, Baltimore, MD, USA
- The University of Maryland Institute for Health Computing, Bethesda, MD, USA
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Alrehaili JA. Evaluation to Determine Antibiotic Resistance Reduction in Gram-Negative Bacteria from 2019 to 2021 by the Saudi Arabia National Plan. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S393-S398. [PMID: 38595413 PMCID: PMC11001131 DOI: 10.4103/jpbs.jpbs_616_23] [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] [Received: 08/13/2023] [Accepted: 08/21/2023] [Indexed: 04/11/2024] Open
Abstract
Introduction The main objective of this study was to investigate the three-year evaluation of antibiotic resistance (AR) of multi-drug-resistant organisms and extended-spectrum beta-lactamase (ESBL)-resistant rate of gram-negative bacteria in one of the largest hospitals by the Saudi Arabia Nation Plan. Methods This study was conducted in the Department of Laboratory Medicine, in a private hospital in Riyadh City, Saudi Arabia, from January 2019 to December 2021 in 120-bed private hospitals. A total of 4700 gram-negative isolated organisms were obtained from the various specimens of the patients, and antibiotic sensitivity tests were performed. According to the manufacturer's instructions, the inoculum prepared was applied to two test cards, one for the identification system VITEK 2 ID-GNB and another for susceptibility testing antimicrobial susceptibility testing (AST) No. 12. Result The most common gram-negative bacteria isolated was Escherichia coli (2706/4700; 57.57%), followed by Klebsiella pneumoniae (905/4700; 19.25%) and Pseudomonas aeruginosa (395/4700; 8.40%). Escherichia coli's highest AR reduction was reported for cefotaxime (CTX) of 29% (295/1018; 29%, 172/818; 21%, 0/870; 0%) for 2019, 2020, and 2021, respectively. Except for Salmonella species, which displayed enhanced AR, the ESBL and multidrug-resistant (MDR) rates decreased significantly (p 0.05) for most bacteria. Conclusion This study helps to understand the maximum number of gram-negative bacteria susceptible to the Saudi National Action Plan (SNAP) to decrease the prevalence of AR, ESBL, and MDR. To comprehensively understand SNAP's effectiveness, other trials involving gram-positive bacteria should be considered.
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Affiliation(s)
- Jihad Awadallah Alrehaili
- Department of Pathology, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Lang M, Carvalho A, Baharoglu Z, Mazel D. Aminoglycoside uptake, stress, and potentiation in Gram-negative bacteria: new therapies with old molecules. Microbiol Mol Biol Rev 2023; 87:e0003622. [PMID: 38047635 PMCID: PMC10732077 DOI: 10.1128/mmbr.00036-22] [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] [Indexed: 12/05/2023] Open
Abstract
SUMMARYAminoglycosides (AGs) are long-known molecules successfully used against Gram-negative pathogens. While their use declined with the discovery of new antibiotics, they are now classified as critically important molecules because of their effectiveness against multidrug-resistant bacteria. While they can efficiently cross the Gram-negative envelope, the mechanism of AG entry is still incompletely understood, although this comprehension is essential for the development of new therapies in the face of the alarming increase in antibiotic resistance. Increasing antibiotic uptake in bacteria is one strategy to enhance effective treatments. This review aims, first, to consolidate old and recent knowledge about AG uptake; second, to explore the connection between AG-dependent bacterial stress and drug uptake; and finally, to present new strategies of potentiation of AG uptake for more efficient antibiotic therapies. In particular, we emphasize on the connection between sugar transport and AG potentiation.
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Affiliation(s)
- Manon Lang
- Institut Pasteur, Université Paris Cité, CNRS UMR3525, Unité Plasticité du Génome Bactérien, Paris, France
| | - André Carvalho
- Institut Pasteur, Université Paris Cité, CNRS UMR3525, Unité Plasticité du Génome Bactérien, Paris, France
| | - Zeynep Baharoglu
- Institut Pasteur, Université Paris Cité, CNRS UMR3525, Unité Plasticité du Génome Bactérien, Paris, France
| | - Didier Mazel
- Institut Pasteur, Université Paris Cité, CNRS UMR3525, Unité Plasticité du Génome Bactérien, Paris, France
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Riester MR, Douglas CM, Silva JB, Datta R, Zullo AR. Clinicians who primarily practice in nursing homes and outcomes among residents with urinary tract infection or pneumonia. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e253. [PMID: 38178878 PMCID: PMC10762639 DOI: 10.1017/ash.2023.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
Objective Assess the association between clinicians who primarily practice in nursing homes (NHs) and 14-day resident outcomes following initial antibiotic dispensing for pneumonia or urinary tract infection (UTI). Design Retrospective cohort. Setting U.S. NHs. Participants NH residents aged ≥65 years who were prescribed antibiotics for pneumonia or UTI between 1 January 2016 and 30 November 2018. Methods Medicare fee-for-service claims were linked to Minimum Data Set data. Clinicians who primarily practiced in NHs prescribed ≥90% of Part D dispensings to NH residents. Outcomes included death, all-cause and infection-specific hospitalization, and subsequent antibiotic dispensing. Adjusted risk ratios were estimated using inverse-probability-of-treatment-weighted (IPTW) modified Poisson regression models adjusting for 53 covariates. Results The study population included 28,826 resident-years who were prescribed antibiotics for pneumonia and 106,354 resident-years who were prescribed antibiotics for UTI. Among the pneumonia group, clinicians who primarily practiced in NHs were associated with a greater risk of death (RR 1.3; 95%CLs 1.0, 1.6), lower risks of all-cause (RR 0.9; 95%CLs 0.8, 0.9) and infection-specific hospitalization (RR 0.8; 95%CLs 0.7, 0.9), and similar risk of subsequent antibiotic dispensing (RR 1.0; 95%CLs 1.0, 1.1) after IPTW. No meaningful associations were observed between clinicians who primarily practiced in NHs and outcomes among the UTI group. Conclusions Clinicians who primarily practiced in NHs were associated with a lower risk of hospitalization but greater risk of mortality for NH residents with pneumonia. Further examination is needed to better understand drivers of differences in infection-related outcomes based on clinicians' training and primary practice setting.
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Affiliation(s)
- Melissa R. Riester
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Cody M. Douglas
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Joe B.B. Silva
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Rupak Datta
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Andrew R. Zullo
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA
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Rojas-Larios F, Martínez-Guerra BA, López-Jácome LE, Bolado-Martínez E, Vázquez-Larios MDR, Velázquez-Acosta MDC, Romero-Romero D, Mireles-Dávalos CD, Quintana-Ponce S, Feliciano-Guzmán JM, Pérez-Hernandez JM, Correa-León YP, López-Gutiérrez E, Rodriguez-Noriega E, González-Díaz E, Choy-Chang EV, Mena-Ramírez JP, Monroy-Colín VA, Ponce-de-León-Garduño A, Alcaraz-Espejel M, Avilés-Benítez LK, Quintanilla-Cazares LJ, Ramírez-Alanís E, Barajas-Magallón JM, Padilla-Ibarra C, Ballesteros-Silva MB, Atanacio-Sixto NA, Morales-de-la-Peña CT, Galindo-Méndez M, Pérez-Vicelis T, Jacobo-Baca G, Moreno-Méndez MI, Mora-Pacheco MDLL, Gutiérrez-Brito M, Sánchez-Godínez XY, Navarro-Vargas NV, Mercado-Bravo LE, Delgado-Barrientos A, Santiago-Calderón MA, López-Ovilla I, Molina-Chavarria A, Rincón-Zuno J, Franco-Cendejas R, Miranda-Mauricio S, Márquez-Avalos IC, López-García M, Duarte-Miranda LS, Cetina-Umaña CM, Barroso-Herrera-Y-Cairo IE, López-Moreno LI, Garza-González E. Active Surveillance of Antimicrobial Resistance and Carbapenemase-Encoding Genes According to Sites of Care and Age Groups in Mexico: Results from the INVIFAR Network. Pathogens 2023; 12:1144. [PMID: 37764952 PMCID: PMC10537696 DOI: 10.3390/pathogens12091144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
We analyzed the antimicrobial resistance (AMR) data of 6519 clinical isolates of Escherichia coli (n = 3985), Klebsiella pneumoniae (n = 775), Acinetobacter baumannii (n = 163), Pseudomonas aeruginosa (n = 781), Enterococcus faecium (n = 124), and Staphylococcus aureus (n = 691) from 43 centers in Mexico. AMR assays were performed using commercial microdilution systems (37/43) and the disk diffusion susceptibility method (6/43). The presence of carbapenemase-encoding genes was assessed using PCR. Data from centers regarding site of care, patient age, and clinical specimen were collected. According to the site of care, the highest AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from ICU patients. In contrast, in A. baumannii, higher AMR was observed in isolates from hospitalized non-ICU patients. According to age group, the highest AMR was observed in the ≥60 years age group for E. coli, E. faecium, and S. aureus, and in the 19-59 years age group for A. baumannii and P. aeruginosa. According to clinical specimen type, a higher AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from blood specimens. The most frequently detected carbapenemase-encoding gene in E. coli was blaNDM (84%).
