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Mason E, Nsonwu O, Elmes J, Chudasama D, Pearson C, Hasan L, Hope R, Gerver SM. Increased rates of hospital-onset Staphylococcus aureus bacteraemia in National Health Service acute trusts in England between June 2020 and March 2021: a national surveillance review. J Hosp Infect 2024; 143:33-37. [PMID: 38529780 DOI: 10.1016/j.jhin.2023.10.012] [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: 06/02/2023] [Revised: 10/17/2023] [Accepted: 10/24/2023] [Indexed: 03/27/2024]
Abstract
A large increase in hospital-onset and intensive-care-unit-onset Staphylococcus aureus bacteraemia rates in English acute trusts was observed between 2020 and 2021, coinciding with reported increases in coronavirus disease (COVID-19) cases and associated hospitalizations. Many of these S. aureus bacteraemia cases were defined as co-/secondary infections to COVID-19. Over the same period, increases in the percentage of ventilator-associated pneumonia-related bacteraemia were also found. The COVID-19 pandemic appears to have contributed to the increase in hospital-onset S. aureus bacteraemia in England; further studies are needed to better understand the impacts on patient outcomes.
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Affiliation(s)
- E Mason
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, Clinical & Public Health Group, UK Health Security Agency, London, UK.
| | - O Nsonwu
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, Clinical & Public Health Group, UK Health Security Agency, London, UK
| | - J Elmes
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, Clinical & Public Health Group, UK Health Security Agency, London, UK
| | - D Chudasama
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, Clinical & Public Health Group, UK Health Security Agency, London, UK
| | - C Pearson
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, Clinical & Public Health Group, UK Health Security Agency, London, UK
| | - L Hasan
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, Clinical & Public Health Group, UK Health Security Agency, London, UK
| | - R Hope
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, Clinical & Public Health Group, UK Health Security Agency, London, UK
| | - S M Gerver
- Healthcare Associated Infection, Fungal, Antimicrobial Resistance, Antimicrobial Usage & Sepsis Division, Clinical & Public Health Group, UK Health Security Agency, London, UK
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2
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Lynch JP, Zhanel GG. Escalation of antimicrobial resistance among MRSA part 1: focus on global spread. Expert Rev Anti Infect Ther 2023; 21:99-113. [PMID: 36470275 DOI: 10.1080/14787210.2023.2154653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Staphylococcus aureus produce numerous virulence factors that influence tissue invasion, cytotoxicity, membrane damage, and intracellular persistence allowing them to be very common human pathogens. S. aureus isolates exhibit considerable diversity though specific genotypes have been associated with antimicrobial resistance (AMR) and toxin gene profiles. MRSA is an important pathogen causing both community-acquired (CA) and healthcare-acquired (HCA) infections. Importantly, over the past several decades, both HCA-MRSA and CA-MRSA have spread all over the globe. Even more concerning is that CA-MRSA clones have disseminated into hospitals and HCA-MRSA have entered the community. Factors that enhance spread of MRSA include: poor antimicrobial stewardship and inadequate infection control. The emergence and spread of multidrug resistant (MDR) MRSA has limited therapeutic options. AREAS COVERED The authors discuss the escalation of MRSA, both HCA-MRSA and CA-MRSA across the globe. A literature search of MRSA was performed via PubMed (up to September 2022), using the key words: antimicrobial resistance; β-lactams; community-associated MRSA; epidemiology; infection; multidrug resistance; Staphylococcus aureus. EXPERT OPINION Over the past several decades, MRSA has spread all over the globe. We encourage the judicious use of antimicrobials in accordance with antimicrobial stewardship programs along with infection control measures to minimize the spread of MRSA.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at Ucla, Los Angeles, CA, USA
| | - George G Zhanel
- Professor-Department of Medical Microbiology and Infectious Diseases, Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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3
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Hilton B, Wilson DJ, O'Connell AM, Ironmonger D, Rudkin JK, Allen N, Oliver I, Wyllie DH. Laboratory diagnosed microbial infection in English UK Biobank participants in comparison to the general population. Sci Rep 2023; 13:496. [PMID: 36627297 PMCID: PMC9831014 DOI: 10.1038/s41598-022-20635-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023] Open
Abstract
Understanding the genetic and environmental risk factors for serious bacterial infections in ageing populations remains incomplete. Utilising the UK Biobank (UKB), a prospective cohort study of 500,000 adults aged 40-69 years at recruitment (2006-2010), can help address this. Partial implementation of such a system helped groups around the world make rapid progress understanding risk factors for SARS-CoV-2 infection and COVID-19, with insights appearing as early as May 2020. In principle, such approaches could also to be used for bacterial isolations. Here we report feasibility testing of linking an England-wide dataset of microbial reporting to UKB participants, to enable characterisation of microbial infections within the UKB Cohort. These records pertain mainly to bacterial isolations; SARS-CoV-2 isolations were not included. Microbiological infections occurring in patients in England, as recorded in the Public Health England second generation surveillance system (SGSS), were linked to UKB participants using pseudonymised identifiers. By January 2015, ascertainment of laboratory reports from UKB participants by SGSS was estimated at 98%. 4.5% of English UKB participants had a positive microbiological isolate in 2015. Half of UKB isolates came from 12 laboratories, and 70% from 21 laboratories. Incidence rate ratios for microbial isolation, which is indicative of serious infection, from the UKB cohort relative to the comparably aged general population ranged from 0.6 to 1, compatible with the previously described healthy participant bias in UKB. Data on microbial isolations can be linked to UKB participants from January 2015 onwards. This linked data would offer new opportunities for research into the role of bacterial agents on health and disease in middle to-old age.
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Affiliation(s)
| | - Daniel J Wilson
- Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | | | - Justine K Rudkin
- Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Naomi Allen
- Nuffield Department of Population Health, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | | | - David H Wyllie
- UK Health Security Agency, London, UK.
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
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4
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Kaur K, Khalil S, Singh NP, Dewan P, Gupta P, Shah D. Antibiotic Susceptibility, Carrier State and Predictors of Outcome of Staphylococcus aureus Infections in Hospitalized Children. Indian Pediatr 2023. [DOI: 10.1007/s13312-023-2695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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5
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Methicillin-resistant staphylococcus aureus nosocomial infection has a distinct epidemiological position and acts as a marker for overall hospital-acquired infection trends. Sci Rep 2022; 12:17007. [PMID: 36220870 PMCID: PMC9552150 DOI: 10.1038/s41598-022-21300-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/26/2022] [Indexed: 12/29/2022] Open
Abstract
An ongoing healthcare debate is whether controlling hospital-acquired infection (HAI) from methicillin-resistant Staphylococcus aureus (MRSA) will result in lowering the global HAI rate, or if MRSA will simply be replaced by another pathogen and there will be no change in overall disease burden. With surges in drug-resistant hospital-acquired pathogens during the COVID-19 pandemic, this remains an important issue. Using a dataset of more than 1 million patients in 51 acute care facilities across the USA, and with the aid of a threshold model that models the nonlinearity in outbreaks of diseases, we show that MRSA is additive to the total burden of HAI, with a distinct 'epidemiological position', and does not simply replace other microbes causing HAI. Critically, as MRSA is reduced it is not replaced by another pathogen(s) but rather lowers the overall HAI burden. The analysis also shows that control of MRSA is a benchmark for how well all non-S. aureus nosocomial infections in the same hospital are prevented. Our results are highly relevant to healthcare epidemiologists and policy makers when assessing the impact of MRSA on hospitalized patients. These findings further stress the major importance of MRSA as a unique cause of nosocomial infections, as well as its pivotal role as a biomarker in demonstrating the measured efficacy (or lack thereof) of an organization's Infection Control program.
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6
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Coia JE, Wilson JA, Bak A, Marsden GL, Shimonovich M, Loveday HP, Humphreys H, Wigglesworth N, Demirjian A, Brooks J, Butcher L, Price JR, Ritchie L, Newsholme W, Enoch DA, Bostock J, Cann M, Wilson APR. Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2021; 118S:S1-S39. [PMID: 34757174 DOI: 10.1016/j.jhin.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Affiliation(s)
- J E Coia
- Department of Clinical Microbiology, Hospital South West Jutland, Esbjerg, Denmark; Department of Regional Health Research IRS, University of Southern Denmark, Denmark; Healthcare Infection Society, London, UK
| | - J A Wilson
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - A Bak
- Healthcare Infection Society, London, UK.
| | | | - M Shimonovich
- Healthcare Infection Society, London, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - H P Loveday
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - H Humphreys
- Healthcare Infection Society, London, UK; Department of Clinical Microbiology, The Royal College of Surgeons, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - N Wigglesworth
- Infection Prevention Society, Seafield, UK; East Kent Hospitals University, NHS Foundation Trust, Canterbury, UK
| | - A Demirjian
- Healthcare-associated Infection and Antimicrobial Resistance, Public Health England, London, UK; Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Brooks
- Infection Prevention Society, Seafield, UK; University Hospital Southampton NHS Foundation Trust, UK
| | - L Butcher
- Infection Prevention Society, Seafield, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - J R Price
- Healthcare Infection Society, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - L Ritchie
- Healthcare Infection Society, London, UK; NHS England and NHS Improvement, London, UK
| | - W Newsholme
- Healthcare Infection Society, London, UK; Guy's and St Thomas' NHS Foundation Trust, UK
| | - D A Enoch
- Healthcare Infection Society, London, UK; Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke's Hospital, Cambridge, UK
| | | | - M Cann
- Lay Member, UK; MRSA Action UK, Preston, UK
| | - A P R Wilson
- Healthcare Infection Society, London, UK; University College London Hospitals NHS Foundation Trust, UK.
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7
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Hernandez B, Herrero-Viñas P, Rawson TM, Moore LSP, Holmes AH, Georgiou P. Resistance Trend Estimation Using Regression Analysis to Enhance Antimicrobial Surveillance: A Multi-Centre Study in London 2009-2016. Antibiotics (Basel) 2021; 10:1267. [PMID: 34680846 PMCID: PMC8533047 DOI: 10.3390/antibiotics10101267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022] Open
Abstract
In the last years, there has been an increase of antimicrobial resistance rates around the world with the misuse and overuse of antimicrobials as one of the main leading drivers. In response to this threat, a variety of initiatives have arisen to promote the efficient use of antimicrobials. These initiatives rely on antimicrobial surveillance systems to promote appropriate prescription practices and are provided by national or global health care institutions with limited consideration of the variations within hospitals. As a consequence, physicians' adherence to these generic guidelines is still limited. To fill this gap, this work presents an automated approach to performing local antimicrobial surveillance from microbiology data. Moreover, in addition to the commonly reported resistance rates, this work estimates secular resistance trends through regression analysis to provide a single value that effectively communicates the resistance trend to a wider audience. The methods considered for trend estimation were ordinary least squares regression, weighted least squares regression with weights inversely proportional to the number of microbiology records available and autoregressive integrated moving average. Among these, weighted least squares regression was found to be the most robust against changes in the granularity of the time series and presented the best performance. To validate the results, three case studies have been thoroughly compared with the existing literature: (i) Escherichia coli in urine cultures; (ii) Escherichia coli in blood cultures; and (iii) Staphylococcus aureus in wound cultures. The benefits of providing local rather than general antimicrobial surveillance data of a higher quality is two fold. Firstly, it has the potential to stimulate engagement among physicians to strengthen their knowledge and awareness on antimicrobial resistance which might encourage prescribers to change their prescription habits more willingly. Moreover, it provides fundamental knowledge to the wide range of stakeholders to revise and potentially tailor existing guidelines to the specific needs of each hospital.
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Affiliation(s)
- Bernard Hernandez
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK; (P.H.-V.); (P.G.)
- Centre for Antimicrobial Optimisation (CAMO), Imperial College London, London W12 0NN, UK; (T.M.R.); (A.H.H.)
| | - Pau Herrero-Viñas
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK; (P.H.-V.); (P.G.)
- Centre for Antimicrobial Optimisation (CAMO), Imperial College London, London W12 0NN, UK; (T.M.R.); (A.H.H.)
| | - Timothy M. Rawson
- Centre for Antimicrobial Optimisation (CAMO), Imperial College London, London W12 0NN, UK; (T.M.R.); (A.H.H.)
