1
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Rosa R, de Paula Baptista R, Tran TT, Cifuentes RO, Manzanillo K, Rosello G, Ghaemmaghami C, Zambrana D, Martinez OV, Arias CA, Abbo LM. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) harboring mupirocin and biocide resistance genes in a large health care system. Am J Infect Control 2024:S0196-6553(24)00699-0. [PMID: 39277036 DOI: 10.1016/j.ajic.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 09/01/2024] [Accepted: 09/02/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND We aimed to determine the prevalence of genes associated with high-level mupirocin and biocide resistance in methicillin-resistant Staphylococcus aureus (MRSA) isolates among hospitalized patients and to characterize their genomic and epidemiologic features. METHODS Study conducted on an integrated health system. Clinical cultures with MRSA from hospitalized patients collected between March 1, 2023, and January 20, 2024 underwent prospective whole-genome sequencing, including assessment for the presence of markers of resistance against mupirocin (mupA) and biocides (qac). Demographic and clinical characteristics were reviewed. RESULTS We analyzed 463 MRSA isolates. The overall prevalence of mupA(+), qacA(+), and qacC(+) genes was 22.0%, 2.4%, and 19.0%, respectively. Most mupA(+) isolates belonged to ST8, but ST8732 (a novel variant of ST8) had the highest prevalence of mupA(+) isolates at 95%. Patients mupA(+) were older, and none of the isolates from pediatric patients harbored this gene. DISCUSSION Through prospective whole-genome sequencing of MRSA isolates, we detected a prevalence of genes conferring mupirocin resistance considerably higher than previously reported, particularly among MRSA ST8 variants. CONCLUSIONS Our findings highlight the need for monitoring resistance to agents used for the prevention of S aureus infections, as these trends have implications for infection prevention programs and public health at large.
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Affiliation(s)
- Rossana Rosa
- Infection Prevention and Control Program, Jackson Health System, Miami, FL.
| | - Rodrigo de Paula Baptista
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, TX; Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX; Department of Medicine, Weill Cornell Medical College, New York City, NY
| | - Truc T Tran
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, TX; Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX; Department of Medicine, Weill Cornell Medical College, New York City, NY
| | - Renzo O Cifuentes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Kelley Manzanillo
- Infection Prevention and Control Program, Jackson Health System, Miami, FL
| | - Gemma Rosello
- Infection Prevention and Control Program, Jackson Health System, Miami, FL
| | | | | | - Octavio V Martinez
- Microbiology Section, Jackson Memorial Hospital, Miami, FL; Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Cesar A Arias
- Division of Infectious Diseases, Houston Methodist Hospital, Houston, TX; Center for Infectious Diseases, Houston Methodist Research Institute, Houston, TX; Department of Medicine, Weill Cornell Medical College, New York City, NY
| | - Lilian M Abbo
- Infection Prevention and Control Program, Jackson Health System, Miami, FL; Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
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2
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Heinzinger LR, Pugh AR, Wagner JA, Otto M. Evaluating the Translational Potential of Bacteriocins as an Alternative Treatment for Staphylococcus aureus Infections in Animals and Humans. Antibiotics (Basel) 2023; 12:1256. [PMID: 37627676 PMCID: PMC10451987 DOI: 10.3390/antibiotics12081256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Antibiotic resistance remains a global threat to human and animal health. Staphylococcus aureus is an opportunistic pathogen that causes minor to life-threatening infections. The widespread use of antibiotics in the clinical, veterinary, and agricultural setting combined with the increasing prevalence of antibiotic-resistant S. aureus strains makes it abundantly clear that alternatives to antibiotics are urgently needed. Bacteriocins represent one potential alternative therapeutic. They are antimicrobial peptides that are produced by bacteria that are generally nontoxic and have a relatively narrow target spectrum, and they leave many commensals and most mammalian cells unperturbed. Multiple studies involving bacteriocins (e.g., nisin, epidermicin, mersacidin, and lysostaphin) have demonstrated their efficacy at eliminating or treating a wide variety of S. aureus infections in animal models. This review provides a comprehensive and updated evaluation of animal studies involving bacteriocins and highlights their translational potential. The strengths and limitations associated with bacteriocin treatments compared with traditional antibiotic therapies are evaluated, and the challenges that are involved with implementing novel therapeutics are discussed.
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Affiliation(s)
| | | | | | - Michael Otto
- Pathogen Molecular Genetics Section, Laboratory of Bacteriology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20814, USA; (L.R.H.); (A.R.P.); (J.A.W.)
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3
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Ogonowska P, Szymczak K, Empel J, Urbaś M, Woźniak-Pawlikowska A, Barańska-Rybak W, Świetlik D, Nakonieczna J. Staphylococcus aureus from Atopic Dermatitis Patients: Its Genetic Structure and Susceptibility to Phototreatment. Microbiol Spectr 2023; 11:e0459822. [PMID: 37140374 PMCID: PMC10269521 DOI: 10.1128/spectrum.04598-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 04/08/2023] [Indexed: 05/05/2023] Open
Abstract
We characterized the population of Staphylococcus aureus from patients with atopic dermatitis (AD) in terms of (i) genetic diversity, (ii) presence and functionality of genes encoding important virulence factors: staphylococcal enterotoxins (sea, seb, sec, sed), toxic shock syndrome 1 toxin (tsst-1), and Panton-Valentine leukocidin (lukS/lukF-PV) by spa typing, PCR, drug resistance profile determination, and Western blot. We then subjected the studied population of S. aureus to photoinactivation based on a light-activated compound called rose bengal (RB) to verify photoinactivation as an approach to effectively kill toxin-producing S. aureus. We have obtained 43 different spa types that can be grouped into 12 clusters, indicating for the first-time clonal complex (CC) 7 as the most widespread. A total of 65% of the tested isolates had at least one gene encoding the tested virulence factor, but their distribution differed between the group of children and adults, and between patients with AD and the control group without atopy. We detected a 3.5% frequency of methicillin-resistant strains (MRSA) and no other multidrug resistance. Despite genetic diversity and production of various toxins, all isolates tested were effectively photoinactivated (bacterial cell viability reduction ≥ 3 log10 units) under safe conditions for the human keratinocyte cell line, which indicates that photoinactivation can be a good option in skin decolonization. IMPORTANCE Staphylococcus aureus massively colonizes the skin of patients with atopic dermatitis (AD). It is worth noting that the frequency of detection of multidrug-resistant S. aureus (MRSA) in AD patients is higher than the healthy population, which makes treatment much more difficult. Information about the specific genetic background of S. aureus accompanying and/or causing exacerbations of AD is of great importance from the point of view of epidemiological investigations and the development of possible treatment options.
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Affiliation(s)
- Patrycja Ogonowska
- Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Gdańsk, Poland
| | - Klaudia Szymczak
- Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Gdańsk, Poland
| | - Joanna Empel
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Małgorzata Urbaś
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Agata Woźniak-Pawlikowska
- Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Gdańsk, Poland
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Dariusz Świetlik
- Division of Biostatistics and Neural Networks, Medical University of Gdańsk, Gdańsk, Poland
| | - Joanna Nakonieczna
- Intercollegiate Faculty of Biotechnology, University of Gdansk and Medical University of Gdansk, Gdańsk, Poland
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4
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Anderson BJ, Wilz L, Peterson A. The Identification and Treatment of Common Skin Infections. J Athl Train 2023; 58:502-510. [PMID: 35984712 PMCID: PMC10496455 DOI: 10.4085/1062-6050-0142.22] [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] [Indexed: 11/09/2022]
Abstract
Skin conditions are a common problem addressed by medical providers. Up to 25% of individuals in the United States will seek attention for these conditions each year. The same problem occurs in the athletic training room, where athletes with infectious skin conditions can be seen. Most conditions are simple and can be treated without concern for spread to susceptible athletes. However, others can be quite serious and spread rapidly through a team and opponents during competition. Knowledge of the different types of skin infections is necessary to help treat these athletes and prevent spread to others. With proper diagnosis and treatment, certified athletic trainers can keep the athlete off the field of play for a minimum period and prevent transmission.
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Affiliation(s)
- B. J. Anderson
- Boynton Health Service, University of Minnesota, Minneapolis
- Medical Director of Sports Medicine, Augsburg University, Minneapolis, MN
| | - Logan Wilz
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City
| | - Andrew Peterson
- Carver College of Medicine, University of Iowa, Iowa City
- Stead Family Department of Pediatrics, University of Iowa, Iowa City
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City
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5
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Aftab R, Dodhia VH, Jeanes C, Wade RG. Bacterial sensitivity to chlorhexidine and povidone-iodine antiseptics over time: a systematic review and meta-analysis of human-derived data. Sci Rep 2023; 13:347. [PMID: 36611032 PMCID: PMC9825506 DOI: 10.1038/s41598-022-26658-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/19/2022] [Indexed: 01/09/2023] Open
Abstract
Surgical site infection (SSI) is the most common complication of surgery, increasing healthcare costs and hospital stay. Chlorhexidine (CHX) and povidone-iodine (PVI) are used for skin antisepsis, minimising SSIs. There is concern that resistance to topical biocides may be emergeing, although the potential clinical implications remain unclear. The objective of this systematic review was to determine whether the minimum bactericidal concentration (MBC) of topical preparations of CHX or PVI have changed over time, in microbes relevant to SSI. We included studies reporting the MBC of laboratory and clinical isolates of common microbes to CHX and PVI. We excluded studies using non-human samples and antimicrobial solvents or mixtures with other active substances. MBC was pooled in random effects meta-analyses and the change in MBC over time was explored using meta-regression. Seventy-nine studies were included, analysing 6218 microbes over 45 years. Most studies investigated CHX (93%), with insufficient data for meta-analysis of PVI. There was no change in the MBC of CHX to Staphylococci or Streptococci over time. Overall, we find no evidence of reduced susceptibility of common SSI-causing microbes to CHX over time. This provides reassurance and confidence in the worldwide guidance that CHX should remain the first-choice agent for surgical skin antisepsis.
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Affiliation(s)
- Raiyyan Aftab
- Department of Plastic Surgery, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Vikash H Dodhia
- Royal Hampshire County Hospital, Hampshire Hospitals Foundation Trust, Winchester, UK
| | - Christopher Jeanes
- Department of Microbiology, Norfolk and Norwich University Hospital, Norfolk, UK
| | - Ryckie G Wade
- Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, UK.
- Faculty of Medicine and Health Sciences, University of Leeds, Leeds, UK.
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6
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Yiek WK, Tromp M, Strik-Albers R, van Aerde K, van der Geest-Blankert N, Wertheim HFL, Meijer C, Tostmann A, Bleeker-Rovers CP. Success rates of MRSA decolonization and factors associated with failure. Antimicrob Resist Infect Control 2022; 11:143. [PMID: 36414999 PMCID: PMC9682637 DOI: 10.1186/s13756-022-01177-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background We evaluated the success rate of MRSA decolonization directly after treatment and after one year in patients who were treated at the outpatient MRSA clinic of a large university medical centre to identify potential contributing factors to treatment success and failure.
