Management of multidrug resistant bacterial endemic

Comparison between a complete preconditioning programme and conventional conduct on behaviour, health and performance of young bulls from small cow-calf herds

Bovine respiratory diseases (BRDs) have major socioeconomic impacts in the beef sector. Antimicrobials have been traditionally used to prevent the development of BRDs upon arrival in fattening units. Currently, from a "One Health and One Welfare" perspective, alternative solutions are being investigated. Preconditioning programmes that aim at reducing stress and reinforcing immune functions have been proposed to decrease BRDs incidence. In this study, we assessed the effect of a preconditioning protocol set up in nine commercial beef herds on young bulls' behaviour, health, and performance. Preconditioned bulls (PREC) were weaned indoors 50 days before departure, and progressively fed a concentrate diet supplemented with vitamins and trace elements. They also received an anthelmintic treatment, and two doses of a trivalent vaccine against respiratory pathogens at 4-week intervals. In contrast, controls (CTRL) were kept on pasture with their dams with no vaccination or particular diets. All calves were transported together to a single sorting facility to be sorted by experimental groups, origins, and BW, forming new groups before dispatch to four fattening units. At arrival, CTRL were treated with anthelmintic drugs and received one injection of the same BRDs vaccine. No intervention was performed on PREC bulls. BRD-scores were 0.73 in PREC versus 0.07 in CTRL (P = 0.01) during the preconditioning period and 0.96 in PREC versus 0.54 in CTRL (P = 0.41) after 15 days in the fattening units. Morbidity estimates were 18% in PREC versus 1% in CTRL (P < 0.001) during the preconditioning period and 32% in PREC versus 19% (P = 0.07) in CTRL after 15 days in the fattening units. Poor housing conditions during preconditioning and a different aetiology could partly explain these results. At arrival to fattening, the average daily gain (ADG) was 1 605 g for PREC versus 1 140 g (P = 0.012) for CTRL. After fattening for 180 days, differences in BW, ADG, carcass weight and conformation were inconclusive. In Europe, preconditioning programmes including vaccination must be set up coherently with good husbandry practices and with a global adaptation of batch management of the beef sector otherwise, they may be less effective than expected.

Colonização pré-operatória por Staphylococcus aureus e as bactérias não suscetíveis à cefalosporina, em pacientes com fratura proximal do fêmur

Objective  To estimate the frequency of Staphylococcus aureus and cephalosporin nonsusceptible bacteria colonization in patients with proximal femoral fracture during preoperative hospitalization.

Methods  Prevalence and incidence assessment in 63 hospitalized patients over 1 year. The median time of pretreatment hospitalization was 12 days. Samples were collected from the nostrils, groin skin and anal mucosa during the pretreatment hospitalization and were tested by the disc-diffusion technique.

Results  The hospital colonization incidence and the prevalence of positive results were 14.3 and 44.4% for S. aureus ; 3.2 and 6.4% for meticillin-resistant S. aureus ; 28.6 and 85.7% for meticillin-resistant coagulase-negative Staphylococcus ; 28.6 and 61.9% for cefazolin nonsusceptible Enterobacteriaceae (KFNSE); and 20.6 and 28.6% for cefuroxime nonsusceptible Enterobacteriaceae (CXNSE). In addition, factors such as to the duration of the pretreatment hospitalization period, being non-walker before fracture, antimicrobial use, American Society of Anesthesiologists (ASA) 4 surgical risk, and previous hospitalization, were related to an increase in the incidence of hospital acquisition and prevalence of colonization by the evaluated strains. The prevalence of colonization by KFNSE was three times higher than by CXNSE on admission, and twice as high at the time of fracture treatment.

Conclusion  There was a high incidence of hospital colonization and prevalence of colonization by all strains studied, which may guide the indication of prophylactic measures for infection.

Anti-Inflammatory, Antimicrobial and Insecticidal Properties of Daucus Gracilis Steinh Flowers Essential Oil

BACKGROUND

Daucus gracilis Steinh belongs to the Apiaceae family. The flowers of this plant have been used by the population of western Algeria for the treatment of mouth ulcers. However, very few studies exist concerning the biological properties of essential oil of Daucus gracilis Steinh flowers.

OBJECTIVES

The purpose of this work was to study the chemical composition of the essential oil of Daucus gracilis flowers and to evaluate their antimicrobial, insecticidal and anti-inflammatory properties.

METHODS

The distilled essential oil was analyzed by GC and GC-MS. The antimicrobial activity of the essential oil was evaluated using two methods i) diffusion method, and ii) micro dilution technique. The insecticidal activity of essential oil was evaluated against adults of Tribolium confusum by fumigant test. The in vitro assessment of the anti-inflammatory property of essential oil was assessed by the protein denaturation method.