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | - Luke S. P. Moore
- Chelsea and Westminster NHS Foundation Trust, London SW10 9NH, UK;
| | - Alison H. Holmes
- Centre for Antimicrobial Optimisation (CAMO), Imperial College London, London W12 0NN, UK; (T.M.R.); (A.H.H.)
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
| | - Pantelis Georgiou
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London SW7 2AZ, UK; (P.H.-V.); (P.G.)
- Centre for Antimicrobial Optimisation (CAMO), Imperial College London, London W12 0NN, UK; (T.M.R.); (A.H.H.)
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8
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Watanabe H, Norimatsu Y, Ohno Y. Scrotal Abscess in a Japanese Patient Caused by Prevotella bivia and Streptococcus agalactiae, Successfully Treated with Cefazolin and Amoxicillin: A Case Report. Int Med Case Rep J 2021; 14:475-481. [PMID: 34285597 PMCID: PMC8286098 DOI: 10.2147/imcrj.s321547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background Infections caused by Prevotella bivia, a gram-negative anaerobic bacillus, are rare, with no reported cases in Japan. We present a novel case of scrotal abscess in a Japanese patient co-infected with Prevotella bivia and Streptococcus agalactiae. Case Presentation A 41-year-old uncontrolled diabetic man complained of swelling and pain in the scrotum. On examination, computed tomography revealed an abscess of 5-cm diameter in the scrotum. Then, the abscess was incised and drained. He was treated with cefazolin empirically. Prevotella bivia and Streptococcus agalactiae were identified in the pus cultures obtained from the abscess. However, the susceptibility tests for Prevotella bivia could not be submitted. Seven days following admission, the pain reduced, and the drainage slowed. The patient was discharged on day 14 when cefazolin was discontinued and oral amoxicillin (750 mg/day) was started. Amoxicillin was continued until day 42; improvement was confirmed. Conclusion To the best of our knowledge, this case is the first report of Prevotella bivia in Japan. We suggest that cephem antibiotics such as cefazolin may be effective against Prevotella bivia in Japan.
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Affiliation(s)
- Haruka Watanabe
- Department of Dermatology, JR Tokyo General Hospital, Tokyo, Japan
| | - Yuta Norimatsu
- Department of Dermatology, JR Tokyo General Hospital, Tokyo, Japan.,Department of Dermatology, University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yuki Ohno
- Department of Dermatology, JR Tokyo General Hospital, Tokyo, Japan
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9
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Antimicrobial Resistance in Pathogens Isolated from Blood Cultures: A Two-Year Multicenter Hospital Surveillance Study in Italy. Antibiotics (Basel) 2020; 10:antibiotics10010010. [PMID: 33374232 PMCID: PMC7824585 DOI: 10.3390/antibiotics10010010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Antimicrobial resistance (AMR) is one of the most concerning issues in medicine today. The objectives of this study were to investigate the AMR distribution of the blood-borne pathogens isolated over a two-year period in an Italian region. Methods: A retrospective electronic record review of laboratory-confirmed bloodstream infections (BSIs) was done, and data from three major diagnostic laboratories were used. Twelve invasive clinically important bacteria species were included in the sample. Results: During the study period, 1228 positive BSIs were collected. The most common pathogens were Coagulase-negative Staphylococcus (CoNS) (29.7%), Staphylococcus aureus (19.1%) and Escherichia coli (15.9%). With regard to the AMR pattern, 31.7% of CoNS and 28.1% of Staphylococcus aureus were oxacillin-resistant, and almost half of the Enterococci showed resistance to high-level gentamicin. Among Gram-negative species, 11.7% of Escherichia coli and 39.5% of Klebsiella pneumoniae were carbapenem-resistant. Among the non-fermentative Gram-negative bacteria, the most frequently combined AMR pattern was aminoglycosides and fluoroquinolones (48.4% in A. baumannii and 14.6% in P. aeruginosa). Conclusion: The results display an alarming prevalence of AMR among hospital isolated pathogens, consistently higher than the European average. Information from surveillance systems to better characterize the trend in the incidence of AMR at local and national levels is needed.
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10
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Xiao M, Huang JJ, Zhang G, Yang WH, Kong F, Kudinha T, Xu YC. Antimicrobial activity of omadacycline in vitro against bacteria isolated from 2014 to 2017 in China, a multi-center study. BMC Microbiol 2020; 20:350. [PMID: 33198626 PMCID: PMC7667747 DOI: 10.1186/s12866-020-02019-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Omadacycline (ZL-2401) is a semi-synthetic derivative of minocycline. It has a broadspectrum activity against Gram-positive and Gram-negative bacteria, and atypical pathogens. The objective of this study was to evaluate the antibacterial activity of omadacycline against recently collected bacterial isolates from Chinese patients. RESULTS Omadacycline showed potent activity against all Gram-positive pathogens: S. aureus MICs were low regardless of susceptibility to methicillin (methicillin-resistant Staphylococcus aureus, MRSA: N = 97, MIC50/90 0.12/0.25 mg/L, 98.5% susceptible; methicillin-sensitive Staphylococcus aureus, MSSA: N = 100, MIC50/90 0.12/0.12 mg/L, 100.0% susceptible). Omadacycline was also very effective against β-haemolytic streptococci (MIC50/90, 0.06/0.12 mg/L), viridans group streptococci (MIC50/90,<0.03/0. 06 mg/L), and enterococci (MIC50/90, 0.03/0.12 mg/L). Against S. pneumoniae, omadacycline was highly active regardless of penicillin-resistance (MIC90 0.06 mg/L) and despite the fact that less than 10.0% of these strains were susceptible to tetracycline. Omadacycline exhibited good in vitro activity against Enterobacterales isolates (MIC50/90, 2/8 mg/L), inhibiting 81.7% of the isolates at ≤4 mg/L. M. catarrhalis isolates (MIC50/90, 0.12/0.25 mg/L) were fully susceptible to omadacycline at ≤0.5 mg/L. CONCLUSIONS Omadacycline showed potent in vitro activity against most common bacterial pathogens, and even against highly resistant problem pathogens, such as MRSA, penicillin-R and tetracycline-R S. pneumoniae and enterococci. The susceptibility rate of Chinese isolates was similar to those reported in other countries, but the decreased activity against K. pneumoniae isolates in the present study should be noted.
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Affiliation(s)
- Meng Xiao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China.,Graduate School, Peking Union Medical College, Chinese academy of Medical Science, Beijing, 100730, China
| | - Jing-Jing Huang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China.,Graduate School, Peking Union Medical College, Chinese academy of Medical Science, Beijing, 100730, China
| | - Ge Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China
| | - Wen-Hang Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China
| | - Fanrong Kong
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR-Pathology West, Westmead Hospital, Westmead, NSW, Australia
| | - Timothy Kudinha
- Charles Sturt University, Leeds Parade, Orange, Sydney, NSW, Australia.,NSW Health Pathology, Regional and Rural, Orange Hospital, Orange, NSW, Australia
| | - Ying-Chun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, 100730, China.
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11
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Qiu Y, Yang J, Chen Y, Yang J, Zhu Q, Zhu C, Li S, Liu J, Wan C, Zhu Y, Chen M, Xu Y, Tong J, Li R, Shan Q, Lin D, Wu S, Zhuo Z, Wang C, Zhao S, Qi Z, Sun X, Maihebuba B, Jia C, Gao H, Cheng Y, Zeng M. Microbiological profiles and antimicrobial resistance patterns of pediatric bloodstream pathogens in China, 2016-2018. Eur J Clin Microbiol Infect Dis 2020; 40:739-749. [PMID: 33078219 DOI: 10.1007/s10096-020-04069-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study aimed to investigate the microbiological profiles and antimicrobial resistance patterns of bloodstream pathogens in Chinese children. METHODS This retrospective study was conducted at 13 tertiary hospitals in China during 2016-2018. The first bloodstream isolates of the same species from one pediatric patient < 18 years were included to this study for analysis. Antimicrobial susceptibility testing was determined based on minimum inhibitory concentrations or Kirby-Bauer disk diffusion methods according to the 2018 Clinical and Laboratory Standards Institute guidelines. RESULTS Overall, 9345 nonduplicate bloodstream isolates were collected. Top 10 pathogens included Coagulase-negative staphylococcus (CoNS) (44.4%), Escherichia coli (10.2%), Klebsiella pneumoniae (5.9%), Staphylococcus aureus (5.0%), Streptococcus pneumoniae (4.9%), Pseudomonas aeruginosa(2.8%), Enterococcus faecium (2.7%), Stenotrophomonas maltophilia (2.4%), Salmonella spp. (2.3%), and Streptococcus agalactiae (2.0%). The commonest pathogens apart from CoNS in age group 0-28 days, 29 days-2 months, 3-11 months, 1-5 years, and ≥ 5 years were Escherichia coli (17.2%), Escherichia coli (14.0%), Escherichia coli (7.9%), Streptococcus pneumoniae (10.7%) ,and Staphylococcus aureus (13.6%), respectively. The overall prevalence of extended-spectrum β-lactamases-producing Enterobacteriaceae, carbapenem-resistant Klebsiella pneumoniae, carbapenem-resistant Acinetobacter baumannii, and carbapenem-resistant Pseudomonas aeruginosa were 41.4, 28.4, 31.7, and 5.6%, respectively. The overall prevalence of methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae and vancomycin-resistant Enterococcus was 38.1, 28.3, and 0.7%, respectively. CONCLUSIONS The major bacterial pathogens have differences in different age groups, ward types, and regions in Chinese children, and the commonest causing microorganism was the Escherichia coli, especially in neonates and infants. High prevalence of important resistant phenotypes is of a serious concern.
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Affiliation(s)
- Yue Qiu
- Department of Infectious Diseases, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China
| | - Junwen Yang
- Department of Microbiology Laboratory, Children's Hospital Affiliated to Zhengzhou University (Henan Children's Hospital), Zhengzhou, China
| | - Yiping Chen
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jinhong Yang
- Department of Microbiology Laboratory, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qingxiong Zhu
- Department of Infection Diseases, Children's hospital of Jiangxi Province, Nanchang, China
| | - Chunhui Zhu
- Department of Infection Diseases, Children's hospital of Jiangxi Province, Nanchang, China
| | - Shuangjie Li
- Department of Hepatology, Hunan Children's Hospital, Changsha, China
| | - Jing Liu
- Department of Infection Diseases, Hunan Children's Hospital, Changsha, China
| | - Chaomin Wan
- Department of Pediatrics, Sichuan University West China Second Hospital, Chengdu, China
| | - Yu Zhu
- Department of Pediatrics, Sichuan University West China Second Hospital, Chengdu, China
| | - Minxia Chen
- Department of Infections Disease, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Yi Xu
- Department of Infections Disease, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Jianning Tong
- Department of Pediatric, Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Rui Li
- Department of Pediatric, Gastroenterology and Infectious Diseases, Qingdao Women and Children's Hospital, Qingdao, China
| | - Qingwen Shan
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Daojiong Lin
- Department of infectious diseases, Hainan Women and Children's Medical Center, Haikou, China
| | - Shouye Wu
- Department of infectious diseases, Hainan Women and Children's Medical Center, Haikou, China
| | - Zhiqiang Zhuo
- Department of infectious diseases, Xiamen Children's Hospital, Xiamen, China
| | - Caihong Wang
- Department of infectious diseases, Xiamen Children's Hospital, Xiamen, China
| | - Shiyong Zhao
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou, China
| | - Zhenghong Qi
- Department of Infectious Diseases, Hangzhou Children's Hospital, Hangzhou, China
| | - Xiaofeng Sun
- Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Bieerding Maihebuba
- Department of Infectious Diseases, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Chunmei Jia
- Department of Pharmacy, The fourth Hospital of Baotou, Baotou, China
| | - Huiling Gao
- Department of Pharmacy, The fourth Hospital of Baotou, Baotou, China
| | - Yibing Cheng
- Department of Emergency, Henan Children's Hospital Affiliated to Zhengzhou University, 33, Longhu Outer Ring East Road, Zhengzhou, 450018, China.