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Affiliation(s)
- Fabian Rojas-Larios
- Laboratorio de Microbiología, Hospital Regional Universitario de Colima, Colima 28040, Mexico
| | - Bernardo Alfonso Martínez-Guerra
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico
| | - Luis Esaú López-Jácome
- Servicio de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | - Enrique Bolado-Martínez
- Departamento de Ciencias Químico-Biológicas, Universidad de Sonora, Hermosillo 83000, Mexico
| | - María Del Rosario Vázquez-Larios
- Laboratorio de Microbiología, Servicio de Infectología y Microbiología Cínica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | | | | | - Christian Daniel Mireles-Dávalos
- Laboratorio de Microbiología Clínica, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City 14080, Mexico
| | - Sandra Quintana-Ponce
- Facultad de Ciencias Naturales, Universidad Autónoma de Guerrero, Chilpancingo 39000, Mexico
| | | | - José Miguel Pérez-Hernandez
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | - Yoselin Paola Correa-León
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | - Eduardo López-Gutiérrez
- Área de Microbiología, Laboratorio Clínico, Hospital Regional de alta Especialidad de Oaxaca, Oaxaca 71256, Mexico
| | - Eduardo Rodriguez-Noriega
- Instituto de Patología Infecciosa y Experimental, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
| | - Esteban González-Díaz
- Instituto de Patología Infecciosa y Experimental, Centro Universitario Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44280, Mexico
- Departamento de Medicina Preventiva, Hospital Civil de Guadalajara, Fray Antonio Alcalde, Guadalajara 44280, Mexico
| | - Elena Victoria Choy-Chang
- Departamento de Bacteriología, Hospital General de Zona No.1 IMSS "Nueva Frontera", Tapachula 30767, Mexico
| | - Juan Pablo Mena-Ramírez
- Laboratorio de Microbiología, Hospital General de Zona No. 21 IMSS, Centro Universitario de los Altos (CUALTOS), Universidad de Guadalajara, Tepatitlán de Morelos 47630, Mexico
| | | | - Alfredo Ponce-de-León-Garduño
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México 14080, Mexico
| | | | - Laura Karina Avilés-Benítez
- Laboratorio de Microbiología y Parasitología, Hospital Infantil de Morelia "Eva Sámano de López Mateos", Morelia 58253, Mexico
| | | | | | | | - Cecilia Padilla-Ibarra
- Laboratorio Clínico, Hospital General de Estado "Dr. Ernesto Ramos Bours", Hermosillo 83000, Mexico
| | | | | | | | | | - Talía Pérez-Vicelis
- Hospital Regional de Alta Especialidad Bicentenario de la Independencia, Tultitlán 54916, Mexico
| | - Guillermo Jacobo-Baca
- Centro Universitario de Salud, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
| | | | | | | | | | | | | | | | | | - Ismelda López-Ovilla
- Hospital Chiapas Nos Une Dr. Jesús Gilberto Gómez Maza, Tuxtla Gutiérrez 29045, Mexico
| | | | - Joaquín Rincón-Zuno
- Instituto Materno Infantil del Estado de México, Toluca de Lerdo 50170, Mexico
| | - Rafael Franco-Cendejas
- Servicio de Infectología, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México 14389, Mexico
| | | | | | - Maribel López-García
- Hospital de la Madre y el Niño Guerrerense, Chilpancingo de los Bravo 39075, Mexico
| | | | | | | | | | - Elvira Garza-González
- Departamento de Bioquímica y Medicina Molecular, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey 66460, Mexico
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Kim HJ, Oh DK, Lim SY, Cho YJ, Park S, Suh GY, Lim CM, Lee YJ. Antibiogram of Multidrug-Resistant Bacteria Based on Sepsis Onset Location in Korea: A Multicenter Cohort Study. J Korean Med Sci 2023; 38:e75. [PMID: 36918029 PMCID: PMC10010909 DOI: 10.3346/jkms.2023.38.e75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/07/2022] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Administration of adequate antibiotics is crucial for better outcomes in sepsis. Because no uniform tool can accurately assess the risk of multidrug-resistant (MDR) pathogens, a local antibiogram is necessary. We aimed to describe the antibiogram of MDR bacteria based on locations of sepsis onset in South Korea. METHODS We performed a prospective observational study of adult patients diagnosed with sepsis according to Sepsis-3 from 19 institutions (13 tertiary referral and 6 university-affiliated general hospitals) in South Korea. Patients were divided into four groups based on the respective location of sepsis onset: community, nursing home, long-term-care hospital, and hospital. Along with the antibiogram, risk factors of MDR bacteria and drug-bug match of empirical antibiotics were analyzed. RESULTS MDR bacteria were detected in 1,596 (22.7%) of 7,024 patients with gram-negative predominance. MDR gram-negative bacteria were more commonly detected in long-term-care hospital- (30.4%) and nursing home-acquired (26.3%) sepsis, whereas MDR gram-positive bacteria were more prevalent in hospital-acquired (10.9%) sepsis. Such findings were consistent regardless of the location and tier of hospitals throughout South Korea. Patients with long-term-care hospital-acquired sepsis had the highest risk of MDR pathogen, which was even higher than those with hospital-acquired sepsis (adjusted odds ratio, 1.42; 95% confidence interval, 1.15-1.75) after adjustment of risk factors. The drug-bug match was lowest in patients with long-term-care hospital-acquired sepsis (66.8%). CONCLUSION Gram-negative MDR bacteria were more common in nursing home- and long-term-care hospital-acquired sepsis, whereas gram-positive MDR bacteria were more common in hospital-acquired settings in South Korea. Patients with long-term-care hospital-acquired sepsis had the highest the risk of MDR bacteria but lowest drug-bug match of initial antibiotics. We suggest that initial antibiotics be carefully selected according to the onset location in each patient.
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Affiliation(s)
- Hyung-Jun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Yoon Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Nursing home-associated bloodstream infection: A scoping review. Infect Control Hosp Epidemiol 2023; 44:82-87. [PMID: 35232503 DOI: 10.1017/ice.2022.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To update a 2005 review of nursing home-associated bloodstream infection (NHABSI) regarding sources, organisms, antibiotic resistance, and outcome. METHODS A scoping review of studies of NHABSI identified by searching Google Scholar and Medline with OVID for the period January 1, 2004, to June 30, 2021, was conducted. RESULTS Overall, 6 studies of NHABSI were identified. Only 1 study was conducted with residents in North American facilities whereas in the 2005 review all studies were conducted in North America. Escherichia coli was the most common blood isolate, the urinary tract was the most common source of NHABSI; and the case-fatality rates ranged from 21% to 28%. These findings were comparable to those in the 2005 review. However, the proportion of NHABSI episodes due to antibiotic-resistant organisms increased substantially compared to the 2005 review. The most common antibiotic-resistant organisms were extended-spectrum β-lactamase-producing E. coli and Klebsiella spp. The 2 studies that evaluated the relationship between appropriate empiric antibiotic therapy and outcome came to different conclusions. CONCLUSIONS The only major difference between the 2 reviews in the epidemiology of NHABSI was the marked increase in antibiotic resistance among blood isolates. Despite the increased antibiotic resistance, the case fatality rates in the current review were comparable to those reported in the 2005 review. However, the impact of appropriate empiric antibiotic therapy on outcome of NHABSI remains unclear.
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Laupland KB. Preventing healthcare-related infections among older adults: a focus on cross-transmission of antibiotic-resistant bacteria. Expert Rev Anti Infect Ther 2022; 20:1171-1178. [PMID: 35793840 DOI: 10.1080/14787210.2022.2099375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Older individuals (i.e. age ≥65 years) are at increased risk for development of infections including those due to antimicrobial-resistant bacteria, and transmission may occur between institutional and community settings. AREAS COVERED This article reviews infections in older individuals with a specific focus on healthcare-related and antimicrobial resistant infections. A structured narrative review was performed to identify articles published in English since 2010. Themes included defining the scope of the problem, establishing characteristics of older individuals that impact the burden of resistant infections, and interventions aimed at minimizing their impact. EXPERT OPINION Older individuals suffer a high burden of illness related to antimicrobial resistant infections. Individuals with chronic illnesses, frailty, and residents of nursing homes are at highest risk. Clinical trials have shown that antimicrobial stewardship interventions may reduce antibiotic use in nursing homes without compromising safety. Antimicrobial resistant bacteria are prevalent among nursing home residents, and bundled infection prevention and control interventions can reduce their transmission. Transmission of antimicrobial resistant bacteria occurs among older adults across hospital and institutional settings, which may further spread to the community. The burden of infections in older adults is expected to increase in the coming years and represents a healthcare and research priority.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
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Ageru TA, Seid H, Abiso TL, Kumalo A, Sidamo T, Balcha T. Burden of Antibiotic Resistance at Wolaita Sodo University Comprehensive Specialized Hospital. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7272024. [PMID: 38525432 PMCID: PMC10960649 DOI: 10.1155/2022/7272024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/29/2022] [Accepted: 05/24/2022] [Indexed: 03/26/2024]
Abstract
Background Antibiotic resistance is a serious threat to the human population everywhere. However, less attention is given to its concern in sub-Saharan Africa including Ethiopia. There is an information gap concerning antibiotic resistance and its pattern in Wolaita Sodo University Teaching Referral Hospital. This study is aimed at investigating the prevalence of antimicrobial resistance in the study area. Methods Five-year retrospective data of cultures and records of 581 patients were utilized to analyze the pattern of antibiotic resistance. The statistical software including SPSS version 25 and Microsoft excel 2013 were used. Laboratory records with incompletely registered age, sex, culture isolation, or drug susceptibility test data were excluded. Results Out of the total of 581 samples extracted from the microbiology laboratory, 237 (40.8%) samples were culture positive for bacteria. From positive culture growth, 165 (69.6%) were gram-positive bacteria whereas 72 (30.4%) were gram negative. Staphylococcus aureus was the most prevalent isolate among gram-positive isolates as Escherichia coli was for gram-negative isolates. Overall antibiotic resistance of gram-positive isolates was 57.2% whereas that of gram-negative bacteria was 58.8%. Conclusion S. aureus and E. coli were found to be the most prevalent pathogenic isolates among gram-positive and gram-negative bacteria, respectively. Most of the isolated pathogens showed high resistance towards the commonly prescribed antibiotic agents. The overall antibiotic resistance in this study was 57.7%, and the overall MDR prevalence was 72.2%.
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Affiliation(s)
- Temesgen Anjulo Ageru
- Department of Medical Laboratory Services, Wolaita Sodo University Comprehensive Specialized Hospital, Wolaita, P.O. Box 138, Ethiopia
| | - Habtamu Seid
- Department of Medical Laboratory Services, Wolaita Sodo University Comprehensive Specialized Hospital, Wolaita, P.O. Box 138, Ethiopia
| | - Temesgen Lera Abiso
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, P.O. Box 138, Ethiopia
| | - Abera Kumalo
- School of Medical Laboratory, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, P.O. Box 138, Ethiopia
| | - Temesgen Sidamo
- School of Pharmacy, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, P.O. Box 138, Ethiopia
| | - Tamrat Balcha
- School of Pharmacy, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita, P.O. Box 138, Ethiopia
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Beyene AM, Gezachew M, Mengesha D, Yousef A, Gelaw B. Prevalence and drug resistance patterns of Gram-negative enteric bacterial pathogens from diarrheic patients in Ethiopia: A systematic review and meta-analysis. PLoS One 2022; 17:e0265271. [PMID: 35294487 PMCID: PMC8926281 DOI: 10.1371/journal.pone.0265271] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/25/2022] [Indexed: 11/18/2022] Open
Abstract
Background Diarrhoea is the leading cause of morbidity and mortality in the world particularly in developing countries and among vulnerable groups of the population. Gram-negative enteric bacterial pathogens (GNEBPs) are a group of organisms that reside mainly in the intestine and induce diarrhoea. Antimicrobial agents are usually the part of their treatment regimen. The therapeutic effect of antimicrobials is hindered by the emergence and spread of drug-resistant strains. The information regarding the prevalence and antimicrobial resistance patterns of GNEBPs in Ethiopia is limited and found in a scattered form. Objectives This study was designed to determine the pooled prevalence and drug resistance patterns of GNEBPs by meta-analysis of data from diarrhoeic patients in Ethiopia. Method A comprehensive literature search was conducted through internet searches using Google Scholar, PubMed, Science Direct, HINARI databases, and reference lists of previous studies. Published articles were included in the study based on priorly set inclusion and exclusion criteria. Results were presented in the forest plot, tables, and figures with a 95% confidence interval (CI). The inconsistency index (I2) test statistics was used to assess heterogeneity across studies. The pooled prevalence estimate of GNEBPs and their drug resistance patterns were computed by a random-effects model. Software for Statistics and Data Science (STATA) version 14 statistical software was used for the analysis. Result After removing those articles which did not fulfil the inclusion criteria, 43 studies were included in the analysis. Studies were conducted in 8 regions of the country and most of the published articles were from the Amhara region (30.23%) followed by Oromia (18.60%) and Southern Nations, Nationalities, and Peoples’ region (SNNP) (18.60%). The pooled prevalence of GNEBPs was 15.81% (CI = 13.33–18.29). The funnel plot indicated the presence of publication bias. The pooled prevalence of GNEBPs in Addis Ababa, Amhara, SNNP, and Oromia regions were 20.08, 16.67, 12.12, and 11.61%, respectively. The pooled prevalence was 14.91, 18.03, and 13.46% among studies conducted from 2006–2010, 2011–2015, and 2016–2021, respectively and it was the highest (20.35%) in children having age less than or equal to 15 years. The pooled prevalence of Escherichia coli, Campylobacter spp., Shigella spp., and Salmonella enterica were 19.79, 10.76, 6.24, and 5.06%, respectively. Large proportions (60–90%) of the isolates were resistant to ampicillin, amoxicillin, tetracycline, and trimethoprim-sulphamethoxazole. The pooled prevalence of multidrug resistance (MDR) was 70.56% (CI = 64.56–76.77%) and MDR in Campylobacter spp., Shigella spp., E. coli, and S. enterica. were 80.78, 79.08, 78.20, and 59.46%, respectively. Conclusion The pooled estimate showed a high burden of GNEBPs infections and a high proportion of drug resistance characters to commonly used antimicrobial agents in Ethiopia. Therefore, performing drug susceptibility tests, establishing an antimicrobial surveillance system and confirmation by molecular techniques are needed.