Methods Data from November 1, 2013 to August 1, 2020 were used. Only patients who had undergone complete MRSA decolonization were included. Risk factors for MRSA treatment failure were identified using a multivariable logistic regression model. Results In total, 127 MRSA carriers were included: 7 had uncomplicated carriage, 91 had complicated carriage, and 29 patients had complicated carriage in combination with an infection. In complicated carriers and complicated carriers with an infection final treatment was successful in 75.0%. Risk factors for initial treatment failure included having one or more comorbidities and not testing the household members. Risk factors for final treatment failure were living in a refugee centre, being of younger age (0–17 years), and having one or more comorbidities.
Conclusions The results of this study indicate that patients with a refugee status and children treated at the paediatric clinic have a higher risk of MRSA decolonisation treatment failure. For this reason, it might be useful to revise decolonization strategies for these subgroups and to refer these patients to specialized outpatient clinics in order to achieve higher treatment success rates.
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Affiliation(s)
- Wing-Kee Yiek
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, P O Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Mirjam Tromp
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, P O Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Riet Strik-Albers
- Department of Paediatric Infectious Disease and Immunology, Radboud University Medical Center, Radboudumc Institute for Molecular Life Sciences, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Koen van Aerde
- Department of Paediatric Infectious Disease and Immunology, Radboud University Medical Center, Radboudumc Institute for Molecular Life Sciences, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - Heiman F L Wertheim
- Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Corianne Meijer
- Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alma Tostmann
- Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, P O Box 9101, 6500 HB, Nijmegen, The Netherlands.
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7
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Bencardino D, Amagliani G, Brandi G. Carriage of Staphylococcus aureus among food handlers: An ongoing challenge in public health. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.108362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Lee AS, Huttner BD, Catho G, Harbarth S. Methicillin-Resistant Staphylococcus aureus: An Update on Prevention and Control in Acute Care Settings. Infect Dis Clin North Am 2021; 35:931-952. [PMID: 34752226 DOI: 10.1016/j.idc.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health-care-associated infections. Controversies regarding the effectiveness of various control strategies have contributed to varying approaches to MRSA control. However, new evidence from large-scale studies has emerged, particularly concerning screening and decolonization. Importantly, implementation and outcomes of control measures in practice are not only influenced by scientific evidence, but also economic, administrative, and political factors, as demonstrated by decreasing MRSA rates in a number of countries after concerted and coordinated efforts at a national level. Flexibility to adapt measures based on local epidemiology and resources is essential for successful MRSA control.
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Affiliation(s)
- Andie S Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
| | - Benedikt D Huttner
- Division of Infectious Diseases, University of Geneva Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Gaud Catho
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
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9
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Bes TM, Perdigão-Neto L, Martins RR, Heijden I, Trindade PDA, Camilo G, Nagano DS, Mongelos D, Marchi AP, Tomaz M, Oliveira LMD, Rossi F, Levin AS, Costa SF. Susceptibility to chlorhexidine and mupirocin among methicillin-resistant Staphylococcus aureus clinical isolates from a teaching hospital. Rev Inst Med Trop Sao Paulo 2021; 63:e27. [PMID: 33852710 PMCID: PMC8046504 DOI: 10.1590/s1678-9946202163027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/14/2021] [Indexed: 11/21/2022] Open
Abstract
Despite the widespread use of chlorhexidine (CHX) to prevent infection, data
regarding the in vitro action of CHX against
methicillin-resistant Staphylococcus aureus(MRSA) are limited. Clinical isolates from Hospital das Clinicas,
Sao Paulo, Brazil, identified during 2002/2003 and 2012/2013 were studied to
describe the susceptibility to CHX and mupirocin, molecular characteristics, and
virulence profile of MRSA. Susceptibility test to Mupirocin was performed by the
disk diffusion method and to CHX by the agar dilution technique. PCR for
virulence genes, mecA gene and Staphylococcal Cassette
Chromosome mec (SCCmec) types were
investigated as well. Mupirocin- and CHX-resistant isolates were sequenced using
the IlluminaTM plataform. Two hundred and sixteen MRSA clinical
isolates were evaluated: 154 from infected and 62 from colonized patients.
Resistance to mupirocin was observed in four isolates assigned as
SCCmec type III and STs (ST05; ST239 and ST105) carrying
mupA and blaZ, two of them co-harboring
the ileS gene. Only one isolate assigned as
SCCmec type III was resistant to CHX (MIC of 8.0
μg.mL-1) and harbored the qacA gene. Resistance
to chlorhexidine and mupirocin were found in isolates carrying
qacA and mupA in our hospital. Since these
genes are plasmid-mediated, this finding draws attention to the potential spread
of resistance to mupirocin in our hospital.
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Affiliation(s)
- Taniela Marli Bes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Lauro Perdigão-Neto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Roberta Ruedas Martins
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Inneke Heijden
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Gaspar Camilo
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Debora Satie Nagano
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Diego Mongelos
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Paula Marchi
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Mariama Tomaz
- Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Flavia Rossi
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, São Paulo, Brazil
| | - Anna Sara Levin
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
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10
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Azrad M, Shmuel C, Leshem T, Hamo Z, Baum M, Rokney A, Agay-Shay K, Peretz A. Reduced Susceptibility to Chlorhexidine among Staphylococcus aureus Isolates in Israel: Phenotypic and Genotypic Tolerance. Antibiotics (Basel) 2021; 10:342. [PMID: 33807049 PMCID: PMC8005201 DOI: 10.3390/antibiotics10030342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
Antiseptic use for body decolonization is the main activity applied to prevent healthcare-associated infections, including those caused by S. aureus. Consequentially, tolerance to several antiseptics such as chlorhexidine gluconate (CHG) has developed. This study aimed to estimate the prevalence of CHG tolerance among S. aureus strains in Israel and to evaluate factors that may affect this tolerance. Furthermore, it tested the associations between phenotypic and genotypic CHG tolerance. S. aureus strains (n = 190) were isolated from clinical samples of patients admitted to various medical institutions in Israel. Phenotypic susceptibility to CHG was assessed by determining minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Genotypic tolerance was detected using real-time PCR for detection of qac A/B genes. MIC for the antibiotic mupirocin was determined using the Etest method. Presence of the Panton-Valentine Leucocidin (pvl) toxin, mecA and mecC genes was detected using an eazyplex® MRSAplus kit (AmplexDiagnostics GmbH, Gars, Germany). CHG tolerance was observed in 13.15% of the isolates. An association between phenotypic and genotypic tolerance to CHG was observed. Phenotypic tolerance to CHG was associated with methicillin resistance but not with mupirocin resistance. Additionally, most of the CHG-tolerant strains were isolated from blood cultures. In conclusion, this work shed light on the prevalence of reduced susceptibility to CHG among S. aureus strains in Israel and on the characteristics of tolerant strains. CHG-tolerant strains were more common than methicillin-resistant ones in samples from invasive infections. Further research should be performed to evaluate risk factors for the development of CHG tolerance.
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Affiliation(s)
- Maya Azrad
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
| | - Chen Shmuel
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
| | - Tamar Leshem
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
| | - Zohar Hamo
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
| | - Moti Baum
- Central Government Laboratories, Israel Ministry of Health, Jerusalem 9446724, Israel; (M.B.); (A.R.)
| | - Assaf Rokney
- Central Government Laboratories, Israel Ministry of Health, Jerusalem 9446724, Israel; (M.B.); (A.R.)
| | - Keren Agay-Shay
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel;
| | - Avi Peretz
- Clinical Microbiology Laboratory, The Baruch Padeh Medical Center, Poriya, Tiberias 1528001, Israel; (M.A.); (C.S.); (T.L.); (Z.H.)
- The Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel;
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11
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Babiker A, Lutgring JD, Fridkin S, Hayden MK. Assessing the Potential for Unintended Microbial Consequences of Routine Chlorhexidine Bathing for Prevention of Healthcare-associated Infections. Clin Infect Dis 2021; 72:891-898. [PMID: 32766819 PMCID: PMC8432606 DOI: 10.1093/cid/ciaa1103] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Chlorhexidine gluconate (CHG) is an antiseptic that is widely used in healthcare due to its excellent safety profile and wide spectrum of activity. Daily bathing with CHG has proven to be effective in the prevention of healthcare-associated infections and multidrug-resistant pathogen decolonization. Despite the proven benefits of CHG use, there remain concerns and unanswered questions about the potential for unintended microbial consequences of routine CHG bathing. This review aims to explore some of these questions.
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Affiliation(s)
- Ahmed Babiker
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joseph D Lutgring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Scott Fridkin
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mary K Hayden
- Department of Internal Medicine (Infectious Diseases), Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
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12
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Kang HM, Park KC, Park J, Park SH, Lee DG, Kim JH. Mupirocin and Chlorhexidine Genotypic Resistance Found in Staphylococcus aureus Isolated From Young Infants Below 90 Days Old: A Genetic Basis for Eradication Failure. Pediatr Infect Dis J 2021; 40:49-54. [PMID: 32925545 DOI: 10.1097/inf.0000000000002882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate the genetic characteristics associated with eradication failure of Staphylococcus aureus in infants below 90 days old. METHODS S. aureus isolated from clinical specimen cultures (blood, surgical tissue, or drainage, pus, etc.) and routine screening cultures in the neonatal intensive care unit (nasal and axillary skin swab) from patients below 90 days old were collected prospectively for 1 year, from August 2017 to July 2018. The isolates underwent typing and screening for genes associated with chlorhexidine (qacA/B), quaternary ammonium (smr), and mupirocin resistance (iles mutation, mupA, mupB), as well as Panton-Valentine leukocidin (PVL) toxin. RESULTS During the study period, 40 nonduplicate isolates were included for analyses, of which 70.0% were methicillin-resistant S. aureus (MRSA). Mupirocin resistance was found in 25% of the total isolates; 17.4% of the colonizers; and 35.3% of the pathogens (P = 0.196). Chlorhexidine resistance gene was found in 3 MRSA isolates colonized in the nares of preterm infants. All isolates harbored the disinfectant quaternary ammonium compound (QAC) resistance gene. PVL toxin gene was found in 57.5%, and the presence of PVL gene among colonizers and pathogens was similar (69.6% vs. 41.2%, P = 0.072). CONCLUSIONS Mupirocin, chlorhexidine, and QAC-resistant MRSAs harboring the PVL toxin gene were found in the nasal carriages of preterm infants. In this highly vulnerable patient population, one-fourth of the isolates harbored mupirocin-resistant genes, and all were resistant to QAC disinfectants. These strains are associated with persistence in both carriage and environmental reservoirs within the hospitals.