| | - Mei Zeng
- Department of Infectious Diseases, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
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Lim C, Miliya T, Chansamouth V, Aung MT, Karkey A, Teparrukkul P, Rahul B, Lan NPH, Stelling J, Turner P, Ashley E, van Doorn HR, Lin HN, Ling C, Hinjoy S, Iamsirithaworn S, Dunachie S, Wangrangsimakul T, Hantrakun V, Schilling W, Yen LM, Tan LV, Hlaing HH, Mayxay M, Vongsouvath M, Basnyat B, Edgeworth J, Peacock SJ, Thwaites G, Day NP, Cooper BS, Limmathurotsakul D. Automating the Generation of Antimicrobial Resistance Surveillance Reports: Proof-of-Concept Study Involving Seven Hospitals in Seven Countries. J Med Internet Res 2020; 22:e19762. [PMID: 33006570 PMCID: PMC7568216 DOI: 10.2196/19762] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Reporting cumulative antimicrobial susceptibility testing data on a regular basis is crucial to inform antimicrobial resistance (AMR) action plans at local, national, and global levels. However, analyzing data and generating a report are time consuming and often require trained personnel. OBJECTIVE This study aimed to develop and test an application that can support a local hospital to analyze routinely collected electronic data independently and generate AMR surveillance reports rapidly. METHODS An offline application to generate standardized AMR surveillance reports from routinely available microbiology and hospital data files was written in the R programming language (R Project for Statistical Computing). The application can be run by double clicking on the application file without any further user input. The data analysis procedure and report content were developed based on the recommendations of the World Health Organization Global Antimicrobial Resistance Surveillance System (WHO GLASS). The application was tested on Microsoft Windows 10 and 7 using open access example data sets. We then independently tested the application in seven hospitals in Cambodia, Lao People's Democratic Republic, Myanmar, Nepal, Thailand, the United Kingdom, and Vietnam. RESULTS We developed the AutoMated tool for Antimicrobial resistance Surveillance System (AMASS), which can support clinical microbiology laboratories to analyze their microbiology and hospital data files (in CSV or Excel format) onsite and promptly generate AMR surveillance reports (in PDF and CSV formats). The data files could be those exported from WHONET or other laboratory information systems. The automatically generated reports contain only summary data without patient identifiers. The AMASS application is downloadable from https://www.amass.website/. The participating hospitals tested the application and deposited their AMR surveillance reports in an open access data repository. CONCLUSIONS The AMASS is a useful tool to support the generation and sharing of AMR surveillance reports.
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Affiliation(s)
- Cherry Lim
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Thyl Miliya
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Vilada Chansamouth
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | | | - Abhilasha Karkey
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Patan Hospital, Kathmandu, Nepal
- Oxford University Clinical Research Unit, Patan Hospital, Kathmandu, Nepal
| | | | - Batra Rahul
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostic Research, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - John Stelling
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Paul Turner
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Elizabeth Ashley
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Myanmar Oxford Clinical Research Unit, Yangon, Myanmar
| | - H Rogier van Doorn
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Clare Ling
- Shoklo Malaria Research Unit and Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Soawapak Hinjoy
- Department of Disease Control, Bureau of Epidemiology, Ministry of Public Health, Nonthaburi, Thailand
- Department of Disease Control, Office of International Cooperation, Ministry of Public Health, Nonthaburi, Thailand
| | - Sopon Iamsirithaworn
- Division of Communicable Diseases, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Susanna Dunachie
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Tri Wangrangsimakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Viriya Hantrakun
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - William Schilling
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Mayfong Mayxay
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
- Institute of Research and Education Development, University of Health Sciences, Vientiane, Lao People's Democratic Republic
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People's Democratic Republic
| | - Buddha Basnyat
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Patan Hospital, Kathmandu, Nepal
- Oxford University Clinical Research Unit, Patan Hospital, Kathmandu, Nepal
| | - Jonathan Edgeworth
- Department of Infectious Diseases, Centre for Clinical Infection and Diagnostic Research, King's College London & Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Guy Thwaites
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nicholas Pj Day
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Ben S Cooper
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
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Coombs GW, Daley DA, Mowlaboccus S, Pang S. Australian Group on Antimicrobial Resistance (AGAR) Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP) Annual Report 2019. ACTA ACUST UNITED AC 2020; 44. [PMID: 32988337 DOI: 10.33321/cdi.2020.44.71] [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] [Indexed: 11/20/2022]
Abstract
From 1 January to 31 December 2019, 39 institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2019 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin and on characterising the molecular epidemiology of the methicillin-resistant isolates. A total of 3,157 S. aureus bacteraemia episodes were reported, of which 79.8% were community-onset. 18.5% of S. aureus were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 14.0%, which was not significantly different from the 14.3% mortality associated with methicillin-susceptible SAB (p = 0.9). With the exception of the β-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However, in addition to the β-lactams, approximately 36% of methicillin-resistant S. aureus (MRSA) were resistant to ciprofloxacin, 34% to erythromycin, 13% to tetracycline, 9% to gentamicin and 4% to co-trimoxazole. When applying the EUCAST breakpoints, teicoplanin resistance was detected in two S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). ST22-IV [2B] (EMRSA-15) is the predominant healthcare-associated clone in Australia. Eighty percent of methicillin-resistant SAB, however, were due to community-associated clones. Although polyclonal, approximately 71.4% of community-associated clones were variously characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5], ST1-IV [2B], ST30-IV [2B], ST78-IV [2B] and ST8-IV [2B]. Community-associated MRSA (CA-MRSA), in particular the ST45-VT [5C2&5] clone, have acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. The multiresistant ST45-VT [5C2&5] clone accounted for 12.7% of CA-MRSA. As CA-MRSA is well established in the Australian community, it is important that antimicrobial resistance patterns in community- and healthcare-associated SAB are monitored, as this information will guide therapeutic practices in treating S. aureus sepsis.
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Affiliation(s)
- Geoffrey W Coombs
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Denise A Daley
- Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Shakeel Mowlaboccus
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Stanley Pang
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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14
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Lagacé-Wiens PRS, Adam HJ, Poutanen S, Baxter MR, Denisuik AJ, Golden AR, Nichol KA, Walkty A, Karlowsky JA, Mulvey MR, Golding G, Hoban DJ, Zhanel GG. Trends in antimicrobial resistance over 10 years among key bacterial pathogens from Canadian hospitals: results of the CANWARD study 2007-16. J Antimicrob Chemother 2020; 74:iv22-iv31. [PMID: 31505648 DOI: 10.1093/jac/dkz284] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We sought to analyse 10 years of longitudinal surveillance data (2007-16) from the CANWARD study and describe emerging trends in antimicrobial resistance for key bacterial pathogens across Canada. METHODS Longitudinal data from CANWARD study sites that contributed isolates every year from 2007 to 2016 were analysed to identify trends in antimicrobial resistance over time using univariate tests of trend and multivariate regression models to account for the effects of patient demographics. RESULTS Statistically significant increases occurred in the proportion of Escherichia coli isolates resistant to extended-spectrum cephalosporins, amoxicillin/clavulanate, trimethoprim/sulfamethoxazole and ciprofloxacin. Similarly, the proportion of Klebsiella pneumoniae isolates resistant to extended-spectrum cephalosporins, amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, ciprofloxacin and carbapenems increased during the study. The proportion of Enterobacter cloacae isolates resistant to ceftazidime and trimethoprim/sulfamethoxazole increased. The proportion of both ESBL-positive E. coli and K. pneumoniae (including bloodstream isolates) increased significantly between 2007 and 2016. A reduction in the proportion of Pseudomonas aeruginosa that were ciprofloxacin, cefepime, colistin, amikacin and gentamicin resistant and an increase in the proportion of P. aeruginosa isolates non-susceptible to meropenem were observed. The proportion of isolates of Staphylococcus aureus non-susceptible to clarithromycin, clindamycin and trimethoprim/sulfamethoxazole decreased over time while an increase in the proportion of isolates of Streptococcus pneumoniae non-susceptible to clarithromycin, clindamycin and doxycycline was observed. CONCLUSIONS Increases in Enterobacteriaceae resistance to multiple classes of antimicrobials, increases in ESBL-positive E. coli and K. pneumoniae, and the small but significant increase in carbapenem-resistant K. pneumoniae were the most remarkable changes in antimicrobial resistance observed from 2007 to 2016 in Canada.
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Affiliation(s)
- Philippe R S Lagacé-Wiens
- Diagnostic Services, Shared Health, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather J Adam
- Diagnostic Services, Shared Health, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susan Poutanen
- Department of Microbiology, Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Melanie R Baxter
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Andrew J Denisuik
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Alyssa R Golden
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Andrew Walkty
- Diagnostic Services, Shared Health, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James A Karlowsky
- Diagnostic Services, Shared Health, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael R Mulvey
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - George Golding
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.,National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Daryl J Hoban
- Diagnostic Services, Shared Health, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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Toleman MS, Reuter S, Jamrozy D, Wilson HJ, Blane B, Harrison EM, Coll F, Hope RJ, Kearns A, Parkhill J, Peacock SJ, Török ME. Prospective genomic surveillance of methicillin-resistant Staphylococcus aureus (MRSA) associated with bloodstream infection, England, 1 October 2012 to 30 September 2013. ACTA ACUST UNITED AC 2020; 24. [PMID: 30696529 PMCID: PMC6351993 DOI: 10.2807/1560-7917.es.2019.24.4.1800215] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundMandatory reporting of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) has occurred in England for over 15years. Epidemiological information is recorded, but routine collection of isolates for characterisation has not been routinely undertaken. Ongoing developments in whole-genome sequencing (WGS) have demonstrated its value in outbreak investigations and for determining the spread of antimicrobial resistance and bacterial population structure. Benefits of adding genomics to routine epidemiological MRSA surveillance are unknown.AimTo determine feasibility and potential utility of adding genomics to epidemiological surveillance of MRSA.MethodsWe conducted an epidemiological and genomic survey of MRSA BSI in England over a 1-year period (1 October 2012--30 September 2013).ResultsDuring the study period, 903 cases of MRSA BSI were reported; 425 isolates were available for sequencing of which, 276 (65%) were clonal complex (CC) 22. Addition of 64 MRSA genomes from published outbreak investigations showed that the study genomes could provide context for outbreak isolates and supported cluster identification. Comparison to other MRSA genome collections demonstrated variation in clonal diversity achieved through different sampling strategies and identified potentially high-risk clones e.g. USA300 and local expansion of CC5 MRSA in South West England.ConclusionsWe demonstrate the potential utility of combined epidemiological and genomic MRSA BSI surveillance to determine the national population structure of MRSA, contextualise previous MRSA outbreaks, and detect potentially high-risk lineages. These findings support the integration of epidemiological and genomic surveillance for MRSA BSI as a step towards a comprehensive surveillance programme in England.
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Affiliation(s)
- Michelle S Toleman
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Wellcome Sanger Institute, Hinxton, United Kingdom.,University of Cambridge, Department of Medicine, Cambridge, United Kingdom
| | - Sandra Reuter
- University of Freiburg, Institute for Infection Prevention and Hospital Epidemiology, Freiburg, Germany
| | | | - Hayley J Wilson
- University of Cambridge, Department of Medicine, Cambridge, United Kingdom
| | - Beth Blane
- University of Cambridge, Department of Medicine, Cambridge, United Kingdom
| | - Ewan M Harrison
- Wellcome Sanger Institute, Hinxton, United Kingdom.,University of Cambridge, Department of Medicine, Cambridge, United Kingdom
| | - Francesc Coll
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Russell J Hope
- Public Health England, National Infection Service, Colindale, London, United Kingdom
| | - Angela Kearns
- Public Health England, National Infection Service, Colindale, London, United Kingdom
| | | | - Sharon J Peacock
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Wellcome Sanger Institute, Hinxton, United Kingdom.,University of Cambridge, Department of Medicine, Cambridge, United Kingdom
| | - M Estée Török
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, United Kingdom.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,University of Cambridge, Department of Medicine, Cambridge, United Kingdom
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16
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Jubeh B, Breijyeh Z, Karaman R. Resistance of Gram-Positive Bacteria to Current Antibacterial Agents and Overcoming Approaches. Molecules 2020; 25:E2888. [PMID: 32586045 PMCID: PMC7356343 DOI: 10.3390/molecules25122888] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
The discovery of antibiotics has created a turning point in medical interventions to pathogenic infections, but unfortunately, each discovery was consistently followed by the emergence of resistance. The rise of multidrug-resistant bacteria has generated a great challenge to treat infections caused by bacteria with the available antibiotics. Today, research is active in finding new treatments for multidrug-resistant pathogens. In a step to guide the efforts, the WHO has published a list of the most dangerous bacteria that are resistant to current treatments and requires the development of new antibiotics for combating the resistance. Among the list are various Gram-positive bacteria that are responsible for serious healthcare and community-associated infections. Methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and drug-resistant Streptococcus pneumoniae are of particular concern. The resistance of bacteria is an evolving phenomenon that arises from genetic mutations and/or acquired genomes. Thus, antimicrobial resistance demands continuous efforts to create strategies to combat this problem and optimize the use of antibiotics. This article aims to provide a review of the most critical resistant Gram-positive bacterial pathogens, their mechanisms of resistance, and the new treatments and approaches reported to circumvent this problem.
