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Alkuraythi DM, Alkhulaifi MM. Methicillin-resistant Staphylococcus aureus prevalence in food-producing animals and food products in Saudi Arabia: A review. Vet World 2024; 17:1753-1764. [PMID: 39328450 PMCID: PMC11422649 DOI: 10.14202/vetworld.2024.1753-1764] [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: 02/10/2024] [Accepted: 07/15/2024] [Indexed: 09/28/2024] Open
Abstract
In Saudi Arabia, the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) in food and livestock represents a major public health hazard. The emergence of livestock-associated MRSA has heightened the risk of human infection with comparable virulence traits. The lack of information about MRSA transmission in our region hinders accurate risk assessment, despite its detection in food animals and retail foods. Adopting a One Health approach is essential for effectively combating MRSA in Saudi Arabia. This method unites actions in the human, animal, and environmental spheres. To combat MRSA contamination, surveillance measures need strengthening; interdisciplinary collaboration among healthcare professionals, veterinarians, and environmental scientists is crucial, and targeted interventions must be implemented in local food chains and animal populations. Through a holistic strategy, public health and sustainable food production in the region are protected. This review aims to improve public health interventions by increasing understanding of MRSA prevalence and related risks in local food chains and animal populations.
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Affiliation(s)
- Dalal M Alkuraythi
- Department of Biology, College of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Manal M Alkhulaifi
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia
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Greene MT, Borg MA, Schwaber MJ, Najjar-Debbiny R, Apisarnthanarak A, Saint S. Perceptions of organizational culture among infection preventionists in Israel, the United States, and Thailand: Results from national infection prevention surveys. Am J Infect Control 2024; 52:246-248. [PMID: 37625548 DOI: 10.1016/j.ajic.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
In national surveys of infection preventionists in Israel (n = 15), the United States (n = 415), and Thailand (n = 100), we found that views of organizational culture track well with these countries' cultural dimension scores of power distance and individualism. Our findings highlight the importance of considering cultural dimensions when implementing infection prevention efforts.
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Affiliation(s)
- M Todd Greene
- VA Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; VA/UM Patient Safety Enhancement Program, Ann Arbor, MI.
| | - Michael A Borg
- Department of Infection Prevention and Control, Mater Dei Hospital, Malta; Department of Pathology, University of Malta, Msida, Malta
| | - Mitchell J Schwaber
- National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronza Najjar-Debbiny
- Infection Prevention and Control Unit, Lady Davis Carmel Medical Center, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | | | - Sanjay Saint
- VA Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; VA/UM Patient Safety Enhancement Program, Ann Arbor, MI
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3
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Hasanpour AH, Sepidarkish M, Mollalo A, Ardekani A, Almukhtar M, Mechaal A, Hosseini SR, Bayani M, Javanian M, Rostami A. The global prevalence of methicillin-resistant Staphylococcus aureus colonization in residents of elderly care centers: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2023; 12:4. [PMID: 36709300 PMCID: PMC9884412 DOI: 10.1186/s13756-023-01210-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 01/21/2023] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a difficult to treat infection, particularly in residents of elderly care centers (ECCs). Despite the substantial burden of MRSA, an inadequate number of studies have analyzed MRSA prevalence in ECCs. OBJECTIVES We conducted a worldwide systematic review and meta-analysis on the prevalence and risk factors of MRSA in ECCs. METHODS We searched MEDLINE/PubMed, EMBASE, Web of Science, and Scopus databases and the gray literature sources for all studies published between January 1980 and December 2022 on the prevalence of MRSA in ECCs. A random-effects model was utilized to estimate pooled prevalence rates at 95% confidence intervals (CI). Moreover, the data were analyzed based on World Health Organization-defined regions, income, and human development index levels. RESULTS In total, 119 studies, including 164,717 participants from 29 countries, were found eligible for meta-analysis. The pooled global prevalence of MRSA was 14.69% (95% CI 12.39-17.15%; 16,793/164,717). Male gender [prevalence ratio (PR) = 1.55; 95% CI 1.47-1.64], previous MRSA infection (PR = 3.71; 95% CI 3.44-4.01), prior use of antibiotics (PR = 1.97; 95% CI 1.83-2.12), hospitalized within the previous year (PR = 1.32; 95% CI 1.20-1.45), have had any wound (PR = 2.38; 95% CI 2.23-2.55), have used urinary catheter (PR = 2.24; 95% CI 2.06-2.43), have used any medical device (PR = 1.78; 95% CI 1.66-1.91), and those with diabetes (PR = 1.55; CI 1.43-1.67) were more likely to be colonized by MRSA than other patients. CONCLUSION Screening programs and preventive measures should target MRSA in ECCs due to the high global prevalence rates.
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Affiliation(s)
- Amir Hossein Hasanpour
- grid.411495.c0000 0004 0421 4102Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mahdi Sepidarkish
- grid.411495.c0000 0004 0421 4102Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Abolfazl Mollalo
- grid.252749.f0000 0001 1261 1616Department of Public Health and Prevention Science, School of Health Sciences, Baldwin Wallace University, Berea, OH USA
| | - Ali Ardekani
- grid.412571.40000 0000 8819 4698School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amal Mechaal
- grid.240145.60000 0001 2291 4776Department of Hematopoietic Biology and Malignancy, The University of Texas Md Anderson Cancer Center, Houston, TX USA
| | - Seyed Reza Hosseini
- grid.411495.c0000 0004 0421 4102Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Masoumeh Bayani
- grid.411495.c0000 0004 0421 4102Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mostafa Javanian
- grid.411495.c0000 0004 0421 4102Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Noel AR, Attwood M, Bowker KE, MacGowan AP. The pharmacodynamics of minocycline alone and in combination with rifampicin against Staphylococcus aureus studied in an in vitro pharmacokinetic model of infection. J Antimicrob Chemother 2021; 76:1840-1844. [PMID: 33975336 DOI: 10.1093/jac/dkab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/10/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Tetracyclines are widely used as oral therapy of MRSA infection, however, the pharmacodynamic underpinning is absent. OBJECTIVES We employed an in vitro pharmacokinetic model to study the pharmacodynamics of minocycline alone and in combination with rifampicin. METHODS An exposure-ranging design was used to establish fAUC/MIC targets for static, -1 log drop and -2 log drop effects against Staphylococcus aureus for minocycline and in combination with rifampicin. We then simulated 7-10 day human dosing of minocycline and the combination. RESULTS The minocycline fAUC/MIC for 24 h static effect and -1 log drop in bacterial load were 12.5 ± 7.1 and 23.3 ± 12.4. fAUC/MIC targets for static and -1 log drop were greater at 48 and 72 h. The addition of simulated free rifampicin associated with dosing 300 mg q12h reduced the 24 h minocycline fAUC/MICs. Simulations performed over 7-10 days exposure indicated that for minocycline standard human doses there was a 1-3 log reduction in viable count and no changes in population profiles. Addition of rifampicin resulted in larger reductions in staphylococcal load but emergence of resistance to rifampicin. There was no resistance to minocycline. CONCLUSIONS An fAUC/MIC minocycline target of 12-36 is appropriate for S. aureus. Addition of rifampicin decreases bacterial load but results in emergence of resistance to rifampicin. Unusually, there was no emergence of resistance to minocycline.