RESULTS

Daucus gracilis flowers essential oil mainly represented oxygenated monoterpenes such as geranyl acetate (18.3%), lavandulyl acetate (15.2%), lavandulyl isobutyrate (13.6%) and citronellyl isobutyrate (6.8%). According to the results of antimicrobial activity, the essential oil of flowers presented prominent inhibitory action against Aspergillus flavus (0.06 μg/mL), followed by Staphylococcus aureus, Escherichia faecalis, Bacillus cereus and Candida albicans with MIC values of 0.125 μg/mL. The Daucus gracilis essential oil flowers proved to be very biocidal toward adults of Tribolium confusum; mortality of 100% of the population was noted with a dose of 2 μl/L air after 24 hours of exposure. Furthermore, the oil has shown a very good inhibition of protein denaturation comparable to Diclofenac at a concentration of 30 μL/mL.

CONCLUSION

Daucus gracilis essential oil can be used as a pharmacological tools for inflammatory, antimicrobial and insecticidal properties.

Extended Spectrum Beta Lactamase (ESBL), blaTEM,blaSHV and blaCTX-M, Resistance Genes in Community and Healthcare Associated Gram Negative Bacteria from Osun State, Nigeria

BACKGROUND

Extended Spectrum Beta Lactamase (ESBL) production in gram negative bacteria confers multiple antibiotic resistance, adversely affecting antimicrobial therapy in infected individuals. ESBLs result from mutations in β-lactamases encoded mainly by the bla_TEM,bla_SHV and bla_CTX-M genes. The prevalence of ESBL producing bacteria has been on the increase globally, especially its upsurge among isolates from community-acquired infections has been observed.

AIM

To determine ESBL prevalence and identify ESBL genes among clinical isolates in Osun State, Nigeria.

MATERIAL AND METHODS

A cross-sectional study was carried out from August 2016 - July 2017 in Osun State, Nigeria. Three hundred and sixty Gram-negative bacteria recovered from clinical samples obtained from both community and healthcare-associated infections were tested. They included 147 Escherichia coli (40.8%), 116 Klebsiella spp (32.2%), 44 Pseudomonas aeruginosa (12.2%) and 23 Proteus vulgaris (6.4%) isolates. Others were Acinetobacter baumannii, Serratia rubidae, Citrobacter spp, Enterobacter spp and Salmonella typhi. Disk diffusion antibiotic susceptibility testing was carried out, isolates were screened for ESBL production and confirmed using standard laboratory procedures. ESBLs resistance genes were identified by Polymerase Chain Reaction (PCR).

RESULTS

All isolates demonstrated multiple antibiotic resistance. Resistance to ampicillin, amoxicillin with clavulanate and erythromycin was 100%, whereas resistance to Imipenem was very low (5.0%). The overall prevalence of ESBL producers was 41.4% with Klebsiella spp as the highest ESBL producing Enterobacteriacaea. ESBL producers were more prevalent among the hospital pathogens than community pathogens, 58% vs. 29.5% (p=0.003). ESBL genes were detected in all ESBL producers with the bla_CTX-M gene predominating (47.0%) followed by bla_TEM (30.9%) and bla_SHV gene was the least, 22.1%. The bla_CTX-M gene was also the most prevalent in the healthcare pathogens (62%) but it accounted for only 25% in those of community origin.

CONCLUSION

A high prevalence of ESBL producing gram-negative organisms occurs both in healthcare and in the community in our environment with the CTX-M variant predominating. Efforts to control the spread of these pathogens should be addressed.

Barrier Precautions in the Era of Multidrug Pathogens

Purpose of review

There is a continuing debate regarding contact precaution (CP) usage for endemic multidrug-resistant organisms (MDROs). In this review, we examine current recommendations for CP and highlight differences in CP use between endemic and non-endemic MDROs.

Recent findings

The discontinuation of CP had no effect on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci. The evidence regarding CP for extended-spectrum beta-lactamase producing Enterobacteriaceae is inconclusive, highlighting the need for more research to determine best infection control strategies. Carbapenem-resistant Enterobacteriaceae maintains a sporadic pattern in the USA, supporting current recommendations to use CP for colonized and infected patients. MDR Acinetobacter baumannii (MDR-AB) is extremely virulent and responsible for outbreaks in healthcare settings, emphasizing the need for CP use with MDR-AB infected patients. Candida auris (C. auris) is often misdiagnosed; it is resistant to UV light and quaternary ammonium low-level disinfection. Because little is known about the transmission of C. auris, significant caution and CP use are necessitated. There is little research on vancomycin-resistant S. aureus (VRSA) control strategies due to its rarity; thus, CP is strongly recommended.

Summary

Contact precautions are frequently part of a bundled infection control approach that involves meticulous hand hygiene, patient decolonization, chlorhexidine gluconate bathing, and reducing the use of invasive devices. Healthcare facilities should continue to utilize CP for non-endemic MDROs and the presence of endemic MDROs; however, CP may not add benefit to the current infection prevention bundle approach.