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Affiliation(s)
- Achenef Melaku Beyene
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail: ,
| | - Mucheye Gezachew
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desalegn Mengesha
- Global One Health Initiative, East African Regional Office, Addis Ababa, Ethiopia
| | - Ahmed Yousef
- Department of Food Science and Technology, Ohio State University, Ohio, Columbus, United States of America
| | - Baye Gelaw
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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11
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Resistência microbiana a medicamentos em uma Instituição de Longa Permanência para Idosos. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao03751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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12
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Acosta H, Sadahira T, Sekito T, Maruyama Y, Iwata T, Araki M, Ogawa K, Tsuboi I, Wada K. Post-prostate biopsy acute bacterial prostatitis and screening cultures using selective media: An overview. Int J Urol 2022; 29:486-493. [PMID: 35144308 DOI: 10.1111/iju.14824] [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: 11/14/2021] [Revised: 01/09/2022] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
The development of several culture media and the availability to isolate and treat pathogens prior to a surgical procedure give us the ability to minimize treatment-related complications, and ultimately results in better outcomes for patients and avoidance of unwanted post-procedure inpatient admissions. In the last decade, an increasing incidence of multidrug-resistant Escherichia coli, especially extended-spectrum beta-lactamase-producing E. coli and fluoroquinolone-resistant pathogens, has been reported. These resistant species frequently colonize the rectal flora and gain access to the systemic circulation via the rectal plexus following a prostate biopsy. The bacteria can eventually lead to life-threatening complications, which is especially important in high-risk patients with multiple co-morbidities. Previously published studies have focused on the isolation of these pathogens with selective media before an invasive procedure and the potential benefits of incorporating the use of selective media as a mandatory pre-operative step. This preventive measure will allow us to offer a tailored prophylactic treatment that benefits patients and reduces the economic burden for the hospital.
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Affiliation(s)
- Herik Acosta
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Takanori Sekito
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Takehiro Iwata
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kohei Ogawa
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Ichiro Tsuboi
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Koichiro Wada
- Department of Urology, Shimane University Faculty of Medicine, Shimane, Japan
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13
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Tandan M, Thapa P, Maharjan P, Bhandari B. Impact of Antimicrobial Stewardship Program on Antimicrobial Resistant and Prescribing in Nursing Home: A Systematic Review and Meta-analysis. J Glob Antimicrob Resist 2022; 29:74-87. [DOI: 10.1016/j.jgar.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/25/2022] [Accepted: 02/06/2022] [Indexed: 11/29/2022] Open
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14
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Fernández-Martínez NF, Cárcel-Fernández S, De la Fuente-Martos C, Ruiz-Montero R, Guzmán-Herrador BR, León-López R, Gómez FJ, Guzmán-Puche J, Martínez-Martínez L, Salcedo-Leal I. Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1039. [PMID: 35162062 PMCID: PMC8834020 DOI: 10.3390/ijerph19031039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 01/27/2023]
Abstract
Multidrug-resistant Gram-negative bacteria (MDR-GNB) are microorganisms that have acquired resistance to extended-spectrum antibacterials and constitute an emerging threat to public health. Although carriers are an important source of transmission in healthcare settings, data about risk factors for MDR-GNB carriage are limited. Therefore, we aimed to identify risk factors for MDR-GNB carriage upon intensive care unit (ICU) admission and to optimise screening strategies. We conducted a case-control study. Admissions of adult patients to the ICU of a 1000-bed hospital during a year were included. We collected sociodemographic, clinical and microbiological data and performed a multivariate logistic regression model. A total of 1342 patients resulted in 1476 episodes of ICU admission, 91 (6.2%) of whom harboured MDR-GNB (38.5% women; median age 63.9 years). The most frequently isolated pathogens were Escherichia coli (57%) and Klebsiella pneumoniae (16%). The most frequent resistance mechanism was production of extended-spectrum beta lactamases. MDR-GNB carriage was associated to liver cirrhosis (OR 6.54, 95% CI 2.17-19.17), previous MDR-GNB carriage (OR 5.34, 1.55-16.60), digestive surgery (OR 2.83, 1.29-5.89) and length of hospital stay (OR 1.01 per day, 1.00-1.03). Several risk factors for MDR-GNB carriage upon admission to a high-risk setting were identified; the main comorbidity was liver cirrhosis.
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Affiliation(s)
- Nicolás Francisco Fernández-Martínez
- Preventive Medicine and Public Health Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain; (N.F.F.-M.); (B.R.G.-H.); (I.S.-L.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
| | - Sheila Cárcel-Fernández
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Intensive Care Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Department of Medicine, University of Granada, 18011 Granada, Spain;
| | - Carmen De la Fuente-Martos
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Intensive Care Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | - Rafael Ruiz-Montero
- Preventive Medicine and Public Health Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain; (N.F.F.-M.); (B.R.G.-H.); (I.S.-L.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Department of Medical and Surgical Sciences, University of Córdoba, 14004 Córdoba, Spain
| | - Bernardo R. Guzmán-Herrador
- Preventive Medicine and Public Health Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain; (N.F.F.-M.); (B.R.G.-H.); (I.S.-L.)
| | - Rafael León-López
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Intensive Care Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | | | - Julia Guzmán-Puche
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Microbiology Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Carlos III Research Institute, 28029 Majadahonda, Spain
| | - Luis Martínez-Martínez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Microbiology Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Carlos III Research Institute, 28029 Majadahonda, Spain
- Department of Agricultural Chemistry, Soil Science and Microbiology, University of Córdoba, 14004 Córdoba, Spain
| | - Inmaculada Salcedo-Leal
- Preventive Medicine and Public Health Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain; (N.F.F.-M.); (B.R.G.-H.); (I.S.-L.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Carlos III Research Institute, 28029 Majadahonda, Spain
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15
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Shin IS, Shin JH, Jang DE, Lee J. A Methodological Quality Evaluation of Meta-Analyses on Nursing Home Research: Overview and Suggestions for Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:505. [PMID: 35010765 PMCID: PMC8744792 DOI: 10.3390/ijerph19010505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 02/04/2023]
Abstract
(1) Background: The nursing home (NH) research field lacks quality reporting about meta-analyses (MAs), and most gradings of MA evidence are biased on analyzing the effectiveness of independent variables in randomized control trials. (2) Objectives: This study aimed to perform a critical methodological review of MAs in the NH research field. (3) Methods: We searched the articles from four databases (PubMed, MEDLINE, CINAHL, and PsycINFO) until 15th January 2021. We reviewed a total of 41 published review articles in the NH research field. (4) Results: The studies primarily fell into the following categories: medicine (17/41), nursing (7/41), and psychiatry or psychology (6/41); 36.6% of the reviewed studies did not use any validated MA guidelines. The lowest correctly reported PRISMA 2000 guideline item was protocol and registration (14.6%), and more than 50% of articles did not report risk of bias. Moreover, 78.0% of studies did not describe missing reports of effect size formula. (5) Discussion: NH researchers must follow appropriate and updated guidelines for their MAs in order to provide validated reviews, as well as consider statistical issues such as the complexity of interventions, proper grouping, and scientific effect-size calculations to improve the quality of their study. Future quality review studies should investigate more diverse studies.
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Affiliation(s)
- In-Soo Shin
- Graduate School of Education, Dongkuk University, Seoul 04620, Korea;
| | - Juh-Hyun Shin
- College of Nursing, Ewha Womans University, Seoul 03760, Korea
| | - Dong-Eun Jang
- School of Nursing, University of Texas at Austin, Austin, TX 78712, USA;
| | - Jiyeon Lee
- College of Nursing, Catholic University of Pusan, Seoul 43241, Korea;
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16
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Shugart A, Mahon G, Huang JY, Karlsson M, Valley A, Lasure M, Gross A, Pattee B, Vaeth E, Brooks R, Maruca T, Dominguez CE, Torpey D, Francis D, Bhattarai R, Kainer MA, Chan A, Dubendris H, Greene SR, Blosser SJ, Shannon DJ, Jones K, Brennan B, Hun S, D'Angeli M, Murphy CN, Tierney M, Reese N, Bhatnagar A, Kallen A, Brown AC, Spalding Walters M. Carbapenemase production among less-common Enterobacterales genera: 10 US sites, 2018. JAC Antimicrob Resist 2021; 3:dlab137. [PMID: 34514407 PMCID: PMC8417453 DOI: 10.1093/jacamr/dlab137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Historically, United States’ carbapenem-resistant Enterobacterales (CRE) surveillance and mechanism testing focused on three genera: Escherichia, Klebsiella, and Enterobacter (EsKE); however, other genera can harbour mobile carbapenemases associated with CRE spread. Objectives From January through May 2018, we conducted a 10 state evaluation to assess the contribution of less common genera (LCG) to carbapenemase-producing (CP) CRE. Methods State public health laboratories (SPHLs) requested participating clinical laboratories submit all Enterobacterales from all specimen sources during the surveillance period that were resistant to any carbapenem (Morganellaceae required resistance to doripenem, ertapenem, or meropenem) or were CP based on phenotypic or genotypic testing at the clinical laboratory. SPHLs performed species identification, phenotypic carbapenemase production testing, and molecular testing for carbapenemases to identify CP-CRE. Isolates were categorized as CP if they demonstrated phenotypic carbapenemase production and ≥1 carbapenemase gene (blaKPC, blaNDM, blaVIM, blaIMP, or blaOXA-48-like) was detected. Results SPHLs tested 868 CRE isolates, 127 (14.6%) were from eight LCG. Overall, 195 (26.3%) EsKE isolates were CP-CRE, compared with 24 (18.9%) LCG isolates. LCG accounted for 24 (11.0%) of 219 CP-CRE identified. Citrobacter spp. was the most common CP-LCG; the proportion of Citrobacter that were CP (11/42, 26.2%) was similar to the proportion of EsKE that were CP (195/741, 26.3%). Five of 24 (20.8%) CP-LCG had a carbapenemase gene other than blaKPC. Conclusions Participating sites would have missed approximately 1 in 10 CP-CRE if isolate submission had been limited to EsKE genera. Expanding mechanism testing to additional genera could improve detection and prevention efforts.