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Affiliation(s)
- A R Noel
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), North Bristol NHS Trust, Department of Infection Sciences, Pathology Sciences Building-Phase 2, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - M Attwood
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), North Bristol NHS Trust, Department of Infection Sciences, Pathology Sciences Building-Phase 2, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - K E Bowker
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), North Bristol NHS Trust, Department of Infection Sciences, Pathology Sciences Building-Phase 2, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
| | - A P MacGowan
- Bristol Centre for Antimicrobial Research & Evaluation (BCARE), North Bristol NHS Trust, Department of Infection Sciences, Pathology Sciences Building-Phase 2, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK
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Kumar R. Impact of Societal Culture on Covid-19 Morbidity and Mortality across Countries. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2021. [DOI: 10.1177/00220221211025100] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Researchers have begun exploring the impact of societal culture on Covid-19 outcomes (morbidity and mortality). However, emerging findings need integration with prior literature on societal culture and infectious diseases. Moreover, accumulation of knowledge warrants an update while overcoming certain limitations of samples as well as construct validity concerns. Accordingly, hypotheses are derived based on extant evidence proposing the impact of certain cultural practices on Covid-19 outcomes across countries. These hypotheses are tested using the cultural practice scores from GLOBE studies after controlling for certain covariates identified in literature. Multiple regression results reveal that societal culture significantly explains Covid-19 outcomes beyond the explanation due to control variables. Specifically, power distance and institutional collectivism show negative association with both Covid-19 morbidity and mortality. Additionally, performance orientation shows negative association with Covid-19 morbidity. It appears that power distance may ensure conformity to prescribed behaviors and features of performance orientation may facilitate swift and effective containment of Covid-19 cases. The significance of institutional collectivism—but not in-group collectivism—emerging as the form of collectivism showing negative association with Covid-19 outcomes is also discussed.
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Affiliation(s)
- Rajiv Kumar
- Indian Institute of Management Calcutta, Kolkata, West Bengal, India
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Borg MA, Suda D, Scicluna E, Brincat A, Zarb P. Universal admission screening: a potential game-changer in hospitals with high prevalence of MRSA. J Hosp Infect 2021; 113:77-84. [PMID: 33811962 DOI: 10.1016/j.jhin.2021.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Despite the perception that meticillin-resistant Staphylococcus aureus (MRSA) is now under control in high-income countries, global prevalence remains high, even increasing in some regions. Universal admission screening and decolonization has been instituted in some hospitals to attempt control but the practice remains controversial. METHODS In 2014, Mater Dei Hospital in Malta introduced a universal admission screening policy, utilizing a novel, centralized and customized approach to achieve high compliance and low cost. Admissions are screened nasally by designated staff using chromogenic media, irrespective of risk factors. Carriers are decolonized without concurrent isolation or contact precautions. In this study, longitudinal, quasi-experimental evaluation was undertaken using time series analysis to analyse the impact of the intervention on the proportion of MRSA among clinical S. aureus isolates (%MRSA) and incidence per 1000 bed-days. A cost-utility analysis was also attempted to identify approximate quality-adjusted life years (QALYs) gained. RESULTS A transfer function model approach concluded that the intervention had a significant effect on both %MRSA and incidence. Six years following its introduction, the screening programme had led to an overall 43% long-term reduction in %MRSA from pre-screening levels [R2=0.687; Bayesian information criterion (BIC)=4.063], translating to a decrease in incidence of approximately 0.56 cases/1000 bed-days (R2=0.633, BIC=-3.063). No correlation was identified with consumption of antibiotics or alcohol hand rub. The annual cost-benefit of the programme was calculated at €1058 per QALY gain per year. CONCLUSION The universal admission screening and decolonization intervention was successful and cost-effective in this high-endemicity setting. It facilitated improvement in the prevalence of MRSA, achieving reduction levels rarely reported by Mediterranean hospitals.
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Affiliation(s)
- M A Borg
- University of Malta, Msida, Malta; Mater Dei Hospital, Msida, Malta.
| | - D Suda
- University of Malta, Msida, Malta
| | | | | | - P Zarb
- University of Malta, Msida, Malta; Mater Dei Hospital, Msida, Malta
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Borg MA, Camilleri L. What Is Driving the Epidemiology of Methicillin-Resistant Staphylococcus aureus Infections in Europe? Microb Drug Resist 2020; 27:889-894. [PMID: 33337277 DOI: 10.1089/mdr.2020.0259] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The burden from infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the European Union/European Economic Area (EU/EEA) has increased in recent years, especially in the higher prevalence southern and eastern countries. Addressing this challenge requires a clear knowledge of the factors driving this epidemiology to inform effective national interventions and campaigns. Methods: We identified national quality metrics for antibiotic use and hand hygiene from the 2016/2017 European Centre for Disease Control (ECDC) Point Prevalence study as well as structural, cultural, and governance indicators from other sources. We then utilized general linear modeling to identify parsimonious correlations with national MRSA proportions reported by the European Antimicrobial Resistance Surveillance Network (EARS-Net). Results: The main process predictor of MRSA prevalence in EU/EEA countries was the use of more than one concurrent antibiotic per patient. The impact of hand hygiene was less clear, possibly because consumption of alcohol hand-rub was suboptimal throughout Europe. Hospital and infection control structural factors did not appear relevant at overall national level. Culture and governance were collectively key predictor groups; uncertainty avoidance, masculinity, and corruption indices strongly correlated with MRSA prevalence. Discussion: Our results suggest that the critical antibiotic stewardship factor associated with MRSA in EU/EEA countries is the quality of antibiotic prescribing, especially spectrum of activity, rather than overall consumption levels in hospitals or proportion of patients treated. Above all, MRSA hyperendemicity is correlated with a set of sociocultural behavioral constructs that typically manifest themselves in lack of urgency to address risk and normalization of deviance in relation to noncompliant practices.
