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Ahmed EF, Gad GF, Soliman WE, El-Asady RS, Hasaneen AM, Abdelwahab SF. Prevalence of methicillin-resistant coagulase-negative staphylococci among Egyptian patients after surgical interventions. Trop Doct 2021; 51:40-44. [PMID: 33050839 DOI: 10.1177/0049475520962740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Coagulase-negative staphylococci (CoNS) are frequently isolated from wound infections. There are limited data examining the prevalence of methicillin-resistant CoNS (MRCoNS) among Egyptian patients after surgery. Thus, we studied 208 hospitalised patients, who had skin and soft tissue infections (SSTIs) due to various causes. Samples were cultured for isolation and identification of CoNS and isolates were screened for susceptibility against 23 different antimicrobials. Out of 241 Staphylococcal isolates, 114 (47.3%) were CoNS. The prevalence of MRCoNS among surgical site infection, diabetic foot, abscess, and burn patients was 13.4%, 11.5%, 15.6%, and 10.3%, respectively. The lowest resistance of the 27 identified MRCoNS isolates was to vancomycin, amikacin and gatifloxacin (7% each). We conclude that CoNS isolates are major pathogens associated with wound infections at our institution and MRCoNS probably poses a substantial threat for patients in Egypt, though most MRCoNS isolates demonstrated susceptibility to vancomycin.
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Affiliation(s)
- Eman F Ahmed
- Assistant professor, Microbiology and Immunology Department, Faculty of Pharmacy, Deraya University, Minia, Egypt
- Professor, Microbiology and Immunology Department, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Gamal Fm Gad
- Professor, Microbiology and Immunology Department, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Wafaa E Soliman
- Associate professor, Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, AL AHSA, Kingdom of Saudi Arabia
- Associate professor, Microbiology and Immunology Department, Faculty of Pharmacy, Delta University for Science and Technology, Gamasa, Egypt
| | - Riham S El-Asady
- Associate professor, Department of Microbiology and Immunology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman M Hasaneen
- Professor, Department of General Surgery, Minia University, Minia, Egypt
| | - Sayed F Abdelwahab
- Professor, Department of Microbiology and Immunology, Faculty of Medicine, Minia University, Minia, Egypt
- Professor, Division of Pharmaceutical Microbiology, Department of Pharmaceutics and Industrial Pharmacy, College of Pharmacy, Taif University, Taif, Kingdom of Saudi Arabia
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2
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Sommerstein R, Atkinson A, Kuster SP, Thurneysen M, Genoni M, Troillet N, Marschall J, Widmer AF. Antimicrobial prophylaxis and the prevention of surgical site infection in cardiac surgery: an analysis of 21 007 patients in Switzerland†. Eur J Cardiothorac Surg 2020; 56:800-806. [PMID: 30796448 DOI: 10.1093/ejcts/ezz039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Our goal was to determine the optimal timing and choice of surgical antimicrobial prophylaxis (SAP) in patients having cardiac surgery. METHODS The setting was the Swiss surgical site infection (SSI) national surveillance system with a follow-up rate of >94%. Participants were patients from 14 hospitals who had cardiac surgery from 2009 to 2017 with clean wounds, SAP with cefuroxime, cefazolin or a vancomycin/cefuroxime combination and timing of SAP within 120 min before the incision. Exposures were SAP timing and agents; the main outcome was the incidence of SSI. We fitted generalized additive and mixed-effects generalized linear models to describe effects predicting SSIs. RESULTS A total of 21 007 patients were enrolled with an SSI incidence of 5.5%. Administration of SAP within 30 min before the incision was significantly associated with decreased deep/organ space SSI [adjusted odds ratio (OR) 0.73, 95% confidence interval (CI) 0.54-0.98; P = 0.035] compared to administration of SAP 60-120 min before the incision. Cefazolin (adjusted OR 0.64, 95% CI 0.49-0.84; P = 0.001) but not vancomycin/cefuroxime combination (adjusted OR 1.05, 95% CI 0.82-1.34; P = 0.689) was significantly associated with a lower risk of overall SSI compared to cefuroxime alone. Nevertheless, there were no statistically significant differences between the SAP agents and the risk of deep/organ space SSI. CONCLUSIONS The results from this large prospective study provide substantial arguments that administration of SAP close to the time of the incision is more effective than earlier administration before cardiac surgery, making compliance with SAP administration easier. The choice of SAP appears to play a significant role in the prevention of all SSIs, even after adjusting for confounding variables.
