1
|
Salle R, Del Giudice P, Skayem C, Hua C, Chosidow O. Secondary Bacterial Infections in Patients with Atopic Dermatitis or Other Common Dermatoses. Am J Clin Dermatol 2024; 25:623-637. [PMID: 38578398 DOI: 10.1007/s40257-024-00856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with Staphylococcus aureus and Streptococcus pyogenes being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting S. aureus. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of S. aureus is deemed necessary, particularly in atopic dermatitis.
Collapse
Affiliation(s)
- Romain Salle
- Service de Dermatologie Générale et Oncologique, UVSQ, EA4340-BECCOH, AP-HP, Hôpital Ambroise-Paré, Université Paris-Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
| | - Pascal Del Giudice
- Unité D'Infectiologie et Dermatologie, Centre Hospitalier Intercommunal de Fréjus-Saint-Raphaël, Fréjus, France
| | - Charbel Skayem
- Service de Dermatologie Générale et Oncologique, UVSQ, EA4340-BECCOH, AP-HP, Hôpital Ambroise-Paré, Université Paris-Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Camille Hua
- AP-HP, Service de Dermatologie, Hôpital Henri Mondor, Créteil, France
| | - Olivier Chosidow
- Consultation Dermatoses Faciales, Service d'ORL, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
- UPEC Créteil, Créteil, France
| |
Collapse
|
2
|
Kok CR, Bram Z, Thissen JB, Horseman TS, Fong KSK, Reichert-Scrivner SA, Paguirigan C, O'Connor K, Thompson K, Scheiber AE, Mabery S, Ngauy V, Uyehara CF, Be NA. The military gear microbiome: risk factors surrounding the warfighter. Appl Environ Microbiol 2024; 90:e0117623. [PMID: 38170999 PMCID: PMC10807412 DOI: 10.1128/aem.01176-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/16/2023] [Indexed: 01/05/2024] Open
Abstract
Combat extremity wounds are highly susceptible to contamination from surrounding environmental material. This bioburden could be partially transferred from materials in immediate proximity to the wound, including fragments of the uniform and gear. However, the assessment of the microbial bioburden present on military gear during operational conditions of deployment or training is relatively unexplored. Opportunistic pathogens that can survive on gear represent risk factors for infection following injury, especially following combat blasts, where fibers and other materials are embedded in wounded tissue. We utilized 16S rRNA sequencing to assess the microbiome composition of different military gear types (boot, trouser, coat, and canteen) from two operational environments (training in Hawai'i and deployed in Indonesia) across time (days 0 and 14). We found that microbiome diversity, stability, and composition were dependent on gear type, training location, and sampling timepoint. At day 14, species diversity was significantly higher in Hawai'i samples compared to Indonesia samples for boot, coat, and trouser swabs. In addition, we observed the presence of potential microbial risk factors, as opportunistic pathogenic species, such as Acinetobacter, Pseudomonas, and Staphylococcus, were found to be present in all sample types and in both study sites. These study outcomes will be used to guide the design of antimicrobial materials and uniforms and for infection control efforts following combat blasts and other injuries, thereby improving treatment guidance during military training and deployment.IMPORTANCECombat extremity wounds are vulnerable to contamination from environments of proximity to the warfighter, leading to potential detrimental outcomes such as infection and delayed wound healing. Therefore, microbial surveillance of such environments is necessary to aid the advancement of military safety and preparedness through clinical diagnostics, treatment protocols, and uniform material design.
Collapse
Affiliation(s)
- Car Reen Kok
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California, USA
| | | | - James B. Thissen
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California, USA
| | - Timothy S. Horseman
- Tripler Army Medical Center, Honolulu, Hawaii, USA
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | | | | | | | | | | | | | - Shalini Mabery
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California, USA
| | - Viseth Ngauy
- Tripler Army Medical Center, Honolulu, Hawaii, USA
| | | | - Nicholas A. Be
- Physical and Life Sciences Directorate, Lawrence Livermore National Laboratory, Livermore, California, USA
| |
Collapse
|
3
|
Cai Y, Philips EC, Arora S, Sim JXY, Chow W, Nazeha N, Whiteley S, Auw MYX, Tiang DC, Neo SL, Hong W, Venkatachalam I, Graves N. Cost-effectiveness of a real-time spatiotemporal mapping surveillance system for meticillin-resistant Staphylococcus aureus prevention. J Hosp Infect 2024; 143:178-185. [PMID: 37774929 DOI: 10.1016/j.jhin.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES An infection surveillance system based on a hospital's digital twin [4D-Disease Outbreak Surveillance System (4D-DOSS)] is being developed in Singapore. It offers near-real-time infection surveillance and mapping capabilities. This early economic modelling study was conducted, using meticillin-resistant Staphylococcus aureus (MRSA) as the pathogen of interest, to assess the potential cost-effectiveness of 4D-DOSS. METHODS A Markov model that simulates the likelihood of MRSA colonization and infection was developed to evaluate the cost-effectiveness of adopting 4D-DOSS for MRSA surveillance from the hospital perspective, compared with current practice. The cycle duration was 1 day, and the model horizon was 30 days. Probabilistic sensitivity analysis was conducted, and the probability of cost-effectiveness was reported. Scenario analyses and a value of information analysis were performed. RESULTS In the base-case scenario, with 10-year implementation/maintenance costs of 4D-DOSS of $0, there was 68.6% chance that 4D-DOSS would be cost-effective. In a more pessimistic but plausible scenario where the effectiveness of 4D-DOSS in reducing MRSA transmission was one-quarter of the base-case scenario with 10-year implementation/maintenance costs of $1 million, there was 47.7% chance that adoption of 4D-DOSS would be cost-effective. The value of information analysis showed that uncertainty in MRSA costs made the greatest contribution to model uncertainty. CONCLUSIONS This early-stage modelling study revealed the circumstances for which 4D-DOSS is likely to be cost-effective at the current willingness-to-pay threshold, and identified the parameters for which further research will be worthwhile to reduce model uncertainty. Inclusion of other drug-resistant organisms will provide a more thorough assessment of the cost-effectiveness of 4D-DOSS.
Collapse
Affiliation(s)
- Y Cai
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - E C Philips
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - S Arora
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore
| | - J X Y Sim
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - W Chow
- Department of Cardiology, Changi General Hospital, Singapore
| | - N Nazeha
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | | | | | - D C Tiang
- Office for Service Transformation, SingHealth, Singapore
| | - S L Neo
- Office of Digital Strategy, SingHealth, Singapore
| | - W Hong
- Office for Service Transformation, SingHealth, Singapore
| | - I Venkatachalam
- Department of Infection Prevention and Epidemiology, Singapore General Hospital, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - N Graves
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| |
Collapse
|