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Affiliation(s)
- Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Garrett Mahon
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Jennifer Y Huang
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Maria Karlsson
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Ann Valley
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | - Megan Lasure
- Wisconsin State Laboratory of Hygiene, Madison, WI, USA
| | | | | | | | - Richard Brooks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.,Maryland Department of Health, Baltimore, MD, USA
| | - Tyler Maruca
- Maryland Department of Health, Baltimore, MD, USA
| | | | - David Torpey
- Maryland Department of Health, Baltimore, MD, USA
| | - Drew Francis
- Arizona Department of Health Services, Phoenix, AZ, USA
| | | | | | - Allison Chan
- Tennessee Department of Health, Nashville, TN, USA
| | - Heather Dubendris
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Shermalyn R Greene
- North Carolina Department of Health and Human Services, Raleigh, NC, USA
| | - Sara J Blosser
- Indiana State Department of Health, Indianapolis, IN, USA
| | - D J Shannon
- Indiana State Department of Health, Indianapolis, IN, USA
| | - Kelly Jones
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Brenda Brennan
- Michigan Department of Health and Human Services, Lansing, MI, USA
| | - Sopheay Hun
- Washington State Department of Health, Tumwater, WA, USA
| | | | - Caitlin N Murphy
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, NE, USA
| | - Maureen Tierney
- Nebraska Department of Health and Human Services, Lincoln, NE, USA
| | - Natashia Reese
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Amelia Bhatnagar
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA.,Goldbelt C6 Inc, Juneau, AK, USA
| | - Alex Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Allison C Brown
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, USA
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Sood G, Perl TM. Outbreaks in Health Care Settings. Infect Dis Clin North Am 2021; 35:631-666. [PMID: 34362537 DOI: 10.1016/j.idc.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Outbreaks and pseudo-outbreaks in health care settings are complex and should be evaluated systematically using epidemiologic and molecular tools. Outbreaks result from failures of infection prevention practices, inadequate staffing, and undertrained or overcommitted health care personnel. Contaminated hands, equipment, supplies, water, ventilation systems, and environment may also contribute. Neonatal intensive care, endoscopy, oncology, and transplant units are areas at particular risk. Procedures, such as bronchoscopy and endoscopy, are sources of infection when cleaning and disinfection processes are inadequate. New types of equipment can be introduced and lead to contamination or equipment and medications can be contaminated at the manufacturing source.
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Affiliation(s)
- Geeta Sood
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, Center Tower, 3rd Floor, 5200 Eastern Avenue, Baltimore, MD 21224, USA.
| | - Trish M Perl
- Division of Infectious Diseases and Geographic Medicine, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Y7;302, Dallas, TX 75390, USA
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18
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Moschou A, Ioannou P, Moraitaki E, Stafylaki D, Maraki S, Samonis G, Kofteridis DP. Rectal Colonization by Drug Resistant Bacteria in Nursing Home Residents in Crete, Greece. Trop Med Infect Dis 2021; 6:tropicalmed6030123. [PMID: 34287352 PMCID: PMC8293340 DOI: 10.3390/tropicalmed6030123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/03/2021] [Accepted: 07/03/2021] [Indexed: 11/30/2022] Open
Abstract
(1) Background: In an area with a high prevalence of multi-drug resistant Gram-negative bacteria (MDR-GNB), we investigated the colonization of nursing home residents by such organisms. (2) Methods: A point prevalence study was performed in six nursing homes of the Heraklion area on the island of Crete. A rectal swab was taken and cultured from each participant, while additional risk factors such as recent hospitalization or antimicrobial usage were recorded and evaluated. (3) Results: A total of 137 nursing home residents were included in the study. Their mean age was 82.1 years and 19.7% were males. In total, cultures yielded 255 GNB; E. coli, K. pneumoniae and P. aeruginosa were the most common. Among the microorganisms cultured, 17.6% had the extended-spectrum beta-lactamase phenotype, while 18% were MDR. A statistically significant association was found between recent antimicrobial use and colonization by MDR-GNB; (4) Conclusions: Colonization by MDR-GNB was found to be highly prevalent in nursing home residents. Recent antimicrobial use was associated with MDR-GNB carriage.
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Affiliation(s)
- Aikaterini Moschou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, PC 71110 Crete, Greece; (A.M.); (G.S.); (D.P.K.)
| | - Petros Ioannou
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, PC 71110 Crete, Greece; (A.M.); (G.S.); (D.P.K.)
- Correspondence: ; Tel.: +30-28-1039-2424
| | - Eleni Moraitaki
- Department of Clinical Microbiology, University Hospital of Heraklion, PC 71110 Crete, Greece; (E.M.); (D.S.); (S.M.)
| | - Dimitra Stafylaki
- Department of Clinical Microbiology, University Hospital of Heraklion, PC 71110 Crete, Greece; (E.M.); (D.S.); (S.M.)
| | - Sofia Maraki
- Department of Clinical Microbiology, University Hospital of Heraklion, PC 71110 Crete, Greece; (E.M.); (D.S.); (S.M.)
| | - George Samonis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, PC 71110 Crete, Greece; (A.M.); (G.S.); (D.P.K.)
| | - Diamantis P. Kofteridis
- Department of Internal Medicine, University Hospital of Heraklion, Heraklion, PC 71110 Crete, Greece; (A.M.); (G.S.); (D.P.K.)
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19
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Alemayehu T. Prevalence of multidrug-resistant bacteria in Ethiopia: a systematic review and meta-analysis. J Glob Antimicrob Resist 2021; 26:133-139. [PMID: 34129993 DOI: 10.1016/j.jgar.2021.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Multidrug-resistant (MDR) bacteria are a significant public-health threat worldwide, especially in low- and middle-income countries. Comprehensive data are important to understand the magnitude of multidrug resistance (MDR), however these are not available in Ethiopia. METHODS Five electronic databases and grey literature of Addis Ababa University Repository were searched for data regarding the prevalence of MDR bacteria in Ethiopia. OpenMetaAnalyst R1.3 was used for analysis using a random-effects model to determine the effect size. Heterogeneity among articles was checked using the inconsistency index (I2). Funnel plot was used to check for publication bias. The quality of each article was checked using the Newcastle-Ottawa checklist adapted for cross-sectional studies. RESULTS Through database searching, 2094 articles were identified, of which 37 fulfilled the study inclusion criteria. This review comprises 6856 bacteria, of which 4949 isolates were MDR. The overall pooled prevalence of MDR was 70.5% (95% CI 64.9-76.1%), with considerable heterogeneity (I2 = 97.48%, P < 0.001). Funnel plot revealed no publication bias. Sidama (81.7%) had the highest MDR and Tigray (51.1%) the lowest. The greatest source of MDR was from multiple sites of infection (MSI) (76.8%); the least was from bloodstream infections (62.9%). MDR was higher in studies conducted on hospital-acquired infections (72.1%) compared with both hospital- and community-acquired infections (69.8%). CONCLUSION Our study indicates a high prevalence of MDR in Ethiopia. Sidama region, MSI and hospital-acquired infections showed the highest MDR in subgroup analysis. Regional hospitals should implement infection prevention and proper use of antibiotics in the community.
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Affiliation(s)
- Tsegaye Alemayehu
- Hawassa University College of Medicine and Health Science, School of Medical Laboratory, P.O. Box. 1560, Hawassa, Ethiopia.
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Aliyu S, Travers JL, Heimlich SL, Ifill J, Smaldone A. Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis. J Appl Gerontol 2021; 41:892-901. [PMID: 34075829 DOI: 10.1177/07334648211018299] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988-2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran's Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.
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Affiliation(s)
| | - Jasmine L Travers
- New York University Rory Meyers College of Nursing, New York City, USA
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Aliyu S, McGowan K, Hussain D, Kanawati L, Ruiz M, Yohannes S. Prevalence and Outcomes of Multi-Drug Resistant Blood Stream Infections Among Nursing Home Residents Admitted to an Acute Care Hospital. J Intensive Care Med 2021; 37:565-571. [PMID: 33938320 DOI: 10.1177/08850666211014450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The prevalence of multi-drug resistant organism (MDRO) colonization in nursing home residents has been well documented, but little is known about the impact of MDRO bloodstream infections (BSIs). The aim of this study was to assess the prevalence, cost, and outcomes of MDRO-BSI vs. non-MDRO-BSI among nursing home residents. DESIGN Retrospective cohort study. SETTING 960 bed tertiary academic medical center. PATIENTS Persons ≥18 years old admitted to an acute care tertiary hospital from Skilled Nursing Facilities with a diagnosis of sepsis between 2015 and 2018. INTERVENTIONS Retrospective analysis of prevalence and outcomes. MEASUREMENTS AND MAIN RESULTS Among patients admitted to the study hospital with a diagnosis of sepsis during the study period, 7% were from nursing homes. The prevalence of MDRO-BSI was 47%. We identified 54 (50%) gram positive BSIs, 48 (45%) gram negative BSI and 5 (5%) fungal BSI. Thirty-one (57%) of the gram-positive infections and 14 (30%) of the gram-negative infections were with MDROs. The prevalence of BSI organisms were Staphylococcus aureus in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%. We found that intensive care unit length of stay (7 days vs 5 days, P = .009), direct cost ($13,639 vs $9,922, P = .027), and total cost ($23,752 vs $17,900 P = .032) were significantly higher in patients with MDRO-BSI vs. non-MDRO-BSI. Patients with MDRO-BSI were twice as likely to receive inappropriate empiric antiinfective therapy (31% vs 16%, P = .006) and were more likely to die (49.1% vs 29.6%, P = .049). CONCLUSION Nursing home residents have a high prevalence of MDRO-BSI, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher ICU LOS, and higher mortality. Our research adds new information about the prevalence of fungemia in this population.