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Affiliation(s)
- Michael A Borg
- Department of Infection Control, Mater Dei Hospital, Msida, Malta.,Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Liberato Camilleri
- Department of Statistics and Operations Research, Faculty of Science, University of Malta, Msida, Malta
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Mayer JD, Schintler LA, Bledsoe S. Culture, Freedom, and the Spread of Covid‐19: Do Some Societies and Political Systems Have National Anti‐Bodies? WORLD MEDICAL & HEALTH POLICY 2020. [DOI: 10.1002/wmh3.377] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Braun BI, Chitavi SO, Suzuki H, Soyemi CA, Puig-Asensio M. Culture of Safety: Impact on Improvement in Infection Prevention Process and Outcomes. Curr Infect Dis Rep 2020; 22:34. [PMID: 33288982 PMCID: PMC7710367 DOI: 10.1007/s11908-020-00741-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
Purpose Safety culture is known to be related to a wide range of outcomes, and measurement of safety culture is now required for many hospitals in the U.S.A. In previous reviews, the association with outcomes has been limited by the research design and strength of the evidence. The goal of this review was to examine recent literature on the relationship between safety culture and infection prevention and control-related (IPC) processes and healthcare-associated infections (HAIs) in U.S. healthcare organizations. We also sought to quantitatively characterize the challenges to empirically establishing these relationships and limitations of current research. Recent Findings A PubMed search for U.S. articles published 2009–2019 on the topics of infection prevention, HAIs, and safety culture yielded 448 abstracts. After screening, 55 articles were abstracted for information on purpose, measurement, analysis, and conclusions drawn about the role of safety culture in the outcome. Approximately ½ were quality improvement (QI) initiatives and ½ were research studies. Overall, 51 (92.7%) concluded there was an association between safety culture and IPC processes or HAIs. However, only 39 studies measured safety culture and 26 statistically analyzed safety culture data for associations. Though fewer QI initiatives analyzed associations, a higher proportion concluded an association exists than among research studies. Summary Despite limited empirical evidence and methodologic challenges to establishing associations, most articles supported a positive relationship between safety culture, improvement in IPC processes, and decreases in HAIs. Authors frequently reported experiencing improvements in safety culture when not directly measured. The findings suggest that associations between improvement and safety culture may be bi-directional such that positive safety culture contributes to successful interventions and implementing effective interventions drives improvements in culture. Greater attention to article purpose, design, and analysis is needed to confirm these presumptive relationships.
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Affiliation(s)
- Barbara I Braun
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Salome O Chitavi
- Department of Research, The Joint Commission, Oakbrook Terrace, IL USA
| | - Hiroyuki Suzuki
- Department of Internal Medicine - Infectious Diseases, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA USA
| | - Caroline A Soyemi
- Neihoff School of Nursing, Loyola University Chicago, Chicago, IL USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, Iowa City, IA USA.,Present Address: Department of Infectious Diseases, Hospital Universitari de Bellvitge: L'Hospitalet de Llobregat, Barcelona, Catalunya Spain
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Ibanez A, Sisodia GS. The role of culture on 2020 SARS-CoV-2 Country deaths: a pandemic management based on cultural dimensions. GEOJOURNAL 2020; 87:1175-1191. [PMID: 33020679 PMCID: PMC7527153 DOI: 10.1007/s10708-020-10306-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 06/11/2023]
Abstract
This study aims to analyze the role of cross-cultural country differences during a global pandemic. Based on country cultural dimensions and country economic indicators, the research proposes specific policies that might prove of value in order to manage and better respond to present and future critical events such as the 2020 SARS-CoV-2 outbreak. The methodology is based on multivariate analysis for the first set of countries and cross-country comparative analysis for the second set of countries. Research results reveal the critical role of the cultural dimensions individualism, power distance, masculinity, long-term orientation and indulgence, along with the country economic context in the magnitude of the consequences of a global pandemic within a country specific context. Based on these results, the study proposes policies adjusted to the countries specific cultural and economic frameworks in order to promote the most effective and efficient management of a critical event such as a global pandemic.
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Affiliation(s)
- Alberto Ibanez
- College of Business Administration, University of Science and Technology of Fujairah, Fujairah, UAE
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11
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Rectal vancomycin-resistant enterococcus colonization before admission to neonatal intensive care unit. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.746021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Ozdamar M. Nasal colonization with methicillin-resistant Staphylococcus aureus at admission among high-risk Turkish and international patients. Acta Microbiol Immunol Hung 2020; 67:73-78. [PMID: 32160784 DOI: 10.1556/030.2020.01081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 01/03/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to detect the frequency of methicillin-resistant Staphylococcus aureus (MRSA) colonization at admission in a group of presumably high-risk international or Turkish patients referred to our center for elective operations, some of whom were from countries with an unknown prevalence of MRSA infection or colonization. METHODS The results of nasal swab screening for MRSA colonization performed using a specific algorithm between 2011 and 2018 in a private medical center were retrospectively reviewed. Presence of MRSA was ascertained using culture and/or real-time polymerase chain reaction (real-time PCR). RESULTS A total of 3,795 patients were included in the study. More than half of the patients were ≤19 years of age (2,094, 55.2%), and MRSA positivity was more common among these patients. Turkish patients constituted 24.5% of the study population. International patients were most frequently referred from Iraq (55.92%), Libya (11.44%), Romania (2.69%), and Bulgaria (1.98%). MRSA positivity was significantly more common among patients referred from other countries when compared to Turkish nationals (11.5% vs. 4.4%, P = 0.00001). Countries with the highest prevalence rates of MRSA colonization were as follows with decreasing order: United Arab Emirates, 25.0%; Georgia, 23.1%; Russia, 22.7%; Iraq, 13.0%, Romania, 12.7%. Other countries with high number of admitted patients (>70 patients) had the following MRSA rates: Turkey, 4.4%; Libya, 6.0%; Bulgaria, 5.3%. CONCLUSIONS Although MRSA has a low prevalence in our center, a variation in the rate of MRSA positivity was observed across patients from different countries. Absence hospital acquired contamination or outbreaks in our institution may be attributed to the screening algorithm used and underscores the importance of risk analysis for patients referred from geographical locations with unknown MRSA frequency, to reduce the risk of transmission.