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Affiliation(s)
- Hyun Mi Kang
- From the Division of Infectious Diseases, Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ki Cheol Park
- Clinical Research Institute, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - Joonhong Park
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Hyun Kim
- From the Division of Infectious Diseases, Departments of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Abstract
Staphylococcus aureus infections are associated with increased morbidity, mortality, hospital stay, and health care costs. S aureus colonization has been shown to increase risk for invasive and noninvasive infections. Decolonization of S aureus has been evaluated in multiple patient settings as a possible strategy to decrease the risk of S aureus transmission and infection. In this article, we review the recent literature on S aureus decolonization in surgical patients, patients with recurrent skin and soft tissue infections, critically ill patients, hospitalized non-critically ill patients, dialysis patients, and nursing home residents to inform clinical practice.
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Affiliation(s)
- Sima L Sharara
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Lisa L Maragakis
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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14
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Povidone Iodine: Properties, Mechanisms of Action, and Role in Infection Control and Staphylococcus aureus Decolonization. Antimicrob Agents Chemother 2020; 64:AAC.00682-20. [PMID: 32571829 PMCID: PMC7449185 DOI: 10.1128/aac.00682-20] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA) infections. The two most commonly used agents for decolonization are intranasal mupirocin 2% ointment and chlorhexidine wash, but the increasing emergence of resistance and treatment failure has underscored the need for alternative therapies. This article discusses povidone iodine (PVP-I) as an alternative decolonization agent and is based on literature reviewed during an expert’s workshop on resistance and MRSA decolonization. Nasal decolonization is an integral part of the strategies used to control and prevent the spread of methicillin-resistant Staphylococcus aureus (MRSA) infections. The two most commonly used agents for decolonization are intranasal mupirocin 2% ointment and chlorhexidine wash, but the increasing emergence of resistance and treatment failure has underscored the need for alternative therapies. This article discusses povidone iodine (PVP-I) as an alternative decolonization agent and is based on literature reviewed during an expert’s workshop on resistance and MRSA decolonization. Compared to chlorhexidine and mupirocin, respectively, PVP-I 10 and 7.5% solutions demonstrated rapid and superior bactericidal activity against MRSA in in vitro and ex vivo studies. Notably, PVP-I 10 and 5% solutions were also active against both chlorhexidine-resistant and mupirocin-resistant strains, respectively. Unlike chlorhexidine and mupirocin, available reports have not observed a link between PVP-I and the induction of bacterial resistance or cross-resistance to antiseptics and antibiotics. These preclinical findings also translate into clinical decolonization, where intranasal PVP-I significantly improved the efficacy of chlorhexidine wash and was as effective as mupirocin in reducing surgical site infection in orthopedic surgery. Overall, these qualities of PVP-I make it a useful alternative decolonizing agent for the prevention of S. aureus infections, but additional experimental and clinical data are required to further evaluate the use of PVP-I in this setting.
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15
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Zheng S, Chung SJ, Sim HCJ, Chlebicka TM, Chan YH, Lim TP, Kwa LHA, Chlebicki MP. Impact of formulary interventions on the minimum inhibitory concentration of methicillin-resistant Staphylococcus aureus to mupirocin, chlorhexidine, and octenidine in a Singapore tertiary institution. Eur J Clin Microbiol Infect Dis 2020; 39:2397-2403. [PMID: 32712737 DOI: 10.1007/s10096-020-03995-5] [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: 06/01/2020] [Accepted: 07/21/2020] [Indexed: 11/26/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) decolonization is an effective measure to prevent clinical infection but resistance is a concern. We aim to evaluate the impact of mupirocin (MUP) ointment formulary removal, plateauing use of chlorhexidine gluconate (CHG), and hospital-wide introduction of octenidine (OCT)-based products on the minimum inhibitory concentration (MIC) of MRSA to MUP, CHG, and OCT in our hospital. A prevalence study was conducted at three time points (TP) on consecutive MRSA screening isolates to evaluate for their MICs to MUP, CHG, and OCT using broth microdilution sensititre plates and detection of the ileS-2 gene encoding high-level MUP resistance in 2013 (pre-intervention TP1; n = 160), 2016 (early post-intervention TP2; n = 99) and 2017 (late post-intervention TP3; n = 76). Statistical analyses were performed using Chi square test with reference from TP1. There was a significant improvement in MUP susceptibility (MIC < 4 mcg/ml) from 71.9% (TP1) to 86.9% (TP2; p = 0.006) to 88.2% (TP3; p = 0.007). The prevalence of MUP high-level resistance (MIC > 256 mcg/ml) reduced from 25.0% (TP1) to 12.1% (TP2; p = 0.014) to 5.3% (TP3; p = 0.001). Likewise, the prevalence of isolates harboring the ileS-2 gene decreased from 28.1% (TP1) to 18.2% (TP2; p = 0.072) to 9.2% (TP3; p = 0.002). OCT MIC range remains stable at 0.5 to 1 mcg/ml across all three TPs. The proportion of isolates with reduced CHG susceptibility (MIC ≥ 4 mcg/ml) increased over the three TPs from 23.1 to 27.2% (p = 0.45) to 42.1% (p = 0.003). Active formulary regulations have an impact on the resistance profile of MRSA and can be used as a strategy to preserve the MRSA decolonization armamentarium.
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Affiliation(s)
- Shuwei Zheng
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore.
| | - S J Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - H C J Sim
- Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - T M Chlebicka
- University of New South Wales, Medicine, Sydney, Australia
| | - Y H Chan
- Biostatistics Unit, National University of Singapore, Singapore, Singapore
| | - T P Lim
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - L H A Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore, Singapore
| | - M P Chlebicki
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
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16
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Park KH, Jung M, Kim DY, Lee YM, Lee MS, Ryu BH, Hong SI, Hong KW, Bae IG, Cho OH. Effects of subinhibitory concentrations of chlorhexidine and mupirocin on biofilm formation in clinical meticillin-resistant Staphylococcus aureus. J Hosp Infect 2020; 106:295-302. [PMID: 32679053 DOI: 10.1016/j.jhin.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The effects of subinhibitory concentrations (sub-MICs) of antibacterial agents on the biofilm-forming ability of Staphylococcus aureus require further study. AIM To investigate the effects of sub-MICs of chlorhexidine and mupirocin on biofilm formation in clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates. METHODS MRSA isolates were collected from patients with bloodstream infections at a tertiary care hospital. The basal level of biofilm formation and biofilm induction by sub-MICs of chlorhexidine and mupirocin were evaluated by measuring biofilm mass stained with Crystal Violet. FINDINGS Of the 112 MRSA isolates tested, 63 (56.3%) and 44 (39.3%) belonged to sequence type (ST)5 and ST72 lineages, respectively, which are the predominant healthcare- and community-associated clones in South Korea. ST5 isolates were more likely to have chlorhexidine MIC ≥4 (73.0% vs 29.5%), resistance to mupirocin (23.8% vs 0%), agr dysfunction (73.0% vs 9.1%), and qacA/B gene (58.7% vs 2.3%) compared to ST72 isolates. The basal level of biofilm formation ability was frequently stronger in ST72 isolates compared to ST5 isolates (77.3% vs 12.7%). Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in 56.3% and 53.6%, respectively, of all isolates. Biofilm induction was more prevalent in ST5 isolates (85.7% for chlorhexidine, 69.8% for mupirocin) than in ST72 isolates (15.9% for chlorhexidine, 27.3% for mupirocin). CONCLUSION Sub-MICs of chlorhexidine and mupirocin promoted biofilm formation in half of the clinical MRSA isolates. Our results suggest that ST5 MRSA biofilm can be induced together with some other bacterial virulent factors following exposure to chlorhexidine, which might confer a survival advantage to this clone in the healthcare environment.
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Affiliation(s)
- K-H Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - M Jung
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - D Y Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - Y-M Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - M S Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Republic of Korea
| | - B-H Ryu
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - S I Hong
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea
| | - K-W Hong
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - I-G Bae
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - O-H Cho
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Republic of Korea; Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
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17
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Hogan PG, Parrish KL, Mork RL, Boyle MG, Muenks CE, Thompson RM, Morelli JJ, Sullivan ML, Hunstad DA, Wardenburg JB, Rzhetsky A, Gehlert SJ, Burnham CAD, Fritz SA. HOME2: Household vs. Personalized Decolonization in Households of Children with Methicillin-Resistant Staphylococcus aureus Skin and Soft Tissue Infection - A Randomized Clinical Trial. Clin Infect Dis 2020; 73:e4568-e4577. [PMID: 32521007 DOI: 10.1093/cid/ciaa752] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/05/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND A household approach to decolonization decreases skin and soft tissue infection (SSTI) incidence, though this is burdensome and costly. As prior SSTI increases risk for SSTI, we hypothesized the effectiveness of decolonization measures to prevent SSTI when targeted to household members with prior year SSTI would be non-inferior to decolonizing all household members. METHODS Upon completion of our 12-month observational HOME study, 102 households were enrolled in HOME2, a 12-month, randomized non-inferiority trial. Pediatric index patients with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) SSTI, their household contacts, and pets were enrolled. Households were randomized 1:1 to the Personalized (decolonization performed only by household members who experienced SSTI during the HOME study) or Household (decolonization performed by all household members) approaches. The 5-day regimen included hygiene education, twice-daily intranasal mupirocin, and daily bleach-water baths. At 5 follow-up visits in participants' homes, swabs to detect S. aureus were collected from participants, environmental surfaces, and pets; incident SSTI were ascertained. RESULTS Non-inferiority of the Personalized Approach was established for the primary outcome 3-month cumulative SSTI: 23 of 212 (10.8%) participants reported SSTI in Household Approach households, while 23 of 236 (9.7%) participants reported SSTI in Personalized Approach households; difference in proportions -1.1% (95% CI -6.7%, 4.5%). In multivariable analyses, prior year SSTI and baseline MRSA colonization were associated with cumulative SSTI. CONCLUSIONS The Personalized Approach was non-inferior to the Household Approach in preventing SSTI. Future studies should interrogate longer durations of decolonization and/or decontamination of the household environment to reduce household MRSA burden.