Effect of using portable alcohol-based handrub on nurses' hand hygiene compliance and nasal carriage of staphylococcus aureus in a low-income health setting

BACKGROUND

Low hand-hygiene compliance (HHC) in low-income countries due to deficient hand hygiene resources may increase nasal carriage of S. aureus, a causative agent of health care-associated infections. The study aimed to assess the effect of using locally available portable alcohol-based handrub (ABHR) regarding nurses' HHC and nasal carriage of S. aureus.

METHODS AND DESIGN

Nonrandomized interventional design. Seventy-two (72) of 86 nurses were provided with portable ABHR to use during patient care (intervention group). The remaining 14 nurses constituted the control group. Evaluation was done via HHC observation per WHO 5-moments of HH, determining S. aureus nasal carriage prevalence and HH guideline knowledge assessment via a self-response questionnaire.

RESULTS

In the intervention group, HHC improved from 48.9% to 67.7% (P < .001) especially for hand-hygiene before and after patient contact. Hand-hygiene by handrubbing improved from 16 to 105 moments. There was positive feedback to portable ABHR use from nurses. S. aureus nasal carriage significantly decreased from 30.6% to 21% (P < .031). Negative carriage of S. aureus was significantly associated with increase in HHC (P < .001). Despite the low preintervention HHC, nurses showed considerably high levels of knowledge on relevance of hand hygiene.

CONCLUSIONS

Portable ABHR use was associated with improved HHC and reduced S. aureus nasal carriage prevalence. As nurses' knowledge of HH guidelines was high, provision of portable ABHR compensated for deficient facility HH resources resulting in improved HHC, which effected reduction in nasal carriage of S. aureus among nurses.

A toolkit for the management of infection or colonization by extended-spectrum beta-lactamase producing Enterobacteriaceae in Italy: implementation and outcome of a European project

Among European countries, prevalence rates of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are particularly high in those bordering the Mediterranean. This is the case for Italy, with 26% of Escherichia coli displaying resistance to the 3rd generation cephalosporins in 2013. An ESBL-E toolkit designed to assist clinicians in managing patients harboring ESBL-E was favorably implemented in Southern France. In a context of lack of specific Italian recommendations, its extension to an adjacent region of Italy was made possible through a cross-border EU cooperation program. Italian infectious disease (ID) specialists, microbiologists, and community-based general practitioners from three districts in Liguria were offered a toolkit consisting in a warning system and detailed procedures for the management of patients harboring ESBL-E, including seeking advice from an ID specialist, and were trained during 52 video conferences by an experienced French team. Indications and trends in antimicrobial prescription were studied following implementation of the toolkit. Between November 2013 and November 2014, 476 patients were identified as harboring ESBL-E and expert advice was sought for 364 of these; all patients and/or their caregivers were advised on appropriate hygiene measures and 209/341 with documented management received antimicrobial treatment, while asymptomatic carriers (39%) were not prescribed antibiotics. The ESBL-E toolkit was well received by the healthcare staff. A specific, simple tool consisting in a care-bundle approach to manage ESBL-E carriers can restrict antimicrobial prescription to symptomatic patients while raising awareness among caregivers of the importance of seeking expert advice and implementing appropriate hygiene measures.

The potential role of microbiota for controlling the spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in neonatal population

The spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in the hospital and also the community is worrisome. Neonates particularly are exposed to the risk of ESBL-PE acquisition and, owing to the immaturity of their immune system, to a higher secondary risk of ESBL-PE-related infection. Reducing the risk of acquisition in the hospital is usually based on a bundle of measures, including screening policies at admission, improving hand hygiene compliance, and decreasing antibiotic consumption. However, recent scientific data suggest new prevention opportunities based on microbiota modifications.

Distribution and drug resistance of pathogenic bacteria isolated from cancer hospital in 2013

OBJECTIVE

To understand distribution and drug resistance of pathogenic bacteria from a specialized cancer hospital in 2013 in order to provide a basis for rational clinical antimicrobial agents.

METHODS

Pathogenic bacteria identification and drug sensitivity tests were performed with a VITEK 2 compact automatic identification system and data were analyzed using WHONET5.6 software.

RESULTS

Of the 1,378 strains tested, 980 were Gram-negative bacilli, accounting for 71.1%, in which Klebsiella pneumonia, Escherichia coli and Pseudomonas aeruginosa were the dominant strains. We found 328 Gram-positive coccus, accounting for 23.8%, in which the amount of Staphylococcus aureus was the highest. We identified 46 fungi, accounting for 4.1%. According to the departmental distribution within the hospital, the surgical departments isolated the major strains, accounting for 49.7%. According to disease types, lung cancer, intestinal cancer and esophagus cancer were the top three, accounting for 20.9%, 17.3% and 14.2%, respectively. No strains were resistant to imipenem, ertapenem or vancomycin.

CONCLUSIONS

Pathogenic bacteria isolated from the specialized cancer hospital have different resistance rates compared to commonly used antimicrobial agents; therefore antimicrobial agents to reduce the morbidity and mortality of infections should be used.