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Affiliation(s)
- Sainfer Aliyu
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Kevin McGowan
- Georgetown University School of Medicine, Washington, DC, USA
| | - Dilbi Hussain
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Lama Kanawati
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Maria Ruiz
- 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Seife Yohannes
- 8405MedStar Washington Hospital Center, Washington, DC, USA
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Mutair AA, Alhumaid S, Alawi ZA, Zaidi ARZ, Alzahrani AJ, Al-Tawfiq JA, Al-Shammari H, Rabaan AA, Khojah O, Al-Omari A. Five-year resistance trends in pathogens causing healthcare-associated infections at a multi-hospital healthcare system in Saudi Arabia, 2015-2019. J Glob Antimicrob Resist 2021; 25:142-150. [PMID: 33762211 DOI: 10.1016/j.jgar.2021.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Awareness of antimicrobial resistance (AMR) patterns in a given healthcare setting is important to inform the selection of appropriate antimicrobial therapy to reduce the further rise and spread of AMR as well as the rate of healthcare-associated infections (HAIs) and multidrug-resistant (MDR) organisms. We aimed to describe resistance patterns to several antimicrobial agents in pathogens causing HAIs isolated from patients using data gathered at three private tertiary-care hospitals in Saudi Arabia. METHODS Data on trends in AMR among bacteria causing HAIs and MDR events in children and adults at three private hospitals were collected retrospectively (2015-2019) using surveillance data. RESULTS Over the 5-year period, 29 393 pathogens caused 17 539 HAIs in 15 259 patients. Approximately 57.3% of patients were female and the mean age was 38.4 ± 16.8 years (81.4% adults, 18.6% children). Gram-negative pathogens were four times more likely to cause HAIs compared with Gram-positive bacteria (79.3% vs. 20.7%). Ranking of causative pathogens in decreasing order was Escherichia coli (42.2%), Klebsiella spp. (16.8%) and Staphylococcus aureus (13.9%). Acinetobacter spp. were the only pathogens to decrease significantly (7% reduction; P = 0.033). The most common resistant pathogens were extended-spectrum cephalosporin-resistant E. coli (37.1%), extended-spectrum cephalosporin-resistant Klebsiella (27.8%), carbapenem-non-susceptible Acinetobacter spp. (19.5%), carbapenem-non-susceptible Pseudomonas aeruginosa (19.2%) and methicillin-resistant S. aureus (18.6%). CONCLUSION National collaboration is required by prompt feedback to local authorities to tackle regional differences in AMR. This can help plan timely containment interventions to stop and contain microbial threats and swiftly assess their impact.
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Affiliation(s)
- Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Al-Ahsa, Saudi Arabia; College of Nursing, Princess Nora University, Riyadh, Saudi Arabia; School of Nursing, University of Wollongong, Australia.
| | - Saad Alhumaid
- Administration of Pharmaceutical Care, Al-ahsa Health Cluster, Ministry of Health, Al-ahsa, Saudi Arabia
| | - Zainab Al Alawi
- Department of Pediatrics, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Abdul Rehman Z Zaidi
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmed J Alzahrani
- Department of Pathology, College of Medicine, Al-Imam Mohammed Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine and Infection Control Unit, Quality and Patient Safety, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Haifa Al-Shammari
- Department of Histopathology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostics Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Osamah Khojah
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Laboratory Services, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Awad Al-Omari
- Research Center, Dr. Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Risk adjustment for benchmarking nursing home infection surveillance data: A narrative review. Am J Infect Control 2021; 49:366-374. [PMID: 32791257 DOI: 10.1016/j.ajic.2020.08.006] [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: 05/08/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 11/20/2022]
Abstract
Until recently, there was no national surveillance system for monitoring infection occurrence in long-term care facilities (LTCF) in the United States. As a result, there are no national benchmarks for LTCF infection rates that can be utilized for quality improvement at the facility level. One of the major challenges in the reporting of health care-related infection data is accounting for nonmodifiable facility and patient characteristics that influence benchmarks for infection. The objectives of this paper are to review: (a) published infection rates in LTCF in the United States to assess the level of variability; (b) studies describing facility- and resident-level risk factors for infection that can be used in risk adjustment models; (c) published attempts to risk-adjust LTCF infection rates; and (d) efforts to develop models specifically for risk adjustment of infection rates in LTCF for benchmarking. It is anticipated that this review will stimulate further study of methods to risk-adjust LTCF infection rates for benchmarking that will facilitate research and public reporting.
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Schoevaerdts D, Sibille FX, Gavazzi G. Infections in the older population: what do we know? Aging Clin Exp Res 2021; 33:689-701. [PMID: 31656032 DOI: 10.1007/s40520-019-01375-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 10/04/2019] [Indexed: 12/20/2022]
Abstract
The incidence of infections increases with age and results in a higher risk of morbidity and mortality. This rise is not mainly related to chronological age per se but has been linked mostly to individual factors such as immunosenescence; the presence of comorbidities; the occurrence of geriatric syndromes such as poor nutrition, polypharmacy, and cognitive disorders; and the presence of functional impairment concomitant with environmental, healthcare-related and microbiological factors such as the increasing risk of multidrug-resistant microorganisms. The geriatric concept of frailty introduces a new approach for considering the risk of infection; this concept highlights the importance of functional status and is a more comprehensive and multicomponent approach that may help to reverse the vulnerability to stress. The aim of this article is to provide some typical hallmarks of infections among older adults in comparison to younger individuals. The main differences among the older population that are presented are an increased prevalence of infections and potential risk factors, a higher risk of carrying multidrug-resistant microorganisms, an increase in barriers to a prompt diagnosis related to atypical presentations and challenges with diagnostic tools, a higher risk of under- and over-diagnosis, a worse prognosis with a higher risk of acute and chronic complications and a particular need for better communication among all healthcare sectors as they are closely linked together.
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Affiliation(s)
- Didier Schoevaerdts
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium.
| | - François-Xavier Sibille
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium
| | - Gaetan Gavazzi
- Geriatric Department, CHU UCL Namur, Site Godinne, Avenue Dr. Gaston Thérasse, 1, B-5530, Yvoir, Belgium
- Service Gériatrie Clinique, Centre Hospitalo-Universitaire Grenoble-Alpes, Avenue Central 621, 38400, Saint-Martin-d'Hères, France
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Bio fabrication of silver nanoparticles with antibacterial and cytotoxic abilities using lichens. Sci Rep 2020; 10:16781. [PMID: 33033304 PMCID: PMC7544908 DOI: 10.1038/s41598-020-73683-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/21/2020] [Indexed: 01/28/2023] Open
Abstract
Recently, increase bacterial resistance to antimicrobial compounds issue constitutes a real threat to human health. One of the useful materials for bacterial control is Silver nanoparticles (AgNPs). Researchers tend to use biogenic agents to synthesize stable and safe AgNPs. The principal aim of this study was to investigate the ability of lichen in AgNPs formation and to find out their suppression ability to MDR bacteria as well as their cytotoxic activity. In the current study, lichens (Xanthoria parietina, Flavopunctelia flaventior) were collected from the south of the Kingdom of Saudi Arabia. Lichens methanolic extracts were used for conversion of Ag ions to AgNPs. Prepared biogenic AgNPs were characterized by Ultraviolet–Visible (UV–Vis) Spectroscopy, Transmission electron microscopy (TEM), Dynamic Light Scattering (DLS) and Zeta potential and Energy-Dispersive X-ray Spectroscopy (EDS). Lichens Secondary metabolites were determined by Fourier-Transform Infrared Spectroscopy (FTIR) and Gas Chromatography–Mass Spectrometry (GC–MS). The antibacterial activity and synergistic effect of AgNPs were evaluated against pathogenic bacteria, including gram-positive; Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE), and gram-negative; (Pseudomonas aeruginosa, Escherichia coli) as well as the reference strains (ATCC) using the agar disk diffusion method. Cytotoxic effect of biogenic AgNPs was tested against HCT 116 (Human Colorectal Cancer cell), MDA-MB-231 (Breast cancer cell), and FaDu (Pharynx cancer cell) by MTT test. TEM imaging showed well-dispersed spherical particles of 1–40 nm size as well as zeta size showed 69–145 nm. Furthermore, FTIR and GC–MS identified various lichen chemical molecules. On the other hand, the highest antibacterial activity of AgNPs was noticed against P. aeruginosa, followed by MRSA, VRE, and E. coli. AgNPs influence on gram-negative bacteria was greater than that on gram-positive bacteria and their synergistic effect with some antibiotics was noted against examined microbes. Moreover, higher cytotoxicity for biogenic AgNPs against FaDu and HCT 116 cell line in relation to MDA-MB-231 was noted. Given the current findings, the biogenic AgNPs mediated by lichens had positive antibacterial, synergistic and cytotoxic powers. Therefore, they might be considered as a promising candidate to combat the multi-drug resistance organisms and some cancer cells.
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26
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McKinnell JA, Miller LG, Singh RD, Gussin G, Kleinman K, Mendez J, Laurner B, Catuna TD, Heim L, Saavedra R, Felix J, Torres C, Chang J, Estevez M, Mendez J, Tchakalian G, Bloomfield L, Ceja S, Franco R, Miner A, Hurtado A, Hean R, Varasteh A, Robinson PA, Park S, Tam S, Tjoa T, He J, Agrawal S, Yamaguchi S, Custodio H, Nguyen J, Bittencourt CE, Evans KD, Mor V, McConeghy K, Weinstein RA, Hayden MK, Stone ND, Steinberg K, Beecham N, Montgomery J, DeAnn W, Peterson EM, Huang SS. High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect". J Am Med Dir Assoc 2020; 21:1937-1943.e2. [PMID: 32553489 DOI: 10.1016/j.jamda.2020.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/06/2020] [Accepted: 04/09/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs). DESIGN Point prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas. SETTING Twenty-eight NHs in Southern California from 2016 to 2017. PARTICIPANTS NH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing and decolonization vs routine care. METHODS Fifty residents were randomly sampled per NH. Twenty objects were sampled, including 5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and dementia care residents). RESULTS A total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16% (range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of 45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental MDRO contamination was found in 74% of resident rooms and 93% of common areas. CONCLUSIONS AND IMPLICATIONS In more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated. The unknown submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection prevention and control practices, particularly high-fidelity adoption of universal strategies such as hand hygiene, environmental cleaning, and decolonization.