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Affiliation(s)
- Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katelyn L Parrish
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan L Mork
- Graduate Program in the Biophysical Sciences, University of Chicago, Chicago, Illinois, USA.,Committee of Microbiology, University of Chicago, Chicago, Illinois, USA.,Institute for Genomics and Systems Biology, and University of Chicago, Chicago, Illinois, USA
| | - Mary G Boyle
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carol E Muenks
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryley M Thompson
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - John J Morelli
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Melanie L Sullivan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Andrey Rzhetsky
- Department of Human Genetics, University of Chicago, Chicago, Illinois, USA
| | - Sarah J Gehlert
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Carey-Ann D Burnham
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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18
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Reitzel RA, Rosenblatt J, Gerges BZ, Jarjour A, Fernández-Cruz A, Raad II. The potential for developing new antimicrobial resistance from the use of medical devices containing chlorhexidine, minocycline, rifampicin and their combinations: a systematic review. JAC Antimicrob Resist 2020; 2:dlaa002. [PMID: 34222960 PMCID: PMC8210168 DOI: 10.1093/jacamr/dlaa002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 12/04/2019] [Accepted: 12/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background Catheter infections remain one of the most persistent adverse events causing significant morbidity, economic impact and mortality. Several strategies have been proposed to reduce these infections including the use of catheters embedded with antibiotics and/or antiseptics. One reoccurring challenge is the fear that antimicrobial medical devices will induce resistance. The aim of this systematic review is to evaluate the evidence for induced antimicrobial resistance caused by exposure to antimicrobial medical devices. Methods Four electronic databases [MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus] were screened for studies published between 1983 and 2019 regarding assessment of microbial resistance with use of medical devices containing chlorhexidine, minocycline, rifampicin or combinations thereof. Development of new resistance, selection for tolerant organisms and 'no change in resistance' were assessed. Results Forty-four publications, grouped by study type and stratified by drug assessed, were included for analyses. The majority of studies found no change in resistance after exposure to antimicrobial medical devices (13 in vitro, 2 in vivo, 20 clinical). Development of new resistance was commonly reported with the use of rifampicin as a single agent and only reported in one study assessing the minocycline/rifampicin combination (M/R); however, the increase in MIC was well below clinical relevance. Conclusions Emergence of new resistance to combinations of M/R, minocycline/rifampicin/chlorhexidine (M/R/CH) and chlorhexidine/silver sulfadiazine (CHXSS) was rare. No clinical trials confirmed its occurrence and some refuted it. The risk of development of new resistance to these antimicrobial combinations appears more fear-based than substantiated by clinical and experimental evidence but warrants continued surveillance.
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Affiliation(s)
- Ruth A Reitzel
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joel Rosenblatt
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bahgat Z Gerges
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew Jarjour
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ana Fernández-Cruz
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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19
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Popovich KJ. Intersection of HIV and community-associated methicillin-resistant Staphylococcus aureus. Future Virol 2020. [DOI: 10.2217/fvl-2019-0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The epidemiology of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has evolved over the past approximately 20 years, with certain populations appearing to have disproportionate risk. Of concern is the potential worsening of S. aureus infections in light of the continued opioid crisis. This review will discuss how CA-MRSA has significantly impacted HIV-infected individuals and address additional factors and populations that are associated with increased risk for MRSA. It will review therapeutic options and infection control strategies as well as highlight how whole genome sequencing can be used to extend traditional epidemiologic analysis and ultimately, inform infection prevention efforts. Continued work identifying those at the highest risk for MRSA, what the best infection prevention settings are in community settings and how to effectively implement and target these strategies is needed. Ultimately, infection control efforts will likely need to extend beyond healthcare settings to effectively and sustainably reduce MRSA infections.
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Affiliation(s)
- Kyle J Popovich
- Associate Professor, Section of Infectious Diseases, Rush University Medical Center, 600 South Paulina St. Suite 143, Chicago, IL 60612, USA
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20
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Gaber SN, Bassyouni RH, Masoud M, Ahmed FA. Promising anti-microbial effect of apple vinegar as a natural decolonizing agent in healthcare workers. ALEXANDRIA JOURNAL OF MEDICINE 2020. [DOI: 10.1080/20905068.2020.1769391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Sylvana N. Gaber
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Rasha H. Bassyouni
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Mohamed Masoud
- Department of Public Health, Faculty of Medicine-Fayoum University, Fayoum, Egypt
| | - Fatma A. Ahmed
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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21
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Heal C, Gorges H, van Driel ML, Tapley A, Davis J, Davey A, Holliday L, Ball J, Najib N, Spike N, FitzGerald K, Magin P. Antibiotic stewardship in skin infections: a cross-sectional analysis of early-career GP's management of impetigo. BMJ Open 2019; 9:e031527. [PMID: 31662391 PMCID: PMC6830714 DOI: 10.1136/bmjopen-2019-031527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/12/2019] [Accepted: 08/23/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To establish the prevalence and associations of systemic antibiotic prescription for impetigo by early-career general practitioners (GPs) (GP registrars in their first 18 months in general practice). DESIGN A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study. SETTING ReCEnT is an ongoing multisite cohort study of Australian registrars' in-consultation clinical practice across five Australian states. PARTICIPANTS Registrars participating in ReCEnT from 2010 to 2017. OUTCOME MEASURES Management of impetigo with systemic antibiotics. RESULTS 1741 registrars (response rate 96%) provided data from 384 731 problems identified in 246 434 consultations. Impetigo, on first presentation or follow-up, was managed in 930 (0.38%, 95% CI 0.35 to 0.40) consultations and comprised 0.24% (95% CI 0.23 to 0.26) of problems. 683 patients presented with a new diagnosis of impetigo of which 38/683 (5.6%) were not prescribed antibiotics; 239/683 (35.0%) were prescribed solely topical antibiotics; 306/683 (44.8%) solely systemic antibiotics and 100/683 (14.6%) both systemic and topical antibiotics. The most common systemic antibiotic prescribed was cephalexin (53.5%). Variables independently associated with prescription of systemic antibiotics were an inner regional (compared with major city) location (OR 1.82, 95% CI 1.06 to 3.13; p=0.028), seeking in-consultation information or advice (OR 2.17, 95% CI 1.47 to 3.23; p<0.001) and ordering pathology (OR 2.13, 95% CI 1.37 to 3.33; p=0.01). CONCLUSIONS Australian early-career GPs prescribe systemic antibiotics (the majority broad-spectrum) for a high proportion of initial impetigo presentations. Impetigo guidelines should clearly specify criteria for systemic antibiotic prescription and individual antibiotic choice. The role of non-antibiotic management and topical antiseptics needs to be explored further.
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Affiliation(s)
- Clare Heal
- School of Medicine and Dentistry, James Cook University, Mackay, Queensland, Australia
| | - Hilary Gorges
- Department of General Practice and Rural Medicine, James Cook University, Mackay, Queensland, Australia
| | - Mieke L van Driel
- Academic Discipline of General Practice, University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia
- Discipline of General Practice, School of Medicine & Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Josh Davis
- Global and Tropical Health Division, Menzies School of Health Research, Casuarina, New South Wales, Australia
| | - Andrew Davey
- GP Synergy Ltd, Liverpool Westfield, New South Wales, Australia
| | - L Holliday
- The University of Newcastle, Newcastle, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistics, The University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nashwa Najib
- GP Synergy Ltd, Liverpool Westfield, New South Wales, Australia
| | - Neil Spike
- Eastern Victoria General Practice Training, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Parker Magin
- Discipline of General Practice, University of Newcastle, Callaghan, New South Wales, Australia
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22
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Best Practices and Evolving Techniques for Preventing Infection After Fracture Surgery. Tech Orthop 2019. [DOI: 10.1097/bto.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Efficacy and safety of a novel antimicrobial preoperative skin preparation. Infect Control Hosp Epidemiol 2019; 40:1157-1163. [PMID: 31385562 DOI: 10.1017/ice.2019.200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Alternatives to skin preparation with conventional preoperative antiseptics are required because of adverse reactions and the potential emergence of resistance. Here, we present 2 phase 2 studies of ZuraGard (ZG), a novel formulation of isopropyl alcohol and functional excipients developed for preoperative skin antisepsis. METHODS Microbial skin flora on abdominal and inguinal sites in healthy volunteers were quantitatively assessed following application of ZG versus a negative control (ZV) and a chlorhexidine/alcohol preparation, Chloraprep (CP). In trial 1, ZG administered for both recommended and abbreviated application times was compared with CP and ZV via bacterial reductions at 10 minutes, and 6 hours, 12 hours, and 24 hours following application. In trial 2, the 10-minute postapplication responder rates (RRs) for ZG, participants with abdominal ≥2 log10 per cm2, and inguinal ≥3 log10 per cm2 reductions in colony-forming units (CFU) were compared to RRs of participants treated with CP. RESULTS In trial 1, ZG at the recommended application time reduced mean bacterial counts by ~3.18 log10 CFU/cm2 and ~2.98 log10 CFU/cm2 at abdominal and inguinal sites, respectively. Qualitatively similar reductions were observed for the abbreviated ZG application time and all CP applications. Application of ZV was ineffective. In trial 2, 10-minute RRs for ZG and CP exceeded 90% at abdominal sites. At inguinal sites, RRs were 83.3% for ZG and 86.7% for CP. No skin irritation or other adverse events were observed. CONCLUSIONS ZG matched CP efficacy under these experimental conditions with immediate and persistent microbial reductions, including abbreviated application times. Further clinical studies of this novel preoperative antiseptic are merited.
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Kwiatkowski P, Grygorcewicz B, Pruss A, Wojciuk B, Dołęgowska B, Giedrys-Kalemba S, Sienkiewicz M, Wojciechowska-Koszko I. The Effect of Subinhibitory Concentrations of trans-Anethole on Antibacterial and Antibiofilm Activity of Mupirocin Against Mupirocin-Resistant Staphylococcus aureus Strains. Microb Drug Resist 2019; 25:1424-1429. [PMID: 31314694 DOI: 10.1089/mdr.2019.0101] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim: The aim of this study was to evaluate the effect of subinhibitory concentrations of trans-anethole on antibacterial and antibiofilm properties of mupirocin against mupirocin-resistant Staphylococcus aureus strains. Methods: Following parameters were examined: isolates susceptibility to antibiotics, minimum inhibitory concentration (MIC) of trans-anethole, antibacterial activity of mupirocin/trans-anethole combination, detection of ileS2 gene, genotypic relativity of isolates using pulsed-field gel electrophoresis method, and the influence of mupirocin/trans-anethole combination on S. aureus biofilm formation. Results: Our study revealed that trans-anethole combined with mupirocin increased the growth inhibition zone diameter around the mupirocin disk, independently on S. aureus strains susceptibility to this antibiotic. Moreover, combination of subinhibitory (MIC50) concentration of mupirocin and trans-anethole significantly decreased biofilm biomass. Conclusions: trans-Anethole appeared efficient in increasing susceptibility to mupirocin and decreasing biofilm formation in S. aureus strains used in this study. Reduction of biofilm formation can potentially protect against S. aureus recolonization. Moreover, use of trans-anethole in combination with mupirocin can increase the mupirocin activity against methicillin-resistant and mupirocin-resistant S. aureus strains.