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Kaba HEJ, Kuhlmann E, Scheithauer S. Thinking outside the box: Association of antimicrobial resistance with climate warming in Europe - A 30 country observational study. Int J Hyg Environ Health 2019; 223:151-158. [PMID: 31648934 DOI: 10.1016/j.ijheh.2019.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 11/28/2022]
Abstract
The association of antimicrobial resistance (AMR) with climatic factors gained higher attention since resistance increased with increasing local temperatures in the USA. We aimed to investigate whether the explanatory strength of climatic factors holds true in a region encompassing diverse healthcare systems, like Europe. In particular, we determined whether exposure to temporal climate warming is associated with an increase in AMR prevalence for clinically relevant pathogens. A 30-country cross-sectional study was conducted. The six-year prevalence of carbapenem-resistant Pseudomonas aeruginosa (CRPA), Klebsiella pneumoniae (CRKP), Multiresistant Escherichia coli (MREC), and Methicillin-resistant Staphylococcus aureus (MRSA) was determined based on > 900 k clinical isolates. Bi- and multivariate analysis were performed to identify associations with climatic variables using healthcare and socio-economic confounders. CRPA was significantly associated with the warm-season change in temperature, which, alongside corruption perception, explained 78% of total CRPA variance. Accordingly, a 0.5 °C increase of year-wise temperature change (exposition) resulted in a 1.02-fold increase (p = 0.035) in CRPA prevalence (outcome). For a given country, exposition status doubled the odds of outcome attainment compared to non-exposition (OR = 2.03, 95%-CI [1.03-3.99]). Moreover, we found significant associations of CRKP, MREC, and MRSA with the warm-season mean temperature, which had a higher contribution to MRSA variance explanation than outpatient antimicrobial drug use. We identified a novel association between AMR and climatic factors in Europe, which reveals two aspects: climatic factors significantly contribute to the explanation of AMR in different types of healthcare systems, while climate change (i.e. warming) might increase AMR transmission, in particular CRPA.
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Affiliation(s)
- Hani E J Kaba
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, Germany
| | - Ellen Kuhlmann
- Institute of Epidemiology, Social Medicine and Health System Research, Hannover Medical School (MHH), Germany
| | - Simone Scheithauer
- Institute of Infection Control and Infectious Diseases, University Medical Center Göttingen (UMG), Georg-August University Göttingen, Germany.
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Sabbagh P, Riahi SM, Gamble HR, Rostami A. The global and regional prevalence, burden, and risk factors for methicillin-resistant Staphylococcus aureus colonization in HIV-infected people: A systematic review and meta-analysis. Am J Infect Control 2019; 47:323-333. [PMID: 30170767 DOI: 10.1016/j.ajic.2018.06.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important opportunistic pathogens in HIV+ patients, resulting in considerable morbidity and mortality. METHODS The MEDLINE, Scopus, Web of Science, and EMBASE databases were comprehensively searched for studies that investigated the prevalence of MRSA colonization in HIV+ patients. We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CI) and analyzed data based on World Health Organization regions. RESULTS Among 9,772 records identified, 69 were included in the meta-analysis, comprising 30,050 HIV+ patients from 21 countries. We estimated the pooled worldwide prevalence of MRSA in people living with HIV to be 7% (95% CI 5%-9%, 1,623/30,050), with the highest prevalence in Southeast Asia (16%, 95% CI 9%-24%) and the region of the Americas (10%; 95% CI 7%-13%) and lowest prevalence in the European region (1%; 95% CI 0%-1%). Globally, we estimated approximately 2,659,000 (95% CI 1,835,000-3,303,000) HIV+ patients with colonized MRSA. Potential risk factors for MRSA colonization in HIV+ patients included previous MRSA infection (OR, 7.5; 95% CI, 3.91-14.37), hospitalization in the past year (OR, 1.87; 95% CI 1.11-3.16), and use of antibiotics (OR, 2.52; 95% CI 1.39-4.58). CONCLUSIONS Our findings emphasize the importance of routine screening for MRSA among all HIV+ patients throughout the world, especially in regions that have a high burden of disease.
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van Buijtene A, Foster D. Does a hospital culture influence adherence to infection prevention and control and rates of healthcare associated infection? A literature review. J Infect Prev 2018; 20:5-17. [PMID: 30719083 DOI: 10.1177/1757177418805833] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 09/09/2018] [Indexed: 11/16/2022] Open
Abstract
Background Over 4 million patients acquire a healthcare-associated infection (HCAI) in Europe every year, indicating possible shortcomings in hospitals converting evidence-based infection prevention and control (IPC) strategies into universal adherence. We present a literature review exploring whether insufficient adherence could be culturally based. Aim To find empirical evidence if and how specific traits of organisational culture improve adherence to IPC strategies utilising HCAI rates as the marker of system failures or successes. Methods PubMed, CINAHL, PsycINFO and the British Nursing index database were searched from January 2007 to June 2018. Hand-searching, Google Scholar and the snowball effect completed the investigation. The quality of the studies was assessed with the guidance of CASP and Cochrane tools. Results Twenty papers were eligible for data extraction and thematic analysis. Studies predominantly report positive findings for the association, but none were determined high quality due to multiple methodological concerns. Analysing both quantitative and qualitative research revealed eight major themes: hospital cultures with better HCAI rates foster safety culture; have a generative leadership style; embrace innovation; ensure interventions fit local context; accept long-term orientation; engage and empower health professionals; promote collaboration and communication; and see the benefits of a non-punitive climate. Interpretation The literature linking organisational culture and HCAI rates is suggestive, but not conclusive, indicating caution about their inferences. Leaving cultural growth to chance or allowing for weak or toxic cultures impedes on our IPC strategies and equivalently our HCAI rates.