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Affiliation(s)
- James A McKinnell
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA; Los Angeles County Department of Public Health, Healthcare Outreach Unit, Los Angeles, CA, USA; Expert Stewardship, Newport, CA, USA.
| | - Loren G Miller
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Raveena D Singh
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Gabrielle Gussin
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Ken Kleinman
- University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, USA
| | - Job Mendez
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Bryn Laurner
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Tabitha D Catuna
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Lauren Heim
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Raheeb Saavedra
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - James Felix
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Crystal Torres
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Justin Chang
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Marlene Estevez
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Joanna Mendez
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Gregory Tchakalian
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Leah Bloomfield
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Sandra Ceja
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ryan Franco
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Aaron Miner
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Aura Hurtado
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Ratharo Hean
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Alex Varasteh
- Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Philip A Robinson
- Expert Stewardship, Newport, CA, USA; Hoag Hospital, Newport, CA, USA
| | - Steven Park
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Steven Tam
- Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, CA, USA
| | - Thomas Tjoa
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jiayi He
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Shalini Agrawal
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Stacey Yamaguchi
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Harold Custodio
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Jenny Nguyen
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Cassiana E Bittencourt
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Kaye D Evans
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Vincent Mor
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Providence, RI, USA; Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Kevin McConeghy
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Providence, RI, USA; Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, RI, USA
| | - Robert A Weinstein
- Cook County Health and Hospitals System, Chicago, IL, USA; Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Mary K Hayden
- Department of Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Nimalie D Stone
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karl Steinberg
- California Association of Long Term Care Medicine, Santa Clarita, CA, USA
| | - Nancy Beecham
- The National Association of Directors of Nursing Administration in Long Term Care, Springdale, OH, USA
| | | | - Walters DeAnn
- California Association of Health Facilities, Sacramento, CA, USA
| | - Ellena M Peterson
- Department of Pathology and Laboratory Medicine, University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Susan S Huang
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine, CA, USA; Department of Medicine, Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, USA
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Assessment of race and sex as risk factors for colonization with multidrug-resistant organisms in six nursing homes. Infect Control Hosp Epidemiol 2020; 41:1222-1224. [PMID: 32493534 DOI: 10.1017/ice.2020.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The role of demographic characteristics, such as sex and race, as risk factors for colonization with multidrug-resistant organisms, has not been established in the nursing home setting. We demonstrate significantly higher prevalence overall in male patients, and sex differences are dependent on organism of interest and body site.
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28
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A regional initiative to improve cleaning of high-touch surfaces in long-term care facilities. Infect Control Hosp Epidemiol 2020; 41:844-847. [PMID: 32284073 DOI: 10.1017/ice.2020.90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A total of 38 long-term care facilities within a region participated in a 3-month quality improvement initiative focused on environmental cleaning and disinfection. Significant improvements in daily and discharge cleaning were observed during the project period. Further study of the sustainability and clinical impact of this type of initiative is warranted.
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Rowan-Nash AD, Araos R, D'Agata EMC, Belenky P. Antimicrobial Resistance Gene Prevalence in a Population of Patients with Advanced Dementia Is Related to Specific Pathobionts. iScience 2020; 23:100905. [PMID: 32106056 PMCID: PMC7044522 DOI: 10.1016/j.isci.2020.100905] [Citation(s) in RCA: 4] [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: 11/15/2019] [Revised: 01/10/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022] Open
Abstract
Long-term care facilities are significant reservoirs of antimicrobial-resistant organisms, and patients with advanced dementia are particularly vulnerable to multidrug-resistant organism (MDRO) acquisition and antimicrobial overuse. In this study, we longitudinally examined a group of patients with advanced dementia using metagenomic sequencing. We found significant inter- and intra-subject heterogeneity in microbiota composition, suggesting temporal instability. We also observed a link between the antimicrobial resistance gene density in a sample and the relative abundances of several pathobionts, particularly Escherichia coli, Proteus mirabilis, and Enterococcus faecalis, and used this relationship to predict resistance gene density in samples from additional subjects. Furthermore, we used metagenomic assembly to demonstrate that these pathobionts had higher resistance gene content than many gut commensals. Given the frequency and abundances at which these pathobionts were found in this population and the underlying vulnerability to MDRO of patients with advanced dementia, attention to microbial blooms of these species may be warranted.
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Affiliation(s)
- Aislinn D Rowan-Nash
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI 02912, USA
| | - Rafael Araos
- Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile; Millenium Nucleus for Collaborative Research on Bacterial Resistance (MICROB-R), Santiago, Chile; Advanced Center for Chronic Diseases (ACCDiS), Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Erika M C D'Agata
- Infectious Diseases Division, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Peter Belenky
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI 02912, USA.
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Yu S, Wang S, Zou P, Chai G, Lin YW, Velkov T, Li J, Pan W, Zhou QT. Inhalable liposomal powder formulations for co-delivery of synergistic ciprofloxacin and colistin against multi-drug resistant gram-negative lung infections. Int J Pharm 2020; 575:118915. [PMID: 31816354 PMCID: PMC7313379 DOI: 10.1016/j.ijpharm.2019.118915] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/23/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023]
Abstract
The aim of this study was to design and characterize dry powder inhaler formulations of ciprofloxacin and colistin co-loaded liposomes prepared by the ultrasonic spray-freeze-drying (USFD) technique. Liposomal formulations and powder production parameters were optimized to achieve optimal characteristics and in-vitro performance such as encapsulation efficiency (EE), particle size, particle distribution index (PDI), fine particle fraction (FPF), emitted dose (ED) and in vitro antibacterial activity. The formulation (F6) with the mannitol (5% w/v) as the internal lyoprotectant and sucrose (5%, w/v), mannitol (10%, w/v) and leucine (5%, w/w) as the external lyoprotectants/aerosolization enhancers showed an optimal rehydrated EE values of ciprofloxacin and colistin (44.9 ± 0.9% and 47.0 ± 0.6%, respectively) as well as satisfactory aerosol performance (FPF: 45.8 ± 2.2% and 43.6 ± 1.6%, respectively; ED: 97.0 ± 0.5% and 95.0 ± 0.6%, respectively). For the blank liposomes, there was almost no inhibitory effect on the cell proliferation in human lung epithelial A549 cells, showing that the lipid materials used in the liposome formulation is safe for use in pulmonary drug delivery. The cytotoxicity study demonstrated that the optimized liposomal formulation (F6) was not cytotoxic at least at the drug concentrations of colistin 5 μg/mL and ciprofloxacin 20 μg/mL. Colistin (2 mg/L) monotherapy showed no antibacterial effect against P. aeruginosa H131300444 and H133880624. Ciprofloxacin (8 mg/L) monotherapy showed moderate bacterial killing for both clinical isolates; however, regrowth was observed in 6 h for P. aeruginosa H133880624. The liposomal formulation displayed superior antibacterial activity against clinical isolates of Pseudomonas aeruginosa H131300444 and P. aeruginosa H133880624 compared to each antibiotic per se. These results demonstrate that the liposomal powder formulation prepared by USFD could potentially be a pulmonary delivery system for antibiotic combination to treat multi-drug resistant Gram-negative lung infections.
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Affiliation(s)
- Shihui Yu
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China; Department of Industrial and Physical Pharmacy, College of Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
| | - Shaoning Wang
- Department of Medicinal Chemistry, School of Pharmaceutical Engineering, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China
| | - Peizhi Zou
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China; Department of Industrial and Physical Pharmacy, College of Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
| | - Guihong Chai
- Department of Industrial and Physical Pharmacy, College of Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA
| | - Yu-Wei Lin
- Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Tony Velkov
- Department of Pharmacology & Therapeutics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Jian Li
- Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Weisan Pan
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, China.
| | - Qi Tony Zhou
- Department of Industrial and Physical Pharmacy, College of Pharmacy, Purdue University, 575 Stadium Mall Drive, West Lafayette, IN 47907, USA.
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Niaz T, Shabbir S, Noor T, Imran M. Antimicrobial and antibiofilm potential of bacteriocin loaded nano-vesicles functionalized with rhamnolipids against foodborne pathogens. Lebensm Wiss Technol 2019. [DOI: 10.1016/j.lwt.2019.108583] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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32
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Salem‐Schatz S, Griswold P, Kandel R, Benjamin‐Bothwell S, DeMaria A, McElroy N, Bolstorff B, McHale E, Doron S. A Statewide Program to Improve Management of Suspected Urinary Tract Infection in Long‐Term Care. J Am Geriatr Soc 2019; 68:62-69. [DOI: 10.1111/jgs.16261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/18/2019] [Accepted: 09/21/2019] [Indexed: 02/05/2023]
Affiliation(s)
| | - Paula Griswold
- Massachusetts Coalition for the Prevention of Medical Errors Burlington MA
| | | | | | - Alfred DeMaria
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health Boston Massachusetts
| | - Nora McElroy
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health Boston Massachusetts
| | - Barbara Bolstorff
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health Boston Massachusetts
| | - Eileen McHale
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health Boston Massachusetts
| | - Shira Doron
- Division of Infectious DiseaseTufts Medical Center Boston Massachusetts
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Yoon YK, Suh JW, Kang EJ, Kim JY. Efficacy and safety of fecal microbiota transplantation for decolonization of intestinal multidrug-resistant microorganism carriage: beyond Clostridioides difficile infection. Ann Med 2019; 51:379-389. [PMID: 31468999 PMCID: PMC7877873 DOI: 10.1080/07853890.2019.1662477] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Persistent reservoirs of multidrug-resistant microorganisms (MDRO) that are prevalent in hospital settings and communities can lead to the spread of MDRO. Currently, there are no effective decolonization strategies, especially non-pharmacological strategies without antibiotic regimens. Our aim was to evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for the eradication of MDRO. A systematic literature search was performed to identify studies on the use of FMT for the decolonization of MDRO. PubMed, EMBASE, Web of Science, and Cochrane Library were searched from inception through January 2019. Of the 1395 articles identified, 20 studies met the inclusion and exclusion criteria. Overall, the efficacy of FMT for the eradication of each MDRO was 70.3% (102/146) in 121 patients from the 20 articles. The efficacy rates were 68.2% (30/44) for gram-positive bacteria and 70.6% (72/102) for gram-negative bacteria. Minor adverse events, including vomiting, diarrhea, abdominal pain, and ileus, were reported in patients who received FMT. FMT could be a promising strategy to eradicate MDRO in patients. Further studies are needed to confirm these findings and establish a comprehensive FMT protocol for standardized treatment.Key messagesThe development of new antibiotics lags behind the emergence of multidrug-resistant microorganisms (MDRO). New strategies are needed.Theoretically, fecal microbiota transplantation (FMT) might recover the diversity and function of commensal microbiota from dysbiosis in MDRO carriers and help restore colonization resistance to pathogens.A literature review indicated that FMT could be a promising strategy to eradicate MDRO in patients.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jin Woong Suh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Eun-Ji Kang
- Korea University Medical Library, Seoul, Korea
| | - Jeong Yeon Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Yoon YK, Ryu JM, Lee MJ, Lee SE, Yang KS, Lee CK, Kim MJ, Sohn JW. Active surveillance at the time of hospital admission for multidrug-resistant microorganisms among patients who had recently been hospitalized at health care facilities. Am J Infect Control 2019; 47:1188-1193. [PMID: 31122673 DOI: 10.1016/j.ajic.2019.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND This study aimed to investigate the epidemiology of multidrug-resistant microorganism (MDRO) carriage at hospital admission and to identify risk factors for MDRO influx into hospital settings. METHODS This cohort study was conducted at a 1,051-bed university-affiliated hospital in the Republic of Korea between July 1 and December 31, 2017. Active surveillance for MDRO carriage was performed within 48 hours of hospitalization in all adult patients who had prior hospitalization within the preceding 3 months. RESULTS During the study, 575 patients were admitted with a hospitalization history within 3 months. Active surveillance at hospital admission was performed in 192 eligible patients. Thirty-three (17.2%) patients with MDRO carriage were identified from active surveillance. In the multivariate logistic regression analysis, prior exposure to antibiotics within 90 days, hospitalization for ≥60 days before admission, cognitive dysfunction, percutaneous drainage, and underlying pulmonary diseases were identified as independent risk factors for MDRO influx. CONCLUSIONS Our findings suggest a significant prevalence of MDRO acquisition at acute care hospital admission in patients who had been recently hospitalized. To control the spread of MDRO, collaborations among health care institutions and targeted screening at hospital admission according to patient risk factors are warranted.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea; Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea
| | - Jee Myung Ryu
- Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea
| | - Min Jung Lee
- Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea
| | - Sung Eun Lee
- Infection Control Unit, Korea University Medical Center, Seoul, Republic of Korea
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyu Lee
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea.