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Affiliation(s)
- Paweł Kwiatkowski
- Department of Diagnostic Immunology; Chair of Microbiology, Immunology and Laboratory Medicine; Pomeranian Medical University in Szczecin, Poland
| | - Bartłomiej Grygorcewicz
- Department of Laboratory Medicine; Chair of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Agata Pruss
- Department of Laboratory Medicine; Chair of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Bartosz Wojciuk
- Department of Diagnostic Immunology; Chair of Microbiology, Immunology and Laboratory Medicine; Pomeranian Medical University in Szczecin, Poland
| | - Barbara Dołęgowska
- Department of Laboratory Medicine; Chair of Microbiology, Immunology and Laboratory Medicine, Pomeranian Medical University in Szczecin, Poland
| | - Stefania Giedrys-Kalemba
- Department of Diagnostic Immunology; Chair of Microbiology, Immunology and Laboratory Medicine; Pomeranian Medical University in Szczecin, Poland
| | - Monika Sienkiewicz
- Department of Allergology and Respiratory Rehabilitation; 2nd Chair of Otolaryngology; Medical University of Lodz, Poland
| | - Iwona Wojciechowska-Koszko
- Department of Diagnostic Immunology; Chair of Microbiology, Immunology and Laboratory Medicine; Pomeranian Medical University in Szczecin, Poland
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Frosini SM, Bond R, Rantala M, Grönthal T, Rankin SC, O’Shea K, Timofte D, Schmidt V, Lindsay J, Loeffler A. Genetic resistance determinants to fusidic acid and chlorhexidine in variably susceptible staphylococci from dogs. BMC Microbiol 2019; 19:81. [PMID: 31023224 PMCID: PMC6485160 DOI: 10.1186/s12866-019-1449-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 04/01/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Concern exists that frequent use of topically-applied fusidic acid (FA) and chlorhexidine (CHX) for canine pyoderma is driving clinically relevant resistance, despite rare description of FA and CHX genetic resistance determinants in canine-derived staphylococci. This study aimed to determine minimum inhibitory concentrations (MICs) and investigate presence of putative resistance determinants for FA and CHX in canine-derived methicillin-resistant (MR) and -susceptible (MS) staphylococci. Plasmid-mediated resistance genes (fusB, fusC, fusD, qacA/B, smr; PCR) and MICs (agar dilution) of FA and CHX were investigated in 578 staphylococci (50 MR S. aureus [SA], 50 MSSA, 259 MR S. pseudintermedius [SP], 219 MSSP) from Finland, U.S.A., North (NUK) and South-East U.K. (SEUK) and Germany. In all isolates with FA MIC ≥64 mg/L (n = 27) fusA and fusE were amplified and sequenced. RESULTS FA resistance determinants (fusA mutations n = 24, fusB n = 2, fusC n = 36) were found in isolates from all countries bar U.S.A. and correlated with higher MICs (≥1 mg/L), although 4 SP isolates had MICs of 0.06 mg/L despite carrying fusC. CHX MICs did not correlate with qacA/B (n = 2) and smr (n = 5), which were found in SEUK SA, and SP from NUK and U.S.A. CONCLUSIONS Increased FA MICs were frequently associated with fusA mutations and fusC, and this is the first account of fusB in SP. Despite novel description of qacA/B in SP, gene presence did not correlate with CHX MIC. Selection pressure from clinical use might increase prevalence of these genetic determinants, but clinical significance remains uncertain in relation to high skin concentrations achieved by topical therapy.
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Affiliation(s)
- S-M Frosini
- Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK.
| | - R. Bond
- 0000 0004 0425 573Xgrid.20931.39Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA UK
| | - M. Rantala
- 0000 0004 0410 2071grid.7737.4Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014 Helsinki, Finland
| | - T. Grönthal
- 0000 0004 0410 2071grid.7737.4Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, P.O. Box 57, 00014 Helsinki, Finland
| | - S. C. Rankin
- 0000 0004 1936 8972grid.25879.31Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, 3850 Spruce Street, Philadelphia, PA 19104 USA
| | - K. O’Shea
- 0000 0004 1936 8972grid.25879.31Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, 3850 Spruce Street, Philadelphia, PA 19104 USA
| | - D. Timofte
- 0000 0004 1936 8470grid.10025.36Institute of Veterinary Science, University of Liverpool, Chester High Road, Neston, CH64 7TE UK
| | - V. Schmidt
- 0000 0004 1936 8470grid.10025.36Institute of Veterinary Science, University of Liverpool, Chester High Road, Neston, CH64 7TE UK
| | - J. Lindsay
- 0000 0000 8546 682Xgrid.264200.2Institute of Infection and Immunity, St George’s, University of London, Cranmer Terrace, London, SW17 0RE UK
| | - A. Loeffler
- 0000 0004 0425 573Xgrid.20931.39Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA UK
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Sakr A, Brégeon F, Rolain JM, Blin O. Staphylococcus aureus nasal decolonization strategies: a review. Expert Rev Anti Infect Ther 2019; 17:327-340. [PMID: 31012332 DOI: 10.1080/14787210.2019.1604220] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Staphylococcus aureus (S. aureus) infections are associated with increased morbidity, mortality and health-care costs. Persistent nasal carriage of S. aureus found in 10-30% of the general population, constitutes a risk factor for these infections. Nasal decolonization is one of the used strategies to prevent this risk in some situations. Areas covered: Mupirocin nasal ointment has been used for the nasal decolonization and prevention of staphylococcal infections in various settings like surgeries. However, rising rates of resistance to mupirocin require the development of new decolonization agents. In this review, we will discuss mupirocin, its origins, studies that proved its efficacy and the associated resistance, as well as other decolonization agents under investigation. Expert opinion: As some limitations exist to mupirocin use, further research for alternatives is encouraged. Some old approved antiseptics (chlorhexidine, povidone-iodine) or antibiotics (rifampicin, bacitracin) have been investigated for their efficacy in this indication. Other new agents (tea tree oil, retapamulin, LTX-109, XF-73, phages, lysostaphin, squalamine analogues, etc.) are being studied. Some of them are still in preclinical phases, and others have reached clinical trials, but further research is needed. Special interest should be given to single dose decolonization strategies and to molecules that do not select resistant strains.
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Affiliation(s)
- Adèle Sakr
- a R&D department , Biosqual SAS , Marseille , France
| | - Fabienne Brégeon
- b IRD, APHM, MEPHI, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie , Aix Marseille Univ , Marseille , France
| | - Jean-Marc Rolain
- b IRD, APHM, MEPHI, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie , Aix Marseille Univ , Marseille , France
| | - Olivier Blin
- c Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Pharmacologie intégrée et interface clinique et industriel , Institut de Neurosciences des Systèmes, UMR AMU-INSERM 1106 , Marseille , France
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Masroor N, Ferretti-Gallon J, Cooper K, Elgin K, Sanogo K, Nguyen HJ, Doll M, Stevens MP, Bearman G. Universal staphylococcal decolonization for elective surgeries: The patient perspective. Am J Infect Control 2019; 47:391-393. [PMID: 30545578 DOI: 10.1016/j.ajic.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/02/2018] [Accepted: 10/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Staphylococcal decolonization decreases the risk of Staphylococcus aureus surgical site infection. This study evaluates patient perceptions and barriers to a universal Staphylococcal decolonization (USD) protocol. METHODS In October 2013, a protocol for the decolonization of Staphylococcal aureus in elective orthopedic, neurosurgical, and cardiac surgeries was implemented in an effort to further decrease post-operative infections rates. We surveyed patients undergoing these procedures between November 2014 and April 2015 using an anonymous, voluntary, Likert-scale survey; survey questions targeted compliance with the protocol as well as barriers to protocol completion. RESULTS A sample of 546 patients (n=1289, 42%) undergoing elective neurosurgical and orthopedic surgeries completed surveys. Respondents had 85% compliance with USD. Insufficient time prior to the procedure to complete the protocol was the largest barrier to USD completion. CONCLUSIONS This study provides evidence that USD is acceptable to patients, and that the biggest barriers are logistical.
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Clinical and Molecular Characteristics of qacA- and qacB-Positive Methicillin-Resistant Staphylococcus aureus Causing Bloodstream Infections. Antimicrob Agents Chemother 2019; 63:AAC.02157-18. [PMID: 30718251 DOI: 10.1128/aac.02157-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/27/2019] [Indexed: 11/20/2022] Open
Abstract
The increasing use of chlorhexidine for methicillin-resistant Staphylococcus aureus (MRSA) decolonization has raised concerns about the emergence of resistance to these agents. However, the clinical significance of MRSA positive for the qacA and qacB chlorhexidine tolerance genes has not been established. We investigated the clinical features and predictive factors of MRSA bloodstream infection (BSI) isolates, caused by qacA- and qacB-positive MRSA, from 2010 to 2016 at a tertiary hospital in South Korea. A total of 246 MRSA BSI isolates were included; 71 (28.9%) isolates carried qacA/B The annual frequency of qacA- and qacB-positive MRSA bacteremia did not change significantly over the study period. Patients infected with qacA- and qacB-positive MRSA had common risk factors for health care-associated infections, including prior antibiotic use, central venous catheterization in situ, intensive care unit-acquired bacteremia, and nosocomial infection. The qacA- and qacB-positive isolates were also associated with an increasing chlorhexidine MIC and resistance to non-β-lactam antibiotics. The qacA- and qacB-positive isolates were more likely to belong to sequence type 5 (ST5), which is a common health care-associated MRSA strain in South Korea. In multivariable analyses, qacA- and qacB-positive MRSA isolates were found to be associated with agr dysfunction (adjusted odds ratio [aOR], 6.45; 95% confidence interval [CI], 2.59 to 16.10), ST5 MRSA strain (aOR, 4.96; 95% CI, 1.85 to 13.26), nosocomial infection (aOR, 4.88; 95% CI, 2.20 to 10.83), and antibiotic use within the previous 3 months (aOR, 2.59; 95% CI, 1.20 to 5.59). These findings suggest that the microbiological features of qacA and qacB carriage provide a selective advantage for specific MRSA strains in hospital environments.
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Morgan M, McGann P, Gierhart S, Chukwuma U, Richesson D, Hinkle M, Lesho E. Consumption of Chlorhexidine and Mupirocin Across the Health System of the US Department of Defense (DOD) and the Incidence of the qacA/B and mupA Genes in the DOD Facilities of the National Capital Region. Clin Infect Dis 2019; 64:1801-1802. [PMID: 28369328 PMCID: PMC5447884 DOI: 10.1093/cid/cix276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mackenzie Morgan
- Infectious Diseases Service, Walter Reed National Military Medical Center, Bethesda, and
| | - Patrick McGann
- Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Sarah Gierhart
- EpiData Center Department, Naval and Marine Corps Public Health Center, Portsmouth, Virginia; and
| | - Uzo Chukwuma
- EpiData Center Department, Naval and Marine Corps Public Health Center, Portsmouth, Virginia; and
| | - Douglas Richesson
- Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Mary Hinkle
- Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Emil Lesho
- Uniformed Services University of Health Sciences, Bethesda, Maryland
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McNeil JC, Fritz SA. Prevention Strategies for Recurrent Community-Associated Staphylococcus aureus Skin and Soft Tissue Infections. Curr Infect Dis Rep 2019; 21:12. [PMID: 30859379 DOI: 10.1007/s11908-019-0670-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Staphylococcus aureus skin and soft tissue infections (SSTI) are a major source of morbidity. More than half of patients experiencing SSTI will have at least one recurrent infection. These infections frequently cluster in households. Given the burden these infections pose to patients and healthcare, prevention strategies are of major clinical importance and represent an active area of research. Bacterial colonization is frequently an early and critical step in the pathogenesis of infection. As such, strategies to prevent reinfection have aimed to decrease staphylococcal colonization of the skin and mucus membranes, a process referred to as decolonization. RECENT FINDINGS Treatment of acute SSTI with incision and drainage and systemic antibiotics is the mainstay of therapy for healing of the acute infection. Systemic antibiotics also provide benefit through reduced incidence of recurrent SSTI. Education for patients and families regarding optimization of personal and household hygiene measures, and avoidance of sharing personal hygiene items, is an essential component in prevention efforts. For patients experiencing recurrent SSTI, or in households in which multiple members have experienced SSTI, decolonization should be recommended for all household members. A recommended decolonization regimen includes application of intranasal mupirocin and antiseptic body washes with chlorhexidine or dilute bleach water baths. For patients who continue to experience recurrent SSTI, periodic decolonization should be considered. Personal decolonization with topical antimicrobials and antiseptics reduces the incidence of recurrent S. aureus SSTI. Future avenues for investigation include strategies for household environmental decontamination as well as manipulation of the host microbiota.