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Affiliation(s)
| | | | - Rafik Karaman
- Pharmaceutical Sciences Department, Faculty of Pharmacy, Al-Quds University, Jerusalem P.O. Box 20002, Palestine; (B.J.); (Z.B.)
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17
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Donlon NE, Mohan H, Free R, Elbaghir B, Soric I, Fleming C, Balasubramanian I, Ivanovski I, Schmidt K, Mealy K. Predictive value of CRP/albumin ratio in major abdominal surgery. Ir J Med Sci 2020; 189:1465-1470. [DOI: 10.1007/s11845-020-02238-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/16/2020] [Indexed: 01/06/2023]
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18
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Ahmad A, Teoh KH, Lau L, Cheng N, Evans AR. Can we reduce the number of MRSA screening site swabs in elective orthopedic patients? J Orthop Surg (Hong Kong) 2020; 27:2309499019847068. [PMID: 31068084 DOI: 10.1177/2309499019847068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Deep infection after routine elective orthopedic procedures can be catastrophic, leading to further surgery, loss of limb, disability, and risk of mortality. Ring-fencing elective orthopedic ward has been shown to significantly reduce the incidence of all postoperative infections especially with methicillin-resistant Staphylococcus aureus (MRSA). Our hospital's current MRSA screening is a four-site MRSA swabs. OBJECTIVES This study evaluates the possibility of reducing the number of MRSA swab sites as part of a quality improvement project. STUDY DESIGN AND METHODS Patients on the waiting list for elective orthopedic procedure in our trust who had an MRSA-positive swab from either four sites were analyzed over the time period from January 2012 to December 2014. Those without swabs from all four areas (nose, throat, axilla, and groin) were excluded. Positive swabs of different regions were recorded and compared. RESULTS There were 138 MRSA-positive patients, giving an incidence of 31 per 10,000 screen/year over that time period. Some patients ( n = 31, 22.5%) had a positive swab in more than one site. The positive sites were as follows: nose (69.60%, n = 96), groin (26.10%, n = 36), throat (25.30%, n = 35), and axilla (8.70%, n = 12). In our cohort, we would miss a significant proportion of positive patients if we change it to a two swab screening policy (26.8% for nose and axilla combination; 18.10% for nose and groin combination; and 15.20% for nose and throat). However, we would only miss 2.2% of cases for a nose, groin, and throat three-swab policy. There were also 11 instances, where a previously negative site become positive in the next swab. CONCLUSION A three-swab combination of nasal, throat, and groin swabs improves pickup rate of MRSA significantly compared to a two-swab policy and misses only 2.2% compared to a four-swab policy. Axilla swabbing does not make a significant difference to the results. Based on this study, the policy has now been changed from a four-swab to three-swab screening in our trust. This has now been audited four times and they were all negative. This has helped to reduce cost in terms of staff time and resources. We would not recommend screening only the previous positive site for the next repeat screening swabs as there is an 8% chance of missing MRSA carrier status.
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Affiliation(s)
- Aziz Ahmad
- Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, Wales, UK
| | - Kar H Teoh
- Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, Wales, UK
| | - Lilian Lau
- Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, Wales, UK
| | - Natalie Cheng
- Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, Wales, UK
| | - Aled R Evans
- Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, Wales, UK
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Coombs GW, Daley DA, Mowlaboccus S, Lee YT, Pang S. Australian Group on Antimicrobial Resistance (AGAR) Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP) Annual Report 2018. ACTA ACUST UNITED AC 2020; 44. [PMID: 32178604 DOI: 10.33321/cdi.2020.44.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2018 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin, and to characterise the molecular epidemiology of the methicillin-resistant isolates. A total of 2,673 S. aureus bacteraemia episodes were reported, of which 78.9% were community-onset. A total of 17.4% of S. aureus isolates were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 17.1% which was not significantly higher than the 13.6% mortality associated with methicillin-susceptible SAB (p = 0.1). With the exception of the β-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However in addition to the β-lactams approximately 42% of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin, 36% to ciprofloxacin and approximately 13% resistant to co-trimoxazole, tetracycline and gentamicin. When applying the EUCAST breakpoints teicoplanin resistance was detected in two S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). The ST22-IV [2B] (EMRSA-15) clone is the predominant healthcare-associated clone in Australia. Seventy-eight percent of methicillin-resistant SAB episodes in 2018 were due to community-associated clones. Although polyclonal, approximately 76.3% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5], ST1-IV [2B], ST30-IV [2B], ST78-IV [2B] and ST97-IV [2B]. Community-associated MRSA, in particular the ST45-VT [5C2&5] clone, has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. The ST45-VT [5C2&5] clone accounted for 11.7% of CA-MRSA. As CA-MRSA is well established in the Australian community, it is important that antimicrobial resistance patterns in community- and healthcare-associated SAB are monitored, as this information will guide therapeutic practices in treating S. aureus sepsis.
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Affiliation(s)
- Geoffrey W Coombs
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Denise A Daley
- Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Shakeel Mowlaboccus
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Yung Thin Lee
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Stanley Pang
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Mandatory surveillance and outbreaks reporting of the WHO priority pathogens for research & discovery of new antibiotics in European countries. Clin Microbiol Infect 2019; 26:943.e1-943.e6. [PMID: 31812771 DOI: 10.1016/j.cmi.2019.11.020] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/31/2019] [Accepted: 11/16/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In 2017 the WHO published a global priority list of 12 antibiotic-resistant bacteria (ARB) in urgent need of new antibiotics. We aimed to identify and assess publicly accessible mandatory surveillance systems and outbreaks reporting for these pathogens in the 28 European Union and four European Free Trade Association member states. METHODS Compulsory reporting was mapped by reviewing national documents without applying language restrictions and through expert consultation. Information on surveillance targets, indicators, metrics and dissemination modalities was extracted and a qualitative assessment was performed for open access systems only. RESULTS Twenty-one countries (66%) had a mandate to survey at least one among the 12 WHO priority pathogens; 15 provided access to surveillance frameworks. These systems covered most frequently carbapenem-resistant Enterobacteriales (12; 38%), methicillin-resistant Staphylococcus aureus (12; 38%), and vancomycin-resistant enterococci (8; 25%). None of the European countries required reporting of resistance in Salmonella, Campylobacter, Helicobacter pylori and Neisseria gonorrhoeae. High heterogeneity was observed in data collection, reporting and dissemination among countries with clinical outcomes and risk factors being reported in less than half (22% and 25%). Only six countries (19%) implemented mandatory surveillance of outbreaks due to at least one WHO priority pathogen. CONCLUSIONS Our review shows that despite the increasing burden of ARB on the European population, very few countries implemented mandatory surveillance and outbreak reporting of the WHO priority pathogens. International efforts are needed to define the effectiveness of implementing mandatory reporting of these pathogens and to assess their role in reducing the spread of ARB in health-care and community settings.
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21
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Coombs GW, Daley DA, Lee YT, Pang S. Australian Group on Antimicrobial Resistance (AGAR) Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP) Annual Report 2017. ACTA ACUST UNITED AC 2019; 43. [PMID: 31522665 DOI: 10.33321/cdi.2019.43.43] [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] [Indexed: 11/20/2022]
Abstract
From 1 January to 31 December 2017, 36 institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2017 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin and to characterise the molecular epidemiology of the methicillin-resistant isolates. A total of 2,515 S. aureus bacteraemia episodes were reported, of which 77% were community-onset. Approximately one in five S. aureus (19.0%) were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 18.7% which was significantly higher than the 14.0% mortality associated with methicillin-susceptible SAB. With the exception of the β-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However in addition to the β-lactams approximately 42% of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin and ciprofloxacin and approximately 14% resistant to co-trimoxazole, tetracycline and gentamicin. When applying the EUCAST breakpoints teicoplanin resistance was detected in five S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). ST22-IV [2B] (EMRSA-15) is the predominant healthcare-associated clone in Australia. Seventy-five percent of methicillin-resistant SAB were due to community-associated clones. Although polyclonal approximately 74% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5] and ST1-IV [2B]. CA-MRSA, in particular the ST45-VT [5C2&5] clone has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. ST45-VT [5C2&5] accounted for 12.8% of CA-MRSA. As CA-MRSA is well established in the Australian community it is important antimicrobial resistance patterns in community- and healthcare-associated SAB is monitored as this information will guide therapeutic practices in treating S. aureus sepsis.
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Affiliation(s)
- Geoffrey W Coombs
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Denise A Daley
- Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Yung Thin Lee
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Stanley Pang
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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22
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Goldstein E, Olesen SW, Karaca Z, Steiner CA, Viboud C, Lipsitch M. Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis. BMC Public Health 2019; 19:1138. [PMID: 31426780 PMCID: PMC6701127 DOI: 10.1186/s12889-019-7431-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/01/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Rates of sepsis/septicemia hospitalization in the US have risen significantly during recent years. Antibiotic resistance and use may contribute to those rates through various mechanisms, including lack of clearance of resistant infections following antibiotic treatment, with some of those infections subsequently devolving into sepsis. At the same time, there is limited information on the effect of prescribing of certain antibiotics vs. others on the rates of septicemia and sepsis-related hospitalizations and mortality. METHODS We used multivariable linear regression to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011 and 2012 to state-specific rates of septicemia hospitalization (ICD-9 codes 038.xx present anywhere on a discharge diagnosis) in each of the following age groups of adults: (18-49y, 50-64y, 65-74y, 75-84y, 85 + y) reported to the Healthcare Cost and Utilization Project (HCUP) between 2011 and 2012, adjusting for additional covariates, and random effects associated with the ten US Health and Human Services (HHS) regions. RESULTS Increase in the rate of prescribing of oral penicillins by 1 annual dose per 1000 state residents was associated with increases in annual septicemia hospitalization rates of 0.19 (95% CI (0.02,0.37)) per 10,000 persons aged 50-64y, of 0.48(0.12,0.84) per 10,000 persons aged 65-74y, and of 0.81(0.17,1.40) per 10,000 persons aged 74-84y. Increase by 1 in the percent of African Americans among state residents in a given age group was associated with increases in annual septicemia hospitalization rates of 2.3(0.32,4.2) per 10,000 persons aged 75-84y, and of 5.3(1.1,9.5) per 10,000 persons aged over 85y. Average minimal daily temperature was positively associated with septicemia hospitalization rates in persons aged 18-49y, 50-64y, 75-84y and over 85y. CONCLUSIONS Our results suggest positive associations between the rates of prescribing for penicillins and the rates of hospitalization with septicemia in US adults aged 50-84y. Further studies are needed to better understand the potential effect of antibiotic replacement in the treatment of various syndromes, including the potential impact of the recent US FDA guidelines on restriction of fluoroquinolone use, as well as the potential effect of changes in the practices for prescribing of penicillins on the rates of sepsis-related hospitalization and mortality.