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Affiliation(s)
| | - Dona Foster
- Oxford Brookes University and University of Oxford, Oxford, UK
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Dyar OJ, Beović B, Pulcini C, Tacconelli E, Hulscher M, Cookson B. ESCMID generic competencies in antimicrobial prescribing and stewardship: towards a European consensus. Clin Microbiol Infect 2018; 25:13-19. [PMID: 30414817 DOI: 10.1016/j.cmi.2018.09.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/14/2018] [Accepted: 09/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To develop a consensus-based set of generic competencies in antimicrobial prescribing and stewardship for European prescribers through a structured consensus procedure. METHODS The RAND-modified Delphi procedure comprised two online questionnaire rounds, a face-to-face meeting between rounds, and a final review. Our departure point was a set of competencies agreed previously by consensus among a UK multi-disciplinary panel, and which had been subsequently revised through consultation with ESCMID Study Group representatives. The 46 draft competency points were reviewed by an expert panel consisting of specialists in infectious diseases and clinical microbiology, and pharmacists. Each proposed competency was assessed using a nine-point Likert scale, for relevance as a minimum standard for all independent prescribers in all European countries. RESULTS A total of 65 expert panel members participated, from 24 European countries (one to six experts per country). There was very high satisfaction (98%) with the final competencies set, which included 35 competency points, in three sections: core concepts in microbiology, pathogenesis and diagnosing infections (11 points); antimicrobial prescribing (20 points); and antimicrobial stewardship (4 points). CONCLUSIONS The consensus achieved enabled the production of generic antimicrobial prescribing and stewardship competencies for all European independent prescribers, and of possible global utility. These can be used for training and can be further adapted to the needs of specific professional groups.
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Affiliation(s)
- O J Dyar
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - B Beović
- University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - E Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | - M Hulscher
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - B Cookson
- Division of Infection and Immunity, University College London, London, UK
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Mizuno S, Iwami M, Kunisawa S, Naylor N, Yamashita K, Kyratsis Y, Meads G, Otter JA, Holmes AH, Imanaka Y, Ahmad R. Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England. J Hosp Infect 2018; 100:280-298. [PMID: 30369423 DOI: 10.1016/j.jhin.2018.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/28/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND National responses to healthcare-associated infections vary between high-income countries, but, when analysed for contextual comparability, interventions can be assessed for transferability. AIM To identify learning from country-level approaches to addressing meticillin-resistant Staphylococcus aureus (MRSA) in Japan and England. METHODS A longitudinal analysis (2000-2017), comparing epidemiological trends and policy interventions. Data from 441 textual sources concerning infection prevention and control (IPC), surveillance, and antimicrobial stewardship interventions were systematically coded for: (a) type: mandatory requirements, recommendations, or national campaigns; (b) method: restrictive, persuasive, structural in nature; (c) level of implementation: macro (national), meso (organizational), micro (individual) levels. Healthcare organizational structures and role of media were also assessed. FINDINGS In England significant reduction has been achieved in number of reported MRSA bloodstream infections. In Japan, in spite of reductions, MRSA remains a predominant infection. Both countries face new threats in the emergence of drug-resistant Escherichia coli. England has focused on national mandatory and structural interventions, supported by a combination of outcomes-based incentives and punitive mechanisms, and multi-disciplinary IPC hospital teams. Japan has focused on (non-mandatory) recommendations and primarily persuasive interventions, supported by process-based incentives, with voluntary surveillance. Areas for development in Japan include resourcing of dedicated data management support and implementation of national campaigns for healthcare professionals and the public. CONCLUSION Policy interventions need to be relevant to local epidemiological trends, while acceptable within the health system, culture, and public expectations. Cross-national learning can help inform the right mix of interventions to create sustainable and resilient systems for future infection and economic challenges.
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Affiliation(s)
- S Mizuno
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - M Iwami
- Division of Infectious Diseases, Imperial College London, London, UK
| | - S Kunisawa
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - N Naylor
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK
| | - K Yamashita
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - Y Kyratsis
- Health Services Research & Management Division, School of Health Sciences, City University of London, London, UK
| | - G Meads
- Health and Wellbeing Research Group, University of Winchester, Winchester, UK
| | - J A Otter
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - A H Holmes
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Y Imanaka
- Department of Healthcare Economics and Quality Management, Kyoto University, Japan
| | - R Ahmad
- NIHR Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, Hammersmith Campus, London, UK; Health Group, Management Department, Imperial College Business School, London, UK.
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Gaygısız Ü, Lajunen T, Gaygısız E. Socio-economic factors, cultural values, national personality and antibiotics use: A cross-cultural study among European countries. J Infect Public Health 2017; 10:755-760. [DOI: 10.1016/j.jiph.2016.11.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 10/17/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022] Open
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Dickmann P, Keeping S, Döring N, Schmidt AE, Binder C, Ariño-Blasco S, Gil J. Communicating the Risk of MRSA: The Role of Clinical Practice, Regulation and Other Policies in Five European Countries. Front Public Health 2017; 5:44. [PMID: 28367432 PMCID: PMC5355491 DOI: 10.3389/fpubh.2017.00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The threat posed by Meticillin-resistant Staphylococcus aureus (MRSA) has taken on an increasingly pan-European dimension. This article aims to provide an overview of the different approaches to the control of MRSA adopted in five European countries (Austria, Germany, Netherlands, Spain, and the UK) and discusses data and reporting mechanisms, regulations, guidelines, and health policy approaches with a focus on risk communication. Our hypothesis is that current infection control practices in different European countries are implicit messages that contribute to the health-related risk communication and subsequently to the public perception of risk posed by MRSA. A reporting template was used to systematically collect information from each country. DISCUSSION Large variation in approaches was observed between countries. However, there were a number of consistent themes relevant to the communication of key information regarding MRSA, including misleading messages, inconsistencies in content and application of published guidelines, and frictions between the official communication and their adoption on provider level. SUMMARY The variability of recommendations within, and across, countries could be contributing to the perception of inconsistency. Having inconsistent guidelines and practices in place may also be affecting the level at which recommended behaviors are adopted. The discrepancy between the official, explicit health messages around MRSA and the implicit messages stemming from the performance of infection control measures should, therefore, be a key target for those wishing to improve risk communication.