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Affiliation(s)
- J Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, CB 8116, St. Louis, MO, 63110, USA.
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Jolivet S, Lucet JC. Surgical field and skin preparation. Orthop Traumatol Surg Res 2019; 105:S1-S6. [PMID: 30393070 DOI: 10.1016/j.otsr.2018.04.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
Surgical site infection (SSI) is the third most frequent healthcare-associated infection in France. SSI rates in total hip or knee replacement are around 2%. The main bacteria implicated in SSI in clean surgery are those of the skin flora, whence the importance of skin preparation to eliminate transient flora and reduce resident flora. Guidelines for the prevention of SSI have progressed in recent years in France: firstly in 2013, and then in 2016. That preoperative hair removal and scrubbing of clean skin ahead of cutaneous asepsis is non-contributive was confirmed in 2013. A shower with normal soap taken as close to the beginning of surgery as possible is still recommended, as is use of alcoholic antiseptics for cutaneous asepsis. The debate remains open between chlorhexidine and povidone-iodine in several surgical specialties in the absence of any multicenter studies. Future choices of antiseptic may need to take account of resistance, especially to chlorhexidine, and possible side-effects. Finally, antimicrobial skin sealants and adhesive surgical drapes are not recommended for the prevention of infection.
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Affiliation(s)
- Sarah Jolivet
- IAME, UMR 1137, Inserm, université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France; UHLIN, hôpital Bichat, AP-HP, 75018 Paris, France.
| | - Jean-Christophe Lucet
- IAME, UMR 1137, Inserm, université Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France; UHLIN, hôpital Bichat, AP-HP, 75018 Paris, France
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Copin R, Sause WE, Fulmer Y, Balasubramanian D, Dyzenhaus S, Ahmed JM, Kumar K, Lees J, Stachel A, Fisher JC, Drlica K, Phillips M, Weiser JN, Planet PJ, Uhlemann AC, Altman DR, Sebra R, van Bakel H, Lighter J, Torres VJ, Shopsin B. Sequential evolution of virulence and resistance during clonal spread of community-acquired methicillin-resistant Staphylococcus aureus. Proc Natl Acad Sci U S A 2019; 116:1745-1754. [PMID: 30635416 PMCID: PMC6358666 DOI: 10.1073/pnas.1814265116] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The past two decades have witnessed an alarming expansion of staphylococcal disease caused by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). The factors underlying the epidemic expansion of CA-MRSA lineages such as USA300, the predominant CA-MRSA clone in the United States, are largely unknown. Previously described virulence and antimicrobial resistance genes that promote the dissemination of CA-MRSA are carried by mobile genetic elements, including phages and plasmids. Here, we used high-resolution genomics and experimental infections to characterize the evolution of a USA300 variant plaguing a patient population at increased risk of infection to understand the mechanisms underlying the emergence of genetic elements that facilitate clonal spread of the pathogen. Genetic analyses provided conclusive evidence that fitness (manifest as emergence of a dominant clone) changed coincidently with the stepwise emergence of (i) a unique prophage and mutation of the regulator of the pyrimidine nucleotide biosynthetic operon that promoted abscess formation and colonization, respectively, thereby priming the clone for success; and (ii) a unique plasmid that conferred resistance to two topical microbiocides, mupirocin and chlorhexidine, frequently used for decolonization and infection prevention. The resistance plasmid evolved through successive incorporation of DNA elements from non-S. aureus spp. into an indigenous cryptic plasmid, suggesting a mechanism for interspecies genetic exchange that promotes antimicrobial resistance. Collectively, the data suggest that clonal spread in a vulnerable population resulted from extensive clinical intervention and intense selection pressure toward a pathogen lifestyle that involved the evolution of consequential mutations and mobile genetic elements.
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Affiliation(s)
- Richard Copin
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - William E Sause
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Yi Fulmer
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - Divya Balasubramanian
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Sophie Dyzenhaus
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Jamil M Ahmed
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - Krishan Kumar
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - John Lees
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Anna Stachel
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - Jason C Fisher
- Division of Pediatric Surgery, Department of Surgery, New York University School of Medicine, New York, NY 10016
| | - Karl Drlica
- Public Health Research Institute, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ 07103
- Department of Microbiology, Biochemistry, and Molecular Genetics, New Jersey Medical School, Rutgers Biomedical and Health Sciences, Rutgers University, Newark, NJ 07103
| | - Michael Phillips
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016
| | - Jeffrey N Weiser
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
| | - Paul J Planet
- Department of Pediatric Infectious Disease, Children's Hospital of Philadelphia, Philadelphia, PA 19104
| | - Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY 10032
| | - Deena R Altman
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY 10029
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Harm van Bakel
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029
| | - Jennifer Lighter
- Division of Pediatric Infectious Diseases, Department of Pediatrics, New York University School of Medicine, New York, NY 10016
| | - Victor J Torres
- Department of Microbiology, New York University School of Medicine, New York, NY 10016;
| | - Bo Shopsin
- Division of Infectious Diseases and Immunology, Department of Medicine, New York University School of Medicine, New York, NY 10016;
- Department of Microbiology, New York University School of Medicine, New York, NY 10016
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Htun HL, Hon PY, Holden MTG, Ang B, Chow A. Chlorhexidine and octenidine use, carriage of qac genes, and reduced antiseptic susceptibility in methicillin-resistant Staphylococcus aureus isolates from a healthcare network. Clin Microbiol Infect 2019; 25:1154.e1-1154.e7. [PMID: 30625411 DOI: 10.1016/j.cmi.2018.12.036] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 12/17/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES With the widespread use of antiseptics in healthcare facilities for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) transmission, there are concerns for antiseptic tolerance and resistance. We sought to understand the use of chlorhexidine and octenidine, carriage of qac genes, and reduced antiseptic susceptibilities. METHODS A serial cross-sectional study was conducted in an acute care hospital and three extended-care facilities of a healthcare network in June-July, 2014-2016. Two of the extended-care facilities were exposed to intranasal octenidine and universal daily chlorhexidine/octenidine bathing. The minimum inhibitory concentration (MIC) levels and qac genes were determined by broth microdilution tests and whole genome sequencing respectively. Multivariable logistic regression was used to assess for the independent associations between antiseptic exposures, qac genes, and reduced antiseptic susceptibilities. RESULTS A total of 878 MRSA isolates were obtained. There were associations between qacA/B carriage and chlorhexidine (adjusted odds ratio (aOR) 7.80; 95% confidence interval (CI) 3.25-18.71) and octenidine (aOR 11.79; 95% CI 5.14-27.04) exposures. Chlorhexidine exposure was associated with reduced chlorhexidine susceptibility (MIC ≥4 mg/L) (aOR 3.15; 95% CI 1.14-8.74). Carriage of qacA/B (aOR 10.65; 95% CI 4.14-27.40) or qacC (aOR 2.55; 95% CI 1.22-5.32) had an association with reduced chlorhexidine susceptibility; while MRSA sequence type modified the association. However, we found no direct association between (i) antiseptics use and qacC carriage, (ii) octenidine exposure and reduced susceptibility, and (iii) reduced octenidine susceptibility and qacA/B or qacC carriage. CONCLUSIONS Antiseptic exposures were associated with carriage of qac genes. Chlorhexidine exposure was associated with reduced chlorhexidine susceptibility, requiring continued surveillance for the emergence of resistance.
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Affiliation(s)
- H L Htun
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore
| | - P Y Hon
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore
| | - M T G Holden
- School of Medicine, University of St Andrews, St Andrews, UK
| | - B Ang
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - A Chow
- Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore, Singapore.
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Deinhardt-Emmer S, Sachse S, Geraci J, Fischer C, Kwetkat A, Dawczynski K, Tuchscherr L, Löffler B. Virulence patterns of Staphylococcus aureus strains from nasopharyngeal colonization. J Hosp Infect 2018; 100:309-315. [DOI: 10.1016/j.jhin.2017.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
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Abstract
CONTEXT: Infections are common in contact sports. This review aims to describe the epidemiology, presenting signs and symptoms, treatment guidelines, and regulations for several common infections seen in contact sport athletes. The conditions discussed include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, human immunodeficiency virus, hepatitis C virus, and vaccine-preventable illnesses. EVIDENCE ACQUISITION: Searches were performed across PubMed and MEDLINE research databases. In addition, general internet search engine results and reviews of reference lists of relevant papers were used to identify additional sources of evidence. STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: The most common infections seen in contact sport athletes include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, and vaccine-preventable illnesses. Other infections, including human immunodeficiency virus and hepatitis C, are uncommon but potentially life threatening. CONCLUSION: Infections are common in contact sport athletes. The provider who cares for these athletes should be aware of the most common infections and their appropriate management. Early diagnosis and appropriate clinical management are important for treating the infected athlete, minimizing risk of transmission, minimizing time lost from competition, and preventing large outbreaks.
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Affiliation(s)
- Andrew R. Peterson
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, Iowa
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Emma Nash
- Carver College of Medicine, University of Iowa, Iowa City, Iowa
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa
| | - B.J. Anderson
- University of Minnesota, Minneapolis, Minnesota
- Boynton Health Service, Minneapolis, Minnesota
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Antimicrobial Resistance to Agents Used for Staphylococcus aureus Decolonization: Is There a Reason for Concern? Curr Infect Dis Rep 2018; 20:26. [PMID: 29882094 DOI: 10.1007/s11908-018-0630-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Chlorhexidine gluconate (CHG) and mupirocin are increasingly used for Staphylococcus aureus decolonization to prevent healthcare-associated infections; however, increased use of these agents has led to concerns for growing resistance and reduced efficacy. In this review, we describe current understanding of reduced susceptibility to CHG and mupirocin in S. aureus and their potential clinical implications. RECENT FINDINGS While emergence of S. aureus tolerant or resistant to topical antimicrobial agents used for decolonization is well described, the clinical impact of reduced susceptibility is not clear. Important challenges are that standardized methods of resistance testing and interpretation are not established, and the risk for selection for co- or cross-resistance using universal, as opposed to targeted decolonization, is unclear. Evidence continues to support S. aureus decolonization in certain patient groups, although further studies are needed to determine the long-term impact of CHG and mupirocin resistance on efficacy. Strategies to mitigate further development of reduced susceptibility and the consequences of selection pressures through universal decolonization on resistance will benefit from further investigation.