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Affiliation(s)
- Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Swissnoso, the National Center for Infection Control, Bern, Switzerland
| | - Maurus Thurneysen
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Michele Genoni
- Department of Cardiac Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Nicolas Troillet
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Swissnoso, the National Center for Infection Control, Bern, Switzerland
| | - Andreas F Widmer
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
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Kachel E, Moshkovitz Y, Sternik L, Sahar G, Grosman-Rimon L, Belotserkovsky O, Reichart M, Stark Y, Emanuel N. Local prolonged release of antibiotic for prevention of sternal wound infections postcardiac surgery-A novel technology. J Card Surg 2020; 35:2695-2703. [PMID: 32743813 DOI: 10.1111/jocs.14890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Sternal wound infection (SWI) is a devastating postcardiac surgical complication. D-PLEX100 (D-PLEX) is a localized prolonged release compound applied as a prophylactic at the completion of surgery to prevent SWI. The D-PLEX technology platform is built as a matrix of alternating layers of polymers and lipids, entrapping an antibiotic (doxycycline). The objective of this study was to assess the safety profile and pharmacokinetics of D-PLEX in reducing SWI rates postcardiac surgery. METHOD Eighty-one patients were enrolled in a prospective single-blind randomized controlled multicenter study. Sixty patients were treated with both D-PLEX and standard of care (SOC) and 21 with SOC alone. Both groups were followed 6 months for safety endpoints. SWI was assessed at 90 days. RESULTS No SWI-related serious adverse events (SAEs) occurred in either group. The mean plasma Cmax in patients treated with D-PLEX was about 10 times lower than the value detected following the oral administration of doxycycline hyclate with an equivalent overall dose, and followed by a very low plasma concentration over the next 30 days. There were no sternal infections in the D-PLEX group (0/60) while there was one patient with a sternal infection in the control group (1/21, 4.8%). CONCLUSION D-PLEX was found to be safe for use in cardiac surgery patients. By providing localized prophylactic prolonged release of broad-spectrum antibiotics, D-PLEX has the potential to prevent SWI postcardiac surgery and long-term postoperative hospitalization, reducing high-treatment costs, morbidity, and mortality.
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Affiliation(s)
- Erez Kachel
- Department of Cardiac Surgery, Poriya Medical Center, Tiberias, Israel.,Department of Cardiac Surgery, Sheba Medical Centre, Tel Hashomer, Israel
| | - Yaron Moshkovitz
- Department of Cardiothoracic Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Leonid Sternik
- Department of Cardiac Surgery, Sheba Medical Centre, Tel Hashomer, Israel
| | - Gideon Sahar
- Department of Cardiothoracic Surgery, Soroka Medical Center, Beer Sheva, Israel
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Albac S, Labrousse D, Hayez D, Anzala N, Bonnot D, Chavanet P, Aslangul E, Croisier D. Activity of Different Antistaphylococcal Therapies, Alone or Combined, in a Rat Model of Methicillin-Resistant Staphylococcus epidermidis Osteitis without Implant. Antimicrob Agents Chemother 2020; 64:e01865-19. [PMID: 31740562 PMCID: PMC6985758 DOI: 10.1128/aac.01865-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/11/2019] [Indexed: 01/30/2023] Open
Abstract
We developed a rat model of methicillin-resistant Staphylococcus epidermidis (MRSE) osteitis without implant to compare the efficacy of vancomycin, linezolid, daptomycin, ceftaroline, and rifampin either alone or in association with rifampin. A clinical strain of MRSE was inoculated into the proximal tibia. Following a 1-week infection period, rats received either no treatment or 3, 7, or 14 days of human-equivalent antibiotic regimen. Quantitative bone cultures were performed throughout the 14-day period. The mean ± SD quantity of staphylococci in the bone after a 1-week infection period was 4.5 ± 1.0 log10 CFU/g bone, with this bacterial load remaining stable after 3 weeks of infection (4.9 ± 1.4 log10 CFU/g bone). Vancomycin monotherapy was the most slowly bactericidal treatment, whereas ceftaroline monotherapy was the most rapidly bactericidal treatment. The addition of rifampin significantly increased the bacterial reduction for vancomycin, linezolid, and daptomycin. All tibias were sterilized after 2 weeks of treatment except for animals receiving vancomycin or daptomycin alone (66.6% and 50% of sterilization, respectively). These results show that ceftaroline and linezolid alone remain good options in the treatment of MRSE osteitis without implant. The combination with rifampin increases the antibiotic effect of vancomycin and daptomycin lines.