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Affiliation(s)
- Edward Goldstein
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Ave, Kresge Room 506, Boston, MA 02115 USA
| | - Scott W. Olesen
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Ave, Kresge Room 506, Boston, MA 02115 USA
| | - Zeynal Karaca
- U.S. Department of Health & Human Services, Agency for HealthCare Research and Quality, Rockville, MD 20850 USA
| | - Claudia A. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO 80231 USA
| | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, MD 20892 USA
| | - Marc Lipsitch
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Ave, Kresge Room 506, Boston, MA 02115 USA
- Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA 02115 USA
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Donker T, Smieszek T, Henderson KL, Walker TM, Hope R, Johnson AP, Woodford N, Crook DW, Peto TEA, Walker AS, Robotham JV. Using hospital network-based surveillance for antimicrobial resistance as a more robust alternative to self-reporting. PLoS One 2019; 14:e0219994. [PMID: 31344075 PMCID: PMC6657867 DOI: 10.1371/journal.pone.0219994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/05/2019] [Indexed: 11/28/2022] Open
Abstract
Hospital performance is often measured using self-reported statistics, such as the incidence of hospital-transmitted micro-organisms or those exhibiting antimicrobial resistance (AMR), encouraging hospitals with high levels to improve their performance. However, hospitals that increase screening efforts will appear to have a higher incidence and perform poorly, undermining comparison between hospitals and disincentivising testing, thus hampering infection control. We propose a surveillance system in which hospitals test patients previously discharged from other hospitals and report observed cases. Using English National Health Service (NHS) Hospital Episode Statistics data, we analysed patient movements across England and assessed the number of hospitals required to participate in such a reporting scheme to deliver robust estimates of incidence. With over 1.2 million admissions to English hospitals previously discharged from other hospitals annually, even when only a fraction of hospitals (41/155) participate (each screening at least 1000 of these admissions), the proposed surveillance system can estimate incidence across all hospitals. By reporting on other hospitals, the reporting of incidence is separated from the task of improving own performance. Therefore the incentives for increasing performance can be aligned to increase (rather than decrease) screening efforts, thus delivering both more comparable figures on the AMR problems across hospitals and improving infection control efforts.
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Affiliation(s)
- Tjibbe Donker
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Timo Smieszek
- National Infection Service, Public Health England, Colindale, London, United Kingdom.,MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Katherine L Henderson
- National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Timothy M Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Russell Hope
- National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Alan P Johnson
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.,National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Neil Woodford
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.,National Infection Service, Public Health England, Colindale, London, United Kingdom
| | - Derrick W Crook
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,National Infection Service, Public Health England, Colindale, London, United Kingdom.,NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - Tim E A Peto
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - A Sarah Walker
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,NIHR Biomedical Research Centre, Oxford, United Kingdom
| | - Julie V Robotham
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, United Kingdom.,National Infection Service, Public Health England, Colindale, London, United Kingdom
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Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS, Jones RN. The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program. Antimicrob Agents Chemother 2019; 63:e00355-19. [PMID: 31010862 PMCID: PMC6591610 DOI: 10.1128/aac.00355-19] [Citation(s) in RCA: 292] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/07/2019] [Indexed: 01/26/2023] Open
Abstract
Bloodstream infection (BSI) organisms were consecutively collected from >200 medical centers in 45 nations between 1997 and 2016. Species identification and susceptibility testing followed Clinical and Laboratory Standards Institute broth microdilution methods at a central laboratory. Clinical data and isolates from 264,901 BSI episodes were collected. The most common pathogen overall was Staphylococcus aureus (20.7%), followed by Escherichia coli (20.5%), Klebsiella pneumoniae (7.7%), Pseudomonas aeruginosa (5.3%), and Enterococcus faecalis (5.2%). S. aureus was the most frequently isolated pathogen overall in the 1997-to-2004 period, but E. coli was the most common after 2005. Pathogen frequency varied by geographic region, hospital-onset or community-onset status, and patient age. The prevalence of S. aureus isolates resistant to oxacillin (ORSA) increased until 2005 to 2008 and then declined among hospital-onset and community-acquired BSI in all regions. The prevalence of vancomycin-resistant enterococci (VRE) was stable after 2012 (16.4% overall). Daptomycin resistance among S. aureus and enterococci (DRE) remained rare (<0.1%). In contrast, the prevalence of multidrug-resistant (MDR) Enterobacteriaceae increased from 6.2% in 1997 to 2000 to 15.8% in 2013 to 2016. MDR rates were highest among nonfermentative Gram-negative bacilli (GNB), and colistin was the only agent with predictable activity against Acinetobacter baumannii-Acinetobacter calcoaceticus complex (97% susceptible). In conclusion, S. aureus and E. coli were the predominant causes of BSI worldwide during this 20-year surveillance period. Important resistant phenotypes among Gram-positive pathogens (MRSA, VRE, or DRE) were stable or declining, whereas the prevalence of MDR-GNB increased continuously during the monitored period. MDR-GNB represent the greatest therapeutic challenge among common bacterial BSI pathogens.
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Affiliation(s)
| | - Po-Ren Hsueh
- National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Michael A Pfaller
- University of Iowa, Iowa City, Iowa, USA
- JMI Laboratories, North Liberty, Iowa, USA
| | - Kenneth V Rolston
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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25
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Mendes RE, Sader HS, Castanheira M, Flamm RK. Distribution of main Gram-positive pathogens causing bloodstream infections in United States and European hospitals during the SENTRY Antimicrobial Surveillance Program (2010-2016): concomitant analysis of oritavancin in vitro activity. J Chemother 2019; 30:280-289. [PMID: 30843778 DOI: 10.1080/1120009x.2018.1516272] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study updates the distribution and trends of Gram-positive organisms causing bloodstream infections (BSIs) in the United States (US) and Europe during 2010-2016. In vitro activities of oritavancin and comparators were also evaluated. Staphylococcus aureus, Enterococcus spp., and coagulase-negative staphylococci (CoNS) were the most common organisms in both regions. The proportion of methicillin-resistant S. aureus (MRSA) among all isolates declined (from 11.5% to 9.9%) in the US, a trend also noted for methicillin resistance rates within S. aureus (from 45.7% to 41.9%). MRSA rates (4.1% to 4.2%) in Europe remained stable during 2013-2016. Enterococcus faecalis (7.0-5.2%) and E. faecium (5.1-3.0%) rates declined in the US while remaining stable in Europe (4.5-5.7% and 3.3-4.7%, respectively). Rates for CoNS increased in the US; no temporal trends were noted in Europe. Oritavancin (MIC50/90, 0.03/0.06 µg/mL) inhibited 99.7-99.8% of S. aureus from both regions at ≤0.12 µg/mL and inhibited 96.8-97.9% of E. faecalis and 99.1-99.9% of E. faecium at this concentration. Oritavancin inhibited 99.7% of streptococci at the susceptible breakpoint. This study updates the distribution of pathogens causing BSI in the US and Europe. The in vitro activity for oritavancin against BSI pathogens supports its further development for bacteraemia.
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26
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Diekema DJ, Pfaller MA, Shortridge D, Zervos M, Jones RN. Twenty-Year Trends in Antimicrobial Susceptibilities Among Staphylococcus aureus From the SENTRY Antimicrobial Surveillance Program. Open Forum Infect Dis 2019; 6:S47-S53. [PMID: 30895214 PMCID: PMC6419894 DOI: 10.1093/ofid/ofy270] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Staphylococcus aureus is among the most common human pathogens, with therapy complicated by the epidemic spread of methicillin-resistant Staphylococcus aureus (MRSA). Methods The SENTRY Antimicrobial Surveillance Program evaluated the in vitro activity of >20 antimicrobials against 191 460 clinical S. aureus isolates collected from 427 centers in 45 countries from 1997 to 2016. Each center contributed isolates and clinical data for consecutive episodes of bacteremia, pneumonia in hospitalized patients, urinary tract infection, and skin and skin structure infection. Results Overall, 191 460 S. aureus isolates were collected, of which 77 146 (40.3%) were MRSA, varying geographically from 26.8% MRSA in Europe to 47.0% in North America. The highest percentage of MRSA was in nosocomial isolates from patients aged >80 years. Overall, MRSA occurrences increased from 33.1% in 1997-2000 to a high of 44.2% in 2005-2008, then declined to 42.3% and 39.0% in 2009-2012 and 2013-2016, respectively. S. aureus bacteremia had a similar trend, with nosocomial and community-onset MRSA rates peaking in 2005-2008 and then declining. Vancomycin activity against S. aureus remained stable (minimum inhibitory concentration [MIC]90 of 1 mg/L and 100% susceptibility in 2016; no increase over time in isolates with a vancomycin MIC >1 mg/L). Several agents introduced during the surveillance period exhibited in vitro potency against MRSA. Conclusions In a large global surveillance program, the rise of MRSA as a proportion of all S. aureus peaked a decade ago and has declined since, consistent with some regional surveillance program reports. Vancomycin maintained high activity against S. aureus, and several newer agents exhibited excellent in vitro potencies.
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Affiliation(s)
| | - Michael A Pfaller
- University of Iowa Carver College of Medicine, Iowa City, Iowa.,JMI Laboratories, North Liberty, Iowa
| | | | - Marcus Zervos
- Henry Ford Hospital, Detroit, Michigan.,Wayne State University School of Medicine, Detroit, Michigan
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27
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Using linked electronic health records to report healthcare-associated infections. PLoS One 2018; 13:e0206860. [PMID: 30403746 PMCID: PMC6221334 DOI: 10.1371/journal.pone.0206860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 10/19/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Reporting of strategic healthcare-associated infections (HCAIs) to Public Health England is mandatory for all acute hospital trusts in England, via a web-based HCAI Data Capture System (HCAI-DCS). AIM Investigate the feasibility of automating the current, manual, HCAI reporting using linked electronic health records (linked-EHR), and assess its level of accuracy. METHODS All data previously submitted through the HCAI-DCS by the Oxford University Hospitals infection control (IC) team for methicillin-resistant and methicillin-susceptible Staphylococcus aureus (MRSA, MSSA), Clostridium difficile, and Escherichia coli, through March 2017 were downloaded and compared to outputs created from linked-EHR, with detailed comparisons between 2013-2017. FINDINGS Total MRSA, MSSA, E. coli and C. difficile cases entered by the IC team vs linked-EHR were 428 vs 432, 795 vs 816, 2454 vs 2450 and 3365 vs 3393 respectively. From 2013-2017, most discrepancies (32/37 (86%)) were likely due to IC recording errors. Patient and specimen identifiers were completed for >98% of cases by both methods, with very high agreement (>97%). Fields relating to the patient at the time the specimen was taken were complete to a similarly high level (>99% IC, >97% linked-EHR), and agreement was fairly good (>80%) except for the main and treatment specialties (57% and 54% respectively) and the patient category (55%). Optional, organism-specific data-fields were less complete, by both methods. Where comparisons were possible, agreement was reasonably high (mostly 70-90%). CONCLUSION Basic factual information, such as demographic data, is almost-certainly better automated, and many other data fields can potentially be populated successfully from linked-EHR. Manual data collection is time-consuming and inefficient; automated electronic data collection would leave healthcare professionals free to focus on clinical rather than administrative work.