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A state of the art review on optimal practices to prevent, recognize, and manage complications associated with intravascular devices in the critically ill. Intensive Care Med 2018; 44:742-759. [PMID: 29754308 DOI: 10.1007/s00134-018-5212-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/05/2018] [Indexed: 12/14/2022]
Abstract
Intravascular catheters are inserted into almost all critically ill patients. This review provides up-to-date insight into available knowledge on epidemiology and diagnosis of complications of central vein and arterial catheters in ICU. It discusses the optimal therapy of catheter-related infections and thrombosis. Prevention of complications is a multidisciplinary task that combines both improvement of the process of care and introduction of new technologies. We emphasize the main component of the prevention strategies that should be used in critical care and propose areas of future investigation in this field.
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D’Journo XB, Falcoz PE, Alifano M, Le Rochais JP, D’Annoville T, Massard G, Regnard JF, Icard P, Marty-Ane C, Trousse D, Doddoli C, Orsini B, Edouard S, Million M, Lesavre N, Loundou A, Baumstarck K, Peyron F, Honoré S, Dizier S, Charvet A, Leone M, Raoult D, Papazian L, Thomas PA. Oropharyngeal and nasopharyngeal decontamination with chlorhexidine gluconate in lung cancer surgery: a randomized clinical trial. Intensive Care Med 2018; 44:578-587. [DOI: 10.1007/s00134-018-5156-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/28/2018] [Indexed: 12/18/2022]
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Writers AM. Prevent surgical site infections in the elderly by taking an individualized approach to antibacterial selection. DRUGS & THERAPY PERSPECTIVES 2018. [DOI: 10.1007/s40267-017-0470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Prävention postoperativer Wundinfektionen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:448-473. [PMID: 29589090 DOI: 10.1007/s00103-018-2706-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Henderson A, Nimmo GR. Control of healthcare- and community-associated MRSA: recent progress and persisting challenges. Br Med Bull 2018; 125:25-41. [PMID: 29190327 DOI: 10.1093/bmb/ldx046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Healthcare adapted meticillin-resistant Staphylococcus aureus (MRSA) has spread to hospitals around the world over 50 years. More recently, other strains of MRSA have emerged with the ability to spread in the community and infect otherwise healthy individuals. Morbidity and mortality associated with MRSA remains high and its control in both the healthcare and community setting has proven challenging. SOURCES OF DATA Pubmed (Medline). AREAS OF AGREEMENT The use of targeted screening and decolonization, hand hygiene and antimicrobial stewardship is supported by the most robust studies, though many studies have implemented bundles for effective healthcare-associated (HA)-MRSA control. AREAS OF CONTENTION Universal screening, universal decolonization and contact precautions for HA-MRSA control are supported by less evidence. Some interventions may not be cost-effective. Contact precautions may be associated with potential for patient harm. Evidence for effective control community acquired (CA)-MRSA is largely lacking. GROWING POINTS Programmes that focus on implementing bundles of interventions aimed at targeting HA-MRSA are more likely to be effective, with an emphasis on hand hygiene as a key component. Control of CA-MRSA is likely to be more difficult to achieve and relies on prevalence, risk factors and community healthcare interactions on a broader scale. AREAS TIMELY FOR DEVELOPING RESEARCH Further research in the area of CA-MRSA in particular is required. Antimicrobial stewardship for both CA and HA-MRSA is promising, as is the role of whole genome sequencing in characterizing transmission. However, further work is required to assess their long-term roles in controlling MRSA. With many institutions applying widespread use of chlorhexidine washes, monitoring for chlorhexidine resistance is paramount to sustaining efforts at controlling MRSA.
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Affiliation(s)
- Andrew Henderson
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia.,School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Queensland 4067, Australia.,University of Queensland Centre for Clinical Research, Herston, Queensland 4029, Australia
| | - Graeme R Nimmo
- Pathology Queensland Central Laboratory, Herston, Queensland 4029, Australia.,School of Medicine, Griffith University, Southport 4222, Queensland, Australia
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Maxwell RA, Croft CA, Creech CB, Thomsen I, Soper N, Brown LE, Mejia VA, Dart BW, Barker DE. Methicillin-Resistant Staphylococcus aureus in a Trauma Population: Does Decolonization Prevent Infection? Am Surg 2017. [DOI: 10.1177/000313481708301227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The purpose of this study was to determine if a decolonization regimen reduces the frequency of methicillin-resistant Staphylococcus aureus (MRSA) infections and if colonization isolates are genetically related to subsequent infectious strains. Trauma patients admitted to the intensive care unit with positive MRSA nasal swabs were randomized to either daily chlorhexidine gluconate (CHG) baths and mupirocin (MUP) ointment to the nares or soap and water baths and placebo ointment for five days. Nasal swabs performed at the end of treatment and invasive MRSA infections during the remaining hospitalization were compared with the original nasal isolate via polymerase chain reaction for genetic relatedness as well as CHG and MUP resistance genes. Six hundred and seventy-eight intensive care unit admissions were screened, and 92 (13.6%) had positive (+) MRSA nasal swabs over a 22-month period ending in 3/2014. After the five day treatment period, there were 13 (59.1%) +MRSA second nasal swabs for CHG + MUP and 9 (90%) for soap and water baths and placebo, P = 0.114. No isolates tested positive for the MUP or CHG resistance genes mupA and qacA/B but 7 of 20 (35%) contained smr. There were seven (31.8%) MRSA infections in the CHG group and six (60%) for soap, P = 0.244. All 13 patients with MRSA infections had the same MRSA isolate present in the original nasal swab. There was no difference in all-cause Gram-negative or positive infections for CHG versus soap, 12 (54.5%) versus 7 (70%), P = 0.467. CHG + MUP are ineffective in eradicating MRSA from the anterior nares but may reduce the incidence of infection. Subsequent invasive MRSA infections are typically caused by the endogenous colonization strain.
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Affiliation(s)
- Robert A. Maxwell
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Chasen A. Croft
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C. Buddy Creech
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Isaac Thomsen
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nicole Soper
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura E. Brown
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Vicente A. Mejia
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Benjamin W. Dart
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Donald E. Barker
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
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Błażewicz I, Jaśkiewicz M, Bauer M, Piechowicz L, Nowicki RJ, Kamysz W, Barańska-Rybak W. Decolonization of Staphylococcus aureus in patients with atopic dermatitis: a reason for increasing resistance to antibiotics? Postepy Dermatol Alergol 2017; 34:553-560. [PMID: 29422820 PMCID: PMC5799759 DOI: 10.5114/ada.2017.72461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 08/19/2016] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Exacerbation of atopic dermatitis can be associated with bacterial infection. The skin of patients is colonized with Staphylococcus aureus in 90% of cases. An attempt has been made to demonstrate that eradication significantly reduces the severity of the disease. Studies indicate the efficacy of topical antibiotics, topical corticosteroids and calcineurin inhibitors. Due to increasing resistance to drugs and the defective antimicrobial peptide profile, decolonization is virtually impossible. AIM To determine the prevalence of S. aureus colonization among patients with atopic dermatitis and to assess antimicrobial susceptibility of isolated strains to antibiotics, especially fusidic acid and mupirocin. MATERIAL AND METHODS One hundred patients with atopic dermatitis and 50 healthy subjects were microbiologically assessed for the carriage of S. aureus. Antimicrobial susceptibility tests were performed using the broth-microdilution method for antibiotics: ampicillin, ciprofloxacin, daptomycin, erythromycin, fusidic acid, linezolid, lincomycin, mupirocin, tetracycline and vancomycin. RESULTS Staphylococcus aureus strains were isolated from the majority of our patients, either from the skin (71%) or the anterior nares (67%). In the present study, 10% of isolations represented methicillin-resistant S. aureus (MRSA). Antibiotics exhibited diverse activities against clinical isolates of S. aureus. Among those tested, the highest rates of resistance were shown for ampicillin - 58.5%, lincomycin - 37.5% and erythromycin - 31.0%. Enhanced resistance levels were expressed to mupirocin (17.5%) and fusidic acid (15.5%). CONCLUSIONS According to the increasing rate of resistance and quick recolonization after discontinuation of the treatment, chronic use of topical antibiotics is not recommended and should be limited to exacerbation of atopic dermatitis with clinical signs of bacterial infection.
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Affiliation(s)
- Izabela Błażewicz
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Maciej Jaśkiewicz
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Marta Bauer
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Lidia Piechowicz
- Department of Medical Microbiology, Medical University of Gdansk, Gdansk, Poland
| | - Roman J. Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
| | - Wojciech Kamysz
- Department of Inorganic Chemistry, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Wioletta Barańska-Rybak
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdansk, Poland
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Saeed K, Gould I, Esposito S, Ahmad-Saeed N, Ahmed SS, Alp E, Bal AM, Bassetti M, Bonnet E, Chan M, Coombs G, Dancer SJ, David MZ, De Simone G, Dryden M, Guardabassi L, Hanitsch LG, Hijazi K, Krüger R, Lee A, Leistner R, Pagliano P, Righi E, Schneider-Burrus S, Skov RL, Tattevin P, Van Wamel W, Vos MC, Voss A. Panton-Valentine leukocidin-positive Staphylococcus aureus: a position statement from the International Society of Chemotherapy. Int J Antimicrob Agents 2017; 51:16-25. [PMID: 29174420 DOI: 10.1016/j.ijantimicag.2017.11.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 10/11/2017] [Accepted: 11/09/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Kordo Saeed
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke & Winchester, UK and University of Southampton Medical School, Southampton, UK.