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Affiliation(s)
- Petra Dickmann
- London School of Economics and Political Science (LSE), LSE Health, London, UK; dickmann risk communication (drc), London, UK; Department for Anaesthesiology and Critical Care Medicine, Jena University Hospital, Jena, Germany
| | - Sam Keeping
- London School of Economics and Political Science (LSE), LSE Health , London , UK
| | - Nora Döring
- Department of Health Services Research, School for Public Health and Primary Care (Caphri) of the Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Claudia Binder
- European Centre for Social Welfare Policy and Research , Vienna , Austria
| | - Sergio Ariño-Blasco
- Universitat Internacional de Catalunya Hospital General Granollers , Granollers , Spain
| | - Joan Gil
- Universitat Internacional de Catalunya Hospital General Granollers, Granollers, Spain; Department of Economics and BEAT Research Institute, University of Barcelona, Barcelona, Spain
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Abstract
Staphylococcus aureus, although generally identified as a commensal, is also a common cause of human bacterial infections, including of the skin and other soft tissues, bones, bloodstream, and respiratory tract. The history of S. aureus treatment is marked by the development of resistance to each new class of antistaphylococcal antimicrobial drugs, including the penicillins, sulfonamides, tetracyclines, glycopeptides, and others, complicating therapy. S. aureus isolates identified in the 1960s were sometimes resistant to methicillin, a ß-lactam antimicrobial active initially against a majority S. aureus strains. These MRSA isolates, resistant to nearly all ß-lactam antimicrobials, were first largely confined to the health care environment and the patients who attended it. However, in the mid-1990s, new strains, known as community-associated (CA-) MRSA strains, emerged. CA-MRSA organisms, compared with health care-associated (HA-) MRSA strain types, are more often susceptible to multiple classes of non ß-lactam antimicrobials. While infections caused by methicillin-susceptible S. aureus (MSSA) strains are usually treated with drugs in the ß-lactam class, such as cephalosporins, oxacillin or nafcillin, MRSA infections are treated with drugs in other antimicrobial classes. The glycopeptide drug vancomycin, and in some countries teicoplanin, is the most common drug used to treat severe MRSA infections. There are now other classes of antimicrobials available to treat staphylococcal infections, including several that have been approved after 2009. The antimicrobial management of invasive and noninvasive S. aureus infections in the ambulatory and in-patient settings is the topic of this review. Also discussed are common adverse effects of antistaphylococcal antimicrobial agents, advantages of one agent over another for specific clinical syndromes, and the use of adjunctive therapies such as surgery and intravenous immunoglobulin. We have detailed considerations in the therapy of noninvasive and invasive S. aureus infections. This is followed by sections on specific clinical infectious syndromes including skin and soft tissue infections, bacteremia, endocarditis and intravascular infections, pneumonia, osteomyelitis and vertebral discitis, epidural abscess, septic arthritis, pyomyositis, mastitis, necrotizing fasciitis, orbital infections, endophthalmitis, parotitis, staphylococcal toxinoses, urogenital infections, and central nervous system infections.
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Dickmann P, Wittgens K, Keeping S, Mischler D, Heudorf U. Re-thinking risk communication: information needs of patients, health professionals and the public regarding MRSA--the communicative behaviour of a public health network in Germany responding to the demand for information. Public Health 2015; 131:56-62. [PMID: 26710665 DOI: 10.1016/j.puhe.2015.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 10/08/2015] [Accepted: 11/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Multidrug resistant organisms (MDRO), including Meticillin-resistant Staphylococcus aureus (MRSA), and health care associated infections (HCAIs) are pressing issues for health care systems across the world. Information and communication are considered key tools for the prevention and management of infectious diseases. Public Health Authorities (PHA) are in a unique position to communicate with health care professionals, patients and the public regarding the health risks. STUDY DESIGN We used PHA helpdesk interaction data to first ascertain the information requirements of those getting in contact with the service, and secondly to examine the communicative behaviour of the PHA, with a view to improving the quality of communication strategies. METHODS Data on helpdesk interactions between 2010 and 2012 were obtained from a MDRO network of nine German PHAs. 501 recordings were coded and descriptive statistics generated for further qualitative thematic analysis. RESULTS Our analysis revealed a similar pattern of questions among different groups. Key areas of need for information were around eradication, cleaning and isolation measures. Reported problems were a lack of expert knowledge and continuity of treatment. The helpdesk response was mainly a conversation offering scientific advice, but also included other communication services that went beyond the provision of scientific facts, such as follow-up calls, referral suggestions and consultations on behalf of the caller. These social communication activities seem to have an important impact on the acceptability of public health recommendations and use of the helpdesk. CONCLUSIONS Our findings support a broader discussion about the role of information in the communication process and underline the importance of social elements in the communication process, such as relationship and trust building.
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Affiliation(s)
- P Dickmann
- London School of Economics and Political Science, LSE Health and Social Care, United Kingdom; Dickmann Risk Communication Drc, 21 Lancaster Grove, London NW3 4EX, United Kingdom.
| | - K Wittgens
- London School of Economics and Political Science, LSE Health and Social Care, United Kingdom
| | - S Keeping
- London School of Economics and Political Science, LSE Health and Social Care, United Kingdom
| | - D Mischler
- Public Health Authority Frankfurt, Germany
| | - U Heudorf
- Public Health Authority Frankfurt, Germany
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Birgand G, Johansson A, Szilagyi E, Lucet JC. Overcoming the obstacles of implementing infection prevention and control guidelines. Clin Microbiol Infect 2015; 21:1067-71. [PMID: 26369604 DOI: 10.1016/j.cmi.2015.09.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 12/21/2022]
Abstract
Reasons for a successful or unsuccessful implementation of infection prevention and control (IPC) guidelines are often multiple and interconnected. This article reviews key elements from the national to the individual level that contribute to the success of the implementation of IPC measures and gives perspectives for improvement. Governance approaches, modes of communication and formats of guidelines are discussed with a view to improve collaboration and transparency among actors. The culture of IPC influences practices and varies according to countries, specialties and healthcare providers. We describe important contextual aspects, such as relationships between actors and resources and behavioural features including professional background or experience. Behaviour change techniques providing goal-setting, feedback and action planning have proved effective in mobilizing participants and may be key to trigger social movements of implementation. The leadership of international societies in coordinating actions at international, national and institutional levels using multidisciplinary approaches and fostering collaboration among clinical microbiology, infectious diseases and IPC will be essential for success.