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Tsutsui A, Suzuki S. Japan nosocomial infections surveillance (JANIS): a model of sustainable national antimicrobial resistance surveillance based on hospital diagnostic microbiology laboratories. BMC Health Serv Res 2018; 18:799. [PMID: 30342499 PMCID: PMC6195991 DOI: 10.1186/s12913-018-3604-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 10/03/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is now recognized as a major threat to public health, and surveillance of AMR is essential for successful containment. In 2000, Japan Nosocomial Infections Surveillance (JANIS) Clinical Laboratory (CL) division has been launched as a voluntary AMR surveillance funded by the Ministry of Health, Labour and Welfare and managed by the National Institute of Infectious Diseases. In this study, we aimed to propose a model of sustainable national AMR surveillance which provides not only national AMR surveillance reports but also benchmarking reports to each hospital to facilitate infection control practices. METHODS JANIS CL division collects comprehensive specimen-based data complies with JANIS data format from participating hospitals each month. It had targeted only blood and cerebrospinal fluid samples but was expanded to all types of specimens in 2007 at revision of JANIS. The JANIS system interprets the antimicrobial susceptibility according to the same criteria and conducts removal of duplicates to allow accurate comparison between hospitals. Monthly feedback reports are created automatically within 48 h, while quarterly and annual reports are generated after data validation. RESULTS At the beginning, 468 hospitals were enrolled in the JANIS CL division, but the number of hospitals that submitted data decreased to 210 (45%) in 2006. After surveillance revision in 2007, annual recruitment of hospitals was initiated and as of 2015, 1475 hospitals participated, and 1461 (99%) of them submitted data throughout the year. Nationwide surveillance data collected over the past decade revealed that the prevalence of methicillin-resistant Staphylococcus aureus has decreased since 2008, and that its prevalence is higher in the western part of Japan, where the number of hospitals per capita is higher than in the eastern part. CONCLUSIONS JANIS CL division serves a model of sustainable national AMR surveillance system. Comprehensive data for all specimens promotes understanding of the sampling frequency and prevalence of AMR. As a well-established system for providing rich information to guide action both locally and nationally, JANIS may also be utilized for sharing AMR data globally.
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Affiliation(s)
- Atsuko Tsutsui
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, 4-2-1 Aoba-cho, Higashi-Murayama, Tokyo, 189-0002 Japan
| | - Satowa Suzuki
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, 4-2-1 Aoba-cho, Higashi-Murayama, Tokyo, 189-0002 Japan
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29
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Schönfeld V, Diercke M, Gilsdorf A, Eckmanns T, Walter J. Evaluation of the statutory surveillance system for invasive MRSA infections in Germany, 2016-2017. BMC Public Health 2018; 18:1063. [PMID: 30143016 PMCID: PMC6109305 DOI: 10.1186/s12889-018-5971-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mandatory notification of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections was introduced for laboratories in Germany in 2009. The aims were to support local health authorities (LHAs) in their mandate to prevent and control infections in hospitals and to improve population-based nationwide surveillance of healthcare associated infections. We evaluated the MRSA surveillance system to assess whether its aims were met and to identify areas for improvement. METHODS Using the updated guidelines for evaluating public health surveillance systems by the Centers for Disease Control and Prevention we assessed the attributes simplicity, timeliness, data quality, acceptability, and usefulness. In 2016/2017 we interviewed staff in LHAs, state health authorities (SHAs), and laboratories and analyzed surveillance data of cases notified between 2009 and 2016. RESULTS We interviewed 10% of LHAs (n = 38), 63% of SHAs (n = 10), 5 selected laboratories and analyzed information on 27,706 notified MRSA cases. LHAs reported that on receiving notifications from laboratories they contacted hospitals for clinical information, which was time-consuming and complicated as physicians were hard to reach or refused to answer questions, citing doctor-patient confidentiality. LHAs suggested reducing the amount of information collected as some clinical information was unnecessary for implementing control measures. LHAs stated that they received notifications on time, however surveillance data analysis showed some delay. Data completeness exceeded 90% for most variables, however it was only 68% and 80% for dates of disease onset and hospital admission respectively making it impossible to discriminate between hospital and community acquired infections in half of the cases. The surveillance system was well accepted by half of the interviewees. A third however stated that the benefits of the surveillance system were outweighed by the work associated with it. The majority rated the system to be useful for recognizing trends in the MRSA incidence and the ability to check up on infection control measures in hospitals. CONCLUSIONS The surveillance system proved to be useful by fulfilling its aims. It was timely, acceptable and provided complete data for most variables. However, the system was complicated; ensuring that only relevant variables are reported could simplify the system without losing any of its usefulness.
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Affiliation(s)
- Viktoria Schönfeld
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. .,Postgraduate Training for Applied Epidemiology, Robert Koch Institute, Berlin, Germany. .,European Programme for Intervention Epidemiology Training, ECDC, Stockholm, Sweden.
| | - M Diercke
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - A Gilsdorf
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - T Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - J Walter
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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31
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Bhattacharya A, Nsonwu O, Johnson A, Hope R. Estimating the incidence and 30-day all-cause mortality rate of Escherichia coli bacteraemia in England by 2020/21. J Hosp Infect 2018; 98:228-231. [DOI: 10.1016/j.jhin.2017.09.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/25/2017] [Indexed: 11/26/2022]
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Toleman MS, Watkins ER, Williams T, Blane B, Sadler B, Harrison EM, Coll F, Parkhill J, Nazareth B, Brown NM, Peacock SJ. Investigation of a Cluster of Sequence Type 22 Methicillin-Resistant Staphylococcus aureus Transmission in a Community Setting. Clin Infect Dis 2017; 65:2069-2077. [PMID: 29077854 PMCID: PMC5850418 DOI: 10.1093/cid/cix539] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Whole-genome sequencing (WGS) has typically been used to confirm or refute hospital/ward outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) identified through routine practice. However, appropriately targeted WGS strategies that identify routinely "undetectable" transmission remain the ultimate aim. METHODS WGS of MRSA isolates sent to a regional microbiological laboratory was performed as part of a 12-month prospective observational study. Phylogenetic analyses identified a genetically related cluster of E-MRSA15 isolated from patients registered to the same general practice (GP) surgery. This led to an investigation to identify epidemiological links, find additional cases, and determine potential for ongoing transmission. RESULTS We identified 15 MRSA-positive individuals with 27 highly related MRSA isolates who were linked to the GP surgery, 2 of whom died with MRSA bacteremia. Of the 13 cases that were further investigated, 11 had attended a leg ulcer/podiatry clinic. Cases lacked epidemiological links to hospitals, suggesting that transmission occurred elsewhere. Environmental and staff screening at the GP surgery did not identify an ongoing source of infection. CONCLUSIONS Surveillance in the United Kingdom shows that the proportion of MRSA bacteremias apportioned to hospitals is decreasing, suggesting the need for greater focus on the detection of MRSA outbreaks and transmission in the community. This case study confirms that the typically nosocomial lineage (E-MRSA15) can transmit within community settings. Our study exemplifies the continued importance of WGS in detecting outbreaks, including those which may be missed by routine practice, and suggests that universal WGS of bacteremia isolates may help detect outbreaks in low-surveillance settings.
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Affiliation(s)
- Michelle S Toleman
- University of Cambridge
- Wellcome Trust Sanger Institute, Hinxton
- Cambridge University Hospitals NHS Foundation Trust
| | | | | | | | - Belinda Sadler
- Infection Prevention and Control, Cambridgeshire and Peterborough Clinical Commissioning Group
| | | | | | | | | | - Nicholas M Brown
- Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, United Kingdom
| | - Sharon J Peacock
- University of Cambridge
- Wellcome Trust Sanger Institute, Hinxton
- Cambridge University Hospitals NHS Foundation Trust
- London School of Hygiene and Tropical Medicine
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You JHS, Choi KW, Wong TY, Ip M, Ming WK, Wong RYK, Chan SN, Tse HT, Chau CTS, Lee NLS. Disease Burden, Characteristics, and Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection in Hong Kong. Asia Pac J Public Health 2017; 29:451-461. [PMID: 28719790 DOI: 10.1177/1010539517717365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to describe disease burden, characteristics, and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) in Hong Kong. A retrospective, observational study was conducted in 26 Hong Kong public hospitals between January 2010 and December 2012. The primary outcome measures were 30-day mortality rate and infection-related hospital cost. Of 1133 patients reviewed, 727 (64.17%) were male, 1075 (94.88%) had health care-associated community-onset and 44 (3.88%) had hospital-onset MRSA infection. The mean age of patients was 76 (SD = 15) years, including 172 (15.18%) aged 20 to 59 years and 961 (84.8%) aged ≥60 years. The annual incidence rates in age groups of 20 to 59 years and ≥60 years were 0.96 to 1.148 per 100 000 and 22.7 to 24.8 per 100 000, respectively. The 30-day mortality was 367 (32.39%). Older patients (>79 years), chronic lung disease, and prior hospitalization were associated with increased mortality. The mean cost was US$10 565 (SD = 11 649; US$1 = HK$7.8). MRSA BSI was a significant burden in Hong Kong.
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Affiliation(s)
- Joyce H S You
- 1 The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kin-Wing Choi
- 2 Centre for Health Protection, Department of Health, the Government of Hong Kong SAR
| | - Tin-Yau Wong
- 2 Centre for Health Protection, Department of Health, the Government of Hong Kong SAR
| | - Margaret Ip
- 3 Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wai-Kit Ming
- 1 The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rity Yee-Kwan Wong
- 4 Divison of Infectious Diseases, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sze-Ngai Chan
- 1 The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hoi-Tung Tse
- 1 The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Nelson L S Lee
- 4 Divison of Infectious Diseases, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Donker T, Reuter S, Scriberras J, Reynolds R, Brown NM, Török ME, James R, Network EOEMR, Aanensen DM, Bentley SD, Holden MTG, Parkhill J, Spratt BG, Peacock SJ, Feil EJ, Grundmann H. Population genetic structuring of methicillin-resistant Staphylococcus aureus clone EMRSA-15 within UK reflects patient referral patterns. Microb Genom 2017; 3:e000113. [PMID: 29026654 PMCID: PMC5605955 DOI: 10.1099/mgen.0.000113] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 04/07/2017] [Indexed: 12/21/2022] Open
Abstract
Antibiotic resistance forms a serious threat to the health of hospitalised patients, rendering otherwise treatable bacterial infections potentially life-threatening. A thorough understanding of the mechanisms by which resistance spreads between patients in different hospitals is required in order to design effective control strategies. We measured the differences between bacterial populations of 52 hospitals in the United Kingdom and Ireland, using whole-genome sequences from 1085 MRSA clonal complex 22 isolates collected between 1998 and 2012. The genetic differences between bacterial populations were compared with the number of patients transferred between hospitals and their regional structure. The MRSA populations within single hospitals, regions and countries were genetically distinct from the rest of the bacterial population at each of these levels. Hospitals from the same patient referral regions showed more similar MRSA populations, as did hospitals sharing many patients. Furthermore, the bacterial populations from different time-periods within the same hospital were generally more similar to each other than contemporaneous bacterial populations from different hospitals. We conclude that, while a large part of the dispersal and expansion of MRSA takes place among patients seeking care in single hospitals, inter-hospital spread of resistant bacteria is by no means a rare occurrence. Hospitals are exposed to constant introductions of MRSA on a number of levels: (1) most MRSA is received from hospitals that directly transfer large numbers of patients, while (2) fewer introductions happen between regions or (3) across national borders, reflecting lower numbers of transferred patients. A joint coordinated control effort between hospitals, is therefore paramount for the national control of MRSA, antibiotic-resistant bacteria and other hospital-associated pathogens.