| | - Ian Gould
- Medical Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen, UK
| | - Silvano Esposito
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Nusreen Ahmad-Saeed
- Public Health England-Southampton and University of Southampton, Southampton, UK
| | - Salman Shaheer Ahmed
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Abhijit M Bal
- Department of Microbiology, University Hospital Crosshouse, NHS Ayrshire & Arran & Honorary Clinical Senior Lecturer Faculty of Medicine, University of Glasgow, Glasgow, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Eric Bonnet
- Department of Infectious Diseases, Hôpital Joseph Ducuing, Toulouse, France
| | - Monica Chan
- Department of Infectious Diseases, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore and Institute of Infectious Diseases and Epidemiology, Communicable Disease Centre, Tan Tock Seng Hospital, Singapore
| | - Geoffrey Coombs
- School of Veterinary and Life Sciences, Murdoch University, Perth, WA, Australia
| | | | - Michael Z David
- Division of Infectious Diseases, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Giuseppe De Simone
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Matthew Dryden
- Microbiology Department, Hampshire Hospitals NHS Foundation Trust, Basingstoke & Winchester, UK and University of Southampton Medical School, Southampton, UK; Rare and Imported Pathogens Department, Public Health England, UK
| | - Luca Guardabassi
- Department of Biomedical Sciences, Ross University School of Veterinary Medicine, Basseterre, Saint Kitts and Nevis
| | - Leif G Hanitsch
- Institute of Medical Immunology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Karolin Hijazi
- Institute of Dentistry, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Renate Krüger
- Department of Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andie Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Pasquale Pagliano
- AORN dei Colli, D. Cotugno Hospital, Department of Infectious Diseases, Naples, Italy
| | - Elda Righi
- Infectious Diseases Clinic, Department of Medicine University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | | | - Robert Leo Skov
- MVZ Synlab, Leverkusen, Department of Clinical Microbiology, Leverkusen, Germany and Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 35033 Rennes cedex, France
| | - Willem Van Wamel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Centre and Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Current and Emerging Topical Antibacterials and Antiseptics: Agents, Action, and Resistance Patterns. Clin Microbiol Rev 2017; 30:827-860. [PMID: 28592405 DOI: 10.1128/cmr.00112-16] [Citation(s) in RCA: 188] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bacterial skin infections represent some of the most common infectious diseases globally. Prevention and treatment of skin infections can involve application of a topical antimicrobial, which may be an antibiotic (such as mupirocin or fusidic acid) or an antiseptic (such as chlorhexidine or alcohol). However, there is limited evidence to support the widespread prophylactic or therapeutic use of topical agents. Challenges involved in the use of topical antimicrobials include increasing rates of bacterial resistance, local hypersensitivity reactions (particularly to older agents, such as bacitracin), and concerns about the indiscriminate use of antiseptics potentially coselecting for antibiotic resistance. We review the evidence for the major clinical uses of topical antibiotics and antiseptics. In addition, we review the mechanisms of action of common topical agents and define the clinical and molecular epidemiology of antimicrobial resistance in these agents. Moreover, we review the potential use of newer and emerging agents, such as retapamulin and ebselen, and discuss the role of antiseptic agents in preventing bacterial skin infections. A comprehensive understanding of the clinical efficacy and drivers of resistance to topical agents will inform the optimal use of these agents to preserve their activity in the future.
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Poovelikunnel TT, Gethin G, Solanki D, McFadden E, Codd M, Humphreys H. Randomized controlled trial of honey versus mupirocin to decolonize patients with nasal colonization of meticillin-resistant Staphylococcus aureus. J Hosp Infect 2017; 98:141-148. [PMID: 29107078 DOI: 10.1016/j.jhin.2017.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Mupirocin is used specifically for the eradication of nasal meticillin-resistant Staphylococcus aureus (MRSA), but increasing mupirocin resistance restricts its repeated use. The antibacterial effects of manuka honey have been established in vitro; antibacterial activity of other honeys has also been reported. AIM To describe the learning experience from a randomized controlled trial (RCT) comparing the efficacy of medical-grade honey (MGH) with mupirocin 2% for the eradication of nasal MRSA. METHODS Patients colonized in the nose with MRSA and age ≥18 years were recruited. Participants received either one or two courses of MGH or mupirocin 2%, three times per day for five consecutive days. FINDINGS The proportion of patients who were decolonized after one or two courses of treatment was not significantly different between MGH [18/42; 42.8%; 95% confidence interval (CI): 27.7-59.0] and mupirocin 2% (25/44; 56.8%; 95% CI: 41.0-71.7). Non-nasal MRSA colonization was significantly associated with persistent nasal colonization (odds ratio: 5.186; 95% CI: 1.736-5.489; P = 0.003). The rate of new acquisition of mupirocin resistance was 9.75%. CONCLUSION Although not significant, a decolonization rate of 42.8% for MGH was impressive. Our findings suggest that this strategy, which has the potential to combat antimicrobial resistance, should be assessed in similar but larger studies.
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Affiliation(s)
- T T Poovelikunnel
- Infection Prevention and Control Department, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland.
| | - G Gethin
- School of Nursing and Midwifery, Áras Moyola, National University of Ireland, Galway, Ireland
| | - D Solanki
- Department of Pharmacy, Beaumont Hospital, Dublin, Ireland
| | - E McFadden
- Microbiology Department, Beaumont Hospital, Dublin, Ireland
| | - M Codd
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - H Humphreys
- Infection Prevention and Control Department, Beaumont Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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Cataldo MA, Granata G, Petrosillo N. Antibacterial Prophylaxis for Surgical Site Infection in the Elderly: Practical Application. Drugs Aging 2017; 34:489-498. [PMID: 28589466 DOI: 10.1007/s40266-017-0471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Surgical site infections are among the most common healthcare-associated infections and are linked with increased length of hospitalization, re-admission, mortality and significant financial burden. Risk factors for the occurrence of surgical site infections include variables related to the surgical procedure as well as host factors. Increasing age is associated with the occurrence of surgical site infections. The aim of this review is to give an update on the antibiotic prophylaxis for surgical site infection in elderly people. We focused on specific issues and practical applications, such as the importance of targeting the antimicrobial agent to the susceptibility pattern of colonizing flora in selected cases and the need for dosage modifications.
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Affiliation(s)
- Maria Adriana Cataldo
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy
| | - Guido Granata
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy
| | - Nicola Petrosillo
- Clinical Department, National Institute for Infectious Diseases "Lazzaro Spallanzani", via Portuense 292, 00149, Rome, Italy.
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Halliwell S, Warn P, Sattar A, Derrick JP, Upton M. A single dose of epidermicin NI01 is sufficient to eradicate MRSA from the nares of cotton rats. J Antimicrob Chemother 2017; 72:778-781. [PMID: 27999015 PMCID: PMC5400076 DOI: 10.1093/jac/dkw457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022] Open
Abstract
Objectives: To investigate the efficacy of a potent novel antimicrobial protein of mass 6 kDa, epidermicin NI01, for eradicating the nasal burden of MRSA in a cotton rat (Sigmodon hispidus) model. Methods: MRSA strain ATCC 43300 was used to establish a robust colonization of cotton rat nares. This model was used to evaluate the efficacy of topical 0.04% and 0.2% epidermicin NI01, administered twice daily for 3 days consecutively, and topical 0.8% epidermicin NI01 administered once, for reducing nasal MRSA burden. Control groups remained untreated or were administered vehicle only (0.5% hydroxypropylmethylcellulose) or 2% mupirocin twice daily for 3 days. The experiment was terminated at day 5 and MRSA quantitative counts were determined. Tissues recovered from animals treated with 0.2% epidermicin twice daily for 3 days were examined for histological changes. Results: Mupirocin treatment resulted in a reduction in burden of log10 (log R) of 2.59 cfu/nares compared with vehicle (P < 0.0001). Epidermicin NI01 administered once at 0.8% showed excellent efficacy, resulting in a log R of 2.10 cfu/nares (P = 0.0004), which was equivalent to mupirocin. Epidermicin NI01 administered at 0.2% or 0.04% twice daily for 3 days did not have a significant impact on the tissue burden recovered from the nares. Mild to marked histological abnormalities were noted, but these were determined to be reversible. Conclusion: A single dose of topical epidermicin NI01 was as effective as mupirocin administered twice daily for 3 days in eradication of MRSA from the nares of cotton rats. This justifies further development of epidermicin for this indication.
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Affiliation(s)
- Samantha Halliwell
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Peter Warn
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Evotec (UK) Ltd, Manchester Science Park, Manchester, UK
| | - Abdul Sattar
- Evotec (UK) Ltd, Manchester Science Park, Manchester, UK
| | - Jeremy P Derrick
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mathew Upton
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,School of Biomedical & Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
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Impact of Exposure of Methicillin-Resistant Staphylococcus aureus to Polyhexanide In Vitro and In Vivo. Antimicrob Agents Chemother 2017; 61:AAC.00272-17. [PMID: 28784678 DOI: 10.1128/aac.00272-17] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/18/2017] [Indexed: 01/13/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) resistant to decolonization agents such as mupirocin and chlorhexidine increases the need for development of alternative decolonization molecules. The absence of reported severe adverse reactions and bacterial resistance to polyhexanide makes it an excellent choice as a topical antiseptic. In the present study, we evaluated the in vitro and in vivo capacity to generate strains with reduced polyhexanide susceptibility and cross-resistance with chlorhexidine and/or antibiotics currently used in clinic. Here we report the in vitro emergence of reduced susceptibility to polyhexanide by prolonged stepwise exposure to low concentrations in broth culture. Reduced susceptibility to polyhexanide was associated with genomic changes in the mprF and purR genes and with concomitant decreased susceptibility to daptomycin and other cell wall-active antibiotics. However, the in vitro emergence of reduced susceptibility to polyhexanide did not result in cross-resistance to chlorhexidine. During in vivo polyhexanide clinical decolonization treatment, neither reduced polyhexanide susceptibility nor chlorhexidine cross-resistance was observed. Together, these observations suggest that polyhexanide could be used safely for decolonization of carriers of chlorhexidine-resistant S. aureus strains; they also highlight the need for careful use of polyhexanide at low antiseptic concentrations.
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NP108, an Antimicrobial Polymer with Activity against Methicillin- and Mupirocin-Resistant Staphylococcus aureus. Antimicrob Agents Chemother 2017; 61:AAC.00502-17. [PMID: 28607014 PMCID: PMC5571353 DOI: 10.1128/aac.00502-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/03/2017] [Indexed: 02/04/2023] Open
Abstract
Staphylococcus aureus is a clinically significant human pathogen that causes infectious diseases ranging from skin and soft tissue infections (SSTI) and health care-associated infections (HAI) to potentially fatal bacteremia and endocarditis. Nasal carriage of S. aureus, especially for persistent carriage, is associated with an increased risk of subsequent infection, particularly nosocomial and surgical site infections (SSI), usually via autoinfection. NP108 is a cationic antimicrobial polymer composed of generally recognized as safe (GRAS) amino acid building blocks. NP108 is broad spectrum and rapidly bactericidal (3-log kill in ≤3 h), killing bacteria by membrane disruption and cell lysis. NP108, contrary to many antibiotics, shows equally effective antimicrobial activity against a variety of S. aureus (MIC100 = 8 to 500 mg/liter) and S. epidermidis (MIC100 = 4 to 8 mg/liter) isolates, whether exponentially growing or in stationary phase. NP108 is antimicrobially active under nutrient-limiting conditions similar to those found in the anterior nares (MIC100 = 8 mg/liter) and kills antibiotic-resilient small colony variants (MIC100 = 32 mg/liter) and S. aureus biofilms (prevention, MIC100 = 1 to 4 mg/liter; eradication, MIC100 ≥ 31.25 mg/liter). NP108 is active against isolates of S. aureus resistant to the current standard-of-care decolonization agent, mupirocin, with no significant increase in the MIC100 NP108 is water soluble and has been formulated into compatible aqueous gel vehicles for human use in which antimicrobial efficacy is retained (2.0% [wt/vol]). NP108 is a potential nonantibiotic antimicrobial alternative to antibiotics for the nasal decolonization of S. aureus, with clear advantages in its mechanism of action over the existing gold standard, mupirocin.
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