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Affiliation(s)
- G Birgand
- Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; INSERM, IAME, UMR 1137, F-75018, Paris, France; AP-HP, Hôpital Bichat - Claude Bernard, Infection Control Unit, Paris, France.
| | - A Johansson
- The Laboratory for Molecular Infection Medicine Sweden, Department of Clinical Microbiology, Umeå University, Umeå, Sweden
| | - E Szilagyi
- National Centre for Epidemiology, Budapest, Hungary
| | - J-C Lucet
- INSERM, IAME, UMR 1137, F-75018, Paris, France; AP-HP, Hôpital Bichat - Claude Bernard, Infection Control Unit, Paris, France
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Cheng AC, Worth LJ. Cultural dimensions relevant to antimicrobial stewardship: the contribution of individualism and power distance to perioperative prescribing practices in European hospitals. ACTA ACUST UNITED AC 2015. [DOI: 10.1071/hi15010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Brandt C, Makarewicz O, Fischer T, Stein C, Pfeifer Y, Werner G, Pletz MW. The bigger picture: the history of antibiotics and antimicrobial resistance displayed by scientometric data. Int J Antimicrob Agents 2014; 44:424-30. [PMID: 25216545 DOI: 10.1016/j.ijantimicag.2014.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/18/2014] [Accepted: 08/12/2014] [Indexed: 11/25/2022]
Abstract
Monitoring the rapid global spread of antimicrobial resistance requires an over-regional and fast surveillance tool. Data from major surveillance studies based on aggregated results of selected sentinel laboratories or retrospective strain collections are not available for the whole scientific community and are limited by time and region. Thus, we tested an alternative approach to monitor resistance trends by automated semantic and scientometric analysis of all (>100000) related PubMed entries. A semantic search was done using 'Gene Ontology' and MeSH vocabulary and additional search terms for further data refinement. Data extraction was performed using the semantic search engine 'GoPubMed'. The timely relationship between introduction of novel β-lactam antibiotic classes into the market and emergence of respective resistance was investigated using nearly 22300 publications over the last 70 years. Further analysis was done with around 54000 publications related to 'infectious diseases' and an additional 50000 publications related to 'antimicrobial resistance' to estimate current trends in publication interest regarding resistance development since 1940. Scientometric results were compared with data from the major surveillance network EARS-Net. Furthermore, the relationship between micro-organism, year and antibiotic market introduction was investigated for eight key antibiotics using nearly 37500 publications. Owing to influencing factors such as availability of alternative antibiotics, scientometric analysis correlated only partly with resistance development. However, it provides a fast, reliable and global overview of the clinical and public health importance of a specific resistance including the period of the 1940s-1980s, when resistance surveillance studies were not yet established.
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Affiliation(s)
- Christian Brandt
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany.
| | - Oliwia Makarewicz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany
| | - Thomas Fischer
- Department of Business Informatics, Friedrich Schiller University, Jena, Germany
| | - Claudia Stein
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany
| | - Yvonne Pfeifer
- Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany
| | - Guido Werner
- Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany
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Borg MA, Hulscher M, Scicluna EA, Richards J, Azanowsky JM, Xuereb D, Huis A, Moro ML, Maltezou HC, Frank U. Prevention of meticillin-resistant Staphylococcus aureus bloodstream infections in European hospitals: moving beyond policies. J Hosp Infect 2014; 87:203-11. [PMID: 24973016 DOI: 10.1016/j.jhin.2014.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 05/19/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is evidence that meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia can be reduced with improved infection control and antibiotic stewardship. AIM To survey infection control and antibiotic stewardship practices within European hospitals and to identify initiatives that correlate with reduced MRSA prevalence. METHODS Online questionnaires were sent to European hospitals about their surveillance, hand hygiene, intravenous device management, admission screening, isolation, antibiotic prescribing, hospital demographics and MRSA blood culture isolates during 2010. FINDINGS In all, 269 replies were received from hospitals in 29 European countries. Lower MRSA prevalence showed significant association with presence of incidence surveillance, performance of root cause analysis, mandatory training requirements for hand hygiene, accountability measures for persistent non-compliance, and multi-stakeholder teamwork in antibiotic prescribing. Presence of policies on intravenous catheter insertion and management showed no variation between different MRSA prevalence groups. However, low-prevalence hospitals reported more competency assessment programmes in insertion and maintenance of peripheral and central venous catheters. Hospitals from the UK and Ireland reported the highest uptake of infection control and antibiotic stewardship practices that were significantly associated with low MRSA prevalence, whereas Southern European hospitals exhibited the lowest. In multiple regression analysis, isolation of high-risk patients, performance of root cause analysis, obligatory training for nurses in hand hygiene, and undertaking joint ward rounds including microbiologists and infectious disease physicians remained significantly associated with lower MRSA prevalence. CONCLUSION Proactive infection control and antibiotic stewardship initiatives that instilled accountability, ownership, teamwork, and validated competence among healthcare workers were associated with improved MRSA outcomes.
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Affiliation(s)
- M A Borg
- Mater Dei Hospital and University of Malta, Msida, Malta.