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35
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Kang Y. Prevention of sepsis in an aging society. Acute Crit Care 2019; 34:221-222. [PMID: 31723932 PMCID: PMC6849019 DOI: 10.4266/acc.2019.00612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Youngjoon Kang
- Department of Emergency Medicine, Jeju National University Hospital, Jeju, Korea
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36
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Leal HF, Azevedo J, Silva GEO, Amorim AML, de Roma LRC, Arraes ACP, Gouveia EL, Reis MG, Mendes AV, de Oliveira Silva M, Barberino MG, Martins IS, Reis JN. Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features. BMC Infect Dis 2019; 19:609. [PMID: 31296179 PMCID: PMC6624930 DOI: 10.1186/s12879-019-4265-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 07/05/2019] [Indexed: 11/12/2022] Open
Abstract
Background Bloodstream infections (BSI) are associated with high morbidity and mortality. This scenario worsens with the emergence of drug-resistant pathogens, resulting in infections which are difficult to treat or even untreatable with conventional antimicrobials. The aim of this study is to describe the epidemiological aspects of BSI caused by multiresistant gram-negative bacilli (MDR-GNB). Methods We conducted a laboratory-based surveillance for gram-negative bacteremia over a 1-year period. The bacterial isolates were identified by MALDI-TOF/MS and the antimicrobial susceptibility testing was performed by VITEK®2. Resistance genes were identified through PCR assays. Results Of the 143 patients, 28.7% had infections caused by MDR-GNB. The risk factors for MDR bacteremia were male sex, age ≥ 60, previous antimicrobial use, liver disease and bacteremia caused by K. pneumoniae. K. pneumoniae was the most frequently observed causative agent and had the highest resistance level. Regarding the resistance determinants, SHV, TEM, OXA-1-like and CTX-M-gp1 were predominant enzymatic variants, whereas CTX-M-gp9, CTX-M-gp2, KPC, VIM, GES, OXA-48-like, NDM and OXA-23-like were considered emerging enzymes. Conclusions Here we demonstrate that clinically relevant antibiotic resistance genes are prevalent in this setting. We hope our findings support the development of intervention measures by policy makers and healthcare professionals to face antibiotic resistance. Electronic supplementary material The online version of this article (10.1186/s12879-019-4265-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helena Ferreira Leal
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Jailton Azevedo
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Giulyana Evelyn Oliveira Silva
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | - Angelica Maria Lima Amorim
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | - Larissa Rangel Cabral de Roma
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil
| | | | | | - Mitermayer Galvão Reis
- Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Salvador, Bahia, 40296-710, Brazil
| | - Ana Verena Mendes
- São Rafael Hospital, São Marcos, Salvador, Bahia, 41253-190, Brazil.,Bahiana School of Medicine and Public Health of the Bahia Foundation for the Development of Sciences, Salvador, Bahia, Brazil
| | | | | | - Ianick Souto Martins
- Faculty of Medicine, Fluminense Federal University Downtown, 24033-900, Niterói, Rio de Janeiro, Brazil
| | - Joice Neves Reis
- Laboratory of Research on Clinical Microbiology (LPMC), School of Pharmacy, Federal University of Bahia, Ondina, Salvador, Bahia, 40170-115, Brazil.
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Sweeney MR, O’Leary KG, Jeney Z, Braunlin MC, Gibb HJ. Systematic review and quality ranking of studies of two phthalate metabolites and anogenital distance, bone health, inflammation, and oxidative stress. Crit Rev Toxicol 2019; 49:281-301. [DOI: 10.1080/10408444.2019.1605332] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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38
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Wang J, Ishfaq M, Xu L, Xia C, Chen C, Li J. METTL3/m 6A/miRNA-873-5p Attenuated Oxidative Stress and Apoptosis in Colistin-Induced Kidney Injury by Modulating Keap1/Nrf2 Pathway. Front Pharmacol 2019; 10:517. [PMID: 31156435 PMCID: PMC6530351 DOI: 10.3389/fphar.2019.00517] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/24/2019] [Indexed: 11/25/2022] Open
Abstract
Nephrotoxicity of colistin is the major factor limiting its clinical application. However, the exact mechanism of colistin-induced nephrotoxicity is still elusive. N6-Methyladenosine (m6A) modification has been implicated in many biological processes, however, its role in colistin-induced nephrotoxicity needs to be elucidated. Mouse renal tubular epithelial cells (mRTECs) were treated with 200 μM colistin with or without METTL3 overexpression. Cells injury, m6A assay, oxidative stress and apoptosis were examined. Levels of m6A are decreased after colistin treatment in mRTECs. METTL3 is the major factor involved in abnormal m6A modification. METTL3 overexpression plays a protective role against colistin-induced oxidative stress and apoptosis. Moreover, METTL3 interacts with the microprocessor protein DGCR8 and positively modulates miR-873-5p mature process in an m6A-dependent manner. Further experiments show that miR-873-5p could regulate Keap1-Nrf2 pathway against colistin-induced oxidative stress and apoptosis. These studies revealed an important role of METTL3/m6A in colistin-induced nephrotoxicity and provide a new insight on m6A modification in drug induced toxicity.
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Affiliation(s)
- Jian Wang
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Muhammad Ishfaq
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Liang Xu
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Chunli Xia
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
| | - Chunli Chen
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China.,Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin, China
| | - Jichang Li
- College of Veterinary Medicine, Northeast Agricultural University, Harbin, China.,Heilongjiang Key Laboratory for Animal Disease Control and Pharmaceutical Development, Harbin, China
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Chen J, Zhu Y, Yin M, Xu Y, Liang X, Huang Y. Characterization of maltocin S16, a phage tail‐like bacteriocin with antibacterial activity againstStenotrophomonas maltophiliaandEscherichia coli. J Appl Microbiol 2019; 127:78-87. [DOI: 10.1111/jam.14294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/19/2018] [Accepted: 04/23/2019] [Indexed: 01/05/2023]
Affiliation(s)
- J. Chen
- Department of Microbiology College of Life Sciences Wuhan University Wuhan China
| | - Y. Zhu
- Department of Microbiology College of Life Sciences Wuhan University Wuhan China
| | - M. Yin
- Department of Microbiology College of Life Sciences Wuhan University Wuhan China
| | - Y. Xu
- Department of Microbiology College of Life Sciences Wuhan University Wuhan China
| | - X. Liang
- Department of Microbiology College of Life Sciences Wuhan University Wuhan China
| | - Y.‐P. Huang
- Department of Microbiology College of Life Sciences Wuhan University Wuhan China
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40
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Johnston KJ, Thorpe KE, Jacob JT, Murphy DJ. The incremental cost of infections associated with multidrug-resistant organisms in the inpatient hospital setting-A national estimate. Health Serv Res 2019; 54:782-792. [PMID: 30864179 DOI: 10.1111/1475-6773.13135] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To estimate the cost of infections associated with multidrug-resistant organisms (MDROs) during inpatient hospitalization in the United States. DATA SOURCES/STUDY SETTING 2014 National Inpatient Sample. STUDY DESIGN Multivariable regression models assessed the incremental effect of MDROs on the cost of hospitalization and hospital length of stay among patients with bacterial infections. DATA COLLECTION/EXTRACTION METHODS We retrospectively identified 6 385 258 inpatient stays for patients with bacterial infection. PRINCIPAL FINDINGS The national incidence rate of inpatient stays with bacterial infection is 20.1 percent. At least 10.8 percent of such stays-and as many as 16.9 percent if we account for undercoded infections-show evidence of one or more MDROs. MRSA, C. difficile, infection with another MDRO, and the presence of more than one MDRO are associated with $1718 (95% CI, $1609-$1826), $4617 (95% CI, $4407-$4827), $2302 (95% CI, $2044-$2560), and $3570 (95% CI, $3019-$4122) in additional costs per stay, respectively. The national cost of infections associated with MDROs is at least $2.39 billion (95% CI, $2.25-$2.52 billion) and as high as $3.38 billion (95% CI, $3.13-$3.62 billion) if we account for undercoded infections. CONCLUSIONS Infections associated with MDROs result in a substantial cost burden to the US health care system.