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Affiliation(s)
- Tjibbe Donker
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
- Department of Medical Microbiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Sandra Reuter
- Department of Medicine, University of Cambridge, Cambridge, UK
- Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - James Scriberras
- The Milner Centre for Evolution, Department of Biology and Biochemistry, University of Bath, Bath, UK
| | - Rosy Reynolds
- British Society for Antimicrobial Chemotherapy, UK
- North Bristol NHS Trust, Bristol, UK
| | - Nicholas M. Brown
- British Society for Antimicrobial Chemotherapy, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, UK
| | - M. Estée Török
- Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, UK
| | - Richard James
- Department of Physics and Centre for Networks and Collective Behaviour, University of Bath, Bath, UK
| | | | - David M. Aanensen
- Faculty of Medicine, School of Public Health, Imperial College, London, UK
| | | | - Matthew T. G. Holden
- Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Julian Parkhill
- Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - Brian G. Spratt
- Faculty of Medicine, School of Public Health, Imperial College, London, UK
| | - Sharon J. Peacock
- Department of Medicine, University of Cambridge, Cambridge, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, UK
| | - Edward J. Feil
- The Milner Centre for Evolution, Department of Biology and Biochemistry, University of Bath, Bath, UK
| | - Hajo Grundmann
- Department of Medical Microbiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Infection Prevention and Hospital Hygiene, University Medical Centre Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
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Abernethy J, Sharland M, Johnson AP, Hope R. How do the epidemiology of paediatric methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus bacteraemia differ? J Med Microbiol 2017; 66:737-743. [DOI: 10.1099/jmm.0.000489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Julia Abernethy
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
- Present address: Patient Safety, NHS Improvement, Skipton House, London, UK
| | - Mike Sharland
- Paediatric Infection Diseases Research Group, St George’s University of London, London, UK
| | - Alan P. Johnson
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - Russell Hope
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
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Epidemiology of Escherichia coli bacteraemia in England: results of an enhanced sentinel surveillance programme. J Hosp Infect 2017; 95:365-375. [DOI: 10.1016/j.jhin.2016.12.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 12/09/2016] [Indexed: 11/19/2022]
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Impact of national policies on the microbial aetiology of surgical site infections in acute NHS hospitals in England: analysis of trends between 2000 and 2013 using multi-centre prospective cohort data. Epidemiol Infect 2016; 145:957-969. [PMID: 28027714 DOI: 10.1017/s0950268816003058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Our study aimed to evaluate changes in the epidemiology of pathogens causing surgical site infections (SSIs) in England between 2000 and 2013 in the context of intensified national interventions to reduce healthcare-associated infections introduced since 2006. National prospective surveillance data on target surgical procedures were used for this study. Data on causative organism were available for 72% of inpatient-detected SSIs meeting the standard case definitions for superficial, deep and organ-space infections (9767/13 531) which were analysed for trends. A multivariable logistic linear mixed model with hospital random effects was fitted to evaluate trends by pathogen. Staphylococcus aureus was the predominant cause of SSI between 2000 (41%) and 2009 (24%), decreasing from 2006 onwards reaching 16% in 2013. Data for 2005-2013 showed that the odds of SSI caused by S. aureus decreased significantly by 14% per year [adjusted odds ratio (aOR) 0·86, 95% confidence interval (CI) 0·83-0·89] driven by significant decreases in methicillin-resistant S. aureus (MRSA) (aOR 0·71, 95% CI 0·68-0·75). However a small significant increase in methicillin-sensitive S. aureus was identified (aOR 1·06, 95% CI 1·02-1·10). Enterobacteriaceae were stable during 2000-2007 (12% of cases overall), increasing from 2008 (18%) onwards, being present in 25% of cases in 2013; the model supported these increasing trends during 2007-2013 (aOR 1·12, 95% CI 1·07-1·18). The decreasing trends in S. aureus SSIs from 2006 and the increases in Enterobacteriaceae SSIs from 2008 may be related to intensified national efforts targeted at reducing MRSA bacteraemia combined with changes in antibiotic use aimed at controlling C. difficile infections.
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Toffolutti V, Reeves A, McKee M, Stuckler D. Outsourcing cleaning services increases MRSA incidence: Evidence from 126 english acute trusts. Soc Sci Med 2016; 174:64-69. [PMID: 28012431 PMCID: PMC5267843 DOI: 10.1016/j.socscimed.2016.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 12/03/2016] [Accepted: 12/11/2016] [Indexed: 11/17/2022]
Abstract
There has been extensive outsourcing of hospital cleaning services in the NHS in England, in part because of the potential to reduce costs. Yet some argue that this leads to lower hygiene standards and more infections, such as MRSA and, perhaps because of this, the Scottish, Welsh, and Northern Irish health services have rejected outsourcing. This study evaluates whether contracting out cleaning services in English acute hospital Trusts (legal authorities that run one or more hospitals) is associated with risks of hospital-borne MRSA infection and lower economic costs. By linking data on MRSA incidence per 100,000 hospital bed-days with surveys of cleanliness among patient and staff in 126 English acute hospital Trusts during 2010–2014, we find that outsourcing cleaning services was associated with greater incidence of MRSA, fewer cleaning staff per hospital bed, worse patient perceptions of cleanliness and staff perceptions of availability of handwashing facilities. However, outsourcing was also associated with lower economic costs (without accounting for additional costs associated with treatment of hospital acquired infections). Investigation on the association between outsourcing cleaning services and HAI. Data on 126 English acute hospital Trust during 2010–2014 were used. Outsourcing cleaning services was associated with greater incidence of MRSA. Outsourcing was also associated with lower economic costs.
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Affiliation(s)
| | - Aaron Reeves
- International Inequalities Institute, London School of Economics and Political Science, Houghton Street, London, UK
| | - Martin McKee
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK; Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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40
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Administrative data has poor accuracy for surveillance of Staphylococcus aureus bacteraemia. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Brewster L, Tarrant C, Dixon-Woods M. Qualitative study of views and experiences of performance management for healthcare-associated infections. J Hosp Infect 2016; 94:41-7. [PMID: 26996088 PMCID: PMC4993094 DOI: 10.1016/j.jhin.2016.01.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/25/2016] [Indexed: 12/02/2022]
Abstract
BACKGROUND Centrally led performance management regimes using standard setting, monitoring, and incentives have become a prominent feature of infection prevention and control (IPC) in health systems. AIM To characterize views and experiences of regulation and performance management relating to IPC in English hospitals. METHODS Two qualitative datasets containing 139 interviews with healthcare workers and managers were analysed. Data directly relevant to performance management and IPC were extracted. Data analysis was based on the constant comparative method. FINDINGS Participants reported that performance management regimes had mobilized action around specific infections. The benefits of establishing organizational structures of accountability were seen in empirical evidence of decreasing infection rates. Performance management was not, however, experienced as wholly benign, and setting targets in one area was seen to involve risks of 'tunnel vision' and the marginalization of other potentially important issues. Financial sanctions were viewed especially negatively; performance management was associated with risks of creating a culture of fearfulness, suppressing learning and disrupting inter-professional relationships. CONCLUSION Centrally led performance management may have some important roles in IPC, but identifying where it is appropriate and determining its limits is critical. Persisting with harsh regimes may affect relationships and increase resistance to continued improvement efforts, but leaving all improvement to local teams may also be a flawed strategy.
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Affiliation(s)
- L Brewster
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - C Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - M Dixon-Woods
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Comparing the epidemiology of hospital-acquired methicillin-resistant Staphylococcus aureus clone groups in Alberta, Canada. Epidemiol Infect 2016; 144:2184-90. [PMID: 26947456 DOI: 10.1017/s0950268816000376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patients with methicillin-resistant Staphylococcus aureus (MRSA) clones, which were traditionally seen in the community setting (USA400/CMRSA7 and USA300/CMRSA10), are often identified as hospital-acquired (HA) infections using Infection Prevention and Control (IPC) surveillance definitions. This study examined the demographics and healthcare risk factors of patients with HA-MRSA to help understand if community MRSA clones are from a source internal or external to the hospital setting. Despite USA300/CMRSA10 being the predominant clone in Alberta, hospital clones (USA100/CMRSA2) still dominated in the acute care setting. In the Alberta hospitalized population, patients with USA400/CMRSA7 and USA300/CMRSA10 clones were significantly younger, had fewer comorbidities, and a greater proportion had none or ambulatory care-only healthcare exposure. These findings suggest that there are two distinct populations of HA-MRSA patients, and the patients with USA400/CMRSA7 and USA300/CMRSA10 clones identified in hospital more greatly resemble patients affected by those clones in the community. It is possible that epidemiological assessment overidentifies HA acquisition of MRSA in patients unscreened for MRSA on admission to acute care.
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Akova M. Epidemiology of antimicrobial resistance in bloodstream infections. Virulence 2016; 7:252-66. [PMID: 26984779 PMCID: PMC4871634 DOI: 10.1080/21505594.2016.1159366] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/17/2016] [Accepted: 02/23/2016] [Indexed: 12/14/2022] Open
Abstract
Antimicrobial resistance in bacterial pathogens is a worldwide challenge leading high morbidity and mortality in clinical settings. Multidrug resistant patterns in gram-positive and -negative bacteria have resulted in difficult-to-treat or even untreatable infections with conventional antimicrobials. Since the early identification of causative microorganisms and their antimicrobial susceptibility patterns in patients with bacteremia and other serious infections is lacking in many healthcare institutions, broad spectrum antibiotics are liberally and mostly unnecessarily used. Such practice has, in turn, caused dramatic increases in emerging resistance and when coupled with poor practice of infection control, resistant bacteria can easily be disseminated to the other patients and the environment. Thus, availability of updated epidemiological data on antimicrobial resistance in frequently encountered bacterial pathogens will be useful not only for deciding on empirical treatment strategies, but also devising an effective antimicrobial stewardship program in hospitals.
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Affiliation(s)
- Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
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Shallcross LJ, Howard SJ, Fowler T, Davies SC. Tackling the threat of antimicrobial resistance: from policy to sustainable action. Philos Trans R Soc Lond B Biol Sci 2016; 370:20140082. [PMID: 25918440 DOI: 10.1098/rstb.2014.0082] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Antibiotics underpin all of modern medicine, from routine major surgery through to caesarean sections and modern cancer therapies. These drugs have revolutionized how we practice medicine, but we are in a constant evolutionary battle to evade microbial resistance and this has become a major global public health problem. We have overused and misused these essential medicines both in the human and animal health sectors and this threatens the effectiveness of antimicrobials for future generations. We can only address the threat of antimicrobial resistance (AMR) through international collaboration across human and animal health sectors integrating social, economic and behavioural factors. Our global organizations are rising to the challenge with the recent World Health Assembly resolution on AMR and development of the Global Action plan but we must act now to avoid a return to a pre-antibiotic era.
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Affiliation(s)
- Laura J Shallcross
- Department of Health, Office of the Chief Medical Officer, 79 Whitehall, London SW1A 2NS, UK Research Department of Infection and Population Health, University College London, 222 Euston Road, London NW1 2DA, UK
| | - Simon J Howard
- North East Health Protection Team, Public Health England, Gallowgate, Newcastle-upon-Tyne NE1 4WH, UK
| | - Tom Fowler
- Genomics England, Queen Mary University of London, Dawson Hall, Charterhouse Square, London EC1M 6BQ, UK Public Health, Epidemiology and Biostatistics, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Sally C Davies
- Department of Health, Office of the Chief Medical Officer, 79 Whitehall, London SW1A 2NS, UK
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Abstract
Surveillance involves the collection and analysis of data for the detection and monitoring of threats to public health. Surveillance should also inform as to the epidemiology of the threat and its burden in the population. A further key component of surveillance is the timely feedback of data to stakeholders with a view to generating action aimed at reducing or preventing the public health threat being monitored. Surveillance of antibiotic resistance involves the collection of antibiotic susceptibility test results undertaken by microbiology laboratories on bacteria isolated from clinical samples sent for investigation. Correlation of these data with demographic and clinical data for the patient populations from whom the pathogens were isolated gives insight into the underlying epidemiology and facilitates the formulation of rational interventions aimed at reducing the burden of resistance. This article describes a range of surveillance activities that have been undertaken in the UK over a number of years, together with current interventions being implemented. These activities are not only of national importance but form part of the international response to the global threat posed by antibiotic resistance.
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Affiliation(s)
- Alan P Johnson
- Department of Healthcare-Associated Infection and Antimicrobial Resistance, Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, UK
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Determinants of Outcome in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: Results From National Surveillance in Canada, 2008-2012. Infect Control Hosp Epidemiol 2016; 37:390-7. [PMID: 26782274 DOI: 10.1017/ice.2015.323] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bloodstream infection (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with considerable morbidity and mortality. OBJECTIVE To determine the incidence of MRSA BSI in Canadian hospitals and to identify variables associated with increased mortality. METHODS Prospective surveillance for MRSA BSI conducted in 53 Canadian hospitals from January 1, 2008, through December 31, 2012. Thirty-day all-cause mortality was determined, and logistic regression analysis was used to identify variables associated with mortality. RESULTS A total of 1,753 patients with MRSA BSI were identified (incidence, 0.45 per 1,000 admissions). The most common sites presumed to be the source of infection were skin/soft tissue (26.6%) and an intravascular catheter (22.0%). The most common spa types causing MRSA BSI were t002 (USA100/800; 55%) and t008 (USA300; 29%). Thirty-day all-cause mortality was 23.8%. Mortality was associated with increasing age (odds ratio, 1.03 per year [95% CI, 1.02-1.04]), the presence of pleuropulmonary infection (2.3 [1.4-3.7]), transfer to an intensive care unit (3.2 [2.1-5.0]), and failure to receive appropriate antimicrobial therapy within 24 hours of MRSA identification (3.2 [2.1-5.0]); a skin/soft-tissue source of BSI was associated with decreased mortality (0.5 [0.3-0.9]). MRSA genotype and reduced susceptibility to vancomycin were not associated with risk of death. CONCLUSIONS This study provides additional insight into the relative impact of various host and microbial factors associated with mortality in patients with MRSA BSI. The results emphasize the importance of ensuring timely receipt of appropriate antimicrobial agents to reduce the risk of an adverse outcome.