| | - M Hulscher
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - J Richards
- International Federation of Infection Control, Norwich, UK
| | | | - D Xuereb
- Mater Dei Hospital, Msida, Malta
| | - A Huis
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M L Moro
- Agenzia Sanitaria e Sociale Regione, Emilia-Romagna, Bologna, Italy
| | - H C Maltezou
- Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - U Frank
- Freiburg University Hospital, Freiburg, Germany
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Borg MA. Lowbury Lecture 2013. Cultural determinants of infection control behaviour: understanding drivers and implementing effective change. J Hosp Infect 2014; 86:161-8. [PMID: 24534705 DOI: 10.1016/j.jhin.2013.12.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 12/28/2013] [Indexed: 11/18/2022]
Abstract
Despite dealing with biomedical practices, infection prevention and control (IPC) is essentially a behavioural science. Human behaviour is influenced by various factors, including culture. Hofstede's model of cultural dimensions proposes that national cultures vary along consistent dimensions which can be grouped and scored as specific constructs. Studies have reported that three Hofstede constructs--power distance, uncertainty avoidance, and masculinity--show significant association with several key performance indicators relevant to IPC and antibiotic stewardship. In addition, national meticillin-resistant Staphylococcus aureus (MRSA) levels within Europe correlate well with general quality-of-care indices, including preventive strategies and patient rights. This suggests that IPC may be simply a microcosm of overall quality and safety standards within hospitals and countries. Effective improvement would therefore need to address underlying and embedded core cultural values relevant to patient safety and quality of care. Successful IPC strategies are likely to be those that are compatible with the cultural background where they are implemented. To this end, content analysis of many current IPC improvement tools identifies elements of strong compatibility with cultures that are low in uncertainty avoidance and power distance, and high in individualism and masculinity. However, this cultural combination is largely restricted to Anglo-Saxon countries, where most of the recent improvements in healthcare-associated infection (HCAI) incidence have taken place. There is a paucity of research on IPC behaviour change in different cultural backgrounds, especially countries that score high for power distance and/or uncertainty avoidance. This information is vital to inform IPC campaigns in these countries, which often show high HCAI prevalence.
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Affiliation(s)
- M A Borg
- Mater Dei Hospital and University of Malta, Msida, Malta.
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27
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Organizational culture and its implications for infection prevention and control in healthcare institutions. J Hosp Infect 2014; 86:1-6. [DOI: 10.1016/j.jhin.2013.10.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 10/21/2013] [Indexed: 12/18/2022]
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28
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Heterogeneous glycopeptide intermediate Staphylococcus epidermidis isolated from prosthetic joint infections. Eur J Clin Microbiol Infect Dis 2013; 33:911-7. [DOI: 10.1007/s10096-013-2025-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 11/19/2013] [Indexed: 10/25/2022]
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Borg MA. Prolonged perioperative surgical prophylaxis within European hospitals: an exercise in uncertainty avoidance? J Antimicrob Chemother 2013; 69:1142-4. [DOI: 10.1093/jac/dkt461] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Ziakas PD, Thapa R, Rice LB, Mylonakis E. Trends and significance of VRE colonization in the ICU: a meta-analysis of published studies. PLoS One 2013; 8:e75658. [PMID: 24086603 PMCID: PMC3785502 DOI: 10.1371/journal.pone.0075658] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 08/14/2013] [Indexed: 12/28/2022] Open
Abstract
Background The burden and significance of vancomycin-resistant enterococci (VRE) colonization in the ICU is not clearly understood. Methods We searched PubMed and EMBASE up to May 2013 for studies reporting the prevalence of VRE upon admission to the ICU and performed a meta-analysis to assess rates and trends of VRE colonization. We calculated the prevalence of VRE on admission and the acquisition (colonization and/or infection) rates to estimate time trends and the impact of colonization on ensuing VRE infections. Findings Across 37 studies (62,959 patients at risk), the estimated prevalence of VRE on admission to the ICU was 8.8% (7.1-10.6). Estimates were more consistent when cultures were obtained within 24 hours from admission. The VRE acquisition rate was 8.8% (95% CI 6.9-11.0) across 26 evaluable studies (35,364 patients at risk). Across US studies, VRE acquisition rate was 10.2% (95% CI 7.7-13.0) and demonstrated significant decline in annual trends. We used the US estimate of colonization on admission [12.3% (10.5-14.3)] to evaluate the impact of VRE colonization on admission in overall VRE prevalence. We demonstrated that VRE colonization on admission is a major determinant of the overall VRE burden in the ICU. Importantly, among colonized patients (including admitted and/or acquired cases) the VRE infection rates vary widely from 0-45% (with the risk of VRE bacteremia being reported from 0-16%) and <2% among those without a proven colonization. Conclusion In summary, up to 10.6% of patients admitted in the ICU are colonized with VRE on admission and a similar percentage will acquire VRE during their ICU stay. Importantly, colonization on admission is a major determinant of VRE dynamics in the ICU and the risk of VRE-related infections is close related to colonization.
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Affiliation(s)
- Panayiotis D. Ziakas
- Infectious Diseases Division, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Rachana Thapa
- Infectious Diseases Division, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Louis B. Rice
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States of America
- * E-mail:
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Theuretzbacher U. Global antibacterial resistance: The never-ending story. J Glob Antimicrob Resist 2013; 1:63-69. [DOI: 10.1016/j.jgar.2013.03.010] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/15/2013] [Accepted: 03/25/2013] [Indexed: 02/08/2023] Open
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Lepelletier D, Lucet JC. Controlling meticillin-susceptible Staphylococcus aureus: not simply meticillin-resistant S. aureus revisited. J Hosp Infect 2013; 84:13-21. [DOI: 10.1016/j.jhin.2013.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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Abstract
Food-borne intoxication, caused by heat-stable enterotoxins produced by Staphylococcus aureus, causes over 240,000 cases of food-borne illness in the United States annually. Other staphylococci commonly associated with animals may also produce these enterotoxins. Foods may be contaminated by infected food handlers during slaughter and processing of livestock or by cross-contamination during food preparation. S. aureus also causes a variety of mild to severe skin and soft tissue infections in humans and other animals. Antibiotic resistance is common in staphylococci. Hospital-associated (HA) S. aureus are resistant to numerous antibiotics, with methicillin-resistant S. aureus (MRSA) presenting significant challenges in health care facilities for over 40 years. During the mid-1990s new human MRSA strains developed outside of hospitals and were termed community-associated (CA). A few years later, MRSA was isolated from horses and methicillin resistance was detected in Staphylococcus intermedius/pseudintermedius from dogs and cats. In 2003, a livestock-associated (LA) MRSA strain was first detected in swine. These methicillin-resistant staphylococci pose additional food safety and occupational health concerns. MRSA has been detected in a small percentage of retail meat and raw milk samples indicating a potential risk for food-borne transmission of MRSA. Persons working with animals or handling meat products may be at increased risk for antibiotic-resistant infections. This review discusses the scope of the problem of methicillin-resistant staphylococci and some strategies for control of these bacteria and prevention of illness.
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Could the incidence of healthcare infections in Europe simply be a reflection of overall quality standards? J Hosp Infect 2012; 82:141-2. [DOI: 10.1016/j.jhin.2012.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/12/2012] [Indexed: 11/23/2022]
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