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Affiliation(s)
- Kenton J Johnston
- Department of Health Management and Policy, Center for Outcomes Research, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri
| | - Kenneth E Thorpe
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jesse T Jacob
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine and Emory Antibiotic Resistance Center, Atlanta, Georgia
| | - David J Murphy
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Office of Quality and Risk, Emory Healthcare, Atlanta, Georgia
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Dagla I, Karkoula E, Baira E, Tsarbopoulos A, Gikas E. Analytical methodologies used for the determination of colistin in biological fluids. Is it still a challenge? J Pharm Biomed Anal 2019; 164:777-788. [DOI: 10.1016/j.jpba.2018.11.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 10/27/2022]
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López Romo A, Quirós R. Appropriate use of antibiotics: an unmet need. Ther Adv Urol 2019; 11:1756287219832174. [PMID: 31105775 PMCID: PMC6502979 DOI: 10.1177/1756287219832174] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/29/2019] [Indexed: 01/04/2023] Open
Abstract
Increasing bacterial resistance combined with a steady decline in the discovery of new antibiotics has resulted in a global healthcare crisis. Overuse of antibiotics, for example, in the poultry and cattle industry, and misuse and improper prescription of antibiotics are leading causes of multidrug resistance (MDR). The increasing use of antibiotics, particularly in developing countries, is a big concern for antibiotic resistance and can cause other health threats such as increased risk of recurrent infections and increased risk of cardiovascular death with chronic use of macrolides. Carbapenems are the last line of defense in many cases of resistant infection, but trends show that resistance against these agents is also increasing. This narrative review is based on relevant literature according to the experience and expertise of the authors and presents an overview of the current knowledge on antibiotic resistance, the key driving factors, and possible strategies to tackle antibiotic resistance. Collectively, studies show that hospital-wide antibiotic stewardship programs are effective in decreasing the spread of antibacterial resistance. As resistance varies according to local patterns of use, it is essential to observe the epidemiology at both a regional and an institutional level. Furthermore, adaptation of clinical guidelines is necessary, particularly for inpatient care. Future guidelines should include a justification step for continued treatment of antibiotic treatments and criteria for selection of antibiotics at the start of treatment. Nonantibiotic prevention strategies can limit infections and should also be considered in treatment plans. Vaccines against MDR organisms have shown some efficacy in phase II trials in critical care patients. Nonimmunogenic and microbiologic treatment options such as fecal transplants may be particularly important for elderly and immune-compromised patients.
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Affiliation(s)
- Alicia López Romo
- Department of Epidemiology, Christus Muguerza
Health System, Monterrey, Nuevo León, Mexico
| | - Rodolfo Quirós
- Clínica Ángel Foianini,
Chuquisaca 766, Santa Cruz de la Sierra, Bolivia
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Trapani A, Catalano A, Carocci A, Carrieri A, Mercurio A, Rosato A, Mandracchia D, Tripodo G, Schiavone BIP, Franchini C, Mesto E, Schingaro E, Corbo F. Effect of Methyl-β-Cyclodextrin on the antimicrobial activity of a new series of poorly water-soluble benzothiazoles. Carbohydr Polym 2018; 207:720-728. [PMID: 30600058 DOI: 10.1016/j.carbpol.2018.12.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/28/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022]
Abstract
The antibacterial activity of the S-unsubstituted- and S-benzyl-substituted-2-mercapto-benzothiazoles 1-4 has been evaluated after complexation with Methyl-β-Cyclodextrin (Me-β-CD) or incorporation in solid dispersions based on Pluronic® F-127 and compared with that of the pure compounds. This with the aim to gain further insights on the possible mechanism(s) involved in the CD-mediated enhancement of antimicrobial effectiveness, a promising methodology to overcome the microbial resistance issue. Together with Differential Scanning Calorimetry, FT-IR spectroscopy and X-ray Powder Diffraction investigations, a molecular modeling study focused on compounds 2 and 4 showed that the S-unsubstituted compound 2/Me-β-CD complex should be more stable than S-benzyl-substituted 4/Me-β-CD. Only for 1/Me-β-CD or, particularly, 2/Me-β-CD complexes, the antibacterial effectiveness was enhanced in the presence of selected bacterial strains. The results herein presented support the mechanisms focusing on the interactions of the bacterial membrane with CD complexes more than those focusing on the improvement of dissolution properties consequent to CD complexation.
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Affiliation(s)
- Adriana Trapani
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Alessia Catalano
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Alessia Carocci
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Antonio Carrieri
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Annalisa Mercurio
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Antonio Rosato
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Delia Mandracchia
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Giuseppe Tripodo
- Dipartimento di Scienze del Farmaco, Università degli Studi di Pavia, viale Taramelli, 12, 27100 Pavia, Italy
| | - Brigida Immacolata Pia Schiavone
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Carlo Franchini
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Ernesto Mesto
- Dipartimento di Scienze della Terra e Geoambientali, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Emanuela Schingaro
- Dipartimento di Scienze della Terra e Geoambientali, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy
| | - Filomena Corbo
- Dipartimento di Farmacia-Scienze del Farmaco, Università degli Studi di Bari "Aldo Moro", Via E. Orabona, 4, I-70125, Bari, Italy.
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Stone PW, Herzig CTA, Agarwal M, Pogorzelska-Maziarz M, Dick AW. Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2018; 55:46958018778636. [PMID: 29806527 PMCID: PMC5974557 DOI: 10.1177/0046958018778636] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recently, the Centers for Medicare & Medicaid Services (CMS) final rule required that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP). The objectives of this study were to provide a baseline assessment of (1) NH facility and infection control program characteristics associated with having an infection control deficiency citation and (2) associations between IP training and the presence of antibiotic stewardship policies, controlling for NH characteristics. A cross-sectional survey of 2514 randomly sampled US NHs was conducted to assess IP training, staff turnover, and infection control program characteristics (ie, frequency of infection control committee meetings and the presence of 7 antibiotic stewardship policies). Responses were linked to concurrent Certification and Survey Provider Enhanced Reporting data, which contain information about NH facility characteristics and citations. Descriptive statistics and multivariable regression analyses were conducted to account for NH characteristics. Surveys were received from 990 NHs; 922 had complete data. One-third of NHs in this sample received an infection control deficiency citation. The NHs that received deficiency citations were more likely to have committees that met weekly/monthly versus quarterly ( P < .01). The IPs in 39% of facilities had received specialized training. Less than 3% of trained IPs were certified in infection control. The NHs with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place (all P < .05). The IP training, although infrequent, was associated with the presence of antibiotic stewardship policies. Receiving an infection control citation was associated with more frequent infection control committee meetings. Training and support of IPs is needed to ensure infection control and antibiotic stewardship in NHs. As the CMS rule becomes implemented, more research is warranted. There is a need for increase in trained IPs in US NHs. These data can be used to evaluate the effectiveness of the CMS final rule on infection management processes in US NHs.
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Affiliation(s)
| | | | - Mansi Agarwal
- 1 Columbia University School of Nursing, New York, NY, USA
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Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities. Infect Control Hosp Epidemiol 2018; 39:1425-1430. [PMID: 30293533 DOI: 10.1017/ice.2018.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission. DESIGN Prospective observational study.Settings and participantsResidents and HCP from 13 community-based nursing facilities in Maryland and Michigan. METHODS Perianal swabs were collected from residents and cultured to detect RGNB. HCP wore gowns and gloves during usual care activities, and at the end of each interaction, these were swabbed in a standardized manner. Transmission of RGNB from a colonized resident to gowns and gloves was estimated. Odds ratios (ORs) of transmission associated with type of care or resident characteristic were calculated. RESULTS We enrolled 403 residents and their HCP in this study. Overall, 19% of enrolled residents with a perianal swab (n=399) were colonized with at least 1 RGNB. RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. Residents with a pressure ulcer were 3 times more likely to transmit RGNB than residents without one (OR, 3.3; 95% confidence interval [CI], 1.0-11.1). CONCLUSIONS Gown and glove use in community nursing facilities should be prioritized for certain residents and care interactions that are deemed a high risk for transmission.
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Ang H, Sun X. Risk factors for multidrug-resistant Gram-negative bacteria infection in intensive care units: A meta-analysis. Int J Nurs Pract 2018; 24:e12644. [PMID: 29575345 DOI: 10.1111/ijn.12644] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/09/2018] [Accepted: 02/10/2018] [Indexed: 12/18/2022]
Abstract
AIMS To identify the risk factors for multidrug-resistant Gram-negative bacteria systematically and provide suggestions and an evidence-base for clinical measures. BACKGROUND With the increase in the social population, changes in human behaviour and ecosystems, as well as economic development, bacteria have gradually produced drug resistance genes. These have swept through intensive care units causing high mortality. METHODS Relevant literature which included case-control and cohort studies published from January 1999 to March 2017 were searched in the Cochrane Library, PubMed, Web of Science, and Medline. Meta-analysis was performed by using StataSE version 12.0 software. RESULTS Eighteen studies of 235 publications were eligible. Male gender (OR 1.40, 95%CI 1.09, 1.80), having an operative procedure (OR 1.31, 95%CI 1.10, 1.56), a central venous catheter (OR 1.22, 95%CI 1.01, 1.48), mechanical ventilation (OR 1.25, 95%CI 1.07, 1.46), previous antibiotic therapy (OR 1.66, 95%CI 1.41, 1.96), length of ICU stay (weighted mean difference 8.18, 95%CI 0.27, 16.10), and types of health-associated infections were the identified risk factors for multidrug-resistant Gram-negative bacterial infection in intensive care units; moreover, diabetes mellitus was not. CONCLUSION Six risk factors were associated with multidrug-resistant Gram-negative bacterial infection in intensive care units. Antimicrobial stewardship, infection control, and medical staff prevention care are needed.
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Affiliation(s)
- Hui Ang
- Medical School, Yangtze University, Jingzhou, Hubei, China
| | - Xuan Sun
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Thorpe KE, Joski P, Johnston KJ. Antibiotic-Resistant Infection Treatment Costs Have Doubled Since 2002, Now Exceeding $2 Billion Annually. Health Aff (Millwood) 2018; 37:662-669. [PMID: 29561692 DOI: 10.1377/hlthaff.2017.1153] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Antibiotic-resistant infections are a global health care concern. The Centers for Disease Control and Prevention estimates that 23,000 Americans with these infections die each year. Rising infection rates add to the costs of health care and compromise the quality of medical and surgical procedures provided. Little is known about the national health care costs attributable to treating the infections. Using data from the Medical Expenditure Panel Survey, we estimated the incremental health care costs of treating a resistant infection as well as the total national costs of treating such infections. To our knowledge, this is the first national estimate of the costs for treating the infections. We found that antibiotic resistance added $1,383 to the cost of treating a patient with a bacterial infection. Using our estimate of the number of such infections in 2014, this amounts to a national cost of $2.2 billion annually. The need for innovative new infection prevention programs, antibiotics, and vaccines to prevent and treat antibiotic-resistant infections is an international priority.
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Affiliation(s)
- Kenneth E Thorpe
- Kenneth E. Thorpe ( ) is the Robert W. Woodruff Professor and chair of the Department of Health Policy and Management, Rollins School of Public Health, Emory University, in Atlanta, Georgia
| | - Peter Joski
- Peter Joski is a senior associate in the Department of Health Policy and Management, Rollins School of Public Health, Emory University
| | - Kenton J Johnston
- Kenton J. Johnston is an assistant professor of health management and policy at Saint Louis University, in Missouri
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Stone PW. Integration of Infection Management and Palliative Care in Nursing Homes: An Understudied Issue. Res Gerontol Nurs 2017; 10:199-204. [PMID: 28926667 PMCID: PMC5818148 DOI: 10.3928/19404921-20170831-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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