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Tosas Auguet O, Betley JR, Stabler RA, Patel A, Ioannou A, Marbach H, Hearn P, Aryee A, Goldenberg SD, Otter JA, Desai N, Karadag T, Grundy C, Gaunt MW, Cooper BS, Edgeworth JD, Kypraios T. Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data. PLoS Med 2016; 13:e1001944. [PMID: 26812054 PMCID: PMC4727805 DOI: 10.1371/journal.pmed.1001944] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Identifying and tackling the social determinants of infectious diseases has become a public health priority following the recognition that individuals with lower socioeconomic status are disproportionately affected by infectious diseases. In many parts of the world, epidemiologically and genotypically defined community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged to become frequent causes of hospital infection. The aim of this study was to use spatial models with adjustment for area-level hospital attendance to determine the transmission niche of genotypically defined CA- and health-care-associated (HA)-MRSA strains across a diverse region of South East London and to explore a potential link between MRSA carriage and markers of social and material deprivation. METHODS AND FINDINGS This study involved spatial analysis of cross-sectional data linked with all MRSA isolates identified by three National Health Service (NHS) microbiology laboratories between 1 November 2011 and 29 February 2012. The cohort of hospital-based NHS microbiology diagnostic services serves 867,254 usual residents in the Lambeth, Southwark, and Lewisham boroughs in South East London, United Kingdom (UK). Isolates were classified as HA- or CA-MRSA based on whole genome sequencing. All MRSA cases identified over 4 mo within the three-borough catchment area (n = 471) were mapped to small geographies and linked to area-level aggregated socioeconomic and demographic data. Disease mapping and ecological regression models were used to infer the most likely transmission niches for each MRSA genetic classification and to describe the spatial epidemiology of MRSA in relation to social determinants. Specifically, we aimed to identify demographic and socioeconomic population traits that explain cross-area extra variation in HA- and CA-MRSA relative risks following adjustment for hospital attendance data. We explored the potential for associations with the English Indices of Deprivation 2010 (including the Index of Multiple Deprivation and several deprivation domains and subdomains) and the 2011 England and Wales census demographic and socioeconomic indicators (including numbers of households by deprivation dimension) and indicators of population health. Both CA-and HA-MRSA were associated with household deprivation (CA-MRSA relative risk [RR]: 1.72 [1.03-2.94]; HA-MRSA RR: 1.57 [1.06-2.33]), which was correlated with hospital attendance (Pearson correlation coefficient [PCC] = 0.76). HA-MRSA was also associated with poor health (RR: 1.10 [1.01-1.19]) and residence in communal care homes (RR: 1.24 [1.12-1.37]), whereas CA-MRSA was linked with household overcrowding (RR: 1.58 [1.04-2.41]) and wider barriers, which represent a combined score for household overcrowding, low income, and homelessness (RR: 1.76 [1.16-2.70]). CA-MRSA was also associated with recent immigration to the UK (RR: 1.77 [1.19-2.66]). For the area-level variation in RR for CA-MRSA, 28.67% was attributable to the spatial arrangement of target geographies, compared with only 0.09% for HA-MRSA. An advantage to our study is that it provided a representative sample of usual residents receiving care in the catchment areas. A limitation is that relationships apparent in aggregated data analyses cannot be assumed to operate at the individual level. CONCLUSIONS There was no evidence of community transmission of HA-MRSA strains, implying that HA-MRSA cases identified in the community originate from the hospital reservoir and are maintained by frequent attendance at health care facilities. In contrast, there was a high risk of CA-MRSA in deprived areas linked with overcrowding, homelessness, low income, and recent immigration to the UK, which was not explainable by health care exposure. Furthermore, areas adjacent to these deprived areas were themselves at greater risk of CA-MRSA, indicating community transmission of CA-MRSA. This ongoing community transmission could lead to CA-MRSA becoming the dominant strain types carried by patients admitted to hospital, particularly if successful hospital-based MRSA infection control programmes are maintained. These results suggest that community infection control programmes targeting transmission of CA-MRSA will be required to control MRSA in both the community and hospital. These epidemiological changes will also have implications for effectiveness of risk-factor-based hospital admission MRSA screening programmes.
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Affiliation(s)
- Olga Tosas Auguet
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Jason R. Betley
- Illumina, Cambridge Limited, Chesterford Research Park, Little Chesterford, Essex, United Kingdom
| | - Richard A. Stabler
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Amita Patel
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Avgousta Ioannou
- Illumina, Cambridge Limited, Chesterford Research Park, Little Chesterford, Essex, United Kingdom
| | - Helene Marbach
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Pasco Hearn
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Anna Aryee
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon D. Goldenberg
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jonathan A. Otter
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Nergish Desai
- Department of Medical Microbiology, King's Hospital NHS Foundation Trust, London, United Kingdom
| | - Tacim Karadag
- Department of Microbiology, University Hospital Lewisham, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Chris Grundy
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael W. Gaunt
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ben S. Cooper
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | - Jonathan D. Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Theodore Kypraios
- School of Mathematical Sciences, University Park, University of Nottingham, Nottingham, United Kingdom
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Aryee A, Edgeworth JD. Carriage, Clinical Microbiology and Transmission of Staphylococcus aureus. Curr Top Microbiol Immunol 2016; 409:1-19. [PMID: 27097812 DOI: 10.1007/82_2016_5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Staphylococcus aureus is one of the most important bacterial pathogens in clinical practice and a major diagnostic focus for the routine microbiology laboratory. It is carried as a harmless commensal in up to two-thirds of the population at any one time predominantly not only in the anterior nares, but also in multiple other sites such as the groin, axilla, throat, perineum, vagina and rectum. It colonizes skin breach sites, such as ulcers and wounds, and causes superficial and deep skin and soft tissue infections and life-threatening deep seated infections particularly endocarditis and osteomyelitis. S. aureus is constantly evolving through mutation and uptake of mobile genetic elements that confer increasing resistance and virulence. Since the 1960s, hospitals have had to contend with emergence of methicillin-resistant S. aureus (MRSA) strains that spread better in hospitals than methicillin-susceptible S. aureus (MSSA) and are harder to treat. Since the 1980s, distinct community MRSA strains have also emerged that cause severe skin and respiratory infections. Conventional identification of MSSA and MRSA in the microbiology laboratory involves microscopy, culture and biochemical analysis that for most samples is straightforward but slow, taking at least 48 h. This delay has significant consequences for individual patient care and public health, through inadequate or excessive empiric antibiotic use, and failure to implement appropriate infection control measures for MRSA-colonized patients during those first 48 h. This unmet need has driven development of rapid molecular diagnostics that either complement or replace conventional culture techniques in the laboratory, or can be placed in the clinical environment as point-of-care (POC) devices. These new technologies provide results to clinicians anything from within an hour to 24 h, depending on sample and clinical setting, and should transform management of patients with S. aureus and other bacterial diseases; however, uptake is often slow due to the disruptive effect of new technologies, costs of transition and uncertainty of the optimal solution given successive advances. More evidence of the health economic, clinical and antimicrobial resistance benefit will help support introduction of these new technologies. Finally, preventing MRSA transmission has been a priority for healthcare organizations for many years. There have been significant recent reductions in transmission following local and national campaigns to re-enforce basic and heightened infection control interventions such as universal hand hygiene, barrier nursing, decolonization and isolation of MRSA-colonized patients detected through routine culture or screening policies. Developments in whole genome sequencing are providing greater insight into reservoirs and routes of transmission that should help better target interventions to ensure sustainable control of endemic strains and to identify and prevent emergence of new strains.
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Affiliation(s)
- Anna Aryee
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's and St. Thomas' NHS Foundation Trust, 5th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK
| | - Jonathan D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, Kings College London and Guy's and St. Thomas' NHS Foundation Trust, 5th Floor North Wing, Westminster Bridge Road, London, SE1 7EH, UK.
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50
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Reuter S, Török ME, Holden MTG, Reynolds R, Raven KE, Blane B, Donker T, Bentley SD, Aanensen DM, Grundmann H, Feil EJ, Spratt BG, Parkhill J, Peacock SJ. Building a genomic framework for prospective MRSA surveillance in the United Kingdom and the Republic of Ireland. Genome Res 2015; 26:263-70. [PMID: 26672018 PMCID: PMC4728378 DOI: 10.1101/gr.196709.115] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/14/2015] [Indexed: 12/27/2022]
Abstract
The correct interpretation of microbial sequencing data applied to surveillance and outbreak investigation depends on accessible genomic databases to provide vital genetic context. Our aim was to construct and describe a United Kingdom MRSA database containing over 1000 methicillin-resistant Staphylococcus aureus (MRSA) genomes drawn from England, Northern Ireland, Wales, Scotland, and the Republic of Ireland over a decade. We sequenced 1013 MRSA submitted to the British Society for Antimicrobial Chemotherapy by 46 laboratories between 2001 and 2010. Each isolate was assigned to a regional healthcare referral network in England and was otherwise grouped based on country of origin. Phylogenetic reconstructions were used to contextualize MRSA outbreak investigations and to detect the spread of resistance. The majority of isolates (n = 783, 77%) belonged to CC22, which contains the dominant United Kingdom epidemic clone (EMRSA-15). There was marked geographic structuring of EMRSA-15, consistent with widespread dissemination prior to the sampling decade followed by local diversification. The addition of MRSA genomes from two outbreaks and one pseudo-outbreak demonstrated the certainty with which outbreaks could be confirmed or refuted. We identified local and regional differences in antibiotic resistance profiles, with examples of local expansion, as well as widespread circulation of mobile genetic elements across the bacterial population. We have generated a resource for the future surveillance and outbreak investigation of MRSA in the United Kingdom and Ireland and have shown the value of this during outbreak investigation and tracking of antimicrobial resistance.
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Affiliation(s)
- Sandra Reuter
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, United Kingdom
| | - M Estée Török
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Public Health England, Microbiology Services Division, Addenbrooke's Hospital, Cambridge CB2 0QW, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Matthew T G Holden
- Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, United Kingdom; School of Medicine, University of St. Andrews, St. Andrews KY16 9TF, United Kingdom
| | - Rosy Reynolds
- British Society for Antimicrobial Chemotherapy, B1 3NJ, United Kingdom; North Bristol NHS Trust, Bristol BS10 5NB, United Kingdom
| | - Kathy E Raven
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Beth Blane
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Tjibbe Donker
- Department of Medical Microbiology, University Medical Centre Groningen, Rijksuniversiteit Groningen, 9713 GZ Groningen, The Netherlands
| | - Stephen D Bentley
- Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, United Kingdom
| | - David M Aanensen
- Faculty of Medicine, School of Public Health, Imperial College, London W2 1PG, United Kingdom
| | - Hajo Grundmann
- Department of Medical Microbiology, University Medical Centre Groningen, Rijksuniversiteit Groningen, 9713 GZ Groningen, The Netherlands; Department of Hospital Epidemiology, Institute for Environmental Medicine and Hospital Hygiene, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Edward J Feil
- The Milner Centre for Evolution, Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, United Kingdom
| | - Brian G Spratt
- Faculty of Medicine, School of Public Health, Imperial College, London W2 1PG, United Kingdom
| | - Julian Parkhill
- Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, United Kingdom
| | - Sharon J Peacock
- Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, United Kingdom; Pathogen Genomics, Wellcome Trust Sanger Institute, Hinxton CB10 1SA, United Kingdom; Public Health England, Microbiology Services Division, Addenbrooke's Hospital, Cambridge CB2 0QW, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom; London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
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