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Affiliation(s)
| | | | | | | | | | - P Chavanet
- Vivexia, Dijon, France
- Département d'Infectiologie, Centre Hospitalier Universitaire, Dijon, France
| | - E Aslangul
- Centre Coordonné de Médecine Interne, Colombes, France
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Luján-Valencia JE, López-Cortes LE, Calvo-Jambrina R, Barquero-Aroca JM, Gálvez-Acebal J. Sequential antimicrobial therapy in mediastinitis after cardiac surgery: An observational study of 81 cases. Enferm Infecc Microbiol Clin 2020; 38:361-366. [PMID: 31932182 DOI: 10.1016/j.eimc.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Mediastinitis is an infrequent but serious complication of cardiac surgery. Antimicrobial treatment guidelines are not well established. The aim was to describe the efficacy of sequential intravenous to oral therapy in selected post-surgical mediastinitis patients. METHODS A retrospective observational study including cases of mediastinitis after cardiac surgery, defined according to CDC criteria, at a third-level university hospital between January 2002 and December 2016. Sequential antimicrobial therapy was proposed in clinically stable patients. Rates of cure, relapse, and hospital stay were compared between patients who received sequential intravenous to oral therapy and those who received therapy exclusively by the intravenous route. RESULTS Eighty-one cases were included. Sequential intravenous to oral therapy was performed in 48 (59.3%) patients on median day 15. No differences in baseline characteristics or causal microorganisms were found between the two cohorts. The average duration of antibiotic therapy was 41.2±10.09 days. The most commonly used drugs in sequential therapy were quinolones in 31 (64.6%) cases and rifampicin, always in association with another antibiotic, in 25 (52.1%). Hospital stay was shorter in the sequential therapy group (57.57±34.03 vs. 84.35±45.67; P=0.007). Cure was achieved in 77 (92.8%) patients. Overall in-hospital mortality was less frequent in the group that received sequential therapy (2.1% vs. 15.2%; P=0.039). There were no differences in relapse between the two cohorts (4.2% vs 9.1%; P=0.366). CONCLUSION Sequential antimicrobial treatment in selected patients with post-surgical mediastinitis may be as effective as exclusively intravenous treatment, reducing risks, hospital stay and associated costs.
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Affiliation(s)
| | - Luis Eduardo López-Cortes
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/CSIC/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | | | | | - Juan Gálvez-Acebal
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/CSIC/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
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Empleo de vancomicina tópica en la profilaxis de infección de herida de esternotomía: experiencia inicial. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zahra A, Sayed HF, El-Hafez Fouly MA, Ghalwash M. Early management of deep sternal wound infections using omental flaps. JOURNAL OF THE EGYPTIAN SOCIETY OF CARDIO-THORACIC SURGERY 2018; 26:141-145. [DOI: 10.1016/j.jescts.2018.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Ma JG, An JX. Deep sternal wound infection after cardiac surgery: a comparison of three different wound infection types and an analysis of antibiotic resistance. J Thorac Dis 2018; 10:377-387. [PMID: 29600070 DOI: 10.21037/jtd.2017.12.109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background Deep sternal wound infection (DSWI) is a severe complication following cardiac surgery. We compared epidemiology, clinical features, and microbiology of three types of DSWI and examined the antibiotic resistance in DSWI patients. Methods From 2011 to 2015, 170 adult post-cardiac surgery DSWI patients were recruited for this study and underwent the pectoralis major muscle flap transposition in our department. Results Of 170 adult patients with DSWI (mean age of 54 years), the majority (99 patients, 58.2%) had type II DSWI. The three types of DSWI patients showed significant differences in terms of gender, smoking history, chronic obstructive pulmonary disease (COPD), length of intensive care unit (ICU) stay, and hospitalization cost (P<0.05). The most common symptoms of DSWI patients were fever and wound dehiscence accompanied by purulent secretions. Types I and II DSWI were more frequently associated with hypoproteinemia and high leucocyte count (P<0.05). Microbiological diagnosis was available for 77 of 170 patients (45.3%). Of 157 pathogens detected, 87 (55.4%) species of gram negative bacilli were identified and most commonly were Pseudomonas aeruginosa (25.5%) and methicillin-susceptible Staphylococcus aureus (20.4%). However, no statistically significant microbiological differences among the three DSWI types were observed (P>0.05). Notably, P. aeruginosa isolates showed 100% resistance to cefazolin and cefuroxime. Meanwhile, the resistance rate of Acinetobacter baumannii isolates to commonly used antibiotics was greater than 70%, while resistance rates of staphylococcus to penicillin-G were 100% and to clindamycin were over 70%. No isolates were resistant to vancomycin, linezolid, and tigecycline. Conclusions Three types of DSWI exhibit differences in epidemiology and clinical features. P. aeruginosa and S. aureus are the most common pathogens in DSWI patients and antibiotic resistance is a serious concern in these patients. Therefore, prevention and treatment of DSWI should be closely tailored to clinical features, local microbiological characteristics, and resistance patterns of commonly encountered pathogens.
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Affiliation(s)
- Jia-Gui Ma
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 100012, China
| | - Jian-Xiong An
- Department of Anesthesiology, Pain Medicine and Critical Care Medicine, Aviation General Hospital of China Medical University and Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 100012, China
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Haucke K, Kuhn M, Lübke-Becker A, Mählmann K, Lischer C. Two Regimes of Perioperative Antimicrobial Prophylaxis for Equine Castration: Clinical Findings, Acute-Phase Proteins, and Bacterial Cultures. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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